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Ryba A, Özdemir Z, Nissimov N, Hönikl L, Neidert N, Jakobs M, Kalasauskas D, Krigers A, Thomé C, Freyschlag C, Ringel F, Unterberg A, Dao Trong P, Beck J, Heiland D, Meyer B, Vajkoczy P, Onken J, Stummer W, Suero Molina E, Gempt J, Westphal M, Schüller U, Mohme M. Insights from a multicenter study on adult H3 K27M-mutated glioma: Surgical resection's limited influence on overall survival, ATRX as molecular prognosticator. Neuro Oncol 2024; 26:1479-1493. [PMID: 38507506 PMCID: PMC11300017 DOI: 10.1093/neuonc/noae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND H3 K27M-mutated gliomas were first described as a new grade 4 entity in the 2016 World Health Organization classification. Current studies have focused on its typical appearance in children and young adults, increasing the need to better understand the prognostic factors and impact of surgery on adults. Here, we report a multicentric study of this entity in adults. METHODS We included molecularly confirmed H3 K27M-mutated glioma cases in patients ≥ 18 years diagnosed between 2016 and 2022. Clinical, radiological, and surgical features were analyzed. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS Among 70 patients with a mean age of 36.1 years, the median overall survival (OS) was 13.6 ± 14 months. Gross-total resection was achieved in 14.3% of patients, whereas 30% had a subtotal resection and 54.3% a biopsy. Tumors located in telencephalon/diencephalon/myelencephalon were associated with a poorer OS, while a location in the mesencephalon/metencephalon showed a significantly longer OS (8.7 vs. 25.0 months, P = .007). Preoperative Karnofsky-Performance Score (KPS) ≤ 80 showed a reduced OS (4.2 vs. 18 months, P = .02). Furthermore, ATRX loss, found in 25.7%, was independently associated with an increased OS (31 vs. 8.3 months, P = .0029). Notably, patients undergoing resection showed no survival benefit over biopsy (12 vs. 11 months, P = .4006). CONCLUSIONS The present study describes surgical features of H3 K27M-mutated glioma in adulthood in a large multicentric study. Our data reveal that ATRX status, location and KPS significantly impact OS in H3 K27M-mutated glioma. Importantly, our dataset indicates that resection does not offer a survival advantage over biopsy.
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Affiliation(s)
- Alice Ryba
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zeynep Özdemir
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Nitzan Nissimov
- Department of Neurosurgery, Charité University Hospital Berlin, Berlin, Germany
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Lisa Hönikl
- Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Nicolas Neidert
- Department of Neurosurgery, Charité University Hospital Berlin, Berlin, Germany
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Martin Jakobs
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Division of Stereotactic Neurosurgery, Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Darius Kalasauskas
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Aleksandrs Krigers
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg University, Medical Faculty, Heidelberg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University Munich, Munich, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Hospital Berlin, Berlin, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité University Hospital Berlin, Berlin, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Jens Gempt
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schüller
- Institute of Neuropathology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children’s Cancer Center Hamburg, Hamburg, Germany
| | - Malte Mohme
- Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Hamburg, Germany
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2
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Hayashi N, Fukai J, Nakatogawa H, Kawaji H, Yoshioka E, Kodama Y, Nakajo K, Uda T, Naito K, Kijima N, Okita Y, Kagawa N, Takahashi Y, Hashimoto N, Arita H, Takano K, Sakamoto D, Iida T, Arakawa Y, Kawauchi T, Sonoda Y, Mitobe Y, Ishibashi K, Matsuda M, Achiha T, Tomita T, Nonaka M, Hara K, Takebe N, Tsuzuki T, Nakajima Y, Ohue S, Nakajima N, Watanabe A, Inoue A, Umegaki M, Kanematsu D, Katsuma A, Sumida M, Shofuda T, Mano M, Kinoshita M, Mori K, Nakao N, Kanemura Y. Neuroradiological, genetic and clinical characteristics of histone H3 K27-mutant diffuse midline gliomas in the Kansai Molecular Diagnosis Network for CNS Tumors (Kansai Network): multicenter retrospective cohort. Acta Neuropathol Commun 2024; 12:120. [PMID: 39061104 PMCID: PMC11282756 DOI: 10.1186/s40478-024-01808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/27/2024] [Indexed: 07/28/2024] Open
Abstract
This study aims to elucidate the clinical and molecular characteristics, treatment outcomes and prognostic factors of patients with histone H3 K27-mutant diffuse midline glioma. We retrospectively analyzed 93 patients with diffuse midline glioma (47 thalamus, 24 brainstem, 12 spinal cord and 10 other midline locations) treated at 24 affiliated hospitals in the Kansai Molecular Diagnosis Network for CNS Tumors. Considering the term "midline" areas, which had been confused in previous reports, we classified four midline locations based on previous reports and anatomical findings. Clinical and molecular characteristics of the study cohort included: age 4-78 years, female sex (41%), lower-grade histology (56%), preoperative Karnofsky performance status (KPS) scores ≥ 80 (49%), resection (36%), adjuvant radiation plus chemotherapy (83%), temozolomide therapy (76%), bevacizumab therapy (42%), HIST1H3B p.K27M mutation (2%), TERT promoter mutation (3%), MGMT promoter methylation (9%), BRAF p.V600E mutation (1%), FGFR1 mutation (14%) and EGFR mutation (3%). Median progression-free and overall survival time was 9.9 ± 1.0 (7.9-11.9, 95% CI) and 16.6 ± 1.4 (13.9-19.3, 95% CI) months, respectively. Female sex, preoperative KPS score ≥ 80, adjuvant radiation + temozolomide and radiation ≥ 50 Gy were associated with favorable prognosis. Female sex and preoperative KPS score ≥ 80 were identified as independent good prognostic factors. This study demonstrated the current state of clinical practice for patients with diffuse midline glioma and molecular analyses of diffuse midline glioma in real-world settings. Further investigation in a larger population would contribute to better understanding of the pathology of diffuse midline glioma.
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Affiliation(s)
- Nobuhide Hayashi
- Department of Neurosurgery, Wakayama Rosai Hospital, Kinomoto 93-1, Wakayama City, Wakayama, 640-8505, Japan.
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan.
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8510, Japan.
| | - Junya Fukai
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan.
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8510, Japan.
