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Lamb M, Painter D, Howell D, Barrans S, Cargo C, de Tute R, Tooze R, Burton C, Patmore R, Roman E, Smith A. Lymphoid blood cancers, incidence and survival 2005-2023: A report from the UK's Haematological Malignancy Research Network. Cancer Epidemiol 2024; 88:102513. [PMID: 38160571 DOI: 10.1016/j.canep.2023.102513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Population-based information on cancer incidence and outcome are required to inform clinical practice and research; but contemporary data are lacking for many lymphoid cancer subtypes. METHODS Set within a socio-demographically representative UK population of ∼4 million, data are from an established UK patient cohort (N = 22,414 diagnoses). Information on incidence (crude and age-standardised) and survival (overall and net) is presented for > 40 subtypes. RESULTS The median diagnostic age was 69.9 years (interquartile range 59.1-78.3), but unlike many other cancers, lymphoid malignancies can be diagnosed at any age; different subtypes dominating at different ages. Males were more likely to be diagnosed than females (age-standardised sex rate ratio: 1.55 (95% Confidence Interval: 1.50,1.59)), and most subtypes had a male predominance, some more than three-fold (e.g. Burkitt lymphoma 3.26 (2.42, 4.40)). Five-year net survival estimates varied hugely, ranging from 97.4% (95% CI: 56.5, 99.9) in patients with hairy cell leukaemia to 31.6% (95% CI: 2.5, 69.8) in those with T-cell prolymphocytic leukaemia. No significant sex difference in survival were observed for the majority of diagnoses; one exception being classical Hodgkin lymphoma, where males had a higher mortality (Excess Mortality Ratio: 1.44 (95% CI: 1.11, 1.87)). An improvement in survival over time was observed for some, but not all, of the major diagnostic groups. CONCLUSIONS Marked incidence and survival variations by subtype, sex and age confirm the heterogeneity of lymphoid neoplasms and highlight the importance of accurately characterising disease entities. Despite recent improvements, routine cancer registration of lymphoid neoplasms remains challenging and new issues continue to emerge; including the lack of an international consensus on classification and the recording of progressions and transformations. Furthermore, the increasing need for additional molecular and genomic information required for accurate classification is likely to impact negatively on the quality of cancer registration data, especially in low income countries.
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Affiliation(s)
- Maxine Lamb
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Debra Howell
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Sharon Barrans
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Catherine Cargo
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Ruth de Tute
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Reuben Tooze
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St. James's University Hospital, Leeds, United Kingdom
| | - Russell Patmore
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, United Kingdom
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom.
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2
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Di Ciaccio PR, Polizzotto MN, Cwynarski K, Gerrie AS, Burton C, Bower M, Kuruvilla J, Montoto S, McKay P, Fox CP, Milliken S, Jiamsakul A, Osborne W, Collins GP, Manos K, Linton KM, Iyengar S, Kassam S, Limei MP, Kliman D, Wong Doo N, Watson AM, Fedele P, Yannakou CK, Hunt S, Ku M, Sehn LH, Smith A, Renshaw H, Maxwell A, Liu Q, Dhairyawan R, Ferguson G, Pickard K, Painter D, Thakrar N, Song KW, Hamad N. The influence of immunodeficiency, disease features, and patient characteristics on survival in plasmablastic lymphoma. Blood 2024; 143:152-165. [PMID: 37832030 DOI: 10.1182/blood.2023021348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/23/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
ABSTRACT Plasmablastic lymphoma (PBL) is a rare and aggressive non-Hodgkin lymphoma associated with immunodeficiency, characterized by uncertain treatment approaches and an unfavorable prognosis. We conducted a multicenter, international, retrospective cohort study, aiming to characterize the clinical features, risk factors, and outcomes of patients with PBL. Data were collected from 22 institutions across 4 countries regarding patients diagnosed with PBL between 1 January 1999 and 31 December 2020. Survival risk factors were analyzed using both univariate and multivariate regression models. Overall survival (OS) was calculated using Kaplan-Meier statistics. First-line treatment regimens were stratified into standard- and higher-intensity regimens, and based on whether they incorporated a proteasome inhibitor (PI). A total of 281 patients (median age, 55 years) were included. Immunodeficiency of any kind was identified in 144 patients (51%), and 99 patients (35%) had HIV-positive results. The 5-year OS for the entire cohort was 36% (95% confidence interval, 30%-42%). In multivariate analysis, inferior OS was associated with Epstein-Barr virus-negative lymphoma, poor performance status, advanced stage, and bone marrow involvement. In an independent univariate analysis, the international prognostic index was associated with OS outcomes. Neither immunosuppression nor HIV infection, specifically, influenced OS. Among patients treated with curative intent (n = 234), the overall response rate was 72%. Neither the intensity of the treatment regimen nor the inclusion of PIs in first-line therapy was associated with OS. In this large retrospective study of patients with PBL, we identified novel risk factors for survival. PBL remains a challenging disease with poor long-term outcomes.
