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Hwang J, Suh C, Kim K, Kim H, Kim AI, Craig JW, Chen KX, Roberson J, Guenette JP, Huang RY. The Incidence and Treatment Response of Double Expression of MYC and BCL2 in Patients with Diffuse Large B-Cell Lymphoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:3369. [PMID: 34282799 PMCID: PMC8268769 DOI: 10.3390/cancers13133369] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
MYC/BCL2 protein co-expression (i.e., double expressor) has been shown to be a negative predictor of outcome in diffuse large B-cell lymphoma (DLBCL). We aimed to establish the incidence of double expressor status in patients with de novo DLBCL and identify the predictive value of this biomarker on treatment response through systematic review and meta-analysis. PubMed and Embase were searched for studies published through December 2019 that reported proportions of double expressor DLBCL. The pooled proportions of MYC and BCL2 expression, both alone and in combination, were computed using the inverse variance method for calculating weights and by the DerSimonian-Laird method. The pooled odds ratios (ORs) of complete remission (CR) rate were calculated, and meta-regression analysis was conducted to explore heterogeneity. Forty-one studies (7054 patients) were included. The pooled incidence of double expressor status in DLBCL was 23% (95% confidence interval [CI], 20-26%), with an adjusted estimate of 31% (95% CI, 27-36%). Neither MYC/BCL2 protein cutoff values, race, mean, or median age of included patients, or overall study quality was a significant factor of heterogeneity (p ≥ 0.20). Cases without double expressor status demonstrated a higher probability of CR to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone treatment (OR, 2.69; 95% CI, 1.55-4.67). Our results reaffirm the predictive power of this important biomarker.
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Affiliation(s)
- Jisun Hwang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea;
| | - Chonghyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Korea; (K.K.); (H.K.)
| | - Kyungwon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Korea; (K.K.); (H.K.)
| | - Hosung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 33, Seoul 05505, Korea; (K.K.); (H.K.)
| | - Austin I. Kim
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA;
| | - Jeffrey W. Craig
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, BC V5Z 4E6, Canada;
| | - Ke Xun Chen
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
| | - Joel Roberson
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
| | - Jeffrey P. Guenette
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
| | - Raymond Y. Huang
- Division of Neuroradiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; (K.X.C.); (J.R.); (J.P.G.); (R.Y.H.)
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Smith-Togobo C, Pedersen MØ, Jensen SG, Duduyemi B, Gyasi RK, Ofori MF, Paintsil V, Renner L, Nørgaard P, Hviid L. Reliable cell and tissue morphology-based diagnosis of endemic Burkitt lymphoma in resource-constrained settings in Ghana. BMC Cancer 2019; 19:1270. [PMID: 31888714 PMCID: PMC6937736 DOI: 10.1186/s12885-019-6488-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 12/20/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endemic Burkitt lymphoma (eBL) is an aggressive B-cell lymphoma, which is a common childhood cancer in areas with intense transmission of Plasmodium falciparum parasites. Early and accurate diagnosis is a prerequisite for successful therapy, but it optimally involves advanced laboratory investigations. These are technologically demanding, expensive, and often difficult to implement in settings where eBL is prevalent. Diagnosis is thus generally based on clinical assessment and morphological examination of tumour biopsies or fine-needle aspirates (FNAs). METHODS The purpose of the present study was to assess the accuracy of eBL diagnosis at two tertiary hospitals in Ghana. To that end, we studied FNAs from 29 eBL patients and 21 non-eBL lymphoma patients originally diagnosed in 2018. In addition, we examined 111 archival formalin-fixed and paraffin-embedded (FFPE) biopsies from Ghanaian patients originally diagnosed as eBL (N = 55) or non-eBL (N = 56) between 2010 and 2017. Availability-based subsets of samples were subjected to haematoxylin-eosin or Giemsa staining, C-MYC immunohistochemistry, and fluorescence in situ hybridisation (FISH) analysis of c-myc rearrangements. RESULTS We found a good correlation between original diagnosis and subsequent retrospective assessment, particularly for FNA samples. However, evidence of intact c-myc genes and normal C-MYC expression in samples from some patients originally diagnosed as eBL indicates that morphological assessment alone can lead to eBL over-diagnosis in our study area. In addition, several FFPE samples could not be assessed retrospectively, due to poor sample quality. Therefore, the simpler FNA method of obtaining tumour material is preferable, particularly when careful processing of biopsy specimens cannot be guaranteed. CONCLUSION We conclude that the accuracy of eBL diagnostic tools available in Ghana is generally adequate, but could be improved by implementation of additional pathology laboratory investigations. Improved attention to adequate preservation of archival samples is recommended.