| | - Hirokazu Nakatogawa
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Pediatric Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, 430-8558, Japan
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Hiroshi Kawaji
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Ema Yoshioka
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Molecular Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Yoshinori Kodama
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
| | - Kosuke Nakajo
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka, 545-8585, Japan
| | - Takehiro Uda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka, 545-8585, Japan
| | - Kentaro Naito
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka, 545-8585, Japan
| | - Noriyuki Kijima
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yoshiko Okita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Naoki Kagawa
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yoshinobu Takahashi
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, School of Medical Science, Kyoto Prefectural University Graduate, Kyoto City, Kyoto, 602-8566, Japan
| | - Naoya Hashimoto
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, School of Medical Science, Kyoto Prefectural University Graduate, Kyoto City, Kyoto, 602-8566, Japan
| | - Hideyuki Arita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
| | - Koji Takano
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
| | - Daisuke Sakamoto
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomoko Iida
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshiki Arakawa
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto, 606-8507, Japan
| | - Takeshi Kawauchi
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Red Cross Hospital, Osaka City, Osaka, 543-8555, Japan
| | - Yukihiko Sonoda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata City, Yamagata, 990-8560, Japan
| | - Yuta Mitobe
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata City, Yamagata, 990-8560, Japan
| | - Kenichi Ishibashi
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka City General Hospital, Osaka City, Osaka, 534-0021, Japan
| | - Masahide Matsuda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takamune Achiha
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, 660-8511, Japan
| | - Takahiro Tomita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama City, Toyama, 930-0194, Japan
| | - Masahiro Nonaka
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, 573-1191, Japan
| | - Keijiro Hara
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8501, Japan
| | - Noriyoshi Takebe
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Medical Research Institute, Tazuke Kofukai Foundation, Kitano Hospital, Osaka City, Osaka, 530-8480, Japan
| | - Takashi Tsuzuki
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Sakai City Medical Center, Sakai, Osaka, 593-8304, Japan
| | - Yoshikazu Nakajima
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Sakai City Medical Center, Sakai, Osaka, 593-8304, Japan
- Department of Neurosurgery, Kobe Tokushukai Hospital, Kobe, Hyogo, 655-0017, Japan
| | - Shiro Ohue
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Matsuyama, Ehime, 790-0024, Japan
| | - Nobuyuki Nakajima
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Tokyo Medical University, Tokyo, 160-0023, Japan
| | - Akira Watanabe
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kindai University Nara Hospital, Ikoma, Nara, 630-0293, Japan
| | - Akihiro Inoue
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Masao Umegaki
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, 564-8567, Japan
| | - Daisuke Kanematsu
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Molecular Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Asako Katsuma
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Miho Sumida
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Tomoko Shofuda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Stem Cell Research, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Masayuki Mano
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Central Laboratory and Surgical Pathology, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Manabu Kinoshita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kanji Mori
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Yao Municipal Hospital, Yao, Osaka, 581-0069, Japan
| | - Naoyuki Nakao
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8510, Japan
| | - Yonehiro Kanemura
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Molecular Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
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Guidara S, Seyve A, Poncet D, Leonce C, Bringuier PP, McLeer A, Sturm D, Cartalat S, Picart T, Ferrari A, Hench J, Frank S, Meyronet D, Ducray F, Barritault M. Characteristics of H3K27M-mutant diffuse gliomas with a non-midline location. J Neurooncol 2024:10.1007/s11060-024-04733-z. [PMID: 38937309 DOI: 10.1007/s11060-024-04733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Diffuse midline gliomas (DMG) with H3K27 alterations (H3K27M-DMG) are a highly aggressive form of brain cancer. In rare cases, H3K27 mutations have been observed in diffuse non-midline gliomas (DNMG). It is currently unclear how these tumors should be classified. Herein, we analyze the characteristics of DNMG with H3K27M mutations. METHODS We reviewed the clinical, radiological and histological characteristics of all patients with an H3K27M mutated diffuse glioma diagnosed in our institution, between 2016 and 2023, to identify cases with a non-midline location. We then performed a molecular characterization (DNA methylation profiling, whole genome and transcriptome sequencing or targeted sequencing) of patients with an H3K27M-mutant DNMG and reviewed previously reported cases. RESULTS Among 51 patients (18 children and 33 adults) diagnosed with an H3K27M diffuse glioma, we identified two patients (4%) who had a non-midline location. Including our two patients, 39 patients were reported in the literature with an H3K27M-mutant DNMG. Tumors were most frequently located in the temporal lobe (48%), affected adolescents and adults, and were associated with a poor outcome (median overall survival was 10.3 months (0.1-84)). Median age at diagnosis was 19.1 years. Tumors frequently harbored TP53 mutations (74%), ATRX mutations (71%) and PDGFRA mutations or amplifications (44%). In DNA methylation analysis, H3K27M-mutant DNMG clustered within or close to the reference group of H3K27M-mutant DMG. Compared to their midline counterpart, non-midline gliomas with H3K27M mutations seemed more frequently associated with PDGFRA alterations. CONCLUSION DNMG with H3K27M mutations share many similarities with their midline counterpart, suggesting that they correspond to a rare anatomical presentation of these tumors. This is of paramount importance, as they may benefit from new therapeutic approaches such as ONC201.
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Affiliation(s)
- Souhir Guidara
- Department of Medical Genetics, Hedi Chaker Hospital, Sfax, Tunisia.
| | - Antoine Seyve
- Department of Neurooncology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Delphine Poncet
- Department of Pathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Institut Neuro Myo Gène (INMG), Pathophysiology and Genetics of Neuron and Muscle (PGNM), Université Claude Bernard Lyon 1, CNRS UMR 5261-INSERM U1315, Neuron-Muscle interaction team, Lyon, France
| | - Camille Leonce
- Department of Pathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Centre Léon Bérard, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Lyon, France
| | - Pierre-Paul Bringuier
- Department of Pathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Anne McLeer
- Service d'Anatomie et Cytologie Pathologiques CHU Grenoble Alpes, Institute for Advanced Biosciences UGA, Université Grenoble Alpes, INSERM U1209/CNRS 5309, Grenoble, France
| | - Dominik Sturm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Pediatric Glioma Research Group, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stéphanie Cartalat
- Department of Neurooncology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Thiebaud Picart
- Centre Léon Bérard, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Anthony Ferrari
- Gilles Thomas Bioinformatics Platform, Synergie Lyon Cancer, Cancer Research Center of Lyon, Centre Léon Bérard FR, Lyon, France
| | - Jürgen Hench
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Stephan Frank
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - David Meyronet
- Department of Pathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Cancer Initiation and Tumoral Cell Identity Department, Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, Lyon, France
| | - François Ducray
- Department of Neurooncology, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Cancer Initiation and Tumoral Cell Identity Department, Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, Lyon, France
| | - Marc Barritault
- Department of Pathology, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France.
- Cancer Initiation and Tumoral Cell Identity Department, Cancer Research Centre of Lyon (CRCL) INSERM 1052, CNRS 5286, Lyon, France.
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Di Nunno V, Lombardi G, Simonelli M, Minniti G, Mastronuzzi A, Di Ruscio V, Corrà M, Padovan M, Maccari M, Caccese M, Simonetti G, Berlendis A, Farinotti M, Pollo B, Antonelli M, Di Muzio A, Dipasquale A, Asioli S, De Biase D, Tosoni A, Silvani A, Franceschi E. The role of adjuvant chemotherapy in patients with H3K27 altered diffuse midline gliomas: a multicentric retrospective study. J Neurooncol 2024:10.1007/s11060-024-04589-3. [PMID: 38457090 DOI: 10.1007/s11060-024-04589-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/25/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Adult Diffuse midline glioma (DMG) is a very rare disease. DMGs are currently treated with radiotherapy and chemotherapy even if only a few retrospective studies assessed the impact on overall survival (OS) of these approaches. METHODS We carried out an Italian multicentric retrospective study of adult patients with H3K27-altered DMG to assess the effective role of systemic therapy in the treatment landscape of this rare tumor type. RESULTS We evaluated 49 patients from 6 Institutions. The median age was 37.3 years (range 20.1-68.3). Most patients received biopsy as primary approach (n = 30, 61.2%) and radiation therapy after surgery (n = 39, 79.6%). 25 (51.0%) of patients received concurrent chemotherapy and 26 (53.1%) patients received adjuvant temozolomide. In univariate analysis, concurrent chemotherapy did not result in OS improvement while adjuvant temozolomide was associated with longer OS (21.2 vs. 9.0 months, HR 0.14, 0.05-0.41, p < 0.001). Multivariate analysis confirmed the role of adjuvant chemotherapy (HR 0.1, 95%CI: 0.03-0.34, p = 0.003). In patients who progressed after radiation and/or chemotherapy the administration of a second-line systemic treatment had a significantly favorable impact on survival (8.0 vs. 3.2 months, HR 0.2, 95%CI 0.1-0.65, p = 0.004). CONCLUSION In our series, adjuvant treatment after radiotherapy can be useful in improving OS of patients with H3K27-altered DMG. When feasible another systemic treatment after treatment progression could be proposed.
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Affiliation(s)
- Vincenzo Di Nunno
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, Bologna, 40139, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University, Policlinico Umberto I, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Angela Mastronuzzi
- Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Di Ruscio
- Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Martina Corrà
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Marta Maccari
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Giorgia Simonetti
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Arianna Berlendis
- Unit of Immunotherapy of Brain Tumors, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, 20133, Italy
| | - Mariangela Farinotti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, 20133, Italy
| | - Bianca Pollo
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, 20133, Italy
| | - Manila Antonelli
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | | | | | - Sofia Asioli
- IRCCS-Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM)-Surgical Pathology Section, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Dario De Biase
- Department of Pharmacy and Biotechnology (FaBit), University of Bologna, Bologna, Italy
- Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alicia Tosoni
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, Bologna, 40139, Italy
| | - Antonio Silvani
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, Bologna, 40139, Italy.