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Affiliation(s)
- Pietro R Di Ciaccio
- Department of Haematology, The Canberra Hospital, Garran, ACT, Australia
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Mark N Polizzotto
- Department of Haematology, The Canberra Hospital, Garran, ACT, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, United Kingdom
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Burton
- Department of Haematology, St James University Hospital, Leeds, United Kingdom
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - John Kuruvilla
- Division of Oncology and Haematology, Princess Margaret Cancer Centre, The Princess Margaret Hospital, Toronto, ON, Canada
| | - Silvia Montoto
- Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Pam McKay
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Christopher P Fox
- University Hospitals NHS Trust, Nottingham, United Kingdom
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Samuel Milliken
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Awachana Jiamsakul
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Graham P Collins
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Manos
- Department of Haematology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Kim M Linton
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
- Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Sunil Iyengar
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - David Kliman
- Department of Haematology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nicole Wong Doo
- Department of Haematology, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Anne-Marie Watson
- Department of Haematology, Liverpool Hospital, Sydney, NSW, Australia
| | - Pasquale Fedele
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Haematology Department, Monash Health, Clayton, VIC, Australia
| | - Costas K Yannakou
- Department of Molecular Oncology and Cancer Immunology, Epworth Freemasons Hospital, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Stewart Hunt
- Department of Haematology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Hanna Renshaw
- Department of Haematology, University College Hospital, London, United Kingdom
| | - Alice Maxwell
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Qin Liu
- Division of Oncology and Haematology, Princess Margaret Cancer Centre, The Princess Margaret Hospital, Toronto, ON, Canada
| | - Rageshri Dhairyawan
- Department of Infection and Immunity, Barts Health NHS Trust, London, United Kingdom
| | - Graeme Ferguson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Keir Pickard
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Nisha Thakrar
- Department of Haematology, University College Hospital, London, United Kingdom
| | - Kevin W Song
- Leukemia/Bone Marrow Transplant Program of British Columbia and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, BC, Canada
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Perth, WA, Australia
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3
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Painter D, Fasoli F, Sulpizio S. The Impact of Stimuli Length and Analytic Method on Auditory 'Gaydar' Research. J Voice 2024; 38:246.e1-246.e14. [PMID: 34763997 DOI: 10.1016/j.jvoice.2021.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022]
Abstract
This research investigates voice-based categorization of speakers' sexual orientation, the so-called 'auditory gaydar', while considering stimuli length and the type of measures assessing gaydar judgments. In Study 1 (N = 80), heterosexual individuals listened to gay and heterosexual male speakers in short (single word), medium (single sentence), or long (two sentences) recordings. Next, they guess the speakers' sexual orientation on a Kinsey-like and binary choice. Participants were overall inaccurate in recognizing gay speakers when gaydar judgments were provided on a binary choice. Gay speakers were rated as more gay on a Kinsey-like scale than their heterosexual counterparts, but only when short and medium recordings were listened to. Study 2 (N = 149) examined gaydar accuracy for both male and female speakers by using the same procedure. Gaydar judgments were overall inaccurate for gay and lesbian speakers. For male speakers, a difference between the perceived sexual orientation of gay and heterosexual speakers emerged when stimuli were long. For female speakers, such a difference occurred only in the short and medium recording conditions. Study 3 (N = 137) examined gaydar judgments for male and female speakers when stimuli length was manipulated as the number of words progressively presented in a sentence: short (article), medium (article + first word), long (sentence) stimulus. Overall, gaydar judgments were inaccurate. Gay and lesbian (vs. heterosexual) speakers tended to be rated as more gay on the Kinsey-like scale in the medium stimulus condition. These findings suggest that gaydar judgments can be influenced by the type of measure and stimuli.
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Affiliation(s)
- Daniel Painter
- School of Psychology, University of Surrey, University of Surrey, Guildford, United Kingdom
| | - Fabio Fasoli
- School of Psychology, University of Surrey, University of Surrey, Guildford, United Kingdom.
| | - Simone Sulpizio
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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4
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Mehta M, Polli JE, Seo P, Bhoopathy S, Berginc K, Kristan K, Cook J, Dressman JB, Mandula H, Munshi U, Shanker R, Volpe DA, Gordon J, Veerasingham S, Welink J, Almeida S, Gonzalez P, Painter D, Tsang YC, Vaidyanathan J, Velagapudi R. Drug Permeability - Best Practices for Biopharmaceutics Classification System (BCS)-Based Biowaivers: A workshop Summary Report. J Pharm Sci 2023; 112:1749-1762. [PMID: 37142122 DOI: 10.1016/j.xphs.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
The workshop "Drug Permeability - Best Practices for Biopharmaceutics Classification System (BCS) Based Biowaivers" was held virtually on December 6, 2021, organized by the University of Maryland Center of Excellence in Regulatory Science and Innovation (M-CERSI), and the Food and Drug Administration (FDA). The workshop focused on the industrial, academic, and regulatory experiences in generating and evaluating permeability data, with the aim to further facilitate implementation of the BCS and efficient development of high-quality drug products globally. As the first international permeability workshop since the BCS based biowaivers was finalized as the ICH M9 guideline, the workshop included lectures, panel discussions, and breakout sessions. Lecture and panel discussion topics covered case studies at IND, NDA, and ANDA stages, typical deficiencies relating to permeability assessment supporting BCS biowaiver, types of evidence that are available to demonstrate high permeability, method suitability of a permeability assay, impact of excipients, importance of global acceptance of permeability methods, opportunities to expand the use of biowaivers (e.g. non-Caco-2 cell lines, totality-of-evidence approach to demonstrate high permeability) and future of permeability testing. Breakout sessions focused on 1) in vitro and in silico intestinal permeability methods; 2) potential excipient effects on permeability and; 3) use of label and literature data to designate permeability class.
