1
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Patients with Classical Hodgkin Lymphoma with Less Than 10.5 CD20-Positive Reed–Sternberg Cells in 10 High-Power Fields Have Better Prognosis. Indian J Hematol Blood Transfus 2022; 38:596-600. [DOI: 10.1007/s12288-021-01517-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022] Open
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2
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Mehtani D, Puri N. Steering Mast Cells or Their Mediators as a Prospective Novel Therapeutic Approach for the Treatment of Hematological Malignancies. Front Oncol 2021; 11:731323. [PMID: 34631562 PMCID: PMC8497976 DOI: 10.3389/fonc.2021.731323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/09/2021] [Indexed: 01/09/2023] Open
Abstract
Tumor cells require signaling and close interaction with their microenvironment for their survival and proliferation. In the recent years, Mast cells have earned a greater importance for their presence and role in cancers. It is known that mast cells are attracted towards tumor microenvironment by secreted soluble chemotactic factors. Mast cells seem to exert a pro-tumorigenic role in hematological malignancies with a few exceptions where they showed anti-cancerous role. This dual role of mast cells in tumor growth and survival may be dependent on the intrinsic characteristics of the particular tumor, differences in tumor microenvironment according to tumor type, and the interactions and heterogeneity of mediators released by mast cells in the tumor microenvironment. In many studies, Mast cells and their mediators have been shown to affect tumor survival and growth, prognosis, inflammation, tumor vascularization and angiogenesis. Modulating mast cell accumulation, viability, activity and mediator release patterns may thus be important in controlling these malignancies. In this review, we emphasize on the role of mast cells in lymphoid malignancies and discuss strategies for targeting and steering mast cells or their mediators as a potential therapeutic approach for the treatment of these malignancies.
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Affiliation(s)
| | - Niti Puri
- Cellular and Molecular Immunology Lab, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
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3
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Gamboa-Cedeño AM, Díaz M, Cristaldo N, Otero V, Schutz N, Fantl D, Cugliari S, Zerga M, Rojas-Bilbao E, Jauk F, García Rivello H, Nuñez M, Ranuncolo SM. Apoptotic regulator BCL-2 blockade as a potential therapy in classical Hodgkin Lymphoma. Life Sci 2021; 268:118979. [PMID: 33421528 DOI: 10.1016/j.lfs.2020.118979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/22/2022]
Abstract
The challenge in classical Hodgkin Lymphoma (cHL) management is the 30-40% of refractory/relapsed cases. AIMS The aim of this work was to determine whether NIK and BCL-2 could be useful as prognosis biomarkers in cHL. In addition, we evaluated BCL-2 as a directed-therapy in cHL cell lines using venetoclax. MAIN METHODS We evaluated NIK and BCL-2 expression in 112 untreated cHL patients' lymph-node biopsies by immunohistochemistry. cHL cell lines were treated with venetoclax alone or combined with vincristine or doxorubicin. Cell viability, metabolic activity and cell death were analyzed by trypan-blue exclusion method, MTS assay and FDA/IP staining respectively. KEY FINDINGS No correlation between NIK or BCL-2 expression and the majority of the clinical parameters was found. Patients with ≥60% BCL-2+ HRS-cells had a shorter disease-free survival (DFS) and overall survival (OS) (p = 0.002, p = 0.02 respectively). A decision tree analysis, in a 30 patients subgroup, showed that patients with <60% NIK+ HRS-cells but with ≥60% BCL-2+ HRS-cells had a worse outcome in terms of DFS and OS. These parameters performed better as prognosis indicators as compared to the diagnosis bone marrow status. Human cHL cell lines U-H01, KM-H2, L1236, SUPHD1, L540 showed sensitivity to venetoclax. The co-treatment effect of venetoclax and vincristine or doxorubicin on cell viability was diverse depending on the cell line evaluated. SIGNIFICANCE BCL-2 should be considered as a prognosis biomarker as well as a potential new therapeutic target in cHL. We report for the first time the cytotoxic effect of venetoclax in human cHL cell lines.
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Affiliation(s)
| | - Mariángeles Díaz
- Research Area, Institute of Oncology "A.H. Roffo", School of Medicine (FMED), Universidad de Buenos Aires, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Argentina
| | - Nancy Cristaldo
- Hematology, Italian Hospital of Buenos Aires (HIBA), Buenos Aires, Argentina
| | - Victoria Otero
- Hematology, Italian Hospital of Buenos Aires (HIBA), Buenos Aires, Argentina
| | - Natalia Schutz
- Hematology, Italian Hospital of Buenos Aires (HIBA), Buenos Aires, Argentina
| | - Dorotea Fantl
- Hematology, Italian Hospital of Buenos Aires (HIBA), Buenos Aires, Argentina
| | - Silvana Cugliari
- Hematology, Institute of Oncology "A.H. Roffo", School of Medicine (FMED), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Marta Zerga
- Hematology, Institute of Oncology "A.H. Roffo", School of Medicine (FMED), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Erica Rojas-Bilbao
- Pathology, Institute of Oncology "A.H. Roffo", School of Medicine (FMED), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Federico Jauk
- Sequencing Laboratory, Italian Hospital of Buenos Aires (HIBA), Buenos Aires, Argentina
| | | | - Myriam Nuñez
- School of Pharmacy and Biochemistry (FFyB), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Stella Maris Ranuncolo
- Traslational Medicine and Biomedical Engineering Institute (IMTIB), Buenos Aires, Argentina; Research Area, Institute of Oncology "A.H. Roffo", School of Medicine (FMED), Universidad de Buenos Aires, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Argentina.
