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Li JW, Deng C, Zhou XY, Deng R. The biology and treatment of Epstein-Barr virus-positive diffuse large B cell lymphoma, NOS. Heliyon 2024; 10:e23921. [PMID: 38234917 PMCID: PMC10792184 DOI: 10.1016/j.heliyon.2023.e23921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 01/19/2024] Open
Abstract
EBV positive Diffuse Large B-cell lymphoma, not otherwise specified (EBV+DLBCL-NOS) referred to DLBCL with expression of EBV encoded RNA in tumor nucleus. EBV+DLBCL-NOS patients present with more advanced clinical stages and frequent extranodal involvement. Although rituximab-containing immunochemotherapy regimens can significantly improve outcomes in patients with EBV+DLBCL, the best first-line treatment needs to be further explored. Due to the relatively low incidence and regional variation of EBV+DLBCL-NOS, knowledge about this particular subtype of lymphoma remains limited. Some signaling pathways was abnormally activated in EBV+DLBCL-NOS, including NF-κB and JAK/STAT pathways) and other signal transduction pathways. In addition, immune processes such as interferon response, antigen-presenting system and immune checkpoint molecule abnormalities were also observed. Currently, chimeric antigen receptor T-cell (CAR-T) therapy, chemotherapy combined with immunotherapy and novel targeted therapeutic drugs are expected to improve the prognosis of EBV+DLBCL-NOS patients, but more studies are needed to confirm this.
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Affiliation(s)
- Ji-Wei Li
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410000, China
| | - Chao Deng
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, 410000, China
| | - Xiao-Yan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Institute of Pathology, Fudan University, Shanghai, China
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Renfang Deng
- Department of Oncology, The Second Hospital of Zhuzhou City, Zhuzhou, 412000, China
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2
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Epstein-Barr Virus and the Pathogenesis of Diffuse Large B-Cell Lymphoma. Life (Basel) 2023; 13:life13020521. [PMID: 36836878 PMCID: PMC9967091 DOI: 10.3390/life13020521] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Epstein-Barr virus (EBV), defined as a group I carcinogen by the World Health Organization (WHO), is present in the tumour cells of patients with different forms of B-cell lymphoma, including Burkitt lymphoma, Hodgkin lymphoma, post-transplant lymphoproliferative disorders, and, most recently, diffuse large B-cell lymphoma (DLBCL). Understanding how EBV contributes to the development of these different types of B-cell lymphoma has not only provided fundamental insights into the underlying mechanisms of viral oncogenesis, but has also highlighted potential new therapeutic opportunities. In this review, we describe the effects of EBV infection in normal B-cells and we address the germinal centre model of infection and how this can lead to lymphoma in some instances. We then explore the recent reclassification of EBV+ DLBCL as an established entity in the WHO fifth edition and ICC 2022 classifications, emphasising the unique nature of this entity. To that end, we also explore the unique genetic background of this entity and briefly discuss the potential role of the tumour microenvironment in lymphomagenesis and disease progression. Despite the recent progress in elucidating the mechanisms of this malignancy, much work remains to be done to improve patient stratification, treatment strategies, and outcomes.
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3
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Rodrigues-Fernandes CI, Abreu LG, Radhakrishnan R, Perez DEDC, Amaral-Silva GK, Gondak RDO, Rahimi S, Brennan PA, Fonseca FP, Vargas PA. Prognostic significance of CD30 expression in diffuse large B-cell lymphoma: A systematic review with meta-analysis. J Oral Pathol Med 2021; 50:587-593. [PMID: 34101913 DOI: 10.1111/jop.13208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND CD30 is variably expressed in diffuse large B-cell lymphoma (DLBCL), but its prognostic potential for the affected patients remains debatable and unclear. Therefore, we aimed to determine the frequency of CD30 expression in DLBCL and its potential for prognostic determination. METHODS An electronic systematic review was performed using multiple databases, followed by a quantitative meta-analysis to assess the frequency of CD30 expression with positivity cut-off values of >0% and >20%, and to determine its association with clinicopathological features and patients' survival. RESULTS Using a cut-off value >0%, we observed that 3.5%-59.1% of the cases were considered positive for CD30. There was a significant association of the protein expression with a lower number of extra-nodal sites affected by the neoplasm, with Ann Arbor advanced stage, the absence of B-symptoms, the lack of MYC and BCL2 translocations, and a lower ECOG performance. Using a cut-off value >20%, we observed that 2.5%-36.7% of the cases were considered positive for CD30, being significantly associated with a lower number of extra-nodal sites affected by the neoplasm, Ann Arbor stages III/IV, non-GCB tumours, the lack of MYC and BCL2 translocations, and a lower ECOG value. CD30 expression was significantly associated with a better survival rate, regardless of what cut-off parameter was used. CONCLUSION Despite variations in the cut-off values used to determine CD30 positivity in DLBCL, the expression of this protein seems to be associated with a higher survival rate and better prognosis.