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Affiliation(s)
- Cecilia Smith-Togobo
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Ø Pedersen
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Steffen G Jensen
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | - Richard K Gyasi
- Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Michael F Ofori
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Vivian Paintsil
- Department of Child Health, Komfo Anokye Hospital, Kumasi, Ghana
| | - Lorna Renner
- Department of Child Health, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Peter Nørgaard
- Department of Pathology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Lars Hviid
- Centre for Medical Parasitology at Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.
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Polyatskin IL, Artemyeva AS, Krivolapov YA. [Revised WHO classification of tumors of hematopoietic and lymphoid tissues, 2017 (4th edition):lymphoid tumors]. Arkh Patol 2019; 81:59-65. [PMID: 31317932 DOI: 10.17116/patol20198103159] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The paper is devoted to changes in the 4th edition of the WHO classification of lymphoid tumors in the 2017 revision, to the principles of the structure and features of the classification. It discusses changes in the identification of new clinical and morphological categories and in the abolition of some previously existing ones. New information about lymphoid tumors, their immunophenotypic and molecular characteristics of classification importance are briefly outlined. The absolute need for molecular genetic studies for the diagnosis of certain lymphoproliferative diseases is underlined. The characteristics of lymphoid pretumor states are given.
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Affiliation(s)
- I L Polyatskin
- N.N.Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - A S Artemyeva
- N.N.Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Yu A Krivolapov
- I.I. Mechnikov North-Western State Medical University, Saint-Petersburg, Russia
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Pedersen MØ, Gang AO, Clasen‐Linde E, Breinholt MF, Knudsen H, Nielsen SL, Poulsen TS, Klausen TW, Høgdall E, Nørgaard P. Stratification by MYC expression has prognostic impact in
MYC
translocated B‐cell lymphoma—Identifies a subgroup of patients with poor outcome. Eur J Haematol 2019; 102:395-406. [DOI: 10.1111/ejh.13219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 01/08/2023]
Affiliation(s)
| | - Anne Ortved Gang
- Department of Hematology Herlev and Gentofte Hospital Herlev Denmark
| | | | | | - Helle Knudsen
- Department of Pathology Herlev and Gentofte Hospital Herlev Denmark
| | | | | | | | - Estrid Høgdall
- Department of Pathology Herlev and Gentofte Hospital Herlev Denmark
| | - Peter Nørgaard
- Department of Pathology Herlev and Gentofte Hospital Herlev Denmark
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Prognostic significances of overexpression MYC and/or BCL2 in R-CHOP-treated diffuse large B-cell lymphoma: A Systematic review and meta-analysis. Sci Rep 2018; 8:6267. [PMID: 29674626 PMCID: PMC5908914 DOI: 10.1038/s41598-018-24631-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/05/2018] [Indexed: 12/31/2022] Open
Abstract
Numerous studies have investigated the prognostic values of MYC and/or BCL2 protein overexpression in diffuse large B-cell lymphoma (DLBCL). However, the results still demonstrate discrepancies among different studies. We aimed to do a systematic review and meta-analysis on the relationships between overexpression MYC and/or BCL2 and DLBCLs treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). This study followed the guidelines of PRISMA and Cochrane handbook. The hazard ratios (HRs) for overall survival (OS) were pooled to estimate the main effect size. Twenty studies recruited a total of 5576 patients were available for this meta-analysis. The results showed that MYC (HR = 1.96, 95%CI (confidence interval) = 1.69–2.27)without heterogeneity(I2 = 17.2%, P = 0.280), BCL2 (HR = 1.65, 95%CI = 1.43–1.89, I2 = 20.7%, P = 0.234) protein overexpression, and co-overexpression (HR = 2.58, 95%CI = 2.19–3.04, I2 = 17.2%, P = 0.275) had a poor prognosis in R-CHOP treated DLBCL patients, respectively. The current analysis indicated that MYC and/or BCL2 protein overexpression, and particularly co-overexpression was related to short overall survival in R-CHOP treated DLBCL patients, showing that application of the two new biomarkers can help to better stratify DLBCL patients and guide targeted treatment.
