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Vogt SL, Patel M, Lakha A, Philip V, Omar T, Ashmore P, Pather S, Haley LM, Zheng G, Stone J, Mayne E, Stevens W, Wagner-Johnston N, Gocke CD, Martinson NA, Ambinder RF, Xian RR. Feasibility of Cell-Free DNA Collection and Clonal Immunoglobulin Sequencing in South African Patients With HIV-Associated Lymphoma. JCO Glob Oncol 2021; 7:611-621. [PMID: 33909482 PMCID: PMC8162966 DOI: 10.1200/go.20.00651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Diagnosis of AIDS lymphoma in low-resource settings, like South Africa, is often delayed, leaving patients with limited treatment options. In tuberculosis (TB) endemic regions, overlapping signs and symptoms often lead to diagnostic delays. Assessment of plasma cell-free DNA (cfDNA) by next-generation sequencing (NGS) may expedite the diagnosis of lymphoma but requires high-quality cfDNA. METHODS People living with HIV with newly diagnosed aggressive B-cell lymphoma and those with newly diagnosed TB seeking care at Chris Hani Baragwanath Academic Hospital and its surrounding clinics, in Soweto, South Africa, were enrolled in this study. Each participant provided a whole blood specimen collected in cell-stabilizing tubes. Quantity and quality of plasma cfDNA were assessed. NGS of the immunoglobulin heavy chain was performed. RESULTS Nine HIV+ patients with untreated lymphoma and eight HIV+ patients with TB, but without lymphoma, were enrolled. All cfDNA quantity and quality metrics were similar between the two groups, except that cfDNA accounted for a larger fraction of recovered plasma DNA in patients with lymphoma. The concentration of cfDNA in plasma also trended higher in patients with lymphoma. NGS of immunoglobulin heavy chain showed robust amplification of DNA, with large amplicons (> 250 bp) being more readily detected in patients with lymphoma. Clonal sequences were detected in five of nine patients with lymphoma, and none of the patients with TB. CONCLUSION This proof-of-principle study demonstrates that whole blood collected for cfDNA in a low-resource setting is suitable for sophisticated sequencing analyses, including clonal immunoglobulin NGS. The detection of clonal sequences in more than half of patients with lymphoma shows promise as a diagnostic marker that may be explored in future studies.
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Affiliation(s)
- Samantha L Vogt
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Moosa Patel
- Clinical Haematology Unit, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Atul Lakha
- Clinical Haematology Unit, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vinitha Philip
- Clinical Haematology Unit, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanvier Omar
- Division of Anatomical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philippa Ashmore
- Clinical Haematology, Netcare Olivedale Hospital, Johannesburg, South Africa
| | - Sugeshnee Pather
- Division of Anatomical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa M Haley
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Gang Zheng
- Department of Pathology, Mayo Clinic, Rochester, MN
| | - Jennifer Stone
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Elizabeth Mayne
- Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa
| | - Wendy Stevens
- Department of Immunology, Faculty of Health Sciences, University of Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Nina Wagner-Johnston
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Christopher D Gocke
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Neil A Martinson
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.,Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
| | - Richard F Ambinder
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rena R Xian
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD.,Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD
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Pather S, Mashele T, Willem P, Patel M, Perner Y, Motaung M, Nagiah N, Waja F, Philip V, Lakha A, Hale MJ. MYC status in HIV-associated plasmablastic lymphoma: dual-colour CISH, FISH and immunohistochemistry. Histopathology 2021; 79:86-95. [PMID: 33450085 DOI: 10.1111/his.14336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/30/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
AIMS We utilised chromogenic and fluorescence in-situ hybridisation (CISH and FISH) to evaluate MYC gene copy numbers and rearrangements within HIV-associated plasmablastic lymphomas (PBLs). Thereafter, clinicopathological features were explored retrospectively. METHODS AND RESULTS Sixty-seven (n = 67) patients were included and the HIV seropositive status was confirmed in 98% (63 of 64) with a median viral load of 55 587 (IQR 273 582) copies/ml and median CD4 count of 170 (IQR 249) cells/µl. The mean age was 41 ± 10.1 years and females comprised 54%. PBL was documented predominantly at extra-oronasal topographic regions. Starry-sky (SS) appearance was evident in 33% in association with monomorphic morphology (P-value 0.02). c-MYC protein was expressed in 81% and latent EBV infection was detected in 90%. EBER ISH-positive status and MYC rearrangement occurred in 67% of HIV PBL. MYC aberrations included MYC rearrangement (70%), low-level increase in MYC gene copy numbers (43%), concurrent MYC rearrangement and increased MYC gene copy numbers (49%) as well as low-level chromosome 8 polysomy (6%). MYC aberrations in HIV PBLs were significantly associated with SS appearance (P -0.01), monomorphic morphology (P - 0.03), c-MYC protein expression ≥40% (P - 0.03) and mortality (P - 0.03). There was advanced stage (Ann Arbor III/IV) at presentation (77%) and the median overall survival for HIV PBL was 75 days (95% CI 14-136). CONCLUSION Majority of the HIV-associated PBL tumours harbour MYC aberrations. Due to the persistently inferior survival outcome of HIV-associated PBL in the era of antiviral treatment, targeted and/or intensified therapy of oncogenic MYC may need to be explored in future.