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Affiliation(s)
| | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Raghu Radhakrishnan
- Department of Oral Pathology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, School of Dentistry, Universidade Federal de Pernambuco, Recife, Brazil
| | | | | | - Siavash Rahimi
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Felipe Paiva Fonseca
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Biology and Oral Pathology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Biology and Oral Pathology, School of Dentistry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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4
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Advances in the Pathogenesis of EBV-Associated Diffuse Large B Cell Lymphoma. Cancers (Basel) 2021; 13:cancers13112717. [PMID: 34072731 PMCID: PMC8199155 DOI: 10.3390/cancers13112717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin's lymphoma (NHL) in adults. Epstein-Barr virus (EBV) positive DLBCL of the elderly was defined by the World Health Organization (WHO) in 2008, it was restricted only to patients older than 50 years old, and it was attributed to immunesenescence associated with physiological aging. After the description of EBV-associated DLBCL in children and young adults, the WHO redefined the definition, leading to the substitution of the modifier "elderly" with "not otherwise specified" (EBV + DLBCL, NOS) in the updated classification, and it is no more considered provisional. The incidence of EBV + DLBCL, NOS varies around the world, in particular influenced by the percentage of EBV+ cells used as cut-off to define a case as EBV-associated. EBV has effect on the genetic composition of tumor cells, on survival, and at the recruitment of immune cells at the microenvironment. In this review, the role of EBV in the pathogenesis of DLBCL is discussed.
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5
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The Incidence of Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13081785. [PMID: 33917961 PMCID: PMC8068359 DOI: 10.3390/cancers13081785] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The worldwide prevalence of Epstein-Barr virus-positive (EBV+) diffuse large B-cell lymphoma (DLBCL) is undetermined. There is no clearly defined cut-off for EBV-encoded RNA (EBER) positivity in tumor cells by in situ hybridization. A lack of common criteria for positive expression of EBER has been raised as a limitation for interpreting and understanding the geographic and ethnic disparity of prevalence of EBV+ DLBCL. We conducted a systematic literature review and meta-analysis to establish the proportions of EBV+ DLBCL patients. Results showed that the pooled proportion of EBER positivity was 7.9% in patients with de novo DLBCL. The prevalence of EBV+ DLBCL was significantly higher in Asia and South America compared with Western countries. A tendency for lower pooled proportions was observed in studies using a higher cut-off for EBER positivity. The patients’ age did not significantly affect the prevalence. These findings may improve our current knowledge of the EBV+ DLBCL. Abstract The worldwide prevalence of Epstein-Barr virus-positive (EBV+) diffuse large B-cell lymphoma (DLBCL) is undetermined. There is no clearly defined cut-off for EBV-encoded RNA (EBER) positivity in tumor cells by in-situ hybridization. The purpose of this study was to establish the proportions of EBV+ DLBCL patients and influence of the different cut-offs for EBER positivity, geographical location, and age on the prevalence of EBV+ DLBCL. PubMed and EMBASE were searched for studies published up to May 28, 2020 that reported proportions of EBER positivity in immunocompetent and de novo DLBCL patients. The pooled proportions were computed by an inverse variance method for calculating the weights and the DerSimonian–Laird method. Multiple subgroup analyses were conducted to explore any heterogeneity. Thirty-one studies (8249 patients) were included. The pooled proportion of EBV+ DLBCL was 7.9% (95% CI, 6.2–10.0%) with significant heterogeneity among studies (p < 0.001). The prevalence of EBV+ DLBCL was significantly higher in Asia and South America compared with Western countries (p < 0.01). The cut-offs for EBER positivity (10%, 20%, 50%) and patients’ age (≥50 years vs. <50 years) did not significantly affect the prevalence (p ≥ 0.10). EBV+ DLBCL is rare with a pooled proportion of 7.9% in patients with DLBCL and the geographic heterogeneity was confirmed.