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4
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Prognostic value of Bcl2 and p53 in Hodgkin lymphoma: A systematic review and meta-analysis. Pathol Res Pract 2021; 219:153370. [PMID: 33618247 DOI: 10.1016/j.prp.2021.153370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/21/2022]
Abstract
AIMS Several studies suggested that high expression of Bcl2 and/or p53 in Hodgkin/Reed-Sternberg cells is an unfavorable prognostic factor in Hodgkin lymphoma (HL). However, results in this field appear contrasting. We aimed to assess the prognostic value of p53 and Bcl2 in HL through a systematic review and meta-analysis. METHODS Electronic databases were searched from January 2000 to December 2020 for all studies assessing the prognostic value of p53 and Bcl2 in HL. The association of high p53 or Bcl2 expression with overall survival (OS), progression-free survival (PFS) and response to treatment was assessed by using hazard ratio (HR) and odds ratio (OR). RESULTS Eighteen studies were included. Bcl2 overexpression was significantly associated with decreased PFS (HR = 2.202; p < 0.0001), while the associations with decreased OS (HR = 1.565; p = 0.257) and refractoriness to treatment (OR = 0.482; p = 0.068) were non-significant. p53 overexpression was not significantly associated with refractoriness to treatment (OR = 0.904; p = 0.155); the analysis of OS and PFS was not feasible, but published data suggested the absence of a significant association. CONCLUSIONS In HL, Bcl2 overexpression is associated with decreased PFS, while a significant prognostic value could not be demonstrated for p53. Defining optimal criteria for interpreting Bcl2 and p53 immunostaining is necessary to draw definitive conclusions.
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5
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Pizzi M, Tazzoli S, Carraro E, Chaviano F, Massano D, Lovisa F, Mussolin L, Todesco A, Biffi A, d'Amore ES, Pillon M, Rugge M. Histology of pediatric classic Hodgkin lymphoma: From diagnosis to prognostic stratification. Pediatr Blood Cancer 2020; 67:e28230. [PMID: 32134194 DOI: 10.1002/pbc.28230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 11/11/2022]
Abstract
AIMS Classic Hodgkin lymphoma (cHL) is a common malignancy of the pediatric age. Although clinical-radiological features are routinely used for disease risk stratification, the role of tumor histology has yet to be defined. This study aimed to characterize the clinical-pathological features of a large cohort of pediatric cHL specifically investigating the relevance of tumor histology for the prognostic stratification of patients. METHODS AND RESULTS The study considered 96 clinically annotated cases of pediatric cHL treated according to the AIEOP-LH2004 protocol. The following histological parameters were considered: (i) cHL variant; (ii) grade of nodular sclerosis (NS); (iii) staining for Bcl2 and p53, and expression of B-cell (BCA) and T-cell antigens (TCA) by Hodgkin/Reed-Sternberg cells. The study population consisted of 51 males and 45 females (median age: 13.6 years) with five-year overall and progression-free survival of 94% and 81%, respectively. Most cases featured NS morphology (96%) with a prevalence of NS1 over NS2 grades. Two NS2 variants were recognized (sarcomatous/syncytial and fibrohistiocytic). A consistent subset of cases disclosed positivity for BCA (34%), TCA (26%), p53 (13%), and Bcl2 (19%). Clinical-pathological correlations showed a more aggressive clinical course for NS2 over NS1 cases. The NS2 fibrohistiocytic variant was associated with the worst outcome. No other histological features correlated with prognosis. CONCLUSIONS Pediatric cHL is a clinically and histologically heterogeneous neoplasm. The majority of cases disclose NS morphology and aberrant phenotypes are frequently encountered. In the pediatric population, NS grading and NS2 subtyping bear significant prognostic impact.
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Affiliation(s)
- Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Sara Tazzoli
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Elisa Carraro
- Paediatric Oncohematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | - Davide Massano
- Paediatric Oncohematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Federica Lovisa
- Paediatric Oncohematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy.,Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Lara Mussolin
- Paediatric Oncohematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy.,Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | - Alessandra Todesco
- Paediatric Oncohematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Alessandra Biffi
- Paediatric Oncohematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | - Marta Pillon
- Paediatric Oncohematology Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Massimo Rugge
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
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6
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Ahmed HAS, Raslan WF, Deifalla AHS, Fathallah MD. CD163 is a predictive biomarker for prognosis of classical Hodgkin's lymphoma in Saudi patients. Mol Clin Oncol 2019; 11:67-76. [PMID: 31289681 PMCID: PMC6535641 DOI: 10.3892/mco.2019.1850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 04/05/2019] [Indexed: 01/05/2023] Open
Abstract
Hodgkin's lymphoma (HL) is a hematological malignancy characterized by a minority of neoplastic cells outnumbered by tumor-associated macrophages (TAMs). The overexpression of the CD163 antigen by TAMs is considered to be a significant predictive biomarker for risk stratification. This is likely caused by a genetic single-nucleotide polymorphism (SNP) at the gene promoter. The aim of the present retrospective case-control study was to establish a gene expression profile of a specific biomarker for classical HL (CHL) in order to predict the outcome and survival of CHL patients in Saudi Arabia. The protein expression of CD163 on TAMs was studied using immunohistochemistry (IHC). A prognosis index was calculated for the CD163 protein to assess the risk stratification of CHL. Genotyping of selected SNPs of this antigen was performed for 100 CHL cases and controls. The analysis revealed that the CD163 protein expression level was significantly correlated with disease relapse (DR) and overall survival (OS). In addition, the CD163 index threshold (15.0) was found to be significantly correlated with the relapse rate. Among the studied CD163 SNPs, rs75608120 exhibited a significant correlation with the DR rate of CHL patients, but not with OS. The findings of the present study confirmed that CD163 is a specific marker for TAMs, and its overexpression by TAMs is significantly associated with relapse and reduced survival post-therapy. In addition, a new methodology of indexing CD163 protein expression for HL risk stratification was proposed. Thus, the present study identified a specific predictive molecular and antigenic biomarker for CHL prognosis.