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Affiliation(s)
- Sugeshnee Pather
- Division of Anatomical Pathology, Faculty of Health Sciences, National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Thembi Mashele
- Division of Anatomical Pathology, Faculty of Health Sciences, National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Pascale Willem
- Department of Haematology and Molecular Medicine, Somatic Cell Genetics Unit, Faculty of Health Sciences, National Health Laboratory Service, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Moosa Patel
- Department of Medicine, Clinical Haematology unit, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Yvonne Perner
- Faculty of Health Sciences, Division of Anatomical Pathology, National Health Laboratory Service, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Mantoa Motaung
- Division of Anatomical Pathology, Faculty of Health Sciences, National Health Laboratory Service, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Natasha Nagiah
- Department of Haematology and Molecular Medicine, Somatic Cell Genetics Unit, Faculty of Health Sciences, National Health Laboratory Service, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Faadil Waja
- Department of Medicine, Clinical Haematology unit, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Vinitha Philip
- Department of Medicine, Clinical Haematology unit, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Atul Lakha
- Department of Medicine, Clinical Haematology unit, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Soweto, Gauteng, South Africa
| | - Martin J Hale
- Faculty of Health Sciences, Division of Anatomical Pathology, National Health Laboratory Service, University of the Witwatersrand, Soweto, Gauteng, South Africa
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Ashmore P, Patel M, Vaughan J, Wiggill T, Willem P, van den Berg E, Philip V, Lakha A. Hepatosplenic T-cell lymphoma: A case series. Hematol Oncol Stem Cell Ther 2014; 8:78-84. [PMID: 25450840 DOI: 10.1016/j.hemonc.2014.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/29/2014] [Accepted: 09/01/2014] [Indexed: 12/01/2022] Open
Abstract
Hepatosplenic T-cell lymphoma (HSTCL) is a rare type of Non-Hodgkin Lymphoma (NHL), grouped under the mature or peripheral T-cell lymphomas. It is characterised by extranodal infiltration and proliferation of malignant T-cells within the sinusoids of the liver, sinuses and red pulp of the spleen, and the bone marrow. The tumour cells express CD2 and CD3, but are CD4, CD5 and CD8 negative and express a clonally restricted gamma-delta (or less commonly alpha-beta) T-cell receptor. The disease has an aggressive clinical course associated with a poor prognosis. We highlight and report three patients from South Africa with HSTCL, all of whom had hepatosplenomegaly and cytopaenias, and despite being HIV seronegative and immunocompetent, had a poor outcome, with a mean survival of 7.5 months in the two evaluable patients. This rare entity has not previously been reported from South Africa and as yet needs to be adequately characterised in a population where lymphoma is the most common haematological malignancy in adults, and where approximately two thirds of the adult lymphoma population are HIV seropositive.
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Affiliation(s)
- Philippa Ashmore
- Division of Clinical Haematology, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Moosa Patel
- Division of Clinical Haematology, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jenifer Vaughan
- Department of Molecular Medicine and Haematology, NHLS (National Health Laboratory Services), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tracey Wiggill
- Department of Molecular Medicine and Haematology, NHLS (National Health Laboratory Services), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pascale Willem
- Department of Molecular Medicine and Haematology, NHLS (National Health Laboratory Services), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eunice van den Berg
- Department of Anatomical Pathology, NHLS (National Health Laboratory Services), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vinitha Philip
- Division of Clinical Haematology, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Atul Lakha
- Division of Clinical Haematology, Department of Medicine, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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