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Xie J, Rinker E, Zaarour M. A Rare, Yet Treatable Pancreatic Tumor: Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921269. [PMID: 32176677 PMCID: PMC7101472 DOI: 10.12659/ajcr.921269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare subtype of B-cell neoplasm that can have diverse presentations. When it involves the pancreas (i.e., pancreatic lymphoma), it can mimic metastatic pancreatic adenocarcinoma. Pancreatic lymphoma and adenocarcinoma often have similar clinical, laboratory, and radiographic features making the distinction challenging without pathological tissue examination. The differentiation of these 2 entities is important as the prognosis of pancreatic lymphoma is certainly more favorable with a chance of cure with chemoimmunotherapy. CASE REPORT We present an unusual case of EBV-positive DLBCL involving the pancreas that was initially believed to be metastatic pancreatic adenocarcinoma. The patient was treated with chemoimmunotherapy and had a remarkable response. This is the first known case of EBV-positive DLBCL involving the pancreas that was successfully treated with chemoimmunotherapy. CONCLUSIONS EBV-positive DLBCL can have diverse presentations, including a pancreatic mass with multi-organ involvement, which mimics metastatic pancreatic adenocarcinoma. The prognosis of EBV-positive DLBCL is thought to be worse than that of EBV-negative tumors. However, it remains certainly superior to that of its adenocarcinoma counterpart with conventional chemoimmunotherapy.
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Affiliation(s)
- John Xie
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Elizabeth Rinker
- Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Mazen Zaarour
- Department of Medicine, Division of Hematology and Oncology, Tulane University School of Medicine, New Orleans, LA, USA
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7
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Vockerodt M, Vrzalikova K, Ibrahim M, Nagy E, Margielewska S, Hollows R, Lupino L, Tooze R, Care M, Simmons W, Schrader A, Perry T, Abdullah M, Foster S, Reynolds G, Dowell A, Rudzki Z, Krappmann D, Kube D, Woodman C, Wei W, Taylor G, Murray PG. Regulation of S1PR2 by the EBV oncogene LMP1 in aggressive ABC-subtype diffuse large B-cell lymphoma. J Pathol 2019; 248:142-154. [PMID: 30666658 DOI: 10.1002/path.5237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 12/14/2018] [Accepted: 01/14/2019] [Indexed: 12/18/2022]
Abstract
The Epstein-Barr virus (EBV) is found almost exclusively in the activated B-cell (ABC) subtype of diffuse large B-cell lymphoma (DLBCL), yet its contribution to this tumour remains poorly understood. We have focused on the EBV-encoded latent membrane protein-1 (LMP1), a constitutively activated CD40 homologue expressed in almost all EBV-positive DLBCLs and which can disrupt germinal centre (GC) formation and drive lymphomagenesis in mice. Comparison of the transcriptional changes that follow LMP1 expression with those that follow transient CD40 signalling in human GC B cells enabled us to define pathogenic targets of LMP1 aberrantly expressed in ABC-DLBCL. These included the down-regulation of S1PR2, a sphingosine-1-phosphate (S1P) receptor that is transcriptionally down-regulated in ABC-DLBCL, and when genetically ablated leads to DLBCL in mice. Consistent with this, we found that LMP1-expressing primary ABC-DLBCLs were significantly more likely to lack S1PR2 expression than were LMP1-negative tumours. Furthermore, we showed that the down-regulation of S1PR2 by LMP1 drives a signalling loop leading to constitutive activation of the phosphatidylinositol-3-kinase (PI3-K) pathway. Finally, core LMP1-PI3-K targets were enriched for lymphoma-related transcription factors and genes associated with shorter overall survival in patients with ABC-DLBCL. Our data identify a novel function for LMP1 in aggressive DLBCL. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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MESH Headings
