PROGNOSTIC FACTORS IN FOLLICULAR LYMPHOMA IN THE RITUXIMAB ERA: HOW TO IDENTIFY A HIGH-RISK PATIENT?

Comprehensive analysis of differentially expressed profiles of lncRNAs and mRNAs reveals ceRNA networks in the transformation of diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is one of the malignancies with a high mortality rate. The molecular mechanisms involved in transformation of DLBCL remain unclear. Therefore, it is critically important to investigate the biological mechanisms of DLBCL. Accumulating evidence indicates that long non-coding RNAs (lncRNAs) serve key functions in tumorigenesis, cancer progression and metastasis. Compared with follicular lymphoma (FL), a total of 123 upregulated lncRNAs and 192 downregulated lncRNAs in DLBCL were identified. Subsequently, a specific DLBCL-associated competing endogenous RNA (ceRNA) network and a specific FL-associated ceRNA network was constructed. Gene Oncology and Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that differentially expressed lncRNAs served key functions in regulating signal transduction, transcription, cell adhesion, development and protein amino acid phosphorylation. Furthermore, the molecular functions of PRKCQ antisense RNA 1, HLA complex P5, OIP5 antisense RNA 1, growth arrest specific 5 and taurine upregulated 1 were investigated, and it was revealed that these lncRNAs served important functions in regulating a series of biological processes, including anti-apoptosis, cell cycle, DNA repair, response to oxidative stress and transcription. The present study may provide a potential novel therapeutic and prognostic target for the treatment of DLBCL.

Follicular Lymphoma: A Clinicopathological Analysis from a Tertiary Care Institute in Southern India

Introduction

Follicular lymphoma (FL) is an indolent lymphoproliferative disorder of B-cells with variable clinical behavior. It is the second most common subtype of Non-Hodgkin lymphoma in western countries but reported to have a lower incidence in Asia.

Materials and methods

Cases of FL diagnosed in the Department of Pathology of our Institute from January 2009 to June 2015 were included in the study. The clinicopathological parameters including staging, histological details, and immunohistochemical markers CD20, CD10 and BCL-2 were recorded in all the cases.

Results

Of the 497 cases of Non-Hodgkin Lymphoma reported during the study period, 36 (7.2%) cases were follicular lymphoma. The mean age was 50 years with male to female ratio of 3.2:1. Grade 1/2 was seen in 70% cases. 22 % cases had low grade with high proliferation index (Ki67 > 40%). Granulomatous response was seen in two cases. Diffuse large cell lymphoma component was present in four cases. Bone marrow involvement and peripheral blood spill were seen in 12 (37.5%) and six cases (18.8%) respectively. 72% cases were in stage 3 or 4.

Conclusion

The incidence of FL was lower in our study than other Indian studies. FL presented in the elderly, with male predominance and disseminated stage. The study highlights features of low grade with high proliferation index, granulomatous response, leukemic involvement, and transformation to high grade lymphoma.

High baseline serum thymidine kinase 1 level predicts unfavorable outcome in patients with follicular lymphoma

Serum thymidine kinase 1 (TK1) is a sensitive marker of tumor cell proliferation. TK1 has been reported as a reliable prognostic factor in solid tumors and chronic lymphocytic leukemia, but has not yet been tested in large populations of patients with non-Hodgkin lymphoma. In this study, the prognostic significance of TK1 levels was assessed in 170 prospectively enrolled patients with previously untreated follicular lymphoma (FL). The TK1 level at the time of treatment initiation was shown to correlate with the clinical stage, Follicular Lymphoma International Prognostic Index (FLIPI) score, β(2)-microglobulin level, lactate dehydrogenase level and B symptoms. No correlation was found with FL grade or Ki-67 proliferation index. Cox regression analysis identified high TK1 levels (≥ 15I U/L) as a prognostic factor for overall survival (hazard ratio 2.91, p = 0.019) and progression-free survival (hazard ratio 1.94, p = 0.022) independent of FLIPI score variables. Thus, TK1 levels may help to refine risk assessment in the modern immunotherapy era.