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5
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Ge X, Yang Y, Wang W, Tian L, Zhang G, Tian Z, Xue X. Pediatric H3K27M‑mutant diffuse midline glioma with vertebral metastasis: A case report and literature review. Oncol Lett 2024; 27:48. [PMID: 38192660 PMCID: PMC10773191 DOI: 10.3892/ol.2023.14181] [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: 05/13/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024] Open
Abstract
H3K27M-mutant diffuse midline glioma (DMG) is a type of high-grade glial tumor, which occurs in the midline structure and develops mostly in children. Extraneural metastases (ENM) are exceedingly rare in patients with H3K27M-mutant DMG. A 9-year-old male patient presented with a headache, nausea and vomiting. Following magnetic resonance imaging and immunohistochemical molecular testing examination, the patient was diagnosed with H3K27M-mutant DMG and received chemoradiotherapy plus five cycles of chemotherapy with temozolomide intermittently as an adjuvant therapy. The treatment resulted in a slight reduction of the tumor volume. However, 2 months later, the patient was admitted to hospital with complaints of drooping of the mouth, and waist and back pain. Magnetic resonance imaging and positron-emission tomography-computed tomography revealed an unusual presentation with multiple vertebral metastases and craniospinal leptomeningeal dissemination. Following discussion between the members of a multidisciplinary medical team, the patient underwent one cycle of chemotherapy with cyclophosphamide, vincristine and cisplatin. However, the condition did not improve and the patient died 4 weeks after the diagnosis of ENM. The mechanisms underlying the development of these rare metastases remain unclear. The present case report provides insights into the clinical characteristics and potential metastasis mechanisms of this aggressive disease and may help to elucidate new pathways for the management of ENM.
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Affiliation(s)
- Xiaohui Ge
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Yu Yang
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Wenyan Wang
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Lei Tian
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Ge Zhang
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Zhesen Tian
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Xiaoying Xue
- Department of Radiotherapy, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
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6
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Gong X, Kuang S, Deng D, Wu J, Zhang L, Liu C. Differences in survival prognosticators between children and adults with H3K27M-mutant diffuse midline glioma. CNS Neurosci Ther 2023; 29:3863-3875. [PMID: 37311690 PMCID: PMC10651973 DOI: 10.1111/cns.14307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/28/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS H3K27M-mutant diffuse midline glioma (DMG) is a rare and aggressive central nervous system tumor. The biological behavior, clinicopathological characteristics, and prognostic factors of DMG have not yet been completely uncovered, especially in adult patients. This study aims to investigate the clinicopathological characteristics and identify prognostic factors of H3K27M-mutant DMG in pediatric and adult patients, respectively. METHODS A total of 171 patients with H3K27M-mutant DMG were included in the study. The clinicopathological characteristics of the patients were analyzed and stratified based on age. The Cox proportional hazard model was used to determine the independent prognostic factors in pediatric and adult subgroups. RESULTS The median overall survival (OS) for the entire cohort was 9.0 months. Significant differences were found in some clinicopathological characteristics between children and adults. The median OS was also significantly different between the pediatric and adult subgroups, with 7.1 months for children and 12.3 months for adults (p < 0.001). In the overall population, the multivariate analysis identified adult patients, single lesion, concurrent chemoradiotherapy/radiotherapy, and intact ATRX expression as independent favorable prognostic factors. In the age-stratified subgroups, the prognostic factors varied between children and adults, with intact ATRX expression and single lesion being independent favorable prognostic factors in adults, while infratentorial localization was significantly associated with worse prognosis in children. CONCLUSIONS The differences in clinicopathological features and prognostic factors between pediatric and adult patients with H3K27M-mutant DMG suggest the need for further clinical and molecular stratification based on age.
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Affiliation(s)
- Xuan Gong
- Departments of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
- National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaChina
| | - Shuwen Kuang
- Departments of OncologyXiangya Hospital, Central South UniversityChangshaChina
| | - Dongfeng Deng
- Departments of OncologyXiangya Hospital, Central South UniversityChangshaChina
| | - Jun Wu
- Departments of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Longbo Zhang
- Departments of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaChina
| | - Chao Liu
- National Clinical Research Center for Geriatric DisordersXiangya Hospital, Central South UniversityChangshaChina
- Departments of OncologyXiangya Hospital, Central South UniversityChangshaChina
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7
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Adhikari S, Bhutada AS, Ladner L, Cuoco JA, Entwistle JJ, Marvin EA, Rogers CM. Prognostic Indicators for H3K27M-Mutant Diffuse Midline Glioma: A Population-Based Retrospective Surveillance, Epidemiology, and End Results Database Analysis. World Neurosurg 2023; 178:e113-e121. [PMID: 37423332 DOI: 10.1016/j.wneu.2023.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Diffuse midline glioma with histone H3K27M mutation (H3K27M DMG) is a recently recognized World Health Organization grade IV glioma with a dismal prognosis. Despite maximal treatment, this high-grade glioma exhibits an estimated median survival of 9-12 months. However, little is known with regards to prognostic risk factors for overall survival (OS) for patients with this malignant tumor. The aim of the present study is to characterize risk factors influencing survival in H3K27M DMG. METHODS This is a population-based retrospective study of survival in patients with H3K27M DMG. The Surveillance, Epidemiology, and End Results database was examined from the years 2018 to 2019 and data from 137 patients were collected. Basic demographics, tumor site, and treatments regimens were retrieved. Univariate and multivariable analyses were conducted to assess for factors associated with OS. Nomograms were built based on the results of the multivariable analyses. RESULTS Median OS of the entire cohort was 13 months. Patients with infratentorial H3K27M DMG exhibited worse OS compared to their supratentorial counterparts. Any form of radiation treatment resulted in a significantly improved OS. Most combination treatments significantly improved OS with the exception of the surgery plus chemotherapy group. The combination of surgery and radiation had the greatest impact on OS. CONCLUSIONS Overall, the infratentorial location of H3K27M DMG portends a worse prognosis compared to their supratentorial counterparts. The combination of surgery and radiation had the greatest impact on OS. These data highlight the survival benefit in utilizing a multimodal treatment approach for H3K27M DMG.
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Affiliation(s)
- Srijan Adhikari
- Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA.
| | | | - Liliana Ladner
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Joshua A Cuoco
- Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - John J Entwistle
- Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Eric A Marvin
- Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Cara M Rogers
- Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA; School of Neuroscience, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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8
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Al Sharie S, Abu Laban D, Nazzal J, Iqneibi S, Ghnaimat S, Al-Ani A, Al-Hussaini M. Midline Gliomas: A Retrospective Study from a Cancer Center in the Middle East. Cancers (Basel) 2023; 15:4545. [PMID: 37760513 PMCID: PMC10527416 DOI: 10.3390/cancers15184545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Midline gliomas are tumors that occur in midline structures and can be circumscribed or diffuse. Classical midline structures include the thalamus, brainstem, and spinal cord. Other midline structures include the corpus callosum, basal ganglia, ventricles, paraventricular structures, and cerebellum. Diffuse midline glioma (DMG) is a diffuse glioma that occurs in the classical midline structures, characterized by a specific genetic alteration, and associated with grim outcome. This study was conducted at King Hussein Cancer Center and reviewed the medical records of 104 patients with circumscribed and diffuse gliomas involving midline structures that underwent biopsy between 2005 and 2022. We included a final cohort of 104 patients characterized by a median age of 23 years and a male-to-female ratio of 1.59-to-1. Diffuse high-grade glioma (DHGG) was the most common pathological variant (41.4%), followed by DMG (28.9%). GFAP was positive in most cases (71.2%). Common positive mutations/alterations detected by surrogate immunostains included H3 K27me3 (28.9%), p53 (25.0%), and H3 K27M (20.2%). Age group, type of treatment, and immunohistochemistry were significantly associated with both the location of the tumor and tumor variant (all; p < 0.05). DMGs were predominantly found in the thalamus, whereas circumscribed gliomas were most commonly observed in the spinal cord. None of the diffuse gliomas outside the classical location, or circumscribed gliomas harbored the defining DMG mutations. The median overall survival (OS) for the entire cohort was 10.6 months. Only the tumor variant (i.e., circumscribed gliomas) and radiotherapy were independent prognosticators on multivariate analysis.