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Affiliation(s)
- M Mehta
- US Food & Drug Administration, Silver Spring, MD, USA.
| | - J E Polli
- University of Maryland, Baltimore, MD, USA
| | - P Seo
- US Food & Drug Administration, Silver Spring, MD, USA
| | | | | | | | - J Cook
- Pfizer Inc, Groton, CT, USA
| | - J B Dressman
- Fraunhofer Institute of Translational Medicine and Pharmacology, Frankfurt, Germany
| | - H Mandula
- US Food & Drug Administration, Silver Spring, MD, USA
| | - U Munshi
- US Food & Drug Administration, Silver Spring, MD, USA
| | | | - D A Volpe
- US Food & Drug Administration, Silver Spring, MD, USA
| | - J Gordon
- World Health Organization, Geneva, Switzerland
| | | | - J Welink
- European Medicines Agency, Amsterdam, the Netherlands
| | - S Almeida
- Medicines for Europe, Brussels, Belgium
| | - P Gonzalez
- Biopharmaceutical Evaluation Center, Santiago, Chile
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5
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Bewicke-Copley F, Korfi K, Araf S, Hodkinson B, Kumar E, Cummin T, Ashton-Key M, Barrans S, van Hoppe S, Burton C, Elshiekh M, Rule S, Crosbie N, Clear A, Calaminici M, Runge H, Hills RK, Scott DW, Rimsza LM, Menon G, Sha C, Davies JR, Nagano A, Davies A, Painter D, Smith A, Gribben J, Naresh KN, Westhead DR, Okosun J, Steele A, Hodson DJ, Balasubramanian S, Johnson P, Wang J, Fitzgibbon J. Longitudinal expression profiling identifies a poor risk subset of patients with ABC-type diffuse large B-cell lymphoma. Blood Adv 2023; 7:845-855. [PMID: 35947123 PMCID: PMC9986713 DOI: 10.1182/bloodadvances.2022007536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Despite the effectiveness of immuno-chemotherapy, 40% of patients with diffuse large B-cell lymphoma (DLBCL) experience relapse or refractory disease. Longitudinal studies have previously focused on the mutational landscape of relapse but fell short of providing a consistent relapse-specific genetic signature. In our study, we have focused attention on the changes in GEP accompanying DLBCL relapse using archival paired diagnostic/relapse specimens from 38 de novo patients with DLBCL. COO remained stable from diagnosis to relapse in 80% of patients, with only a single patient showing COO switching from activated B-cell-like (ABC) to germinal center B-cell-like (GCB). Analysis of the transcriptomic changes that occur following relapse suggest ABC and GCB relapses are mediated via different mechanisms. We developed a 30-gene discriminator for ABC-DLBCLs derived from relapse-associated genes that defined clinically distinct high- and low-risk subgroups in ABC-DLBCLs at diagnosis in datasets comprising both population-based and clinical trial cohorts. This signature also identified a population of <60-year-old patients with superior PFS and OS treated with ibrutinib-R-CHOP as part of the PHOENIX trial. Altogether this new signature adds to the existing toolkit of putative genetic predictors now available in DLBCL that can be readily assessed as part of prospective clinical trials.
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Affiliation(s)
- Findlay Bewicke-Copley
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Koorosh Korfi
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Shamzah Araf
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Brendan Hodkinson
- Oncology Translational Research, Janssen Research & Development, Spring House, PA
| | - Emil Kumar
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Thomas Cummin
- Cancer Research UK Centre, University of Southampton, Southampton, UK
| | - Margaret Ashton-Key
- Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sharon Barrans
- Haematological Malignancy Diagnostic Service, St. James’s Institute of Oncology, Leeds, UK
| | - Suzan van Hoppe
- Haematological Malignancy Diagnostic Service, St. James’s Institute of Oncology, Leeds, UK
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St. James’s Institute of Oncology, Leeds, UK
| | - Mohamed Elshiekh
- Cellular & Molecular Pathology, Imperial College NHS Trust & Imperial College London, London, UK
| | - Simon Rule
- Department of Haematology, Derriford Hospital, University of Plymouth, Plymouth, UK
| | - Nicola Crosbie
- Department of Haematology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Andrew Clear
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Maria Calaminici
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Hendrik Runge
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Robert K. Hills
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David W. Scott
- BC Cancer Centre for Lymphoid Cancer and Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Lisa M. Rimsza
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix AZ
| | - Geetha Menon
- Haemato-Oncology Diagnostic Service, Liverpool Clinical Laboratories, Liverpool, UK
| | - Chulin Sha
- School of Molecular and Cellular Biology, University of Leeds, Leeds, UK
| | - John R. Davies
- School of Molecular and Cellular Biology, University of Leeds, Leeds, UK
| | - Ai Nagano
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Andrew Davies
- Cancer Research UK Centre, University of Southampton, Southampton, UK
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - John Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Kikkeri N. Naresh
- Cellular & Molecular Pathology, Imperial College NHS Trust & Imperial College London, London, UK
| | - David R. Westhead
- School of Molecular and Cellular Biology, University of Leeds, Leeds, UK
| | - Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Andrew Steele
- Oncology Translational Research, Janssen Research & Development, San Diego, CA
| | - Daniel J. Hodson
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | | | - Peter Johnson
- Cancer Research UK Centre, University of Southampton, Southampton, UK
| | - Jun Wang
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University, London, UK
| | - Jude Fitzgibbon
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University, London, UK
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Crouch S, Painter D, Barrans SL, Roman E, Beer PA, Cooke SL, Glover P, Van Hoppe SJ, Webster N, Lacy SE, Ruiz C, Campbell PJ, Hodson DJ, Patmore R, Burton C, Smith A, Tooze RM. Molecular subclusters of follicular lymphoma: a report from the United Kingdom's Haematological Malignancy Research Network. Blood Adv 2022; 6:5716-5731. [PMID: 35363872 PMCID: PMC9619185 DOI: 10.1182/bloodadvances.2021005284] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
Follicular lymphoma (FL) is morphologically and clinically diverse, with mutations in epigenetic regulators alongside t(14;18) identified as disease-initiating events. Identification of additional mutational entities confirms this cancer's heterogeneity, but whether mutational data can be resolved into mechanistically distinct subsets remains an open question. Targeted sequencing was applied to an unselected population-based FL cohort (n = 548) with full clinical follow-up (n = 538), which included 96 diffuse large B-cell lymphoma (DLBCL) transformations. We investigated whether molecular subclusters of FL can be identified and whether mutational data provide predictive information relating to transformation. DNA extracted from FL samples was sequenced with a 293-gene panel representing genes frequently mutated in DLBCL and FL. Three clusters were resolved using mutational data alone, independent of translocation status: FL_aSHM, with high burden of aberrant somatic hypermutation (aSHM) targets; FL_STAT6, with high STAT6 & CREBBP mutation and low aSHM; and FL_Com, with the absence of features of other subtypes and enriched KMT2D mutation. Analysis of mutation signatures demonstrated differential enrichment of predicted mutation signatures between subgroups and a dominant preference in the FL_aSHM subgroup for G(C>T)T and G(C>T)C transitions consistent with previously defined aSHM-like patterns. Of transformed cases with paired samples, 17 of 26 had evidence of branching evolution. Poorer overall survival (OS) in the aSHM group (P = .04) was associated with older age; however, overall tumor genetics provided limited information to predict individual patient risk. Our approach identifies 3 molecular subclusters of FL linked to differences in underlying mechanistic pathways. These clusters, which may be further resolved by the inclusion of translocation status and wider mutation profiles, have implications for understanding pathogenesis as well as improving treatment strategies in the future.