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Affiliation(s)
- Huda Al Sayed Ahmed
- Pathology and Laboratory Services Department, Johns Hopkins Aramco Healthcare, 1709 Dhahran, Saudi Arabia
| | - Wasim Fawzi Raslan
- Pathology and Laboratory Services Department, Johns Hopkins Aramco Healthcare, 10613 Dhahran, Saudi Arabia
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8
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Galati D, Zanotta S, Corazzelli G, Bruzzese D, Capobianco G, Morelli E, Arcamone M, De Filippi R, Pinto A. Circulating dendritic cells deficiencies as a new biomarker in classical Hodgkin lymphoma. Br J Haematol 2018; 184:594-604. [DOI: 10.1111/bjh.15676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/08/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Domenico Galati
- Haematology‐Oncology and Stem‐Cell Transplantation Unit Department of Haematology and Innovative Therapies Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale Napoli Italia
| | - Serena Zanotta
- Haematology‐Oncology and Stem‐Cell Transplantation Unit Department of Haematology and Innovative Therapies Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale Napoli Italia
| | - Gaetano Corazzelli
- Haematology‐Oncology and Stem‐Cell Transplantation Unit Department of Haematology and Innovative Therapies Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale Napoli Italia
| | - Dario Bruzzese
- Department of Public Health Università degli Studi di Napoli Federico II Napoli Italia
| | - Gaetana Capobianco
- Haematology‐Oncology and Stem‐Cell Transplantation Unit Department of Haematology and Innovative Therapies Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale Napoli Italia
| | - Emanuela Morelli
- Haematology‐Oncology and Stem‐Cell Transplantation Unit Department of Haematology and Innovative Therapies Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale Napoli Italia
| | - Manuela Arcamone
- Haematology‐Oncology and Stem‐Cell Transplantation Unit Department of Haematology and Innovative Therapies Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale Napoli Italia
| | - Rosaria De Filippi
- Department of Clinical Medicine and Surgery Università degli Studi di Napoli Federico II Napoli Italia
| | - Antonio Pinto
- Haematology‐Oncology and Stem‐Cell Transplantation Unit Department of Haematology and Innovative Therapies Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale Napoli Italia
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9
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Hollander P, Rostgaard K, Smedby KE, Molin D, Loskog A, de Nully Brown P, Enblad G, Amini RM, Hjalgrim H, Glimelius I. An anergic immune signature in the tumor microenvironment of classical Hodgkin lymphoma is associated with inferior outcome. Eur J Haematol 2017; 100:88-97. [PMID: 29064587 DOI: 10.1111/ejh.12987] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The classical Hodgkin lymphoma (cHL) tumor microenvironment shows an ongoing inflammatory response consisting of varying degrees of infiltrating eosinophils, mast cells, macrophages, regulatory T lymphocytes (Tregs), and activated lymphocytes surrounding the malignant cells. Herein, different immune signatures are characterized and correlated with treatment outcome. METHODS Tumor-infiltrating leukocytes were phenotyped in biopsies from 459 patients with cHL. Time to progression (TTP) (primary progression, relapse, or death from cHL) and overall survival were analyzed using Cox proportional hazards regression. RESULTS The leukocyte infiltration in the microenvironment was highly diverse between patients and was categorized in 4 immune signatures (active, anergic, innate, or mixed). A high proportion of Tregs (anergic) resulted in shorter TTP (median 12.9-year follow-up) in age-adjusted analyses (hazard ratio = 1.82; 95% confidence interval 1.05-3-15). Epstein-Barr virus (EBV)-positive cases had higher proportions of macrophages and activated lymphocytes than EBV negative, but neither of those leukocytes predicted prognosis. CONCLUSIONS Abundant Tregs (anergic signature) indicate a shorter TTP, particularly in younger patients. This is probably due to a reduced ability of the immune system to attack the tumor cells. Our data warrant further investigation if these suggested immune signatures could predict outcome of immunotherapy such as immune checkpoint inhibitors.
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Affiliation(s)
- Peter Hollander
- Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Karin E Smedby
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Molin
- Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Angelica Loskog
- Clinical immunology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Gunilla Enblad
- Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Rose-Marie Amini
- Clinical and Experimental Pathology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Glimelius
- Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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10
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Expression of TIA1 and PAX5 in Classical Hodgkin Lymphoma at Initial Diagnosis May Predict Clinical Outcome. Appl Immunohistochem Mol Morphol 2017; 24:383-91. [PMID: 26067141 DOI: 10.1097/pai.0000000000000200] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although the expression of T-cell antigens and proteins associated with tumor-infiltrating T-lymphocytes (TILs), regulatory T cells (T-regs), and B-cell development have been evaluated in classical Hodgkin lymphoma (cHL), few studies correlate these proteins' expression patterns with clinical outcome. The purpose of this study was to evaluate proteins expressed in the Reed-Sternberg cells (RSCs) and TILs of cHLs at initial diagnosis to determine their prognostic significance. The expression of 12 proteins in RSCs and TILs from 88 diagnostic cHL biopsies was quantitated and correlated to overall survival (OS) and progression-free survival (PFS). CD2, CD3, CD4, CD5, CD7, CD25, PD1, TIA1, MUM1, and ZAP70 expression in RSCs did not correlate with OS or PFS, nor did programmed death 1 (PD1) expression in TILs. High numbers of TIA1-positive TILs (≥50%) correlated with OS (P=0.027), but not PFS (P=0.993) in univariate analysis. Expression of CD2, CD3, CD4, CD5, and/or TIA1 (6%) in RSCs was associated with lymphocyte-rich/mixed-cellularity subtype (P=0.032). High International Prognostic Score (IPS; P=0.036), and high stage (P=0.046) were independent predictors of worse PFS in univariate analysis. Low IPS (P=0.003) and nodular sclerosing subtype (P=0.022) were associated with better OS in univariate analysis. Only the IPS predicted OS in multivariate (P=0.009) analysis. High TIA1+ TILs correlated with worse clinical outcomes for cHLs, as did PAX5-RSCs (P=0.024), although only 2/74 cases were shown to be negative for this marker, suggesting that the tumor microenvironment and a transcription factor crucial for B-cell development are critical biological determinants of the disease course.