- CD40 Antigens/genetics
- CD40 Antigens/metabolism
- Cell Line, Tumor
- Cell Transformation, Viral
- Databases, Genetic
- Epstein-Barr Virus Infections/mortality
- Epstein-Barr Virus Infections/virology
- Gene Expression Regulation, Neoplastic
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/metabolism
- Host-Pathogen Interactions
- Humans
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/virology
- Phosphatidylinositol 3-Kinase/metabolism
- Prognosis
- Proto-Oncogene Proteins c-akt/metabolism
- Signal Transduction
- Sphingosine-1-Phosphate Receptors/genetics
- Sphingosine-1-Phosphate Receptors/metabolism
- Viral Matrix Proteins/genetics
- Viral Matrix Proteins/metabolism
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Affiliation(s)
- Martina Vockerodt
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Anatomy and Cell Biology, University Medical Centre, Georg-August University of Göttingen, Göttingen, Germany
| | - Katerina Vrzalikova
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Maha Ibrahim
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Eszter Nagy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sandra Margielewska
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Robert Hollows
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Lauren Lupino
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Reuben Tooze
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Matthew Care
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - William Simmons
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Alexandra Schrader
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Anatomy and Cell Biology, University Medical Centre, Georg-August University of Göttingen, Göttingen, Germany
- Department of Hematology & Oncology and GRK 1034 of the Deutsche Forschungsgemeinschaft, Georg-August University of Göttingen, Göttingen, Germany
| | - Tracey Perry
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Maizaton Abdullah
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Pathology, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Stephen Foster
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Gary Reynolds
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Alexander Dowell
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Zbigniew Rudzki
- Department of Histopathology, Heartlands Hospital, Birmingham, UK
| | - Daniel Krappmann
- Research Unit Cellular Signal Integration, Helmholtz Zentrum München, Neuherberg, Germany
| | - Dieter Kube
- Department of Hematology & Oncology and GRK 1034 of the Deutsche Forschungsgemeinschaft, Georg-August University of Göttingen, Göttingen, Germany
| | - Ciaran Woodman
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wenbin Wei
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Graham Taylor
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Paul G Murray
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Clinical and Molecular Pathology, Institute of Molecular and Translational Medicine, Palacky University, Olomouc, Czech Republic
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Ting CY, Chang KM, Kuan JW, Sathar J, Chew LP, Wong OLJ, Yusuf Y, Wong L, Samsudin AT, Pana MNBM, Lee SK, Gopal NSR, Puri R, Ong TC, Bahari SK, Goh AS, Teoh CS. Clinical Significance of BCL2, C- MYC, and BCL6 Genetic Abnormalities, Epstein-Barr Virus Infection, CD5 Protein Expression, Germinal Center B Cell/Non-Germinal Center B-Cell Subtypes, Co-expression of MYC/BCL2 Proteins and Co-expression of MYC/BCL2/BCL6 Proteins in Diffuse Large B-Cell Lymphoma: A Clinical and Pathological Correlation Study of 120 Patients. Int J Med Sci 2019; 16:556-566. [PMID: 31171907 PMCID: PMC6535654 DOI: 10.7150/ijms.27610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/29/2018] [Indexed: 01/10/2023] Open
