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Chen W, Liu H, Wang P, Li G. Clinical and biological features of mantle cell lymphoma patients with co-expression of CD10 and BCL-6: a retrospective study. Transl Cancer Res 2022; 10:4786-4793. [PMID: 35116331 PMCID: PMC8798977 DOI: 10.21037/tcr-21-882] [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: 05/22/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022]
Abstract
Background Mantle cell lymphoma (MCL) with co-expression of CD10 and BCL-6 was scarcely reported, and its biological features were largely remained unknown. Thus, this study aimed to describe the clinical and biological features, as well as outcome of MCL patients with co-expression of CD10 and BCL-6. Methods A total of 104 cases of MCL who were admitted to our hospital between January 2011 and October 2018 were recruited. Those patients were diagnosed according to the 2016 World Health Organization (WHO) classification system for tumors of the hematopoietic and lymphoid tissues, in compliance with the results of cytomorphology and immunohistochemical analysis. Patients were followed up through telephone interviews, medical records. Differences in age, gender, leukocyte count, lactate dehydrogenase (LDH) level, beta-2 microglobulin (β2-MG) level and results of immunohistochemistry were analyzed. Then the event-free survival (EFS) rate and overall survival (OS) rate were performed by the Kaplan-Meier method and log-rank test. Results The results showed that, in total, 5 patients had superficial lymph node enlargement, 2 patients suffered from abdominal discomfort, and 1 patient’s red blood cell (RBC) count was abnormal at the time of diagnosis. All patients were in stage IV, 75% had bone marrow involvement, and 75% and 100% of patients had elevated levels of LDH and β2-MG, respectively. Three classic genes and five variants were involved in the 8 patients. MCL patients with the co-expression of CD10 and BCL-6 had higher Ki-67 index, white blood cell (WBC) count, LDH level, and β2-MG level than those of without co-expression of CD10 and BCL-6 (P=0.025, 0.038, 0.015, and 0.021, respectively). Besides, MCL patients with CD10 and BCL-6 co-expression had shorter OS and EFS (χ2=6.401 and 5.975; P=0.011 and 0.015, respectively), indicating patients’ susceptibility to get complex karyotype and TP53 abnormality. Conclusions MCL patients with co-expression of CD10 and BCL-6 were more likely to have bone marrow involvement, higher Ki-67 index, increased WBC count, and elevated levels of LDH and β2-MG at the time of diagnosis, then might has complex cytogenetic and poor prognosis.
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Affiliation(s)
- Wanzi Chen
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hangmin Liu
- Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pengcheng Wang
- Department of pathology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guoping Li
- Department of pathology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Sakhdari A, Ok CY, Patel KP, Kanagal-Shamanna R, Yin CC, Zuo Z, Hu S, Routbort MJ, Luthra R, Medeiros LJ, Khoury JD, Loghavi S. TP53 mutations are common in mantle cell lymphoma, including the indolent leukemic non-nodal variant. Ann Diagn Pathol 2019; 41:38-42. [PMID: 31132650 DOI: 10.1016/j.anndiagpath.2019.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Mantle cell lymphoma (MCL) is an aggressive B-cell neoplasm, but clinically indolent subtypes are also recognized. Data on the utility of mutation profiling in the context of routine workup and its role in risk-stratification of MCL patients are limited. In this study, we describe the mutational landscape and clinicopathologic correlates of a series of MCL cases at a single-institution setting. METHODS Samples from 26 patients with MCL were evaluated by NGS using DNA extracted from peripheral blood (PB) or bone marrow (BM). Evaluation of extent of PB or BM involvement was performed using flow cytometry immunophenotyping. RESULTS The study group included 17 (65%) men and 9 (35%) women with a median age of 65 years (range, 50-94). Twenty-one (81%) patients had nodal MCL (N-MCL) and 5 (19%) had the "leukemic variant" (L-MCL). Mutated genesincluded TP53 (35%), ATM (27%), CARD11 (10%); and FBXW7, NOTCH1, SPEN, BIRC3 (~5% each). Most mutations were clonal in nature. Ten unique TP53 mutations were identified in 9 samples, including 3 L-MCL cases. There was no difference in the frequency of TP53 mutations between L-MCL and N-MCL groups (p = 0.3), but TP53 mutations were subclonal in 2/3 L-MCL cases. Identification of clonal TP53 alterations in L-MCL patients prompted initiation of therapy despite low tumor burden. CONCLUSIONS TP53 is commonly mutated in MCL. TP53 mutations may be clonal or subclonal. Seemingly indolent L-MCL may harbor subclonal TP53 mutations which may serve as a useful biomarker for prognostication, therapeutic planning, follow-up monitoring, and early detection of clonal expansion.
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Affiliation(s)
- Ali Sakhdari
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Chi Young Ok
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - C Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Zhuang Zuo
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Shimin Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Mark J Routbort
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
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Zhu Y, Xu W, Zheng X, Zheng Z. Nomogram incorporating clinicopathological parameters to predict the survival of patients with mantle cell lymphoma. J Investig Med 2018; 67:331-337. [PMID: 30258027 PMCID: PMC6581082 DOI: 10.1136/jim-2018-000837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 12/26/2022]
Abstract
This study intended to present a practicable prognostic nomogram for patients with mantle cell lymphoma (MCL). The clinical data of 281 patients were reviewed. A nomogram that could predict overall survival (OS) was constructed based on the Cox proportional hazard model. To compare the capacity of the nomogram with the International Prognostic Index (IPI) and MCL International Prognostic Index (MIPI) scoring systems, we used the concordance index (C-index) to validate the veracity and the calibration curve. Age, Eastern Cooperation Oncology Group, lactate dehydrogenase, white cell count and Ki-67 were independent prognostic factors in the multivariate analysis and were subsequently included in the nomogram construction. The C-index was 0.81 and 0.79 in the primary and validation cohorts, respectively, which were superior to the predictive capacity of the IPI and MIPI systems in both cohorts. The nomogram makes it possible for physicians to predict patient OS individually and correctly, but certain limitations are noted.