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Affiliation(s)
- Simon Crouch
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Sharon L. Barrans
- Haematological Malignancy Diagnostic Service, St. James’s Institute of Oncology, Leeds, United Kingdom
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Philip A. Beer
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Susanna L. Cooke
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Paul Glover
- Haematological Malignancy Diagnostic Service, St. James’s Institute of Oncology, Leeds, United Kingdom
| | - Suzan J.L. Van Hoppe
- Haematological Malignancy Diagnostic Service, St. James’s Institute of Oncology, Leeds, United Kingdom
| | - Nichola Webster
- Haematological Malignancy Diagnostic Service, St. James’s Institute of Oncology, Leeds, United Kingdom
| | - Stuart E. Lacy
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Camilo Ruiz
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | | | - Daniel J. Hodson
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
| | - Russell Patmore
- Queen’s Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, United Kingdom
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St. James’s Institute of Oncology, Leeds, United Kingdom
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Reuben M. Tooze
- Section of Experimental Haematology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom
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7
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Roman E, Kane E, Howell D, Lamb M, Bagguley T, Crouch S, Painter D, Patmore R, Smith A. Cohort Profile Update: The Haematological Malignancy Research Network (HMRN) UK population-based cohorts. Int J Epidemiol 2022; 51:e87-e94. [PMID: 35134983 PMCID: PMC9189975 DOI: 10.1093/ije/dyab275] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK
| | - Eleanor Kane
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK
| | - Debra Howell
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK
| | - Maxine Lamb
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK
| | - Timothy Bagguley
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK
| | - Simon Crouch
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK
| | | | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, YO10 5DD, UK
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8
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Gong C, Krupka JA, Gao J, Grigoropoulos NF, Giotopoulos G, Asby R, Screen M, Usheva Z, Cucco F, Barrans S, Painter D, Zaini NBM, Haupl B, Bornelöv S, Ruiz De Los Mozos I, Meng W, Zhou P, Blain AE, Forde S, Matthews J, Khim Tan MG, Burke GAA, Sze SK, Beer P, Burton C, Campbell P, Rand V, Turner SD, Ule J, Roman E, Tooze R, Oellerich T, Huntly BJ, Turner M, Du MQ, Samarajiwa SA, Hodson DJ. Sequential inverse dysregulation of the RNA helicases DDX3X and DDX3Y facilitates MYC-driven lymphomagenesis. Mol Cell 2021; 81:4059-4075.e11. [PMID: 34437837 DOI: 10.1016/j.molcel.2021.07.041] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/17/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
DDX3X is a ubiquitously expressed RNA helicase involved in multiple stages of RNA biogenesis. DDX3X is frequently mutated in Burkitt lymphoma, but the functional basis for this is unknown. Here, we show that loss-of-function DDX3X mutations are also enriched in MYC-translocated diffuse large B cell lymphoma and reveal functional cooperation between mutant DDX3X and MYC. DDX3X promotes the translation of mRNA encoding components of the core translational machinery, thereby driving global protein synthesis. Loss-of-function DDX3X mutations moderate MYC-driven global protein synthesis, thereby buffering MYC-induced proteotoxic stress during early lymphomagenesis. Established lymphoma cells restore full protein synthetic capacity by aberrant expression of DDX3Y, a Y chromosome homolog, the expression of which is normally restricted to the testis. These findings show that DDX3X loss of function can buffer MYC-driven proteotoxic stress and highlight the capacity of male B cell lymphomas to then compensate for this loss by ectopic DDX3Y expression.