Abstract
Background: Clinical significance of germinal center B-cell (GCB) and non-GCB sub-categorization, expression of MYC, BCL2, BCL6, CD5 proteins and Epstein Barr virus encoded RNA (EBER) positivity in diffuse large B-cell lymphoma (DLBCL) remain controversial. Could these biomarkers accurately identify high risk DLBCL patients? Are MYC, BCL2 and BCL6 proteins expression feasible as baseline testing to predict c-Myc, BCL2 or BCL6 gene rearrangements? Aims: To investigate prognostic values of GCB/non-GCB sub-categorization, Double Protein Expression Lymphoma (DPL), Triple Protein Expression Lymphoma (TPL), positivity of CD5 protein and EBER in patients with DLBCL disease. To evaluate correlation between BCL2 , c-Myc and BCL6 gene rearrangements with BCL2, MYC and BCL6 proteins expression. Methods: Diagnostic tissue samples of 120 DLBCL patients between January 2012 to December 2013 from four major hospitals in Malaysia were selected. Samples were subjected to immunohistochemical staining, fluorescent in-situ hybridization (FISH) testing, and central pathological review. Pathological data were correlated with clinical characteristics and treatment outcome. Results: A total of 120 cases were analysed. Mean age of diagnosis was 54.1 years ± 14.6, 64 were males, 56 were females, mean follow up period was 25 months (ranged from 1 to 36 months). Of the 120 cases, 74.2% were non-GCB whereas 25.8% were GCB, 6.7% were EBER positive, 6.7% expressed CD5 protein, 13.3% were DPL and 40% were TPL. The prevalence of c-Myc, BCL2, BCL6 gene rearrangements were 5.8%, 5.8%, and 14.2%, respectively; and 1.6% were Double Hit Lymphoma (DHL). EBER positivity, DPL, TPL, c-Myc gene rearrangement, BCL2 gene rearrangement, extra copies of BCL2 gene and BCL6 gene rearrangement were associated with shorter median overall survival (P<0.05). IPI score was the significant determinants of median overall survival in DPL and TPL (P<0.05). CD5 protein expression and GCB/non-GCB sub-categorization did not affect treatment outcome (P>0.05). Overall, c-Myc, BCL2 and BCL6 gene rearrangements showed weak correlation with expression of MYC, BCL2 and BCL6 proteins (P>0.05). Fluorescent in situ hybridization is the preferred technique for prediction of treatment outcome in DLBCL patients. Conclusion: c-Myc, BCL2, and BCL6 gene rearrangements, EBER expression, DHL, TPL and IPI score are reliable risk stratification tools. MYC, BCL2 and BCL6 proteins expression are not applicable as baseline biomarkers to predict c-Myc, BCL2, and BCL6 gene rearrangements.
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Affiliation(s)
- Choo-Yuen Ting
- Department of Hematology, Hospital Ampang, Ministry of Health Malaysia
| | - Kian-Meng Chang
- Department of Hematology, Hospital Ampang, Ministry of Health Malaysia
| | - Jew-Win Kuan
- Department of Medicine, Faculty of Medicine and Health Sciences, University Malaysia Sarawak
| | - Jameela Sathar
- Department of Hematology, Hospital Ampang, Ministry of Health Malaysia.,Clinical Research Centre, National Institutes of Health, Ministry of Health Malaysia
| | - Lee-Ping Chew
- Clinical Research Centre, National Institutes of Health, Ministry of Health Malaysia.,Department of Medicine, Hospital Umum Sarawak, Ministry of Health Malaysia
| | | | - Yusri Yusuf
- Department of Pathology, Hospital Umum Sarawak, Ministry of Health Malaysia
| | - Lily Wong
- Department of Medicine, Queen Elizabeth Hospital, Ministry of Health Malaysia
| | - Ahmad Toha Samsudin
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia
| | | | - Suk-Kam Lee