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11
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Winkfield KM, Advani RH, Ballas LK, Dabaja BS, Dhakal S, Flowers CR, Ha CS, Hoppe BS, Mansur DB, Mendenhall NP, Metzger ML, Plastaras JP, Roberts KB, Shapiro R, Smith SM, Terezakis SA, Younes A, Constine LS. ACR Appropriateness Criteria® Recurrent Hodgkin Lymphoma. ONCOLOGY (WILLISTON PARK, N.Y.) 2016; 30:1099-1108. [PMID: 27987203 PMCID: PMC7440297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This topic addresses the management of recurrent Hodgkin lymphoma. While autologous stem cell transplantation may be appropriate for select cases of recurrent disease following comprehensive combined-modality therapy, other options exist for patients treated with lower-dose therapy for early-stage disease. Additionally, innovative targeted therapies provide newer salvage options to consider. The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation, or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. By combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the complex decision-making associated with the management of recurrent Hodgkin lymphoma.
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Affiliation(s)
- Karen M. Winkfield
- Principal Author; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Ranjana H. Advani
- Stanford Cancer Center, Stanford, California; American Society of Clinical Oncology
| | - Leslie K. Ballas
- University of Southern California Keck School of Medicine, Los Angeles, California
| | | | - Sughosh Dhakal
- University of Rochester Medical Center, Rochester, New York
| | | | - Chul Soo Ha
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Bradford S. Hoppe
- University of Florida Proton Therapy Institute, Jacksonville, Florida
| | - David B. Mansur
- University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Monika L. Metzger
- St. Jude Children’s Research Hospital, Memphis, Tennessee; American Society of Clinical Oncology
| | - John P. Plastaras
- University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | | | - Ronald Shapiro
- Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sonali M. Smith
- University of Chicago, Chicago, Illinois; American Society of Hematology
| | - Stephanie A. Terezakis
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital, Baltimore, Maryland
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York, New York; American Society of Clinical Oncology
| | - Louis S. Constine
- Panel Chair; University of Rochester Medical Center, Rochester, New York
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12
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Lennerz JK, Hoffmann K, Bubolz AM, Lessel D, Welke C, Rüther N, Viardot A, Möller P. Suppressor of cytokine signaling 1 gene mutation status as a prognostic biomarker in classical Hodgkin lymphoma. Oncotarget 2016; 6:29097-110. [PMID: 26336985 PMCID: PMC4745714 DOI: 10.18632/oncotarget.4829] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/07/2015] [Indexed: 12/22/2022] Open
Abstract
Suppressor of cytokine signaling 1 (SOCS1) mutations are among the most frequent somatic mutations in classical Hodgkin lymphoma (cHL), yet their prognostic relevance in cHL is unexplored. Here, we performed laser-capture microdissection of Hodgkin/Reed-Sternberg (HRS) cells from tumor samples in a cohort of 105 cHL patients. Full-length SOCS1 gene sequencing showed mutations in 61% of all cases (n = 64/105). Affected DNA-motifs and mutation pattern suggest that many of these SOCS1 mutations are the result of aberrant somatic hypermutation and we confirmed expression of mutant alleles at the RNA level. Contingency analysis showed no significant differences of patient-characteristics with HRS-cells containing mutant vs. wild-type SOCS1. By predicted mutational consequence, mutations can be separated into those with non-truncating point mutations (‘minor’ n = 49/64 = 77%) and those with length alteration (‘major’; n = 15/64 = 23%). Subgroups did not differ in clinicopathological characteristics; however, patients with HRS-cells that contained SOCS1 major mutations suffered from early relapse and significantly shorter overall survival (P = 0.03). The SOCS1 major status retained prognostic significance in uni-(P = 0.016) and multivariate analyses (P = 0.005). Together, our data indicate that the SOCS1 mutation type qualifies as a single-gene prognostic biomarker in cHL.