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Affiliation(s)
- Chun Gong
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge CB2 0AW, UK; Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK
| | - Joanna A Krupka
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge CB2 0AW, UK; Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK; MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge CB2 0XZ, UK
| | - Jie Gao
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge CB2 0AW, UK; Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK
| | | | - George Giotopoulos
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge CB2 0AW, UK; Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK
| | - Ryan Asby
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge CB2 0AW, UK; Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK
| | - Michael Screen
- Immunology Programme, The Babraham Institute, Cambridge CB22 3AT, UK
| | - Zelvera Usheva
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge CB2 0AW, UK; Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK
| | - Francesco Cucco
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge CB20QQ, UK
| | - Sharon Barrans
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds LS9 7TF, UK
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York YO10 5DD, UK
| | | | - Björn Haupl
- Department of Medicine II, Hematology/Oncology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany; Frankfurt Cancer Institute, Goethe University Frankfurt, 60596 Frankfurt, Germany
| | - Susanne Bornelöv
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge CB2 0AW, UK
| | - Igor Ruiz De Los Mozos
- The Francis Crick Institute, London NW1 1AT, UK; Department for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Wei Meng
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore, Singapore
| | - Peixun Zhou
- National Horizons Centre, Teesside University, 38 John Dixon Lane, Darlington DL1 1HG, UK; School of Health & Life Sciences, Teesside University, Middlesbrough TS1 3BA, UK
| | - Alex E Blain
- National Horizons Centre, Teesside University, 38 John Dixon Lane, Darlington DL1 1HG, UK; Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK; School of Health & Life Sciences, Teesside University, Middlesbrough TS1 3BA, UK
| | - Sorcha Forde
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge CB20QQ, UK
| | - Jamie Matthews
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge CB20QQ, UK
| | - Michelle Guet Khim Tan
- Department of Clinical Translational Research, Singapore General Hospital, Outram Road, Singapore 169856, Singapore
| | - G A Amos Burke
- Department of Paediatric Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Siu Kwan Sze
- School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore, Singapore
| | - Philip Beer
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds LS9 7TF, UK
| | - Peter Campbell
- Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK
| | - Vikki Rand
- National Horizons Centre, Teesside University, 38 John Dixon Lane, Darlington DL1 1HG, UK; School of Health & Life Sciences, Teesside University, Middlesbrough TS1 3BA, UK
| | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge CB20QQ, UK; CEITEC, Masaryk University, Brno, Czech Republic
| | - Jernej Ule
- The Francis Crick Institute, London NW1 1AT, UK; Department for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Reuben Tooze
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds LS9 7TF, UK; Section of Experimental Haematology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Thomas Oellerich
- Department of Medicine II, Hematology/Oncology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany; Frankfurt Cancer Institute, Goethe University Frankfurt, 60596 Frankfurt, Germany
| | - Brian J Huntly
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge CB2 0AW, UK; Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK
| | - Martin Turner
- Immunology Programme, The Babraham Institute, Cambridge CB22 3AT, UK
| | - Ming-Qing Du
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge CB20QQ, UK
| | - Shamith A Samarajiwa
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge CB2 0XZ, UK
| | - Daniel J Hodson
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Puddicombe Way, Cambridge CB2 0AW, UK; Department of Haematology, University of Cambridge, Cambridge CB2 0AW, UK.
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9
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Richards SJ, Painter D, Dickinson AJ, Griffin M, Munir T, Arnold L, Payne D, Pike A, Muus P, Hill A, Newton DJ, McKinley C, Jones R, Kelly R, Smith A, Roman E, Hillmen P. The incidence and prevalence of patients with paroxysmal nocturnal haemoglobinuria and aplastic anaemia PNH syndrome: A retrospective analysis of the UK's population-based haematological malignancy research network 2004-2018. Eur J Haematol 2021; 107:211-218. [PMID: 34060690 DOI: 10.1111/ejh.13640] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A retrospective population-based study to determine the incidence and prevalence of patients with the rare blood disease paroxysmal nocturnal haemoglobinuria (PNH). METHODS All patients were identified by flow cytometric detection of blood cells deficient in glycosylphosphatidylinositol (GPI) linked proteins at a single diagnostic reference laboratory that serves the Yorkshire based, Haematological Malignancy Research Network (HMRN) with a population of 3.8 million. RESULTS One hundred and ninety-seven patients with detectable PNH clones at a level of >0.01% in at least two lineages of cells (neutrophils, monocytes and/or red cells) were identified over a 15-year period (2004-2018). Of these, 88% had aplastic anaemia (AA), 8% classical PNH and 3% myelodysplastic syndrome. The overall incidence rate was estimated at 0.35 cases per 100 000 people per year. This equates to 220 cases newly diagnosed in the United Kingdom each year. The overall prevalence rate was 3.81 per 100 000, this equates to an estimated 2400 prevalent cases in the UK. The overall and relative 5-year survival rates were 72% and 82.7%, respectively. CONCLUSIONS This study showed that classical haemolytic PNH is a rare disease and represents only a small proportion overall of patients with detectable PNH cells, the majority of which have aplastic anaemia.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anemia, Aplastic/complications
- Anemia, Aplastic/diagnosis
- Anemia, Aplastic/epidemiology
- Anemia, Aplastic/history
- Biomarkers
- Child
- Child, Preschool
- Female
- Hemoglobinuria, Paroxysmal/complications
- Hemoglobinuria, Paroxysmal/diagnosis
- Hemoglobinuria, Paroxysmal/epidemiology
- Hemoglobinuria, Paroxysmal/history
- History, 21st Century
- Humans
- Immunophenotyping
- Incidence
- Male
- Middle Aged
- Population Surveillance
- Prevalence
- Retrospective Studies
- Syndrome
- United Kingdom/epidemiology
- Young Adult
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Affiliation(s)
- Stephen J Richards
- Division of Haematology and Immunology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Anita J Dickinson
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Leeds, UK
| | - Morag Griffin
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Talha Munir
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Louise Arnold
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel Payne
- Haematological Malignancy Diagnostic Service, Leeds Teaching Hospitals NHS Trust, St. James's University Hospital, Leeds, UK
| | - Alexandra Pike
- Division of Haematology and Immunology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Petra Muus
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anita Hill
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Alexion Pharmaceuticals Inc., Leeds, UK
| | - Darren J Newton
- Division of Haematology and Immunology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Claire McKinley
- Division of Haematology and Immunology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Rachael Jones
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Richard Kelly
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alex Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Peter Hillmen
- Division of Haematology and Immunology, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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10
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He W, Verhees GF, Bhagwat N, Yang Y, Kulkarni DS, Lombardo Z, Lahiri S, Roy P, Zhuo J, Dang B, Snyder A, Shastry S, Moezpoor M, Alocozy L, Lee KG, Painter D, Mukerji I, Hunter N. SUMO fosters assembly and functionality of the MutSγ complex to facilitate meiotic crossing over. Dev Cell 2021; 56:2073-2088.e3. [PMID: 34214491 DOI: 10.1016/j.devcel.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/07/2020] [Revised: 03/31/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022]
Abstract
Crossing over is essential for chromosome segregation during meiosis. Protein modification by SUMO is implicated in crossover control, but pertinent targets have remained elusive. Here we identify Msh4 as a target of SUMO-mediated crossover regulation. Msh4 and Msh5 constitute the MutSγ complex, which stabilizes joint-molecule (JM) recombination intermediates and facilitates their resolution into crossovers. Msh4 SUMOylation enhances these processes to ensure that each chromosome pair acquires at least one crossover. Msh4 is directly targeted by E2 conjugase Ubc9, initially becoming mono-SUMOylated in response to DNA double-strand breaks, then multi/poly-SUMOylated forms arise as homologs fully engage. Mechanistically, SUMOylation fosters interaction between Msh4 and Msh5. We infer that initial SUMOylation of Msh4 enhances assembly of MutSγ in anticipation of JM formation, while secondary SUMOylation may promote downstream functions. Regulation of Msh4 by SUMO is distinct and independent of its previously described stabilization by phosphorylation, defining MutSγ as a hub for crossover control.