- Department of Pathology, Hospital Pulau Pinang, Ministry of Health Malaysia
| | | | - Rita Puri
- Department of Hematology, Hospital Ampang, Ministry of Health Malaysia
| | - Tee-Chuan Ong
- Department of Hematology, Hospital Ampang, Ministry of Health Malaysia
| | | | - Ai-Sim Goh
- Department of Medicine, Hospital Pulau Pinang, Ministry of Health Malaysia
| | - Ching-Soon Teoh
- Department of Medicine, Hospital Pulau Pinang, Ministry of Health Malaysia
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9
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Yoon H, Ko YH. LMP1+SLAMF1high cells are associated with drug resistance in Epstein-Barr virus-positive Farage cells. Oncotarget 2018; 8:24621-24634. [PMID: 28445949 PMCID: PMC5421874 DOI: 10.18632/oncotarget.15600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 02/13/2017] [Indexed: 12/22/2022] Open
Abstract
How Epstein-Barr virus (EBV) affects the clinical outcome of EBV-positive diffuse large B-cell lymphoma (DLBCL) remains largely unknown. The viral oncogene LMP1 is at the crux of tumorigenesis and cell survival. Therefore, we examined the association between LMP1high cells drug resistance. We first assessed SLAMF1 as a surrogate marker for LMP1high cells. LMP1 and its target gene CCL22 were highly expressed in SLAMF1high Farage cells. These cells survived longer following treatment with a combination of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). Genes associated with interferon-alpha, allograft rejection, NF-κB and STAT3 were also overexpressed in the surviving Farage cells. Specifically, CHOP treatment increased IL10, LMP1 and pSTAT3 expression levels in a dose-dependent fashion. Addition of exogenous IL4 greatly increased the levels of LMP1 and pSTAT3, which rendered the Farage cells more resistant to CHOP by up-regulating the anti-apoptotic genes BCL-XL and MCL1. The Farage cells were sensitive to Velcade and STAT3, 5, and 6 inhibitors. Inhibition of NF-κB and STAT3, in combination with CHOP, decreased LMP1 levels and effectively induced cell death in the Farage cells. We suggest that LMP1high cells are responsible for the poor drug response of EBV+ DLBCL and that perturbation of the NF-κB and STAT signaling pathways increases toxicity in these cells.
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Affiliation(s)
- Heejei Yoon
- Clinical Research Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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10
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Murthy SL, Hitchcock MA, Endicott-Yazdani TR, Watson JT, Krause JR. Epstein-Barr virus-positive diffuse large B-cell lymphoma. Proc AMIA Symp 2018; 30:443-444. [PMID: 28966459 DOI: 10.1080/08998280.2017.11930222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
While the World Health Organization included Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) as a provisional entity of a lymphoma occurring in older individuals without any known immunodeficiency in 2008, it has since been recognized that this entity may occur in younger individuals. As a result, the 2016 revision has substituted the modifier "elderly" with "not otherwise specified" (NOS). The NOS highlights that there are more specific entities with neoplastic EBV-positive large B cells such as lymphomatoid granulomatosis. Diagnosis requires that there be no other cause of immunodeficiency and that other more specific entities with neoplastic EBV plus large B cells be excluded. We present the case of an 81-year-old woman hospitalized for generalized weakness, increasing confusion, unexplained weight loss, and intermittent fevers. Examination showed lymphadenopathy, lesions in the liver and small intestine, and a very high EBV viral load. She experienced a rapid demise and at autopsy was found to have EBV+ DLBCL, NOS.