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Affiliation(s)
- Jochen K Lennerz
- Ulm University, Institute of Pathology, Ulm, Germany.,Massachusetts General Hospital/Harvard Medical School, Department of Pathology, Center for Integrated Diagnostics, Boston, MA, USA
| | - Karl Hoffmann
- Ulm University, Institute of Pathology, Ulm, Germany.,Department of Dermatology and Venerology, University of Freiburg Medical Center, Freiburg, Germany
| | | | - Davor Lessel
- Ulm University, Institute of Human Genetics, Ulm, Germany.,University Medical Center Hamburg-Eppendorf, Institute of Human Genetics, Hamburg, Germany
| | - Claudia Welke
- Comprehensive Cancer Center, Ulm University, Ulm, Germany
| | - Nele Rüther
- Ulm University, Institute of Pathology, Ulm, Germany
| | - Andreas Viardot
- Ulm University, Department of Internal Medicine III, Ulm, Germany
| | - Peter Möller
- Ulm University, Institute of Pathology, Ulm, Germany
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13
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Englund A, Molin D, Enblad G, Karlén J, Glimelius I, Ljungman G, Amini R. The role of tumour‐infiltrating eosinophils, mast cells and macrophages in Classical and Nodular Lymphocyte Predominant Hodgkin Lymphoma in children. Eur J Haematol 2016; 97:430-438. [DOI: 10.1111/ejh.12747] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Annika Englund
- Department of Women's and Children′s Health, Paediatric Oncology Uppsala University Uppsala Sweden
| | - Daniel Molin
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology Uppsala University Uppsala Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology Uppsala University Uppsala Sweden
| | - Jonas Karlén
- Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology Uppsala University Uppsala Sweden
| | - Gustaf Ljungman
- Department of Women's and Children′s Health, Paediatric Oncology Uppsala University Uppsala Sweden
| | - Rose‐Marie Amini
- Department of Immunology, Genetics and Pathology Unit of Pathology Uppsala University Uppsala Sweden
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14
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Benharroch D, Nalbandyan K, Lazarev I. CD20 Over-Expression in Hodgkin-Reed-Sternberg Cells of Classical Hodgkin Lymphoma: the Neglected Quest. J Cancer 2015; 6:1155-9. [PMID: 26516364 PMCID: PMC4615352 DOI: 10.7150/jca.13107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/08/2015] [Indexed: 11/05/2022] Open
Abstract
We have scrutinized a previously analyzed cohort of classical Hodgkin lymphoma patients for evidence of a CD20 over-expression. This was pursued in order to determine whether all the 24 (12.6%) CD20+++ patients had clinical and/or biological profiles which would warrant a separate consideration and treatment or would carry a different outcome from our 166 CD20 (-) classical Hodgkin lymphoma patients. Except for an older age and a significantly lower expression of non-sialyl-CD15 antigen, both previously described in classical Hodgkin lymphoma, no justification to exclude these CD20+++ patients from the cohort at large is apparent. We suggest that the generally accepted view to the contrary be revised. In addition, we propose alternative interpretations for the low expression of CD20 found in a majority of Hodgkin-Reed-Sternberg cells in classical Hodgkin lymphoma.
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Affiliation(s)
- Daniel Benharroch
- 1. Department of Pathology, Soroka University Medical Center, Beer-Sheva and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Karen Nalbandyan
- 1. Department of Pathology, Soroka University Medical Center, Beer-Sheva and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Irina Lazarev
- 2. Department of Oncology, Soroka University Medical Center, Beer-Sheva and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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15
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Elsayed AA, Asano N, Ohshima K, Izutsu K, Kinoshita T, Nakamura S. Prognostic significance of CD20 expression and Epstein-Barr virus (EBV) association in classical Hodgkin lymphoma in Japan: a clinicopathologic study. Pathol Int 2015; 64:336-45. [PMID: 25047504 DOI: 10.1111/pin.12175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/28/2014] [Indexed: 01/07/2023]
Abstract
To investigate the clinicopathological significance of CD20 expression and Epstein-Barr virus (EBV) association in Hodgkin and Reed-Sterberg cells of classical Hodgkin lymphoma (CHL), CD20 expression and EBV positivity (by EBER in situ hybridization) were investigated in 389 CHL patients in Japan. They included 74 CD20-positive cases (19%) and 315 CD20-negative cases (81%). CD20-positive cases showed significantly older age at onset (P = 0.018) and higher association with EBV (P = 0.002). Multivariate analysis identified EBV-positivity (but not CD20-positivity), presence of B symptoms, thrombocytopenia, elevated serum lactate dehydrogenase and performance status >1 as poor prognostic factors for overall survival (OS). We constructed a new prognostic model with these five factors classifying patients into three groups: low risk, 0-1 adverse factor; intermediate risk, 2-3 factors; high risk, 4-5 factors. This prognostic model could stratify the prognosis of CHL patients (P < 0.0001). For 144 patients (58%) classified into the low-risk group, the 5-year OS was 91%. For 92 patients (37%) in the intermediate group, the 5-year OS was 66%; for 11 patients (5%) in the high-risk group, the 5-year OS was 36%. In conclusion, EBV is identified as an independent poor prognostic factor for CHL patients. Therefore, examination of EBV association in CHL is recommended as routine pathologic practice especially in countries where EBV infection prevails.
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Affiliation(s)
- Ahmed Ali Elsayed
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan; Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Koh YW, Jung SJ, Park CS, Yoon DH, Suh C, Huh J. LGALS3 as a prognostic factor for classical Hodgkin's lymphoma. Mod Pathol 2014; 27:1338-44. [PMID: 24603587 DOI: 10.1038/modpathol.2014.38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 12/29/2013] [Accepted: 12/31/2013] [Indexed: 11/09/2022]
Abstract
LGALS3, a member of the lectin family, has an important role in tumor progression through inhibition of apoptosis. LGALS3 shares several significant structural properties with BCL2. In this study, we examined the prognostic significance of LGALS3 and BCL2 in uniformly treated classical Hodgkin's lymphoma. Diagnostic tissues from 110 patients with uniformly treated classical Hodgkin's lymphoma were evaluated retrospectively by immunohistochemical analysis of LGALS3 and BCL2 expression. The median follow-up time was 6.2 years (range, 0.2-17.3 years). Twenty-seven patients (25%) expressed LGALS3 protein in Hodgkin/Reed-Sternberg cells, which was associated with poor overall survival and event-free survival (P=0.007 and P<0.001). Fifteen patients (14%) expressed BCL2 protein in Hodgkin/Reed-Sternberg cells, which was not associated with overall survival and event-free survival (P=0.928 and P=0.900).There was no correlation between LGALS3 and BCL2 expression (P=0.193). Multivariate analysis identified LGALS3 protein as an independent prognostic factor for event-free survival (P=0.007). Subgroup analysis according to the Ann Arbor stage of classical Hodgkin's lymphoma showed that LGALS3 protein expression had a prognostic value in limited-stage classical Hodgkin's lymphoma (P<0.001). The results of this study suggest that LGALS3 is an independent prognostic factor in classical Hodgkin's lymphoma, and may allow the identification of a subgroup of patients with limited-stage classical Hodgkin's lymphoma who require more intensive therapy.