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Affiliation(s)
- Wei He
- Howard Hughes Medical Institute, University of California, Davis, Davis, CA, USA; Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Gerrik F Verhees
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Nikhil Bhagwat
- Howard Hughes Medical Institute, University of California, Davis, Davis, CA, USA; Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Ye Yang
- Howard Hughes Medical Institute, University of California, Davis, Davis, CA, USA; Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Dhananjaya S Kulkarni
- Howard Hughes Medical Institute, University of California, Davis, Davis, CA, USA; Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Zane Lombardo
- Department of Molecular Biology and Biochemistry, Molecular Biophysics Program, Wesleyan University, Middletown, CT, USA
| | - Sudipta Lahiri
- Department of Molecular Biology and Biochemistry, Molecular Biophysics Program, Wesleyan University, Middletown, CT, USA
| | - Pritha Roy
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Jiaming Zhuo
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Brian Dang
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Andriana Snyder
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Shashank Shastry
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Michael Moezpoor
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Lilly Alocozy
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Kathy Gyehyun Lee
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Daniel Painter
- Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA
| | - Ishita Mukerji
- Department of Molecular Biology and Biochemistry, Molecular Biophysics Program, Wesleyan University, Middletown, CT, USA
| | - Neil Hunter
- Howard Hughes Medical Institute, University of California, Davis, Davis, CA, USA; Department of Microbiology & Molecular Genetics, University of California, Davis, Davis, CA, USA.
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11
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Crouch S, Painter D, Barrans S, Roman E, Beer P, Lacy S, Cooke S, Webster N, Glover P, Hoppe S, Campbell PJ, Hodson DJ, Patmore R, Burton C, Smith AG, Tooze R. MOLECULAR SUBCLUSTERS OF FOLLICULAR LYMPHOMA: A REPORT FROM THE UK'S HAEMATOLOGICAL MALIGNANCY RESEARCH NETWORK. Hematol Oncol 2021. [DOI: 10.1002/hon.40_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. Crouch
- University of York Epidemiology and Cancer Statistics Group Department of Health Sciences York UK
| | - D. Painter
- University of York Epidemiology and Cancer Statistics Group Department of Health Sciences York UK
| | - S. Barrans
- Leeds Teaching Hospitals NHS Trust Haematological Malignancy Diagnostic Service Leeds UK
| | - E. Roman
- University of York Epidemiology and Cancer Statistics Group Department of Health Sciences York UK
| | - P. Beer
- University of Glasgow Glasgow Precision Oncology Laboratory Glasgow UK
| | - S. Lacy
- University of York Epidemiology and Cancer Statistics Group Department of Health Sciences York UK
| | - S. Cooke
- University of Glasgow Glasgow Precision Oncology Laboratory Glasgow UK
| | - N. Webster
- Leeds Teaching Hospitals NHS Trust Haematological Malignancy Diagnostic Service Leeds UK
| | - P. Glover
- Leeds Teaching Hospitals NHS Trust Haematological Malignancy Diagnostic Service Leeds UK
| | - S. Hoppe
- Leeds Teaching Hospitals NHS Trust Haematological Malignancy Diagnostic Service Leeds UK
| | - P. J. Campbell
- Wellcome Trust Sanger Institute, Cancer Ageing and Somatic Mutation Programme Cambridge UK
| | - D. J. Hodson
- University of Cambridge Wellcome–MRC CambridgeStem Cell Institute Cambridge UK
| | - R. Patmore
- Hull University Teaching Hospitals NHS Trust Queen's Centre for Oncology and Haematology Hull UK
| | - C. Burton
- Leeds Teaching Hospitals NHS Trust Haematological Malignancy Diagnostic Service Leeds UK
| | - A. G. Smith
- University of York Epidemiology and Cancer Statistics Group Department of Health Sciences York UK
| | - R. Tooze
- Leeds Teaching Hospitals NHS Trust Haematological Malignancy Diagnostic Service Leeds UK
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12
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Lamb MJ, Smith A, Painter D, Kane E, Bagguley T, Newton R, Howell D, Cook G, de Tute R, Rawstron A, Patmore R, Roman E. Health impact of monoclonal gammopathy of undetermined significance (MGUS) and monoclonal B-cell lymphocytosis (MBL): findings from a UK population-based cohort. BMJ Open 2021; 11:e041296. [PMID: 33619185 PMCID: PMC7903106 DOI: 10.1136/bmjopen-2020-041296] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine mortality and morbidity patterns before and after premalignancy diagnosis in individuals with monoclonal gammopathy of undetermined significance (MGUS) and monoclonal B-cell lymphocytosis (MBL) and compare their secondary healthcare activity to that of the general population. DESIGN Population-based patient cohort, within which each patient is matched at diagnosis to 10 age-matched and sex-matched individuals from the general population. Both cohorts are linked to nationwide information on deaths, cancer registrations and Hospital Episode Statistics. SETTING The UK's Haematological Malignancy Research Network, which has a catchment population of around 4 million served by 14 hospitals and a central diagnostic laboratory. PARTICIPANTS All patients newly diagnosed during 2009-2015 with MGUS (n=2193) or MBL (n=561) and their age and sex-matched comparators (n=27 538). MAIN OUTCOME MEASURES Mortality and hospital inpatient and outpatient activity in the 5 years before