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Affiliation(s)
- Yuandong Zhu
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wenxian Xu
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Zheng
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhuojun Zheng
- Department of Hematology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Freiburghaus C, Emruli VK, Johansson A, Eskelund CW, Grønbæk K, Olsson R, Ek F, Jerkeman M, Ek S. Bortezomib prevents cytarabine resistance in MCL, which is characterized by down-regulation of dCK and up-regulation of SPIB resulting in high NF-κB activity. BMC Cancer 2018; 18:466. [PMID: 29695239 PMCID: PMC5918903 DOI: 10.1186/s12885-018-4346-1] [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: 08/17/2017] [Accepted: 04/08/2018] [Indexed: 12/04/2022] Open
Abstract
Background The addition of high-dose cytarabine to the treatment of mantle cell lymphoma (MCL) has significantly prolonged survival of patients, but relapses are common and are normally associated with increased resistance. To elucidate the mechanisms responsible for cytarabine resistance, and to create a tool for drug discovery investigations, we established a unique and molecularly reproducible cytarabine resistant model from the Z138 MCL cell line. Methods Effects of different substances on cytarabine-sensitive and resistant cells were evaluated by assessment of cell proliferation using [methyl-14C]-thymidine incorporation and molecular changes were investigated by protein and gene expression analyses. Results Gene expression profiling revealed that major transcriptional changes occur during the initial phase of adaptation to cellular growth in cytarabine containing media, and only few key genes, including SPIB, are deregulated upon the later development of resistance. Resistance was shown to be mediated by down-regulation of the deoxycytidine kinase (dCK) protein, responsible for activation of nucleoside analogue prodrugs. This key event, emphasized by cross-resistance to other nucleoside analogues, did not only effect resistance but also levels of SPIB and NF-κB, as assessed through forced overexpression in resistant cells. Thus, for the first time we show that regulation of drug resistance through prevention of conversion of pro-drug into active drug are closely linked to increased proliferation and resistance to apoptosis in MCL. Using drug libraries, we identify several substances with growth reducing effect on cytarabine resistant cells. We further hypothesized that co-treatment with bortezomib could prevent resistance development. This was confirmed and show that the dCK levels are retained upon co-treatment, indicating a clinical use for bortezomib treatment in combination with cytarabine to avoid development of resistance. The possibility to predict cytarabine resistance in diagnostic samples was assessed, but analysis show that a majority of patients have moderate to high expression of dCK at diagnosis, corresponding well to the initial clinical response to cytarabine treatment. Conclusion We show that cytarabine resistance potentially can be avoided or at least delayed through co-treatment with bortezomib, and that down-regulation of dCK and up-regulation of SPIB and NF-κB are the main molecular events driving cytarabine resistance development. Electronic supplementary material The online version of this article (10.1186/s12885-018-4346-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | - Kirsten Grønbæk
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - Roger Olsson
- Department of Experimental Medical Science, Chemical Biology & Therapeutics, Lund University, Lund, Sweden
| | - Fredrik Ek
- Department of Experimental Medical Science, Chemical Biology & Therapeutics, Lund University, Lund, Sweden
| | - Mats Jerkeman
- Department of Oncology, Lund University, Lund, Sweden
| | - Sara Ek
- Department of Immunotechnology, Lund University, Lund, Sweden.
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5
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Visco C, Chiappella A, Nassi L, Patti C, Ferrero S, Barbero D, Evangelista A, Spina M, Molinari A, Rigacci L, Tani M, Rocco AD, Pinotti G, Fabbri A, Zambello R, Finotto S, Gotti M, Carella AM, Salvi F, Pileri SA, Ladetto M, Ciccone G, Gaidano G, Ruggeri M, Martelli M, Vitolo U. Rituximab, bendamustine, and low-dose cytarabine as induction therapy in elderly patients with mantle cell lymphoma: a multicentre, phase 2 trial from Fondazione Italiana Linfomi. LANCET HAEMATOLOGY 2017; 4:e15-e23. [DOI: 10.1016/s2352-3026(16)30185-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 01/11/2023]
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6
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van Keep M, Gairy K, Seshagiri D, Thilakarathne P, Lee D. Cost-effectiveness analysis of bortezomib in combination with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (VR-CAP) in patients with previously untreated mantle cell lymphoma. BMC Cancer 2016; 16:598. [PMID: 27488675 PMCID: PMC4972997 DOI: 10.1186/s12885-016-2633-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mantle cell lymphoma (MCL) is a rare and aggressive form of non-Hodgkin's lymphoma. Bortezomib is the first product to be approved for the treatment of patients with previously untreated MCL, for whom haematopoietic stem cell transplantation is unsuitable, and is used in combination with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (VR-CAP). The National Institute of Health and Care Excellence recently recommended the use of VR-CAP in the UK following a technology appraisal. We present the cost effectiveness analysis performed as part of that assessment: VR-CAP versus the current standard of care regimen of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) in a UK setting. METHODS A lifetime economic model was developed with health states based upon line of treatment and progression status. Baseline patient characteristics, dosing, safety and efficacy were based on the LYM-3002 trial. As overall survival data were immature, survival was modelled by progression status, and post-progression survival was assumed equal across arms. Utilities were derived from LYM-3002 and literature, and standard UK cost sources were used. RESULTS Treatment with VR-CAP compared to R-CHOP gave an incremental quality-adjusted life year (QALY) gain of 0.81 at an additional cost of £16,212, resulting in a base case incremental cost-effectiveness ratio of £20,043. Deterministic and probabilistic sensitivity analyses showed that treatment with VR-CAP was cost effective at conventional willingness-to-pay thresholds (£20,000-£30,000 per QALY). CONCLUSIONS VR-CAP is a cost-effective option for previously untreated patients with MCL in the UK.