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Affiliation(s)
- Young Wha Koh
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Se Jin Jung
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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de la Cruz-Merino L, Lejeune M, Nogales Fernández E, Henao Carrasco F, Grueso López A, Illescas Vacas A, Pulla MP, Callau C, Álvaro T. Role of immune escape mechanisms in Hodgkin's lymphoma development and progression: a whole new world with therapeutic implications. Clin Dev Immunol 2012; 2012:756353. [PMID: 22927872 PMCID: PMC3426211 DOI: 10.1155/2012/756353] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 06/05/2012] [Indexed: 12/31/2022]
Abstract
Hodgkin's lymphoma represents one of the most frequent lymphoproliferative syndromes, especially in young population. Although HL is considered one of the most curable tumors, a sizeable fraction of patients recur after successful upfront treatment or, less commonly, are primarily resistant. This work tries to summarize the data on clinical, histological, pathological, and biological factors in HL, with special emphasis on the improvement of prognosis and their impact on therapeutical strategies. The recent advances in our understanding of HL biology and immunology show that infiltrated immune cells and cytokines in the tumoral microenvironment may play different functions that seem tightly related with clinical outcomes. Strategies aimed at interfering with the crosstalk between tumoral Reed-Sternberg cells and their cellular partners have been taken into account in the development of new immunotherapies that target different cell components of HL microenvironment. This new knowledge will probably translate into a change in the antineoplastic treatments in HL in the next future and hopefully will increase the curability rates of this disease.
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Affiliation(s)
- Luis de la Cruz-Merino
- Clinical Oncology Department, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain.
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18
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Three-dimensional Telomere Signatures of Hodgkin- and Reed-Sternberg Cells at Diagnosis Identify Patients with Poor Response to Conventional Chemotherapy. Transl Oncol 2012; 5:269-77. [PMID: 22937179 DOI: 10.1593/tlo.12142] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/07/2012] [Accepted: 07/15/2012] [Indexed: 12/13/2022] Open
Abstract
In classic Hodgkin lymphoma (HL) the malignant mononuclear Hodgkin (H) and multinuclear Reed-Sternberg (RS) cells are characterized by a distinct three-dimensional nuclear telomere organization with shortening of the telomere length and the formation of telomeric aggregates. We asked if the severity of these telomere changes correlates with the clinical behavior of the disease. We retrospectively evaluated three-dimensional telomere organization by quantitative fluorescent in situ hybridization (Q-FISH) of diagnostic biopsies from 16 patients who were good responders and compared them with 16 diagnostic biopsies of 10 patients with refractory or relapsing HL (eight initial biopsies, four confirming progressions, and four confirming relapses). The H cells from patients with refractory/relapsing disease contained a significantly higher percentage of very small telomeres (P = .027) and telomere aggregates (P = .032) compared with H cells of patients entering rapid remission. These differences were even more significant (P = .002 and P = .013, respectively) when comparing the eight initial diagnostic biopsies of refractory/relapsing HL with diagnostic biopsies of eight patients with ongoing long-lasting remission (mean of 47 months). This specific three-dimensional telomere Q-FISH signature identifies these highly aggressive mononuclear H cells at the first diagnostic biopsy and thus may offer a new molecular marker to optimize initial treatment.
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Benharroch D, Pilosof S, Gopas J, Levi I. Primary Refractory and Relapsed Classical Hodgkin Lymphoma - Significance of Differential CD15 Expression in Hodgkin-Reed-Sternberg Cells. J Cancer 2012; 3:322-7. [PMID: 22866166 PMCID: PMC3408696 DOI: 10.7150/jca.4716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 07/21/2012] [Indexed: 11/15/2022] Open
Abstract
We recognized a few possible complications of classical Hodgkin lymphoma therapy in a cohort of 209 patients: 8 developed a primary refractory disease (primary progression), 36 showed an early relapse and 21 showed a late relapse. Sialyl-CD15 expression in Hodgkin-Reed-Sternberg cells was significantly more positive in primary refractory Hodgkin lymphoma, which confirms our previously published findings. Bcl-2 showed a significantly lower level of expression in primary refractory disease than in the other follow-up groups. This is in contrast with a previous finding of Bcl-2, associated with a poor prognosis in primary refractory illness. Another category of variables, old age and advanced stages, was significantly different in the various complications but this finding is probably to be expected. We could not demonstrate a difference between the sequels and the control group with regard to several clinical and immunohistochemical markers. Sialyl-CD15 and Bcl-2 expression, in contrast, were confirmed as prognostic factors, mainly of tumor progression into primary refractory disease.
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Affiliation(s)
- Daniel Benharroch
- 1. Departments of Pathology, Soroka University Medical Center, Israel
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20
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Gotlib J, Akin C. Mast cells and eosinophils in mastocytosis, chronic eosinophilic leukemia, and non-clonal disorders. Semin Hematol 2012; 49:128-37. [PMID: 22449623 DOI: 10.1053/j.seminhematol.2012.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mast cells and eosinophils often travel in the same biologic circles. In non-clonal states, such as allergic and inflammatory conditions, cell-to-cell contact and the pleiotropic actions of multiple cytokines and chemokines, derived from local tissues or mast cells themselves, foster the co-recruitment of these cells to the same geographic cellular niche. While eosinophils and mast cells serve critical roles as part of the host immune response and in maintenance of normal homeostasis, these cell types can undergo neoplastic transformation due to the development of clonal molecular abnormalities that arise in early hematopoietic progenitors. The dysregulated tyrosine kinases, D816V KIT and FIP1L1-PDGFRA, are the prototypic oncogenic lesions resulting in systemic mastocytosis (SM) and chronic eosinophilic leukemia, respectively. We review the pathobiology of these myeloproliferative neoplasms (MPNs) with a focus on the relationship between mast cells and eosinophils, and discuss murine models, which further elucidate how the phenotype of these diseases can be influenced by stem cell factor (SCF) and expression of the potent eosinophilopoietic cytokine, interleukin-5 (IL-5). Therapy of SM and FIP1L1-PDGFRA-positive disease and the prognostic relevance of increased peripheral blood and tissue mast cells in hematolymphoid malignancies will also be addressed.