and 3 years after diagnosis. RESULTS Individuals with MGUS experienced excess morbidity in the 5 years before diagnosis and excess mortality and morbidity in the 3 years after diagnosis. Increased rate ratios (RRs) were evident for nearly all clinical specialties, the largest, both before and after diagnosis, being for nephrology (before RR=4.29, 95% CI 3.90 to 4.71; after RR=13.8, 95% CI 12.8 to 15.0) and rheumatology (before RR=3.40, 95% CI 3.18 to 3.63; after RR=5.44, 95% CI 5.08 to 5.83). Strong effects were also evident for endocrinology, neurology, dermatology and respiratory medicine. Conversely, only marginal increases in mortality and morbidity were evident for MBL. CONCLUSIONS MGUS and MBL are generally considered to be relatively benign, since most individuals with monoclonal immunoglobulins never develop a B-cell malignancy or any other monoclonal protein-related organ/tissue-related disorder. Nonetheless, our findings offer strong support for the view that in some individuals, monoclonal gammopathy has the potential to cause systemic disease resulting in wide-ranging organ/tissue damage and excess mortality.
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Affiliation(s)
- Maxine Je Lamb
- Department of Health Sciences, University of York, York, UK
| | | | - Daniel Painter
- Department of Health Sciences, University of York, York, UK
| | - Eleanor Kane
- Department of Health Sciences, University of York, York, UK
| | | | - Robert Newton
- Department of Health Sciences, University of York, York, UK
- Epidemiology and Prevention Programme, Uganda Virus Research Institute, Entebbe, Uganda
| | - Debra Howell
- Department of Health Sciences, University of York, York, UK
| | - Gordon Cook
- Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ruth de Tute
- Haematological Malignancy Diagnostic Service (HMDS), Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Rawstron
- Haematological Malignancy Diagnostic Service (HMDS), Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Russell Patmore
- Haematology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Eve Roman
- Department of Health Sciences, University of York, York, UK
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13
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Runge HFP, Lacy S, Barrans S, Beer PA, Painter D, Smith A, Roman E, Burton C, Crouch S, Tooze R, Hodson DJ. Application of the LymphGen classification tool to 928 clinically and genetically-characterised cases of diffuse large B cell lymphoma (DLBCL). Br J Haematol 2021; 192:216-220. [PMID: 33010029 DOI: 10.1111/bjh.17132] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/06/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Hendrik F P Runge
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Stuart Lacy
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Sharon Barrans
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds, UK
| | - Philip A Beer
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds, UK
| | - Simon Crouch
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Reuben Tooze
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds, UK
- Section of Experimental Haematology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Daniel J Hodson
- Wellcome-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
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14
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Kane E, Painter D, Smith A, Lamb M, Oliver SE, Patmore R, Roman E. Risk of mature B-cell neoplasms and precursor conditions after joint replacement: A report from the Haematological Malignancy Research Network. Int J Cancer 2020; 147:702-708. [PMID: 31675431 PMCID: PMC7317514 DOI: 10.1002/ijc.32765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022]
Abstract
Associations between previous joint replacement and B-cell lymphoid malignancies have been reported, but despite numerous reports, associations with the disease subtypes have received little attention. Using a UK-based register of haematological malignancies and a matched general population-based cohort, joint replacements from linked hospital inpatient records were examined. Cases diagnosed 2009-2015 who were aged 50 years or more were included; 8,013 mature B-cell neoplasms comprising myeloma (n = 1,763), diffuse large B-cell lymphoma (DLBCL, n = 1,676), chronic lymphocytic leukaemia (CLL, n = 1,594), marginal zone lymphoma (MZL, n = 957), follicular lymphoma (FL, n = 725) and classical Hodgkin lymphoma (CHL, n = 255), together with monoclonal gammopathy of uncertain significance (MGUS, n = 2,138) and monoclonal B-cell lymphocytosis (MBL, n = 632). Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated relative to 10 age- and sex-matched controls using conditional logistic regression. Having had a joint replacement before diagnosis was associated with myeloma (OR = 1.3, 95% CI 1.1-1.5, p = 0.008) and MGUS (OR = 1.3, 95% CI 1.1-1.5, p < 0.001). Excluding replacements in the year before diagnosis, the MGUS risk remained, elevated where two or more joints were replaced (OR = 1.5, 95% CI 1.2-2.0, p = 0.001), with hip (OR = 1.2, 95% CI 1.0-1.5, p = 0.06) or knee replacements (OR = 1.5, 95% CI 1.2-1.8, p < 0.001). Associations with CHL and two or more replacements (OR = 2.7, 95% CI 1.3-5.6, p = 0.005) or hip replacements (OR = 1.9, 95% CI 1.0-3.4, p = 0.04); and between DLBCL and knee replacements (OR = 1.3, 95% CI 1.0-1.6, p = 0.04) were also observed. Our study reports for the first time a relationship between joint replacements and MGUS; while absolute risks of disease are low and not of major public health concern, these findings warrant further investigation.