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Affiliation(s)
| | - Kerry Gairy
- Janssen-Cilag, 50-100 Holmers Farm Way, High Wycombe, HP12 4EG UK
| | | | | | - Dawn Lee
- BresMed, 84 Queen Street, Sheffield, S1 2DW UK
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7
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Trněný M, Lamy T, Walewski J, Belada D, Mayer J, Radford J, Jurczak W, Morschhauser F, Alexeeva J, Rule S, Afanasyev B, Kaplanov K, Thyss A, Kuzmin A, Voloshin S, Kuliczkowski K, Giza A, Milpied N, Stelitano C, Marks R, Trümper L, Biyukov T, Patturajan M, Bravo MLC, Arcaini L. Lenalidomide versus investigator's choice in relapsed or refractory mantle cell lymphoma (MCL-002; SPRINT): a phase 2, randomised, multicentre trial. Lancet Oncol 2016; 17:319-331. [PMID: 26899778 DOI: 10.1016/s1470-2045(15)00559-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/26/2015] [Accepted: 11/26/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lenalidomide, an immunomodulatory drug with antineoplastic and antiproliferative effects, showed activity in many single-group studies in relapsed or refractory mantle cell lymphoma. The aim of this randomised study was to examine the efficacy and safety of lenalidomide versus best investigator's choice of single-agent therapy in relapsed or refractory mantle cell lymphoma. METHODS The MCL-002 (SPRINT) study was a randomised, phase 2 study of patients with mantle cell lymphoma aged 18 years or older at 67 clinics and academic centres in 12 countries who relapsed one to three times, had Eastern Cooperative Oncology Group performance status of 0-2, at least one measurable lesion to be eligible, and who were ineligible for intensive chemotherpy or stem-cell transplantation. Using a centralised interactive voice response system, we randomly assigned (2:1) patients in a permuted block size of six to receive lenalidomide (25 mg orally on days 1-21 every 28 days) until progressive disease or intolerability, or single-agent investigator's choice of either rituximab, gemcitabine, fludarabine, chlorambucil, or cytarabine. Randomisation was stratified by time from diagnosis, time from last anti-lymphoma therapy, and previous stem-cell transplantation. Individual treatment assignment between lenalidomide and investigator's choice was open label, but investigators had to register their choice of comparator drug before randomly assigning a patient. Patients who progressed on investigator's choice could cross over to lenalidomide treatment. We present the prespecified primary analysis results in the intention-to-treat population for the primary endpoint of progression-free survival, defined as the time from randomisation to progressive disease or death, whichever occurred first. Patient enrolment is complete, although treatment and collection of additional time-to-event data are ongoing. This study is registered with ClinicalTrials.gov, number NCT00875667. FINDINGS Between April 30, 2009, and March 7, 2013, we enrolled 254 patients in the intention-to-treat population (170 [67%] were randomly assigned to receive lenalidomide, 84 [33%] to receive investigator's choice monotherapy). Patients had a median age of 68·5 years and received a median of two previous regimens. With a median follow-up of 15·9 months (IQR 7·6-31·7), lenalidomide significantly improved progression-free survival compared with investigator's choice (median 8·7 months [95% CI 5·5-12·1] vs 5·2 months [95% CI 3·7-6·9]) with a hazard ratio of 0·61 (95% CI 0·44-0·84; p=0·004). In the 167 patients in the lenalidomide group and 83 patients in the investigator's choice group who received at least one dose of treatment the most common grade 3-4 adverse events included neutropenia (73 [44%] of 167 vs 28 [34%] of 83) without increased risk of infection, thrombocytopenia (30 [18%] vs 23 [28%]), leucopenia (13 [8%] vs nine [11%]), and anaemia (14 [8%] vs six [7%]). INTERPRETATION Patients with relapsed or refractory mantle cell lymphoma ineligible for intensive chemotherapy or stem-cell transplantation have longer progression-free survival, with a manageable safety profile when treated with lenalidomide compared with monotherapy investigator's choice options. FUNDING Celgene Corporation.
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Affiliation(s)
- Marek Trněný
- Department of Hematology, Charles University Hospital, Prague, Czech Republic.
| | - Thierry Lamy
- Department of Hematology, Rennes University Hospital, Rennes, France
| | - Jan Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie Memorial Institute and Oncology Centre, Warsaw, Poland
| | - David Belada
- Fourth Department of Internal Medicine-Hematology, Charles University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Jiri Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital, Brno, Czech Republic
| | - John Radford
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Wojciech Jurczak
- Department of Haematology, Jagiellonian University, Krakow, Poland
| | - Franck Morschhauser
- Centre Hospitalier Universitaire Régional de Lille, Unité GRITA, Lille, France
| | | | - Simon Rule
- Department of Hematology, Derriford Hospital, Plymouth, UK
| | - Boris Afanasyev
- First Pavlov State Medical University of St Petersburg, St Petersburg, Russia
| | - Kamil Kaplanov
- Volgograd Regional Clinical Oncology Dispensary Number 1, Department of Hematology, Volgograd, Russia
| | - Antoine Thyss
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | - Alexej Kuzmin
- Republican Clinical Oncology Dispensary, Kazan, Russia
| | - Sergey Voloshin
- Russian Research Institute of Hematology and Transfusion, St Petersburg, Russia
| | - Kazimierz Kuliczkowski
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Giza
- Department of Haematology, Jagiellonian University, Krakow, Poland
| | - Noel Milpied
- Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | | | - Reinhard Marks
- Department of Hematology and Oncology, University Medical Center Freiburg, Freiburg, Germany
| | - Lorenz Trümper
- Department of Hematology and Oncology, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Germany
| | | | | | | | - Luca Arcaini
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo & Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Chiron D, Dousset C, Brosseau C, Touzeau C, Maïga S, Moreau P, Pellat-Deceunynck C, Le Gouill S, Amiot M. Biological rational for sequential targeting of Bruton tyrosine kinase and Bcl-2 to overcome CD40-induced ABT-199 resistance in mantle cell lymphoma. Oncotarget 2016; 6:8750-9. [PMID: 25797245 PMCID: PMC4496181 DOI: 10.18632/oncotarget.3275] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/08/2015] [Indexed: 12/11/2022] Open
Abstract
The aggressive biological behavior of mantle cell lymphoma (MCL) and its short response to current treatment highlight a great need for better rational therapy. Herein, we investigate the ability of ABT-199, the Bcl-2-selective BH3 mimetic, to kill MCL cells. Among MCL cell lines tested (n = 8), only three were sensitive (LD50 < 200 nM). In contrast, all primary MCL samples tested (n = 11) were highly sensitive to ABT-199 (LD50 < 10 nM). Mcl-1 and Bcl-xL both confer resistance to ABT-199-specific killing and BCL2/(BCLXL+MCL1) mRNA ratio is a strong predictor of sensitivity. By mimicking the microenvironment through CD40 stimulation, we show that ABT-199 sensitivity is impaired through activation of NF-kB pathway and Bcl-x(L) up-regulation. We further demonstrate that resistance is rapidly lost when MCL cells detach from CD40L-expressing fibroblasts. It has been reported that ibrutinib induces lymphocytosis in vivo holding off malignant cells from their protective microenvironment. We show here for two patients undergoing ibrutinib therapy that mobilized MCL cells are highly sensitive to ABT-199. These results provide evidence that in situ ABT-199 resistance can be overcome when MCL cells escape from the lymph nodes. Altogether, our data support the clinical application of ABT-199 therapy both as a single agent and in sequential combination with BTK inhibitors.