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Affiliation(s)
- Sarah Al Sharie
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Dima Abu Laban
- Department of Radiology, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Jamil Nazzal
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman 11941, Jordan; (J.N.); (S.I.); (S.G.); (A.A.-A.)
| | - Shahad Iqneibi
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman 11941, Jordan; (J.N.); (S.I.); (S.G.); (A.A.-A.)
| | - Sura Ghnaimat
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman 11941, Jordan; (J.N.); (S.I.); (S.G.); (A.A.-A.)
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman 11941, Jordan; (J.N.); (S.I.); (S.G.); (A.A.-A.)
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman 11941, Jordan
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9
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Miguel Llordes G, Medina Pérez VM, Curto Simón B, Castells-Yus I, Vázquez Sufuentes S, Schuhmacher AJ. Epidemiology, Diagnostic Strategies, and Therapeutic Advances in Diffuse Midline Glioma. J Clin Med 2023; 12:5261. [PMID: 37629304 PMCID: PMC10456112 DOI: 10.3390/jcm12165261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Object: Diffuse midline glioma (DMG) is a highly aggressive and lethal brain tumor predominantly affecting children and young adults. Previously known as diffuse intrinsic pontine glioma (DIPG) or grade IV brain stem glioma, DMG has recently been reclassified as "diffuse midline glioma" according to the WHO CNS5 nomenclature, expanding the DMG demographic. Limited therapeutic options result in a poor prognosis, despite advances in diagnosis and treatment. Radiotherapy has historically been the primary treatment modality to improve patient survival. Methods: This systematic literature review aims to comprehensively compile information on the diagnosis and treatment of DMG from 1 January 2012 to 31 July 2023. The review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and utilized databases such as PubMed, Cochrane Library, and SciELO. Results: Currently, molecular classification of DMG plays an increasingly vital role in determining prognosis and treatment options. Emerging therapeutic avenues, including immunomodulatory agents, anti-GD2 CAR T-cell and anti-GD2 CAR-NK therapies, techniques to increase blood-brain barrier permeability, isocitrate dehydrogenase inhibitors, oncolytic and peptide vaccines, are being explored based on the tumor's molecular composition. However, more clinical trials are required to establish solid guidelines for toxicity, dosage, and efficacy. Conclusions: The identification of the H3K27 genetic mutation has led to the reclassification of certain midline tumors, expanding the DMG demographic. The field of DMG research continues to evolve, with encouraging findings that underscore the importance of highly specific and tailored therapeutic strategies to achieve therapeutic success.
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Affiliation(s)
- Gloria Miguel Llordes
- Molecular Oncology Group, Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Víctor Manuel Medina Pérez
- Molecular Oncology Group, Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | | | - Irene Castells-Yus
- Molecular Oncology Group, Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
| | | | - Alberto J. Schuhmacher
- Molecular Oncology Group, Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Zaragoza, Spain
- Fundación Aragonesa para la Investigación y el Desarrollo (ARAID), 50018 Zaragoza, Spain
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10
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Pinto SN, Chiang J, Qaddoumi I, Livingston D, Bag A. Pediatric diencephalic tumors: a constellation of entities and management modalities. Front Oncol 2023; 13:1180267. [PMID: 37519792 PMCID: PMC10374860 DOI: 10.3389/fonc.2023.1180267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
The diencephalon is a complex midline structure consisting of the hypothalamus, neurohypophysis, subthalamus, thalamus, epithalamus, and pineal body. Tumors arising from each of these diencephalic components differ significantly in terms of biology and prognosis. The aim of this comprehensive review is to describe the epidemiology, clinical symptoms, imaging, histology, and molecular markers in the context of the 2021 WHO classification of central nervous system neoplasms. We will also discuss the current management of each of these tumors.
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Affiliation(s)
- Soniya N. Pinto
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Jason Chiang
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Ibrahim Qaddoumi
- Departments of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - David Livingston
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Asim Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, United States
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11
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Damodharan S, Abbott A, Kellar K, Zhao Q, Dey M. Molecular Characterization and Treatment Approaches for Pediatric H3 K27-Altered Diffuse Midline Glioma: Integrated Systematic Review of Individual Clinical Trial Participant Data. Cancers (Basel) 2023; 15:3478. [PMID: 37444588 PMCID: PMC10340772 DOI: 10.3390/cancers15133478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Diffuse midline glioma (DMG), H3 K27-altered are highly aggressive, incurable central nervous system (CNS) tumors. The current standard palliative treatment is radiotherapy, with most children succumbing to the disease in less than one year from the time of diagnosis. Over the past decade, there have been significant advancements in our understanding of these heterogeneous tumors at the molecular level. As a result, most of the newer clinical trials offered utilize more targeted approaches with information derived from the tumor biopsy. In this systematic review, we used individual participant data from seven recent clinical trials published over the past five years that met our inclusion and exclusion criteria to analyze factors that influence overall survival (OS). We found that the most prominent genetic alterations H3.3 (H3F3A) and TP53 were associated with worse OS and that ACVR had a protective effect. In addition, re-irradiation was the only statistically significant treatment modality that showed any survival benefit. Our findings highlight some important characteristics of DMG, H3 K27-altered and their effects on OS along with the importance of continuing to review clinical trial data to improve our therapies for these fatal tumors.
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Affiliation(s)
- Sudarshawn Damodharan
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, School of Medicine & Public Health, University of Wisconsin, Madison, WI 53792, USA;
| | - Alexandra Abbott
- Department of Neurosurgery, School of Medicine & Public Health, University of Wisconsin, UW Carbone Cancer Center, Madison, WI 53792, USA; (A.A.); (K.K.)
| | - Kaitlyn Kellar
- Department of Neurosurgery, School of Medicine & Public Health, University of Wisconsin, UW Carbone Cancer Center, Madison, WI 53792, USA; (A.A.); (K.K.)
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA;
| | - Mahua Dey
- Department of Neurosurgery, School of Medicine & Public Health, University of Wisconsin, UW Carbone Cancer Center, Madison, WI 53792, USA; (A.A.); (K.K.)
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12
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Peng Y, Ren Y, Huang B, Tang J, Jv Y, Mao Q, Liu Y, Lei Y, Zhang Y. A validated prognostic nomogram for patients with H3 K27M-mutant diffuse midline glioma. Sci Rep 2023; 13:9970. [PMID: 37340065 DOI: 10.1038/s41598-023-37078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/15/2023] [Indexed: 06/22/2023] Open
Abstract
H3 K27M-mutant diffuse midline glioma (H3 K27M-mt DMG) is a rare, highly invasive tumor with a poor prognosis. The prognostic factors of H3 K27M-mt DMG have not been fully identified, and there is no clinical prediction model for it. This study aimed to develop and validate a prognostic model for predicting the probability of survival in patients with H3 K27M-mt DMG. Patients diagnosed with H3 K27M-mt DMG in the West China Hospital from January 2016 to August 2021 were included. Cox proportional hazard regression was used for survival assessment, with adjustment for known prognostic factors. The final model was established using the patient data of our center as the training cohort and data from other centers for external independent verification. One hundred and five patients were ultimately included in the training cohort, and 43 cases from another institution were used as the validation cohort. The factors influencing survival probability in the prediction model included age, preoperative KPS score, radiotherapy and Ki-67 expression level. The adjusted consistency indices of the Cox regression model in internal bootstrap validation at 6, 12, and 18 months were 0.776, 0.766, and 0.764, respectively. The calibration chart showed high consistency between the predicted and observed results. The discrimination in external verification was 0.785, and the calibration curve showed good calibration ability. We identified the risk factors that affect the prognosis of H3 K27M-mt DMG patients and then established and validated a diagnostic model for predicting the survival probability of these patients.