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Affiliation(s)
- Stacey L Murthy
- Departments of Pathology (Murthy, Hitchcock, Krause) and Internal Medicine (Endicott-Yazdani, Watson), Baylor University Medical Center at Dallas, Texas
| | - Michael A Hitchcock
- Departments of Pathology (Murthy, Hitchcock, Krause) and Internal Medicine (Endicott-Yazdani, Watson), Baylor University Medical Center at Dallas, Texas
| | - Tiana R Endicott-Yazdani
- Departments of Pathology (Murthy, Hitchcock, Krause) and Internal Medicine (Endicott-Yazdani, Watson), Baylor University Medical Center at Dallas, Texas
| | - John T Watson
- Departments of Pathology (Murthy, Hitchcock, Krause) and Internal Medicine (Endicott-Yazdani, Watson), Baylor University Medical Center at Dallas, Texas
| | - John R Krause
- Departments of Pathology (Murthy, Hitchcock, Krause) and Internal Medicine (Endicott-Yazdani, Watson), Baylor University Medical Center at Dallas, Texas
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11
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Huang JJ, Xia Y, Wang Y, Liu PP, Bi XW, Sun P, Lin TY, Jiang WQ, Li ZM. A comparison of R-EPOCH and R-CHOP as a first-line regimen in de novo DLBCL patients with high Ki-67 expression in a single institution. Oncotarget 2018; 7:41242-41250. [PMID: 27183909 PMCID: PMC5173055 DOI: 10.18632/oncotarget.9271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/31/2016] [Indexed: 01/22/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) patients with high Ki-67 expression receive limited benefits from R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) therapy. This study aims to compare the R-EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) and R-CHOP regimens as first-line therapy in DLBCL patients with high Ki-67 expression. Data from 44 untreated DLBCL patients with high Ki-67 expression receiving R-EPOCH therapy were matched with those from 132 untreated DLBCL patients with high Ki-67 expression receiving R-CHOP therapy based on the International Prognostic Index (IPI: age, Ann Arbor stage, performance status, LDH level, number of extranodal sites), gender, and Ki-67 expression. In the R-EPOCH group, 42/44 patients were eligible for response evaluation. A total of 35 patients (83.3%) achieved complete remission (CR); 6 patients (14.3%) achieved partial remission (PR); and one patient (2.4%) exhibited progressive disease (PD) after 2 cycles of therapy. Patients in the R-EPOCH group presented better survival outcomes than those in the R-CHOP group (3-year overall survival [OS]: 89.9% vs. 70.2%, p = 0.041; 3-year progression-free survival [PFS]: 86.6% vs. 59.7%, p = 0.024). The survival superiority of the R-EPOCH over the R-CHOP regimen persisted when considering only patients of low-to-intermediate IPI risk, but it was not observed in those of high IPI risk. Our data suggest that R-EPOCH could be superior to R-CHOP as a first-line regimen in DLBCL patients with high Ki-67 expression, especially in those of low-to-intermediate IPI risk.
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Affiliation(s)
- Jia-Jia Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yi Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yu Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Pan-Pan Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xi-Wen Bi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Peng Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Tong-Yu Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhi-Ming Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
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12
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Tang YL, Zhou Y, Cheng LL, Su YZ, Wang CB. BCL2/Ki-67 index predict survival in germinal center B-cell-like diffuse large B-cell lymphoma. Oncol Lett 2017; 14:3767-3773. [PMID: 28927145 PMCID: PMC5588076 DOI: 10.3892/ol.2017.6577] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/14/2017] [Indexed: 02/06/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. BCL2 apoptosis regulator (BCL2) and marker of proliferation Ki-67 (Ki-67) are established prognostic markers, which have traditionally been assessed separately in DLBCL. However, no studies have evaluated the prognostic value of the combination of BCL2 and Ki-67 index. Thus, the present study aimed to analyze the prognostic value of combination of these two markers. Immunohistochemical analysis was used to assess the expression of BCL2 and Ki-67 in 274 cases of DLBCL. The BCL2/Ki-67 index demonstrated a significant association with decreased overall and progression free survival of patients with DLBCL, particularly for the germinal center B-cell-like subtype of DLBCL. Following multivariate analysis, the BCL2/Ki-67 index retained prognostic significance. Patients with coexpression of BCL2 and Ki-67 constituted a unique group with poor survival, thus novel therapies targeting BCL2 protein and high proliferative activity may improve the outcome of these patients.