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Affiliation(s)
- David Chiron
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France
| | - Christelle Dousset
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, France.,CIC, INSERM, Nantes, France
| | - Carole Brosseau
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France
| | - Cyrille Touzeau
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, France
| | - Sophie Maïga
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, France
| | - Philippe Moreau
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, France
| | - Catherine Pellat-Deceunynck
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, France
| | - Steven Le Gouill
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, France.,CIC, INSERM, Nantes, France
| | - Martine Amiot
- INSERM, UMR892 - CNRS, UMR 6299, Université de Nantes, France.,Service d'Hématologie Clinique, Unité d'Investigation Clinique, Centre Hospitalier Universitaire de Nantes, France
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9
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Lorkova L, Scigelova M, Arrey TN, Vit O, Pospisilova J, Doktorova E, Klanova M, Alam M, Vockova P, Maswabi B, Klener P, Petrak J. Detailed Functional and Proteomic Characterization of Fludarabine Resistance in Mantle Cell Lymphoma Cells. PLoS One 2015; 10:e0135314. [PMID: 26285204 PMCID: PMC4540412 DOI: 10.1371/journal.pone.0135314] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/20/2015] [Indexed: 11/28/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a chronically relapsing aggressive type of B-cell non-Hodgkin lymphoma considered incurable by currently used treatment approaches. Fludarabine is a purine analog clinically still widely used in the therapy of relapsed MCL. Molecular mechanisms of fludarabine resistance have not, however, been studied in the setting of MCL so far. We therefore derived fludarabine-resistant MCL cells (Mino/FR) and performed their detailed functional and proteomic characterization compared to the original fludarabine sensitive cells (Mino). We demonstrated that Mino/FR were highly cross-resistant to other antinucleosides (cytarabine, cladribine, gemcitabine) and to an inhibitor of Bruton tyrosine kinase (BTK) ibrutinib. Sensitivity to other types of anti-lymphoma agents was altered only mildly (methotrexate, doxorubicin, bortezomib) or remained unaffacted (cisplatin, bendamustine). The detailed proteomic analysis of Mino/FR compared to Mino cells unveiled over 300 differentially expressed proteins. Mino/FR were characterized by the marked downregulation of deoxycytidine kinase (dCK) and BTK (thus explaining the observed crossresistance to antinucleosides and ibrutinib), but also by the upregulation of several enzymes of de novo nucleotide synthesis, as well as the up-regulation of the numerous proteins of DNA repair and replication. The significant upregulation of the key antiapoptotic protein Bcl-2 in Mino/FR cells was associated with the markedly increased sensitivity of the fludarabine-resistant MCL cells to Bcl-2-specific inhibitor ABT199 compared to fludarabine-sensitive cells. Our data thus demonstrate that a detailed molecular analysis of drug-resistant tumor cells can indeed open a way to personalized therapy of resistant malignancies.
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Affiliation(s)
- Lucie Lorkova
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | | | - Ondrej Vit
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jana Pospisilova
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Eliska Doktorova
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Magdalena Klanova
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- First Department of Medicine—Department of Hematology, General University Hospital and Charles University in Prague, Prague, Czech Republic
| | - Mahmudul Alam
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Petra Vockova
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- First Department of Medicine—Department of Hematology, General University Hospital and Charles University in Prague, Prague, Czech Republic
| | - Bokang Maswabi
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Pavel Klener
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- First Department of Medicine—Department of Hematology, General University Hospital and Charles University in Prague, Prague, Czech Republic
| | - Jiri Petrak
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
- * E-mail:
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10
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Choe JY, Yun JY, Na HY, Huh J, Shin SJ, Kim HJ, Paik JH, Kim YA, Nam SJ, Jeon YK, Park G, Kim JE. MYC overexpression correlates with MYC amplification or translocation, and is associated with poor prognosis in mantle cell lymphoma. Histopathology 2015; 68:442-9. [PMID: 26100211 DOI: 10.1111/his.12760] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/18/2015] [Indexed: 11/28/2022]
Abstract
AIMS We aimed to investigate MYC expression and chromosomal aberration in mantle cell lymphoma (MCL), and the clinical significance of these factors. METHODS AND RESULTS Sixty-five patients with MCL, including 54 classic, nine blastoid and two pleomorphic variants, were enrolled. Expression of MYC, Ki67 and p53 was assessed by immunohistochemistry. MYC amplification or translocation was examined by fluorescence in-situ hybridization. MYC expression was higher in blastoid/pleomorphic MCL variants (mean, 19.0%) than in classic MCL (mean, 1.9%; P < 0.001). Expression of p53 and Ki67 was also significantly higher in these variants. MYC amplification was found in two of 53 cases tested, both of which were blastoid variants with high MYC expression (29.7% and 20.4%). MYC translocation was found in two of 52 cases tested, both of which were pleomorphic variants with remarkably high MYC expression (68.5% and 71.0%). High MYC or p53 expression was significantly associated with shortened overall survival and progression-free survival in univariable and multivariable analyses (all P < 0.05). CONCLUSIONS MYC overexpression is a negative predictor of MCL patient outcomes. MYC gene amplification or translocation might be related to the pathogenesis of MCL, particularly in blastoid/pleomorphic variants.