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Affiliation(s)
- Youheng Peng
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yanming Ren
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bowen Huang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jun Tang
- College of Electronics and Information Engineering, Sichuan University, No. 24, South Section 1, First Ring Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yan Jv
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qing Mao
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yinjie Lei
- College of Electronics and Information Engineering, Sichuan University, No. 24, South Section 1, First Ring Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
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13
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El Malki K, Wehling P, Alt F, Sandhoff R, Zahnreich S, Ustjanzew A, Wilzius C, Brockmann MA, Wingerter A, Russo A, Beck O, Sommer C, Ottenhausen M, Frauenknecht KBM, Paret C, Faber J. Glucosylceramide Synthase Inhibitors Induce Ceramide Accumulation and Sensitize H3K27 Mutant Diffuse Midline Glioma to Irradiation. Int J Mol Sci 2023; 24:9905. [PMID: 37373053 DOI: 10.3390/ijms24129905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
H3K27M mutant (mut) diffuse midline glioma (DMG) is a lethal cancer with no effective cure. The glycosphingolipids (GSL) metabolism is altered in these tumors and could be exploited to develop new therapies. We tested the effect of the glucosylceramide synthase inhibitors (GSI) miglustat and eliglustat on cell proliferation, alone or in combination with temozolomide or ionizing radiation. Miglustat was included in the therapy protocol of two pediatric patients. The effect of H3.3K27 trimethylation on GSL composition was analyzed in ependymoma. GSI reduced the expression of the ganglioside GD2 in a concentration and time-dependent manner and increased the expression of ceramide, ceramide 1-phosphate, sphingosine, and sphingomyelin but not of sphingosine 1-phosphate. Miglustat significantly increased the efficacy of irradiation. Treatment with miglustat according to dose recommendations for patients with Niemann-Pick disease was well tolerated with manageable toxicities. One patient showed a mixed response. In ependymoma, a high concentration of GD2 was found only in the presence of the loss of H3.3K27 trimethylation. In conclusion, treatment with miglustat and, in general, targeting GSL metabolism may offer a new therapeutic opportunity and can be administered in close proximity to radiation therapy. Alterations in H3K27 could be useful to identify patients with a deregulated GSL metabolism.
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Affiliation(s)
- Khalifa El Malki
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- University Cancer Center (UCT), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Pia Wehling
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- University Cancer Center (UCT), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Francesca Alt
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- University Cancer Center (UCT), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Roger Sandhoff
- Lipid Pathobiochemistry, German Cancer Research Center, 69120 Heidelberg, Germany
- Helmholtz-Institute for Translational Oncology Mainz (HI-TRON), 55131 Mainz, Germany
| | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Arsenij Ustjanzew
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Carolin Wilzius
- Lipid Pathobiochemistry, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Arthur Wingerter
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- University Cancer Center (UCT), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Alexandra Russo
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- University Cancer Center (UCT), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- German Cancer Consortium (DKTK), Site Frankfurt/Mainz, Germany, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Olaf Beck
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- University Cancer Center (UCT), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Clemens Sommer
- Institute of Neuropathology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Malte Ottenhausen
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Katrin B M Frauenknecht
- Helmholtz-Institute for Translational Oncology Mainz (HI-TRON), 55131 Mainz, Germany
- Institute of Neuropathology, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- National Center of Pathology (NCP), Laboratoire National de Santé, 3555 Dudelange, Luxembourg
- Luxembourg Center of Neuropathology (LCNP), Laboratoire National de Santé, 3555 Dudelange, Luxembourg
| | - Claudia Paret
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- University Cancer Center (UCT), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Helmholtz-Institute for Translational Oncology Mainz (HI-TRON), 55131 Mainz, Germany
- German Cancer Consortium (DKTK), Site Frankfurt/Mainz, Germany, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Research Center of Immunotherapy (FZI), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Jörg Faber
- Department of Pediatric Hematology/Oncology, Center for Pediatric and Adolescent Medicine, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- University Cancer Center (UCT), University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Helmholtz-Institute for Translational Oncology Mainz (HI-TRON), 55131 Mainz, Germany
- German Cancer Consortium (DKTK), Site Frankfurt/Mainz, Germany, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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14
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Vallero SG, Bertero L, Morana G, Sciortino P, Bertin D, Mussano A, Ricci FS, Peretta P, Fagioli F. Pediatric diffuse midline glioma H3K27- altered: A complex clinical and biological landscape behind a neatly defined tumor type. Front Oncol 2023; 12:1082062. [PMID: 36727064 PMCID: PMC9885151 DOI: 10.3389/fonc.2022.1082062] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
The 2021 World Health Organization Classification of Tumors of the Central Nervous System, Fifth Edition (WHO-CNS5), has strengthened the concept of tumor grade as a combination of histologic features and molecular alterations. The WHO-CNS5 tumor type "Diffuse midline glioma, H3K27-altered," classified within the family of "Pediatric-type diffuse high-grade gliomas," incarnates an ideally perfect integrated diagnosis in which location, histology, and genetics clearly define a specific tumor entity. It tries to evenly characterize a group of neoplasms that occur primarily in children and midline structures and that have a dismal prognosis. Such a well-defined pathological categorization has strongly influenced the pediatric oncology community, leading to the uniform treatment of most cases of H3K27-altered diffuse midline gliomas (DMG), based on the simplification that the mutation overrides the histological, radiological, and clinical characteristics of such tumors. Indeed, multiple studies have described pediatric H3K27-altered DMG as incurable tumors. However, in biology and clinical practice, exceptions are frequent and complexity is the rule. First of all, H3K27 mutations have also been found in non-diffuse gliomas. On the other hand, a minority of DMGs are H3K27 wild-type but have a similarly poor prognosis. Furthermore, adult-type tumors may rarely occur in children, and differences in prognosis have emerged between adult and pediatric H3K27-altered DMGs. As well, tumor location can determine differences in the outcome: patients with thalamic and spinal DMG have significantly better survival. Finally, other concomitant molecular alterations in H3K27 gliomas have been shown to influence prognosis. So, when such additional mutations are found, which one should we focus on in order to make the correct clinical decision? Our review of the current literature on pediatric diffuse midline H3K27-altered DMG tries to address such questions. Indeed, H3K27 status has become a fundamental supplement to the histological grading of pediatric gliomas; however, it might not be sufficient alone to exhaustively define the complex biological behavior of DMG in children and might not represent an indication for a unique treatment strategy across all patients, irrespective of age, additional molecular alterations, and tumor location.
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Affiliation(s)
- Stefano Gabriele Vallero
- Pediatric Oncohematology Division, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy,*Correspondence: Stefano Gabriele Vallero,
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Department of Neuroscience, University of Turin, Turin, Italy
| | - Paola Sciortino
- Department of Neuroradiology, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Daniele Bertin
- Pediatric Oncohematology Division, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Anna Mussano
- Radiotherapy Unit, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Federica Silvia Ricci
- Child and Adolescent Neuropsychiatry Division, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Paola Peretta
- Pediatric Neurosurgery Division, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Franca Fagioli
- Pediatric Oncohematology Division, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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15
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Jovanovich N, Habib A, Head J, Hameed F, Agnihotri S, Zinn PO. Pediatric diffuse midline glioma: Understanding the mechanisms and assessing the next generation of personalized therapeutics. Neurooncol Adv 2023; 5:vdad040. [PMID: 37152806 PMCID: PMC10162114 DOI: 10.1093/noajnl/vdad040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Diffuse midline glioma (DMG) is a pediatric cancer that originates in the midline structures of the brain. Prognosis of DMG patients remains poor due to the infiltrative nature of these tumors and the protection they receive from systemically delivered therapeutics via an intact blood-brain barrier (BBB), making treatment difficult. While the cell of origin remains disputed, it is believed to reside in the ventral pons. Recent research has pointed toward epigenetic dysregulation inducing an OPC-like transcriptomic signature in DMG cells. This epigenetic dysregulation is typically caused by a mutation (K27M) in one of two histone genes-H3F3A or HIST1H3B -and can lead to a differentiation block that increases these cells oncogenic potential. Standard treatment with radiation is not sufficient at overcoming the aggressivity of this cancer and only confers a survival benefit of a few months, and thus, discovery of new therapeutics is of utmost importance. In this review, we discuss the cell of origin of DMGs, as well as the underlying molecular mechanisms that contribute to their aggressivity and resistance to treatment. Additionally, we outline the current standard of care for DMG patients and the potential future therapeutics for this cancer that are currently being tested in preclinical and clinical trials.