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Affiliation(s)
- Yun-Long Tang
- Department of Hematology and Oncology, The Affiliated Hospital of Southeast University, The Third People's Hospital of Yancheng, Yancheng, Jiangsu 224000, P.R. China
| | - Yan Zhou
- Department of Hematology and Oncology, The Affiliated Hospital of Southeast University, The Third People's Hospital of Yancheng, Yancheng, Jiangsu 224000, P.R. China
| | - Ling-Ling Cheng
- Department of Oncology, Yancheng Hospital of Traditional Chinese Medicine, Yancheng, Jiangsu 224000, P.R. China
| | - Yong-Zhong Su
- Department of Hematology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515000, P.R. China
| | - Chun-Bin Wang
- Department of Hematology and Oncology, The Affiliated Hospital of Southeast University, The Third People's Hospital of Yancheng, Yancheng, Jiangsu 224000, P.R. China
- Correspondence to: Dr Chun-Bin Wang, Department of Hematology and Oncology, The Affiliated Hospital of Southeast University, The Third People's Hospital of Yancheng, 75 Ju Chang Road, Yancheng, Jiangsu 224000, P.R. China, E-mail:
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13
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Medina-Ortega ÁP, López-Valencia D, Mosquera-Monje SL, Mora-Obando DL, Dueñas-Cuéllar RA. Virus de Epstein-Barr y su relación con el desarrollo del cáncer. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n2a03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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14
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Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive disease with considerable heterogeneity reflected in the 2008 World Health Organization classification. In recent years, genome-wide assessment of genetic and epigenetic alterations has shed light upon distinct molecular subsets linked to dysregulation of specific genes or pathways. Besides fostering our knowledge regarding the molecular complexity of DLBCL types, these studies have unraveled previously unappreciated genetic lesions, which may be exploited for prognostic and therapeutic purposes. Following the last World Health Organization classification, we have witnessed the emergence of new variants of specific DLBCL entities, such as CD30 DLBCL, human immunodeficiency virus-related and age-related variants of plasmablastic lymphoma, and EBV DLBCL arising in young patients. In this review, we will present an update on the clinical, pathologic, and molecular features of DLBCL incorporating recently gained information with respect to their pathobiology and prognosis. We will emphasize the distinctive features of newly described or emerging variants and highlight advances in our understanding of entities presenting a diagnostic challenge, such as T-cell/histiocyte-rich large B-cell lmphoma and unclassifiable large B-cell lymphomas. Furthermore, we will discuss recent advances in the genomic characterization of DLBCL, as they may relate to prognostication and tailored therapeutic intervention. The information presented in this review derives from English language publications appearing in PubMed throughout December 2015. For a complete outline of this paper, please visit: http://links.lww.com/PAP/A12.
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15
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Battle-Lopez A, Gonzalez de Villambrosia S, Nuñez J, Cagigal ML, Montes-Moreno S, Conde E, Piris MA. Epstein-Barr virus-associated diffuse large B-cell lymphoma: diagnosis, difficulties and therapeutic options. Expert Rev Anticancer Ther 2016; 16:411-21. [PMID: 26838128 DOI: 10.1586/14737140.2016.1149065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Epstein Barr Virus (EBV)-positive diffuse large B cell lymphoma (DLBCL) most frequently affects elderly patients, without previous immunosuppression, with frequent extra-nodal involvement and whose disease runs an aggressive clinical course with high International Prognostic Index (IPI) scores. Various EBV-related transforming mechanisms, much favored by immunosenescence, have been described, including activation of the NFKB transcriptional program. Elderly patients show poor survival after treatment with conventional CHOP regimens, even after addition of Rituximab. Younger patients, however, have a better outcome with a similar prognosis to EBV-negative DLBCL cases. New therapeutic strategies, including treatments targeting EBV, new drugs directed against specific pathways constitutively activated in these lymphomas, and new specific conjugate antibodies against molecules usually expressed in the tumor cells, such as CD30, are described.
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Affiliation(s)
- Ana Battle-Lopez
- a Services of Haematology and Pathology , Hospital Universitario Marques de Valdecilla , Santander , Spain
| | | | - Javier Nuñez
- a Services of Haematology and Pathology , Hospital Universitario Marques de Valdecilla , Santander , Spain
| | - Maria-Luisa Cagigal
- a Services of Haematology and Pathology , Hospital Universitario Marques de Valdecilla , Santander , Spain
| | - Santiago Montes-Moreno
- a Services of Haematology and Pathology , Hospital Universitario Marques de Valdecilla , Santander , Spain
| | - Eulogio Conde
- a Services of Haematology and Pathology , Hospital Universitario Marques de Valdecilla , Santander , Spain
| | - Miguel A Piris
- a Services of Haematology and Pathology , Hospital Universitario Marques de Valdecilla , Santander , Spain
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