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Affiliation(s)
- Jason Gotlib
- Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA, USA
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21
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Deau B, Bachy E, Ribrag V, Delarue R, Rubio MT, Bosq J, Varet B, Brousse N, Hermine O, Canioni D. Macrophage, mast cell and T lymphocyte infiltrations are independent predictive biomarkers of primary refractoriness or early relapse in classical Hodgkin lymphoma. Leuk Lymphoma 2012; 54:41-5. [DOI: 10.3109/10428194.2012.698274] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Mast cells promote the growth of Hodgkin's lymphoma cell tumor by modifying the tumor microenvironment that can be perturbed by bortezomib. Leukemia 2012; 26:2269-76. [PMID: 22430634 DOI: 10.1038/leu.2012.81] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hodgkin's lymphoma is frequently associated with mast cell infiltration that correlates directly with disease severity, but the mechanisms underlying this relationship remain unclear. Here, we report that mast cells promote the growth of Hodgkin's tumor by modifying the tumor microenvironment. A transplantation assay shows that primary murine mast cells accelerate tumor growth by established Hodgkin's cell lines, and promote marked neovascularization and fibrosis. Both mast cells and Hodgkin's cells were sensitive to bortezomib, but mast cells were more resistant to bortezomib. However, bortezomib inhibited degranulation, PGE(2)-induced rapid release of CCL2, and continuous release of vascular endothelial growth factor-A from mast cells even at the concentration that did not induce cell death. Bortezomib-treated mast cells lost the ability to induce neovasculization and fibrosis, and did not promote the growth of Hodgkin tumor in vivo. These results provide further evidence supporting causal relationships between inflammation and tumor growth, and demonstrate that bortezomib can target the tumor microenvironment.
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23
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Jakovic LR, Mihaljevic BS, Jovanovic MDP, Bogdanovic AD, Andjelic BM, Bumbasirevic VZ. Prognostic Significance of Bcl-2, Tumor-Associated Macrophages, and Total Neoplastic and Inflammatory Lymph Node Involvement in Advanced Stage Classical Hodgkins Lymphoma. ACTA ACUST UNITED AC 2012. [DOI: 10.1159/000343664] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Steidl C, Connors JM, Gascoyne RD. Molecular Pathogenesis of Hodgkin's Lymphoma: Increasing Evidence of the Importance of the Microenvironment. J Clin Oncol 2011; 29:1812-26. [DOI: 10.1200/jco.2010.32.8401] [Citation(s) in RCA: 292] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hodgkin's lymphoma (HL) represents the most common subtype of malignant lymphoma in young people in the Western world. Most patients can be cured with modern treatment strategies, although approximately 20% will die after relapse or progressive disease. The histologic hallmark of the disease is the presence of the characteristic Hodgkin Reed-Sternberg (HRS) cells in classical HL and so-called lymphocyte-predominant (LP) cells in nodular lymphocyte-predominant HL. HL is unique among all cancers because malignant cells are greatly outnumbered by reactive cells in the tumor microenvironment and make up only approximately 1% of the tumor. Expression of a variety of cytokines and chemokines by the HRS and LP cells is believed to be the driving force for an abnormal immune response, perpetuated by additional factors secreted by reactive cells in the microenvironment that help maintain the inflammatory milieu. The malignant HRS and LP cells manipulate the microenvironment, permitting them to develop their malignant phenotype fully and evade host immune attack. Gene expression signatures derived from non-neoplastic cells correlate well with response to initial and subsequent therapies, reflecting their functional relevance. Recent biomarker studies have added texture to clinical outcome predictors, and their incorporation into prognostic models may improve our understanding of the biologic correlates of treatment failure. Moreover, recent preclinical and clinical studies have demonstrated that the tumor microenvironment represents a promising therapeutic target, raising hope that novel treatment strategies focused on the interface between malignant and reactive cells will soon emerge.
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Affiliation(s)
- Christian Steidl
- From the British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph M. Connors
- From the British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada
| | - Randy D. Gascoyne
- From the British Columbia Cancer Agency, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Derenzini E, Younes A. Predicting treatment outcome in classical Hodgkin lymphoma: genomic advances. Genome Med 2011; 3:26. [PMID: 21542892 PMCID: PMC3129642 DOI: 10.1186/gm240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Classical Hodgkin lymphoma is considered a highly curable disease; however, 20% of patients cannot be cured with standard first-line chemotherapy and have a dismal outcome. Current clinical parameters do not allow accurate risk stratification, and personalized therapies are lacking. In fact, Hodgkin lymphoma (HL) is often over- or undertreated because of this lack of accurate risk stratification. In recent years, the early detection of chemoresistance by fluorodeoxyglucose positron emission tomography has become the most important prognostic tool in the management of HL. However, to date, no prognostic scores or molecular markers are available for the early identification of patients at very high risk of failure of induction therapy. In the last decade, many important advances have been made in understanding the biology of HL. In particular, the development of new molecular profiling technologies, such as SNP arrays, comparative genomic hybridization, and gene-expression profiling, have allowed the identification of new prognostic factors that may be useful for risk stratification and predicting response to chemotherapy. In this review, we focus on the prognostic tools and biomarkers that are available for newly diagnosed HL, and we highlight recent advances in the genomic characterization of classical HL and potential targets for therapy.