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Affiliation(s)
- Nicolina Jovanovich
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ahmed Habib
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeffery Head
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Farrukh Hameed
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sameer Agnihotri
- Sameer Agnihtroi, PhD, 4401 Penn Avenue, Office 7126, Pittsburgh, PA 15224, USA ()
| | - Pascal O Zinn
- Corresponding Authors: Pascal O. Zinn, MD, PhD, 5150 Centre Ave. Suite 433, Pittsburgh, PA 15232, USA ()
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16
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Di Nunno V, Franceschi E, Gatto L, Tosoni A, Bartolini S, Brandes AA. How to treat histone 3 altered gliomas: molecular landscape and therapeutic developments. Expert Rev Clin Pharmacol 2023; 16:17-26. [PMID: 36576307 DOI: 10.1080/17512433.2023.2163385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Diffuse midline gliomas (DMG) and diffuse hemispheric glioma (DHG) are both rare tumors characterized and recognized for specific alterations of histone 3 including H3K27 (DMG) and H3G34 (DHG). Despite these tumors arising from alterations of the same gene their clinical, radiological, and molecular behaviors strongly diverge, requiring a personalized therapeutic approach. AREAS COVERED We performed a review on Medline/PudMed aiming to search papers relative to prospective trials, retrospective studies, case series, and case reports of interest in order to investigate current knowledge toward the main clinical and molecular characteristics, radiology, and diagnosis, loco-regional and systemic treatments of these tumors. Moreover, we also evaluated the novel treatments under investigation. EXPERT OPINION Thanks to an increased knowledge of the genomic landscape of these rare tumors, there are novels promising therapeutic targets for these malignancies. However, the majority of available trials allowed enrollment only in DMG, while few studies are focused on or allow the inclusion of DHG patients.
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Affiliation(s)
| | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Italy
| | - Lidia Gatto
- Department of Oncology, AUSL Bologna, Bologna, Italy
| | - Alicia Tosoni
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Italy
| | - Stefania Bartolini
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Italy
| | - Alba Ariela Brandes
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Italy
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17
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Shalita C, Hanzlik E, Kaplan S, Thompson EM. Immunotherapy for the treatment of pediatric brain tumors: a narrative review. Transl Pediatr 2022; 11:2040-2056. [PMID: 36643672 PMCID: PMC9834947 DOI: 10.21037/tp-22-86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/27/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The goal of this narrative review is to report and summarize the completed pediatric immunotherapy clinical trials for primary CNS tumors. Pediatric central nervous system (CNS) tumors are the most common cause of pediatric solid cancer in children aged 0 to 14 years and the leading cause of cancer mortality. Survival rates for some pediatric brain tumors have improved, however, there remains a large portion of pediatric brain tumors with poor survival outcomes despite advances in treatment. Cancer immunotherapy is a growing field that has shown promise in the treatment of pediatric brain tumors that have historically shown a poor response to treatment. This narrative review provides a summary and discussion of the published literature focused on treating pediatric brain tumors with immunotherapy. METHODS MEDLINE via PubMed, Embase and Scopus via Elsevier were searched. The search utilized a combination of keywords and subject headings to include pediatrics, brain tumors, and immunotherapies. Manuscripts included in the analysis included completed clinical studies using any immunotherapy intervention with a patient population that consisted of at least half pediatric patients (<18 years) with primary CNS tumors. Conference abstracts were excluded as well as studies that did not include completed safety or primary outcome results. KEY CONTENT AND FINDINGS Search results returned 1,494 articles. Screening titles and abstracts resulted in 180 articles for full text review. Of the 180 articles, 18 were included for analysis. Another two articles were ultimately included after review of references and inclusion of newly published articles, for a total of 20 included articles. Immunotherapies included dendritic cell vaccines, oncolytic virotherapy/viral immunotherapy, chimeric antigen receptor (CAR) T-cell therapy, peptide vaccines, immunomodulatory agents, and others. CONCLUSIONS In this review, 20 published articles were highlighted which use immunotherapy in the treatment of primary pediatric brain tumors. To date, most of the studies published utilizing immunotherapy were phase I and pilot studies focused primarily on establishing safety and maximum dose-tolerance and toxicity while monitoring survival endpoints. With established efficacy and toxicity profiles, future trials may progress to further understanding the overall survival and quality of life benefits to pediatric patients with primary brain tumors.
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Affiliation(s)
| | - Emily Hanzlik
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Samantha Kaplan
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Eric M Thompson
- Department of Neurosurgery, Duke University, Durham, NC, USA.,Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
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18
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Vuong HG, Le HT, Jea A, McNall-Knapp R, Dunn IF. Risk stratification of H3 K27M-mutant diffuse midline gliomas based on anatomical locations: an integrated systematic review of individual participant data. J Neurosurg Pediatr 2022; 30:99-106. [PMID: 35535848 PMCID: PMC10193490 DOI: 10.3171/2022.3.peds2250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/24/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The prognostic significance and genetic characteristics of H3 K27M-mutant diffuse midline gliomas (DMGs) in different anatomical locations requires further clarification. In this study, the authors integrated published data to investigate the differences between brainstem, thalamic, and spinal cord tumors. METHODS PubMed and Web of Science databases were used to search for eligible articles. Studies were included if they provided individual patient data of H3 K27M-mutant DMGs with available tumor locations. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed to investigate the survival of each subgroup. RESULTS Eight hundred four tumors were identified, including 467, 228, and 109 in the brainstem, thalamus, and spine, respectively. Brainstem tumors were primarily observed in young children, while patients with thalamic and spinal cord tumors afflicted older patients. The Ki-67 labeling index was highest in brainstem tumors. Compared to patients with brainstem tumors, those with thalamic (HR 0.573, 95% CI 0.463-0.709; p < 0.001) and spinal cord lesions (HR 0.460, 95% CI 0.341-0.621; p < 0.001) had a significantly better survival. When patients were stratified by age groups, superior overall survival (OS) of thalamic tumors was observed in comparison to brainstem tumors in young children and adolescents, whereas adult tumors had uniform OS regardless of anatomical sites. Genetically, mutations in HIST1H3B/C (H3.1) and ACVR1 genes were mostly detected in brainstem tumors, whereas spinal cord tumors were characterized by a higher incidence of mutations in the TERT promoter. CONCLUSIONS This study demonstrated that H3 K27M-mutant DMGs have distinct clinical characteristics, prognoses, and molecular profiles in different anatomical locations.
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Affiliation(s)
- Huy Gia Vuong
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, Oklahoma
| | - Hieu Trong Le
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam; and
| | - Andrew Jea
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, Oklahoma
| | - Rene McNall-Knapp
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, Oklahoma
| | - Ian F. Dunn
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, Oklahoma
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19
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Zheng L, Gong J, Yu T, Zou Y, Zhang M, Nie L, Chen X, Yue Q, Liu Y, Mao Q, Zhou Q, Chen N. Diffuse Midline Gliomas With Histone H3 K27M Mutation in Adults and Children: A Retrospective Series of 164 Cases. Am J Surg Pathol 2022; 46:863-871. [PMID: 35416795 PMCID: PMC9093723 DOI: 10.1097/pas.0000000000001897] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Diffuse midline glioma, H3 K27M-mutant (H3 K27M-mt DMG), is a rare and highly aggressive tumor that is more common in children than in adults. Few studies have compared the differences between pediatric and adult patients with this rare tumor. We here report our retrospective study of 94 adult and 70 pediatric cases of diffuse midline glioma. Surgical tumor samples were analyzed by routine histopathology and immunohistochemistry for H3 K27M, IDH1 R132H, ATRX, p53, OLIG2, glial fibrillary acidic protein, and Ki-67; Sanger sequencing for hot mutation spots in genes including H3F3A, HIST1H3B, IDH1, IDH2, TERT, and BRAF; and methylation-specific polymerase chain reaction for O6-methylguanine DNA methyltransferase promoter methylation. The most frequent anatomic locations in adult and pediatric patients were the thalamus and brainstem, respectively. Molecular profiling revealed higher frequencies of ATRX loss and H3.3 mutation in adult than in pediatric H3 K27M-mt DMGs. TERT promoter mutations and O6-methylguanine DNA methyltransferase promoter methylation were not detected in pediatric patients but were present in a few adult patients. During the follow-up period, 93/122 patients (70.1%) died from the disease, with a median survival time of 10.5 months (range: 1 to 104 mo). Kaplan-Meier analyses demonstrated that the prognosis was better for adult patients than the pediatric cohort (P=0.0003). Multivariate analyses indicated that patient age, primary tumor size, status of ATRX expression, and Ki-67 index were independent prognosticators. The present study showed that there were differences between adult and pediatric H3 K27M-mt DMGs in terms of the anatomic location of tumor, molecular changes, and prognosis.