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Affiliation(s)
- Ji-Young Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - Ji Yun Yun
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - Hee Young Na
- Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea.,Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Centre, Seoul, Korea
| | - Su-Jin Shin
- Department of Pathology, Asan Medical Centre, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Pathology, Inha University Hospital, Incheon, Korea
| | - Jin Ho Paik
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young A Kim
- Department of Pathology, Seoul National University Boramae Hospital, Seoul, Korea
| | - Soo Jeong Nam
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Gyeongsin Park
- Department of Pathology, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ji Eun Kim
- Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea.,Department of Pathology, Seoul National University Boramae Hospital, Seoul, Korea
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11
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Hosein PJ, Sandoval-Sus JD, Goodman D, Arteaga AG, Reis I, Hoffman J, Stefanovic A, Rosenblatt JD, Lossos IS. Updated survival analysis of two sequential prospective trials of R-MACLO-IVAM followed by maintenance for newly diagnosed mantle cell lymphoma. Am J Hematol 2015; 90:E111-6. [PMID: 25737247 DOI: 10.1002/ajh.23996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/06/2015] [Accepted: 02/27/2015] [Indexed: 11/11/2022]
Abstract
A phase II trial of R-MACLO-IVAM followed by thalidomide maintenance for mantle cell lymphoma (MCL) demonstrated promising progression-free survival (PFS) and overall survival (OS) rates. Thalidomide maintenance was associated with significant toxicity and was subsequently modified to rituximab maintenance. Herein, we present updated results and follow-up. Two sequential phase II trials included chemotherapy-naïve patients with MCL up to 75 years old. Four cycles of R-MACLO-IVAM chemotherapy were delivered as previously described. Patients who achieved complete responses (CR) were eligible for thalidomide or rituximab maintenance therapy. Among 36 patients enrolled, the MCL International Prognostic Index (MIPI) was low in 53%, intermediate in 36% and high in 11%. Thirty-five patients completed at least 2 cycles of chemotherapy; 34 (94%) achieved a CR. After a median follow-up of 74.4 months, the 5-year PFS was 51% (95% CI 33-68%) and the 5-year OS was 85% (95% CI 73-97%). Two deaths occurred during the chemotherapy phase due to disease progression and neutropenic sepsis, respectively. One patient developed secondary acute myeloid leukemia after 7 years. R-MACLO-IVAM chemotherapy is effective for patients with newly diagnosed MCL.
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Affiliation(s)
- Peter J. Hosein
- Department of Medicine; Markey Cancer Center; University of Kentucky; Lexington Kentucky
- Division of Medical Oncology, Markey Cancer Center; University of Kentucky; Lexington Kentucky
| | - Jose D. Sandoval-Sus
- Division of Hematological Malignancies; H. Lee Moffitt Cancer Center; Tampa Florida
| | - Deborah Goodman
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Alexandra Gomez Arteaga
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Isildinha Reis
- Department of Public Health Sciences; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Biostatistics, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - James Hoffman
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Alexandra Stefanovic
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Joseph D. Rosenblatt
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
| | - Izidore S. Lossos
- Department of Medicine; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Division of Hematology-Oncology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
- Department of Molecular and Cellular Pharmacology, Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine; Miami Florida
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12
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Hess G, Coiffier B, Crump M, Gisselbrecht C, Offner F, Romaguera J, Kang L, Moran PJ. Effect of prognostic classification on temsirolimus efficacy and safety in patients with relapsed or refractory mantle cell lymphoma: a retrospective analysis. Exp Hematol Oncol 2015; 4:11. [PMID: 25938001 PMCID: PMC4416347 DOI: 10.1186/s40164-015-0006-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/18/2015] [Indexed: 11/26/2022] Open
Abstract