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Affiliation(s)
- Enrico Derenzini
- Institute of Haematology and Medical Oncology L & A Seràgnoli, University of Bologna, Bologna, 40138 Italy
| | - Anas Younes
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, Texas, USA
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Carbone A, Spina M, Gloghini A, Tirelli U. Classical Hodgkin's lymphoma arising in different host's conditions: pathobiology parameters, therapeutic options, and outcome. Am J Hematol 2011; 86:170-9. [PMID: 21264899 DOI: 10.1002/ajh.21910] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Epidemiologic and molecular findings suggest that classical Hodgkin's lymphoma (CHL) is not a single disease but consists of more than one entity and may occur in different clinical settings. This review analyzes similarities and disparities among CHL entities arising in different host's conditions with respect to pathobiology parameters, therapeutic options, and outcome. For the purpose of this analysis, CHL entities have been subdivided according to the immune status of the host. In nonimmunosuppressed hosts, according to the age, CHL include pediatric, adult, and elderly forms, whereas, in immunosuppressed hosts, according to the type of immunosuppression, CHL include human immunodeficiency virus (HIV)-associated, iatrogenic, and post-transplant types. CHL entities in different settings are similar in morphology of neoplastic cells, expression of activation markers, and aberrations/activation of NFKB, JAK/STAT, and P13K/AKT pathways, but differ in the association with Epstein-Barr virus (EBV) infection, persistent B-cell phenotype, and cellular background composition. Large B-cell lymphomas resembling CHL may also be observed in the same clinical settings. These lesions, however, do not fulfill the diagnostic criteria of CHL and clinically display a very aggressive behavior. In this article, current treatment options for the CHL entities, especially for elderly CHL and HIV-associated CHL, are specifically reviewed. ABVD remains the gold standard both in nonimmunosuppressed or immunosuppressed hosts even if there are several data suggesting a possible improvement in outcome using the aggressive BEACOPP regimen in advanced stages. Refractory CHL, a clinical condition that may occur throughout the entire spectrum of CHL, is discussed separately.
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Affiliation(s)
- Antonino Carbone
- Division of Pathology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
| | - Michele Spina
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
| | - Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine, Istituto Nazionale Tumori, Milano, Italy
| | - Umberto Tirelli
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
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27
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Flow cytometric detection of the classical hodgkin lymphoma: clinical and research applications. Adv Hematol 2010; 2011:387034. [PMID: 21127714 PMCID: PMC2993040 DOI: 10.1155/2011/387034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 09/16/2010] [Indexed: 01/22/2023] Open
Abstract
Classical Hodgkin lymphoma (CHL) is a relatively uncommon B cell-derived neoplasm that presents with rare malignant cells in an abundant reactive background. The diagnosis of CHL currently relies on a combination of morphologic findings and immunohistochemical stains. With the exception of rare cases with dramatically increased malignant populations, isolation of pure viable tumor cells has not been historically possible. Recently, a reliable flow cytometric assay for direct detection and isolation of the malignant cells in this disease has been developed. This assay has proven useful diagnostically and has been clinically validated to have a very high sensitivity and nearly absolute specificity for the diagnosis of CHL in routine clinical samples. This paper describes the methodology for the flow cytometric detection of CHL in clinical samples as well as current state of evaluation of background lymphocytes as an adjunct diagnostic test. Also discussed are exciting research applications of the direct isolation of viable tumor cells in CHL. The current state of flow cytometric evaluation of nodular lymphocyte predominant Hodgkin lymphoma and T cell-rich large B cell lymphoma is also briefly discussed.
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28
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Miltényi Z, Simon Z, Páyer E, Váróczy L, Gergely L, Illés A. [Therapy for patients with primary refractory and relapsed Hodgkin-lymphoma--our experience]. Orv Hetil 2010; 151:172-8. [PMID: 20083465 DOI: 10.1556/oh.2010.28799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Recovery have been achieved in the majority of Hodgkin-lymphoma patients. Unfortunately some of the patients refracter and about third of the patients relapsed after the first-line treatment. AIM AND METHODS We investigated the frequency and treatment of refracter or relapsed Hodgkin lymphoma patients between 1996 and 2006. RESULTS We examined 76 women and 71 men, who had HL in this period. 141 patients (95,9%) had remission after first-line therapy. 6 women were primary refracter, 4 of them had high-dose therapy and autolog stem cell transplantation. They died in spite of the multiple treatment. 31 patients - 13 men and 18 women - had relapse (16 cases were in one year). 14 patients had high-dose therapy and autolog stem cell transplantation, 11 patients had only chemotherapy, 3 had only radiotherapy and 3 patients were treated by combined modality treatment. 6 of the relapsed patients were died, 5 because of the progression of lymphoma and one because of secunder myelodysplasia. CONCLUSIONS Relapsed patients have a good prognosis, but refracter patients have long chance despite autolog or allogen hemopoietic stem cell transplantation. Searching for new therapeutical modalities for these patients is extremely important.
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Affiliation(s)
- Zsófia Miltényi
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Altalános Orvostudományi Kar, Belgyógyászati Intézet, III. Belgyógyászati Klinika, Debrecen Móricz Zs., krt. 22., 4032.
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29
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New developments in the pathology of malignant lymphoma: a review of the literature published from January to August 2009. J Hematop 2009; 2:171-83. [PMID: 20309425 PMCID: PMC2766446 DOI: 10.1007/s12308-009-0046-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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30
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Gadelha T, Aquino JHW, Assunção e Silva E, Santos FL, de Oliveira MHCF. The diversity in clinical presentation of acquired factor V inhibitor. Two case reports. Acta Haematol 2008; 119:108-10. [PMID: 18367830 DOI: 10.1159/000121826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 01/14/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Telma Gadelha
- Hematology Service, Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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