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Affiliation(s)
- Linmao Zheng
- Department of Pathology, National Key Laboratory of Biotherapy
| | - Jing Gong
- Department of Pathology, National Key Laboratory of Biotherapy
| | - Tianping Yu
- Department of Pathology, National Key Laboratory of Biotherapy
| | - Yan Zou
- Department of Pathology, National Key Laboratory of Biotherapy
| | - Mengni Zhang
- Department of Pathology, National Key Laboratory of Biotherapy
| | - Ling Nie
- Department of Pathology, National Key Laboratory of Biotherapy
| | - Xueqin Chen
- Department of Pathology, National Key Laboratory of Biotherapy
| | | | - Yanhui Liu
- Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qing Mao
- Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qiao Zhou
- Department of Pathology, National Key Laboratory of Biotherapy
| | - Ni Chen
- Department of Pathology, National Key Laboratory of Biotherapy
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20
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Adult diffuse midline gliomas H3 K27-altered: review of a redefined entity. J Neurooncol 2022; 158:369-378. [PMID: 35567713 DOI: 10.1007/s11060-022-04024-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Diffuse midline glioma (DMG) H3 K27-altered is a type of high-grade gliomas first recognized as a new entity in the 2016 World Health Organization Classification of Central Nervous System (CNS) Tumors as DMG H3 K27M-mutant, recently renamed in the new 2021 WHO classification. The aim of this review is to describe the characteristics of diffuse midline gliomas H3 K27-altered in the adult population. METHODS We performed a review of the current literature regarding the genetic, clinical, imaging characteristics and management of diffuse midline gliomas H3 K27-altered in adult patients. RESULTS The 2021 WHO classification now designates the previously recognized DMG H3K27M-mutant as DMG H3 K27-altered, recognizing the alternative mechanisms by which the pathogenic pathway can be altered. Thus, the diagnostic criteria for this entity consist of diffuse growth pattern, midline anatomic location, and H3 K27-specific neuroglial mutations. DMGs' characteristic midline location makes them difficult to surgically resect and biopsy, carrying high mortality and morbidity rates, with median survival ranging from 9 to 12 months in adult patients. CONCLUSION The diagnosis of DMGs H3 K27-altered in adult patients should be considered upon neurological symptoms associated with an infiltrative midline brain tumor detected on imaging. Future studies are necessary to continue refining their characteristics in this age group.
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21
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Vuong HG, Ngo TNM, Le HT, Jea A, Hrachova M, Battiste J, McNall-Knapp R, Dunn IF. Prognostic Implication of Patient Age in H3K27M-Mutant Midline Gliomas. Front Oncol 2022; 12:858148. [PMID: 35371982 PMCID: PMC8971724 DOI: 10.3389/fonc.2022.858148] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/28/2022] [Indexed: 01/02/2023] Open
Abstract
IntroductionPediatric and adult H3K27M-mutant midline gliomas have variable clinical presentations, prognoses, and molecular backgrounds. In this study, we integrated data from published studies to investigate the differences between these two groups.MethodsPubMed and Web of Science were searched for potential data. Studies were included if they had available individual participant data on patients age of H3K27M-mutant midline gliomas. For time-to-event analyses, Kaplan-Meier analysis and Cox regression models were carried out; corresponding hazard ratios (HR) and 95% confidence intervals (CI) were computed to analyze the impact of age and clinical covariates on progression-free survival (PFS) and overall survival (OS).ResultsWe included 43 studies comprising 272 adults and 657 pediatric midline gliomas with H3K27M mutation for analyses. In adults, there was a male predilection whereas females were slightly more common than males in the pediatric group. Spinal cord tumors were more frequent in adults. The prevalence of H3.1 K27M mutation was significantly higher in the pediatric cohort. Compared to adult patients, pediatric H3K27M-mutant midline gliomas exhibited more aggressive features including higher rates of pathologic features of high-grade tumors and Ki67 proliferation index, and had a shorter PFS and OS. Genetically, ACVR1 mutations were more common whereas MGMT methylation, FGFR1, and NF1 mutations were less prevalent in the pediatric cohort.ConclusionPediatric H3K27M-mutant midline gliomas were demographically, clinically, and molecularly distinct from adult patients, highlighting an opportunity to refine the risk stratification for these neoplasms.
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Affiliation(s)
- Huy Gia Vuong
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, OK, United States
| | - Tam N. M. Ngo
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hieu Trong Le
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Andrew Jea
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Oklahoma Children’s Hospital, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, OK, United States
| | - Maya Hrachova
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, OK, United States
| | - James Battiste
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, OK, United States
| | - Rene McNall-Knapp
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, OK, United States
| | - Ian F. Dunn
- Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma University, Oklahoma City, OK, United States
- *Correspondence: Ian F. Dunn,
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22
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Neth BJ, Balakrishnan SN, Carabenciov ID, Uhm JH, Daniels DJ, Kizilbash SH, Ruff MW. Panobinostat in adults with H3 K27M-mutant diffuse midline glioma: a single-center experience. J Neurooncol 2022; 157:91-100. [PMID: 35076860 DOI: 10.1007/s11060-022-03950-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Diffuse midline gliomas (DMG) with the H3 K27M-mutation are a well-described entity with most DMG harboring this mutation, with notable heterogeneity in adults. No therapy has been proven to improve survival in this tumor type. Panobinostat is a histone deacetylase inhibitor that may have therapeutic benefit. METHODS We report our retrospective experience with use of panobinostat in adults (> 18 years) with H3 K27M-mutant DMG treated at Mayo Clinic (Rochester) from January 2016 to August 2020, with follow-up until October 2021. Survival was calculated using the Kaplan-Meier method. RESULTS 4 patients with H3 K27M-mutant glioma were treated with panobinostat as compassionate use. Patients had a median age of 40 years (range 22-62 years) and 2 were female. Tumor location was midline for all patients, spinal cord (n = 2), brainstem (n = 1), and thalamus (n = 1). All tumors were IDH1/IDH2 wildtype. 3 patients received radiotherapy followed by adjuvant panobinostat. All patients had no other pharmacologic therapy utilized prior to or during panobinostat therapy aside from concurrent dexamethasone utilized in 3 patients. No patient experienced a grade 2 or higher (per CTCAE grade) adverse effect. The median overall survival was 42 months, median progression free survival of 19 months, 2 patients were alive at last follow up (both with spinal cord tumors and received radiation). The best response was stable disease in 2 patients and a partial response in 1 patient. CONCLUSIONS This is the first report of clinical outcomes of panobinostat in adults with H3 K27M-mutant DMG. We showed that it is well-tolerated at the dosage schedule that we describe, with no serious adverse effects throughout the study period.
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Affiliation(s)
- Bryan J Neth
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Ivan D Carabenciov
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Joon H Uhm
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Michael W Ruff
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
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23
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Adult H3K27M mutated thalamic glioma patients display a better prognosis than unmutated patients. J Neurooncol 2022; 156:615-623. [PMID: 34994963 DOI: 10.1007/s11060-022-03943-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adult thalamic gliomas are a rare entity whose management is challenging for physicians. The aim of this study is to describe the characteristics and prognostic factors of thalamic gliomas in adult patients. METHODS We retrospectively analyzed the clinical, neuro-radiological, histological, and molecular characteristics of all cases of adult thalamic glioma in our regional center. RESULTS We included 38 adult patients. Median age at diagnosis was 56.5 years old (range, 24-80). Median KPS at diagnosis was 70%. Two-thirds of patients presented with tumor necrosis on MRI. Bithalamic lesions were present in four patients. The median volume of enhancement associated with lesions was relatively small (14 mm3). Two patients had undergone partial surgical resection. All other patients underwent biopsy. Median PFS was 7.1 months (95% CI [3.7-10.5]) and median OS was 15.6 months (95% CI [11.7-19.6]). Among 20 patients with available tumor samples for molecular analyses, only 4 (20%) presented with H3K27M mutation. Patients with H3K27M mutation had longer survival compared to those without. Finally, we identified a long-term survivor population characterized by a younger age, no cognitive impairment, low steroid dose treatment and the presence of H3K27M mutation. CONCLUSION Thalamic adult glioma differs from bithalamic glioma in children with regards to its clinical, radiological and molecular profiles. Long-term survival is observed in young patients with limited symptoms and H3K27M mutation. A larger prospective cohort is needed to validate these findings.