Background Temsirolimus, a selective inhibitor of the mammalian target of rapamycin, has demonstrated clinical benefit versus investigator’s choice (INV) of therapy in patients with relapsed/refractory mantle cell lymphoma (MCL). Methods This post hoc study retrospectively assigned simplified Mantle Cell Lymphoma International Prognostic Index (MIPI) scores (ie, secondary MIPI) based on parameters at the time of randomization in patients with MCL (N = 162) who received temsirolimus 175 mg once weekly for 3 weeks followed by once-weekly 75 mg or 25 mg or the INV of active therapy. Outcomes were analyzed according to the low-, intermediate- or high-risk category. Results Patient distribution by MIPI risk category was 31%, 39%, and 30% in the low-, intermediate-, and high-risk groups, respectively. Among patients in all categories, objective response rate (complete response + partial response) was higher in patients in the temsirolimus 175/75-mg group versus the INV group, respectively: 42% versus 0% (low-risk); 33% versus 5% (intermediate-risk); 10% versus 0% (high-risk). Median progression-free survival was significantly longer with temsirolimus 175/75 mg versus INV, respectively, in patients with intermediate (4.3 vs 1.9 months; P = 0.035) or high (4.5 vs 1.6 months; P = 0.0025) risk, and a trend toward improvement was observed in patients with low risk (5.3 vs 2.6 months; P = 0.091). Improvement in median overall survival was observed with temsirolimus 175/75 mg versus INV in low-risk patients (18.0 vs 10.5 months, respectively; P = 0.069). Conclusions This analysis suggests that, compared with INV, temsirolimus demonstrated benefit in all MIPI risk categories in patients with MCL. In all treatment groups, patients with high secondary MIPI scores at baseline faced a dismal prognosis. Trial registration ClinicalTrials.gov NCT00117598. Electronic supplementary material The online version of this article (doi:10.1186/s40164-015-0006-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georg Hess
- Department of Hematology/Oncology, Johannes Gutenberg University, Langenbeckstr. 1, Mainz, DE 55101 Germany
| | - Bertrand Coiffier
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | | | | | | | - Jorge Romaguera
- The University of Texas MD Anderson Cancer Center, Houston, TX USA
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13
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Vogt N, Abramov D, Koch K, Masqué-Soler N, Szczepanowski M, Klapper W. No evidence of cell cycle dysregulation in mantle cell lymphoma in vivo. Leuk Lymphoma 2014; 56:2134-40. [PMID: 25315075 DOI: 10.3109/10428194.2014.975700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mantle cell lymphoma (MCL) is characterized by the translocation t(11;14)(q13;q32) leading to an overexpression of cyclin D1, a mediator of G1-S phase transition. Thus MCL is regarded as a paradigm of lymphoma with a dysregulated cell cycle. The proliferation rate of MCL is in fact a strong predictor of outcome. We analyzed proteins that are expressed at defined cell cycle phases, such as Ki67, survivin and phosphorylated histone H3 as well as cyclin D1, p53 and p27, on the cellular level by immunofluorescence double stainings in MCL biopsy specimens. Unexpectedly, we did not detect a shortening of early phases in MCL in vivo. Despite the control of the immunoglobulin enhancer, cyclin D1 was expressed in a cell cycle-dependent manner. However, the proliferating Ki67-positive tumor cells expressed low amounts of cyclin D1. Therefore, the expression of cyclin D1 appears not to be the driving factor behind the total proliferation rate of MCL.
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Affiliation(s)
- Niklas Vogt
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein , Campus Kiel, Kiel , Germany
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14
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15
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Nygren L, Wasik AM, Baumgartner-Wennerholm S, Jeppsson-Ahlberg Å, Klimkowska M, Andersson P, Buhrkuhl D, Christensson B, Kimby E, Wahlin BE, Sander B. T-Cell Levels Are Prognostic in Mantle Cell Lymphoma. Clin Cancer Res 2014; 20:6096-104. [DOI: 10.1158/1078-0432.ccr-14-0889] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Combination of lenalidomide with vitamin D3 induces apoptosis in mantle cell lymphoma via demethylation of BIK. Cell Death Dis 2014; 5:e1389. [PMID: 25165875 PMCID: PMC4454319 DOI: 10.1038/cddis.2014.346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/10/2014] [Accepted: 07/21/2014] [Indexed: 02/07/2023]
Abstract
Mantle cell lymphoma (MCL) is a currently incurable B-cell malignancy.
Lenalidomide (Len) has been demonstrated to be one of the most efficient new
treatment options. Because Len and 1α,25-dihydroxyvitamin (VD3) synergize
to kill breast cancer cells, we investigated whether VD3 could increase the
ability of Len to induce MCL cell death. While MCL cells were weakly sensitive
to Len (1 μM), the addition of VD3 at physiological dose
(100 nM) strongly increased cell death, accompanied by slowdown in cell
cycle progression in MCL cell lines (n=4 out of 6) and primary
samples (n=5 out of 7). The Len/VD3 treatment markedly
increased the expression of the BH3-only BCL2-interacting killer (Bik) without
affecting the expression of other Bcl-2 molecules. Immunoprecipitation assays
demonstrated that Bik was free from anti-apoptotic partners, Bcl-2 and
Bcl-xL, in treated cells. Moreover, silencing of BIK
prevented apoptosis induced by Len/VD3, confirming the direct involvement of
Bik in cell death. Bik accumulation induced by Len/VD3 was related to an
increase in BIK mRNA levels, which resulted from a demethylation of
BIK CpG islands. The sensitivity of MCL cells to Len/VD3 was
similar to the response to 5-azacytidine, which also induced demethylation of
BIK CpG islands. These preclinical data provide the rationale to
investigate the role of VD3 in vivo in the response to Len.