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Allen J, Ruano Mendez AL, Rybicki L, Sawalha Y, Jagadeesh D, Dean R, Pohlman B, Smith MR, Hsi ED, Hill BT. Co-expression of MYC and BCL2 predicts poorer outcomes for relapsed/refractory diffuse large B-cell lymphoma with R-ICE and intent to transplant. Ther Adv Hematol 2018; 9:81-87. [PMID: 29623179 PMCID: PMC5881986 DOI: 10.1177/2040620718759249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/11/2018] [Indexed: 11/17/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) with co-expression of MYC and BCL2 protein by immunohistochemistry (IHC) - that is, double-expresser lymphoma (DEL) - is associated with poor outcomes after standard frontline therapy. Less is known about the prognostic impact of DEL in patients with relapsed/refractory disease treated with salvage therapy and autologous stem cell transplantation (ASCT). We analyzed the outcomes of 167 patients with relapsed/refractory DLBCL treated with R-ICE (rituximab, ifosfamide, carboplatin and etoposide), of whom 111 patients (66%) underwent ASCT. Using predefined cutoffs for positivity by IHC at relapse for MYC and BCL2 of ⩾40% and ⩾50% of positive tumor cells, respectively, 26 patients (16%) were categorized as DEL and the rest as non-DEL. Overall and complete response rates to R-ICE did not differ between DEL and non-DEL. With a median follow up of 20 months, the 3-year progression-free survival (PFS) and overall survival (OS) rates for DEL were inferior compared to non-DEL (for PFS: 6% versus 33%, p = 0.044, for OS: 39% versus 56%, p = 0.03). The negative impact of DEL on PFS and OS remained significant on multivariable analysis. In conclusion, positive DEL status predicts poorer outcomes following salvage therapy.
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Affiliation(s)
- Joshua Allen
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Ana Lucia Ruano Mendez
- Department of Laboratory Medicine, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lisa Rybicki
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yazeed Sawalha
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Dean
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brad Pohlman
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mitchell R. Smith
- Department of Medical Oncology and Hematology, George Washington Cancer Center, Washington, DC, USA
| | - Eric D. Hsi
- Department of Laboratory Medicine, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian T. Hill
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, 9500 Euclid Avenue, CA-60, Cleveland, OH 44195, USA
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Wight JC, Chong G, Grigg AP, Hawkes EA. Prognostication of diffuse large B-cell lymphoma in the molecular era: moving beyond the IPI. Blood Rev 2018; 32:400-415. [PMID: 29605154 DOI: 10.1016/j.blre.2018.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 12/21/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease with variable outcomes. Despite the majority of patients being cured with combination chemoimmunotherapy, up to 30% eventually succumb to the disease. Until recently, baseline prognostic assessment has centred on the International Prognostic Index (IPI), although this index is yet to impact strongly on treatment choice. Molecular features such as cell of origin, MYC and BCL-2 genetic alterations and protein overexpression were identified over a decade ago, yet their prognostic value is still not fully elucidated. Adding complexity are the plethora of new clinical, biological and molecular prognostic markers described in the recent literature, most of which lack independent validation, likely act as surrogate markers for those already in common use and have yet to substantially impact on therapeutic decision making. This review comprehensively assesses the value of individual prognostic markers in the clinical setting and their potential to predict response to novel agents, and ways to optimise their use in future research.
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Affiliation(s)
- Joel C Wight
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia.
| | - Geoffrey Chong
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia.
| | - Andrew P Grigg
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia; University of Melbourne, Melbourne, Australia.
| | - Eliza A Hawkes
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Australia; University of Melbourne, Melbourne, Australia; Eastern Health, Box Hill, Australia.
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Nabhan C, Mato AR. Emerging Strategies in Treating Double Hit Lymphomas. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:563-568. [DOI: 10.1016/j.clml.2017.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/09/2017] [Accepted: 06/15/2017] [Indexed: 11/28/2022]
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Hsi ED. 2016 WHO Classification update-What's new in lymphoid neoplasms. Int J Lab Hematol 2017; 39 Suppl 1:14-22. [DOI: 10.1111/ijlh.12650] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/25/2017] [Indexed: 12/18/2022]
Affiliation(s)
- E. D. Hsi
- Department of Laboratory Medicine; Cleveland Clinic; Cleveland OH USA
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