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Crowell C, Mata-Mbemba D, Bennett J, Matheson K, Mackley M, Perreault S, Erker C. Systematic review of diffuse hemispheric glioma, H3 G34-mutant: Outcomes and associated clinical factors. Neurooncol Adv 2022; 4:vdac133. [PMID: 36105387 PMCID: PMC9466272 DOI: 10.1093/noajnl/vdac133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background A comprehensive review and description of the clinical features that impact prognosis for patients with diffuse hemispheric glioma, H3 G34-mutant (G34-DHG) is needed. Understanding survival and prognostic features is paramount for clinical advancements and patient care. Methods PubMed, Embase, and Google Scholar were searched for English articles published between January 1, 2012 and June 30, 2021. Eligible studies included patient(s) of any age diagnosed with an H3 G34-mutant brain tumor with at least one measure of survival or progression. Patient-level data were pooled for analyses. This study was prospectively registered in PROSPERO (CRD42021267764) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results Twenty-seven studies met the criteria with a total of 135 patients included. Median age at diagnosis was 15.8 years (interquartile range [IQR]: 13.3–22.0) with 90% having localized disease. Co-occurring alterations included ATRX mutation in 93%, TP53 mutation in 88%, and MGMT promoter methylation in 70%. Median time-to-progression was 10.0 months (IQR: 6.0–18.0) and median overall survival was 17.3 months (95% CI: 15.0 to 22.9). The median time from progression to death was 5.0 months (IQR: 3.0–11.7). Factors associated with survival duration were age, as patients ≥18 y/o demonstrated longer survival (hazard ratio [HR] =2.05, 95% CI: 1.16 to 3.62), and degree of upfront resection, as near or gross-total resection demonstrated longer survival compared to those with less than near-total resection (HR = 3.75, 95% CI: 2.11 to 6.62). Conclusion This systematic review highlights available clinical data for G34-DHG demonstrating poor outcomes and important prognostic features, while serving as a baseline for future research and clinical trials.
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Affiliation(s)
- Cameron Crowell
- Division of Hematology and Oncology, IWK Health Centre , Halifax, Nova Scotia , Canada
- Faculty of Science, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Daddy Mata-Mbemba
- Department of Diagnostic Imaging, IWK Health Centre , Halifax, Nova Scotia , Canada
| | - Julie Bennett
- Division of Hematology and Oncology, The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority , Halifax, Nova Scotia , Canada
| | - Michael Mackley
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children , Toronto, Ontario , Canada
| | - Sébastien Perreault
- Department of Pediatrics, Centre Hospitalier Universitaire de Sainte-Justine , Montreal, Quebec , Canada
| | - Craig Erker
- Division of Hematology and Oncology, IWK Health Centre , Halifax, Nova Scotia , Canada
- Department of Pediatrics, Dalhousie University , Halifax , Nova Scotia , Canada
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Vuong HG, Le HT, Ngo TNM, Fung KM, Battiste JD, McNall-Knapp R, Dunn IF. H3K27M-mutant diffuse midline gliomas should be further molecularly stratified: an integrated analysis of 669 patients. J Neurooncol 2021; 155:225-234. [PMID: 34796414 DOI: 10.1007/s11060-021-03890-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/29/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION H3K27M-mutated diffuse midline gliomas (H3-DMGs) are aggressive tumors with a fatal outcome. This study integrating individual patient data (IPD) from published studies aimed to investigate the prognostic impact of different genetic alterations on survival of these patients. METHODS We accessed PubMed and Web of Science to search for relevant articles. Studies were included if they have available data of follow-up and additional molecular investigation of H3-DMGs. For survival analysis, Kaplan-Meier analysis and Cox regression models were utilized, and corresponding hazard ratios (HR) and 95% confidence intervals (CI) were computed to analyze the impact of genetic events on overall survival (OS). RESULT We included 30 studies with 669 H3-DMGs. TP53 mutations were the most common second alteration among these neoplasms. In univariate Cox regression model, TP53 mutation was an indicator of shortened survival (HR 1.446; 95% CI 1.143-1.829) whereas ACVR1 (HR 0.712; 95% CI 0.518-0.976) and FGFR1 mutations (HR 0.408; 95% CI 0.208-0.799) conferred prolonged survival. In addition, ATRX loss was also associated with a better OS (HR 0.620; 95% CI 0.386-0.996). Adjusted for age, gender, and tumor location, the presence of TP53 mutations, the absence of ACVR1 or FGFR1 mutations remained significantly poor prognostic factors. CONCLUSIONS We outlined the prognostic importance of additional genetic alterations in H3-DMGs and recommended that these neoplasms should be further molecularly segregated. This may aid neuro-oncologists in appropriate risk stratification.
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Affiliation(s)
- Huy Gia Vuong
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Hieu Trong Le
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700-000, Vietnam
| | - Tam N M Ngo
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 700-000, Vietnam
| | - Kar-Ming Fung
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - James D Battiste
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Rene McNall-Knapp
- Department of Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA.
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Chia N, Wong A, Teo K, Tan AP, Vellayappan BA, Yeo TT, Oh SY, Tan CL. H3K27M-mutant, hemispheric diffuse glioma in an adult patient with prolonged survival. Neurooncol Adv 2021; 3:vdab135. [PMID: 34647024 PMCID: PMC8500686 DOI: 10.1093/noajnl/vdab135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Noel Chia
- Department of Pathology, National University Health System, Singapore
| | - Andrea Wong
- Department of Medical Oncology, National University Health System, Singapore
| | - Kejia Teo
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
| | - Ai Peng Tan
- Department of Diagnostic Imaging, National University Health System, Singapore
| | | | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
| | - Shoo Yi Oh
- Department of Pathology, National University Health System, Singapore
| | - Char Loo Tan
- Department of Pathology, National University Health System, Singapore
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Cheng R, Li DP, Zhang N, Zhang JY, Zhang D, Liu TT, Yang J, Ge M. Spinal Cord Diffuse Midline Glioma With Histone H3 K27M Mutation in a Pediatric Patient. Front Surg 2021; 8:616334. [PMID: 34222313 PMCID: PMC8245756 DOI: 10.3389/fsurg.2021.616334] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/20/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Diffuse midline glioma (DMG) with histone H3 K27M mutation is a recently identified entity documented in the 2016 World Health Organization (WHO) Classification of Tumors of the Central Nervous System. Spinal cord DMGs with H3 K27M-mutant are commonly reported in adults. Herein, we reported a pediatric patient with spinal cord H3 K27M-mutant DMG. Case Report: A 7-year-old girl with 1-month history of neck pain and 3-week history of progressive weakness in the right hand was presented. Spinal magnetic resonance imaging showed an intramedullary lesion with slight enhancement at the C2-7 levels. With intraoperative neuroelectrophysiological monitoring, the lesion was subtotally resected. Histopathological examination revealed a DMG with histone H3 K27M mutation corresponding to WHO grade IV. Postoperatively, the neck pain was relieved, and the upper-extremity weakness remained unchanged. Oral temozolomide was administrated for 7 months, and radiotherapy was performed for 22 courses. After an 18-month follow-up, no tumor recurrence was noted. Conclusion: Spinal cord H3 K27M-mutant DMGs are extremely rare in pediatric patients. Preoperative differential diagnosis is challenging, and surgical resection with postoperative chemoradiotherapy may be an effective treatment.
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Affiliation(s)
- Ran Cheng
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Da-Peng Li
- Department of Neurosurgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- Department of Pathology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ji-Yin Zhang
- Department of Otolaryngology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Di Zhang
- Department of Neurosurgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Liu
- Department of Emergency Surgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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