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17
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Klanova M, Lorkova L, Vit O, Maswabi B, Molinsky J, Pospisilova J, Vockova P, Mavis C, Lateckova L, Kulvait V, Vejmelkova D, Jaksa R, Hernandez F, Trneny M, Vokurka M, Petrak J, Klener P. Downregulation of deoxycytidine kinase in cytarabine-resistant mantle cell lymphoma cells confers cross-resistance to nucleoside analogs gemcitabine, fludarabine and cladribine, but not to other classes of anti-lymphoma agents. Mol Cancer 2014; 13:159. [PMID: 24972933 PMCID: PMC4094598 DOI: 10.1186/1476-4598-13-159] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/23/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mantle cell lymphoma (MCL) is an aggressive type of B-cell non-Hodgkin lymphoma associated with poor prognosis. Implementation of high-dose cytarabine (araC) into induction therapy became standard-of-care for all newly diagnosed younger MCL patients. However, many patients relapse even after araC-based regimen. Molecular mechanisms responsible for araC resistance in MCL are unknown and optimal treatment strategy for relapsed/refractory MCL patients remains elusive. METHODS Five araC-resistant (R) clones were derived by long-term culture of five MCL cell lines (CTRL) with increasing doses of araC up to 50 microM. Illumina BeadChip and 2-DE proteomic analysis were used to identify gene and protein expression changes associated with araC resistance in MCL. In vitro cytotoxicity assays and experimental therapy of MCL xenografts in immunodeficient mice were used to analyze their relative responsiveness to a set of clinically used anti-MCL drugs. Primary MCL samples were obtained from patients at diagnosis and after failure of araC-based therapies. RESULTS Marked downregulation of deoxycytidine-kinase (DCK) mRNA and protein expression was identified as the single most important molecular event associated with araC-resistance in all tested MCL cell lines and in 50% primary MCL samples. All R clones were highly (20-1000x) cross-resistant to all tested nucleoside analogs including gemcitabine, fludarabine and cladribine. In vitro sensitivity of R clones to other classes of clinically used anti-MCL agents including genotoxic drugs (cisplatin, doxorubicin, bendamustine) and targeted agents (bortezomib, temsirolimus, rituximab) remained unaffected, or was even increased (ibrutinib). Experimental therapy of immunodeficient mice confirmed the anticipated loss of anti-tumor activity (as determined by overall survival) of the nucleoside analogs gemcitabine and fludarabine in mice transplanted with R clone compared to mice transplanted with CTRL cells, while the anti-tumor activity of cisplatin, temsirolimus, bortezomib, bendamustine, cyclophosphamide and rituximab remained comparable between the two cohorts. CONCLUSIONS Acquired resistance of MCL cells to araC is associated with downregulation of DCK, enzyme of the nucleotide salvage pathway responsible for the first phosphorylation (=activation) of most nucleoside analogs used in anti-cancer therapy. The data suggest that nucleoside analogs should not be used in the therapy of MCL patients, who relapse after failure of araC-based therapies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pavel Klener
- Institute of Pathological Physiology, Charles University in Prague, First Faculty of Medicine, Prague, Czech Republic.
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Pure red cell aplasia complicating the course of long-standing mantle cell lymphoma. Int J Hematol 2014; 99:777-81. [PMID: 24668076 DOI: 10.1007/s12185-014-1563-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/22/2014] [Accepted: 02/23/2014] [Indexed: 10/25/2022]
Abstract
Pure red cell aplasia (PRCA) is a rare cause of severe hypoplastic anemia characterized by profound depletion of erythroid precursors. Although PRCA may be associated with lymphoproliferative diseases, it has never been described in mantle cell lymphoma (MCL). We report what to our knowledge is the first case of a patient with indolent, non-nodal MCL complicated by PRCA. The patient presented with severe hypoproliferative anemia in the setting of a long-standing diagnosis of B-cell chronic lymphocytic leukemia. Bone marrow studies revealed the complete absence of erythroid progenitors. Cyclin D1 positivity on immunohistochemistry, confirmed by a positive FISH for t(11;14) (q13;q32), established the final diagnosis of MCL in conjunction with PRCA. Rituximab monotherapy led to rapid remission of splenomegaly and the leukemic picture, but the patient achieved transfusion independency only with subsequent administration of cyclosporine-A, and remained so during the subsequent 15 months despite the gradual disease recurrence.
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19
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Nordström L, Sernbo S, Eden P, Grønbaek K, Kolstad A, Räty R, Karjalainen ML, Geisler C, Ralfkiaer E, Sundström C, Laurell A, Delabie J, Ehinger M, Jerkeman M, Ek S. SOX11 and TP53 add prognostic information to MIPI in a homogenously treated cohort of mantle cell lymphoma--a Nordic Lymphoma Group study. Br J Haematol 2014; 166:98-108. [PMID: 24684350 PMCID: PMC4282019 DOI: 10.1111/bjh.12854] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/12/2014] [Indexed: 11/29/2022]
Abstract
Mantle cell lymphoma (MCL) is an aggressive B cell lymphoma, where survival has been remarkably improved by use of protocols including high dose cytarabine, rituximab and autologous stem cell transplantation, such as the Nordic MCL2/3 protocols. In 2008, a MCL international prognostic index (MIPI) was created to enable stratification of the clinical diverse MCL patients into three risk groups. So far, use of the MIPI in clinical routine has been limited, as it has been shown that it inadequately separates low and intermediate risk group patients. To improve outcome and minimize treatment-related morbidity, additional parameters need to be evaluated to enable risk-adapted treatment selection. We have investigated the individual prognostic role of the MIPI and molecular markers including SOX11, TP53 (p53), MKI67 (Ki-67) and CCND1 (cyclin D1). Furthermore, we explored the possibility of creating an improved prognostic tool by combining the MIPI with information on molecular markers. SOX11 was shown to significantly add prognostic information to the MIPI, but in multivariate analysis TP53 was the only significant independent molecular marker. Based on these findings, we propose that TP53 and SOX11 should routinely be assessed and that a combined TP53/MIPI score may be used to guide treatment decisions.
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Affiliation(s)
- Lena Nordström
- Department of Immunotechnology, CREATE Health, Lund University, Lund, Sweden
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20
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Shah N, Rule S. Management perspective for mantle cell lymphoma. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.13.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Mantle cell lymphoma (MCL) is genetically characterized by the t(11;14) (q13;q32) translocation resulting in the overexpression of cyclin D1. It generally has an aggressive clinical course with a poor prognosis. However, there is now a recognized subgroup with clinically indolent MCL. Management of MCL can be challenging. Early recognition of young and fit patients for potential intensive therapy and autologous stem cell transplant is important. Combination of rituximab with high-dose cytarabine should be used in upfront therapy for appropriate patients. In elderly and/or less fit patients, chemoimmunotherapy may be considered. Novel agents offer promising potential in the management of MCL and are likely to change the way it is treated.
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Affiliation(s)
- Nimish Shah
- Department of Haematology, Derriford Hospital, Derriford, Plymouth, PL6 8DH, UK
| | - Simon Rule
- University of Plymouth, Schools of Medicine & Dentistry, UK
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Are we a step forward with targeted agents in resolving the enigma of mantle cell lymphoma? Contemp Oncol (Pozn) 2014; 18:377-83. [PMID: 25784834 PMCID: PMC4355653 DOI: 10.5114/wo.2014.45111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/18/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022] Open
Abstract
Mantle cell lymphoma has been recognized as a distinct entity from the other non-Hodgkin lymphomas in middle 1990's. It carries a worst prognosis among all mature B-cell malignancies. Cyclin D1 and recently SOX11 are the hallmarks for this disease. Even if it is highly responsive to induction treatment, it remains incurable, since it inevitably relapses. Highly aggressive approaches with stem cell transplantation can shift the survival curve for a bit, but even so the overall survival is not significantly improved in most of the cases. Small portion of patients with this heterogeneous disease have an indolent course with long-term survival. Conventional immunochemotherapy has reached its maximal possibilities, so novel target agents are absolutely warranted. The large number of ongoing early phase trials demonstrated promising results, especially emphasizing agents that target B-cell receptor. They are mostly investigated in relapsed/refractory disease, while front-line approaches with those agents need to be explored in future times.
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22
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Magnusson E, Cao Q, Linden MA, Frolich J, Anand V, Burns LJ, Bachanova V. Hematopoietic cell transplantation for mantle cell lymphoma: predictive value of pretransplant positron emission tomography/computed tomography and bone marrow evaluations for outcomes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:114-21. [PMID: 24388482 DOI: 10.1016/j.clml.2013.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prognostic roles of 18F-fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging and marrow involvement evaluation on outcomes following autologous and allogeneic hematopoietic cell transplantation (HCT) for mantle cell lymphoma (MCL) are uncertain and require more data. PATIENTS AND METHODS We categorized 66 patients with MCL who received HCT (38 autologous and 28 allogeneic) on the basis of pre-HCT residual disease (RD) status as assessed by marrow MCL morphology and flow/molecular analysis and PET/CT imaging to RD positive (RD(+)) (either or both measures positive) and RD(-) (both negative). We analyzed the predictive value of these RD detection methods on transplant outcomes. RESULTS The 2-year relapse rate after autograft was significantly higher in pre-HCT RD(+) patients (46% [95% CI 16-77%]) than in patients who were RD(-) (19% [95% CI 0-42%]; P = .02), leading to worse 5-year disease-free survival (DFS) in RD(+) patients (46% [95% CI 14%-73%] vs. 68% [95% CI 33-87%], P = .04). In multivariate analysis, RD(+) status was associated with a reduction in DFS (hazard ratio, 5.6; P = .02). Most allogeneic HCT recipients had advanced disease and most were RD(+) (12 PET/CT(+); 5 marrow-positive). The 5-year DFS and relapse rates after allogeneic HCT were 34% and 25% for all patients and 40% and 33% for RD(+) recipients, suggesting that active disease at the time of allograft does not preclude long-term remissions in advanced MCL. CONCLUSION Both autologous and allogeneic HCT lead to promising long-term survival. RD detected prior to autograft was associated with increased relapse and worse 5 year DFS. Allograft recipients had favorable long-term outcomes even in presence of pre-HCT detectable disease.
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Affiliation(s)
- Erik Magnusson
- Division of Hematology-Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Qing Cao
- Division of Hematology-Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Michael A Linden
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Jerry Frolich
- Department of Nuclear Medicine, University of Minnesota, Minneapolis, MN
| | - Vidhu Anand
- Division of Hematology-Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Linda J Burns
- Division of Hematology-Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Veronika Bachanova
- Division of Hematology-Oncology and Transplantation, University of Minnesota, Minneapolis, MN.
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Benevolo G, Chiappella A, Vitolo U. XVI. CNS prophylaxis in aggressive lymphomas: for whom and how. Hematol Oncol 2013; 31 Suppl 1:89-91. [DOI: 10.1002/hon.2074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Giulia Benevolo
- Hematology 2; Città della Salute e della Scienza Hospital; Turin; Italy
| | | | - Umberto Vitolo
- Hematology 2; Città della Salute e della Scienza Hospital; Turin; Italy
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Coiffier B. Clinical efficacy and management of temsirolimus in patients with relapsed or refractory mantle cell lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:351-9. [PMID: 23763923 DOI: 10.1016/j.clml.2013.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 04/10/2013] [Accepted: 04/17/2013] [Indexed: 11/30/2022]
Abstract
Most patients with mantle cell lymphoma (MCL) relapse within a few years of treatment. Conventional agents provide little benefit, thus identification of new therapies is critical to improve patient outcomes. Temsirolimus, an inhibitor of mammalian target of rapamycin, is an effective, well-tolerated option authorized in Europe for treatment of patients with relapsed/refractory MCL. Intravenous temsirolimus has been extensively studied in MCL and has consistently demonstrated single-agent antitumor activity. In the pivotal phase III trial, treatment with temsirolimus 175 mg weekly for 3 weeks followed by 75 mg weekly (175/75 mg) resulted in significant improvements in progression-free survival (P = .0009) and objective response rate (P = .002) vs. investigator's choice of therapy. Hematologic toxicities (thrombocytopenia, neutropenia) were the principal grade 3/4 adverse events associated with temsirolimus 175/75 mg. Other toxicities included increases in serum cholesterol and triglycerides, hyperglycemia, fatigue, and dyspnea. Overall, the safety profile of temsirolimus is acceptable in this setting, and most toxicities are manageable with dose modification or medical intervention. Clinical studies of temsirolimus in relapsed or refractory MCL patients aim to clarify the optimal treatment schedule and to assess rational combinations with other therapeutic agents, such as rituximab or chemotherapy. Practical considerations are discussed for the clinical use of temsirolimus in patients with MCL.
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Affiliation(s)
- Bertrand Coiffier
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France.
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Meggendorfer M, Kern W, Haferlach C, Haferlach T, Schnittger S. SOX11 overexpression is a specific marker for mantle cell lymphoma and correlates with t(11;14) translocation, CCND1 expression and an adverse prognosis. Leukemia 2013; 27:2388-91. [PMID: 23648671 DOI: 10.1038/leu.2013.141] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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