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Affiliation(s)
- Eleanor Kane
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
| | - Maxine Lamb
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
| | - Steven E. Oliver
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
- Hull York Medical SchoolYorkUnited Kingdom
| | - Russell Patmore
- Queens Centre for Oncology, Castle Hill HospitalHullUnited Kingdom
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUnited Kingdom
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15
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Lacy SE, Barrans SL, Beer PA, Painter D, Smith AG, Roman E, Cooke SL, Ruiz C, Glover P, Van Hoppe SJL, Webster N, Campbell PJ, Tooze RM, Patmore R, Burton C, Crouch S, Hodson DJ. Targeted sequencing in DLBCL, molecular subtypes, and outcomes: a Haematological Malignancy Research Network report. Blood 2020; 135:1759-1771. [PMID: 32187361 PMCID: PMC7259825 DOI: 10.1182/blood.2019003535] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/09/2020] [Indexed: 12/15/2022] Open
Abstract
Based on the profile of genetic alterations occurring in tumor samples from selected diffuse large B-cell lymphoma (DLBCL) patients, 2 recent whole-exome sequencing studies proposed partially overlapping classification systems. Using clustering techniques applied to targeted sequencing data derived from a large unselected population-based patient cohort with full clinical follow-up (n = 928), we investigated whether molecular subtypes can be robustly identified using methods potentially applicable in routine clinical practice. DNA extracted from DLBCL tumors diagnosed in patients residing in a catchment population of ∼4 million (14 centers) were sequenced with a targeted 293-gene hematological-malignancy panel. Bernoulli mixture-model clustering was applied and the resulting subtypes analyzed in relation to their clinical characteristics and outcomes. Five molecular subtypes were resolved, termed MYD88, BCL2, SOCS1/SGK1, TET2/SGK1, and NOTCH2, along with an unclassified group. The subtypes characterized by genetic alterations of BCL2, NOTCH2, and MYD88 recapitulated recent studies showing good, intermediate, and poor prognosis, respectively. The SOCS1/SGK1 subtype showed biological overlap with primary mediastinal B-cell lymphoma and conferred excellent prognosis. Although not identified as a distinct cluster, NOTCH1 mutation was associated with poor prognosis. The impact of TP53 mutation varied with genomic subtypes, conferring no effect in the NOTCH2 subtype and poor prognosis in the MYD88 subtype. Our findings confirm the existence of molecular subtypes of DLBCL, providing evidence that genomic tests have prognostic significance in non-selected DLBCL patients. The identification of both good and poor risk subtypes in patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) clearly show the clinical value of the approach, confirming the need for a consensus classification.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomedical Research/organization & administration
- Child
- Child, Preschool
- Cohort Studies
- Community Networks
- DNA Mutational Analysis/methods
- Female
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Hematologic Neoplasms/classification
- Hematologic Neoplasms/diagnosis
- Hematologic Neoplasms/genetics
- Hematologic Neoplasms/pathology
- Humans
- Infant
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Medical Oncology/organization & administration
- Middle Aged
- Molecular Diagnostic Techniques/methods
- Neoplasm Staging
- Prognosis
- Transcriptome
- United Kingdom
- Exome Sequencing/methods
- Young Adult
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Affiliation(s)
- Stuart E Lacy
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Sharon L Barrans
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Philip A Beer
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Daniel Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Alexandra G Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Susanna L Cooke
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Camilo Ruiz
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Paul Glover
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Suzan J L Van Hoppe
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Nichola Webster
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Peter J Campbell
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Reuben M Tooze
- Section of Experimental Haematology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom
| | - Russell Patmore
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, United Kingdom; and
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St. James's Institute of Oncology, Leeds, United Kingdom
| | - Simon Crouch
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
| | - Daniel J Hodson
- Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, United Kingdom
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16
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Cucco F, Barrans S, Sha C, Clipson A, Crouch S, Dobson R, Chen Z, Thompson JS, Care MA, Cummin T, Caddy J, Liu H, Robinson A, Schuh A, Fitzgibbon J, Painter D, Smith A, Roman E, Tooze R, Burton C, Davies AJ, Westhead DR, Johnson PWM, Du MQ. Distinct genetic changes reveal evolutionary history and heterogeneous molecular grade of DLBCL with MYC/BCL2 double-hit. Leukemia 2020; 34:1329-1341. [PMID: 31844144 PMCID: PMC7192846 DOI: 10.1038/s41375-019-0691-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022]
Abstract
Using a Burkitt lymphoma-like gene expression signature, we recently defined a high-risk molecular high-grade (MHG) group mainly within germinal centre B-cell like diffuse large B-cell lymphomas (GCB-DLBCL), which was enriched for MYC/BCL2 double-hit (MYC/BCL2-DH). The genetic basis underlying MHG-DLBCL and their aggressive clinical behaviour remain unknown. We investigated 697 cases of DLBCL, particularly those with MYC/BCL2-DH (n = 62) by targeted sequencing and gene expression profiling. We showed that DLBCL with MYC/BCL2-DH, and those with BCL2 translocation, harbour the characteristic mutation signatures that are associated with follicular lymphoma and its high-grade transformation. We identified frequent MYC hotspot mutations that affect the phosphorylation site (T58) and its adjacent amino acids, which are important for MYC protein degradation. These MYC mutations were seen in a subset of cases with MYC translocation, but predominantly in those of MHG. The mutations were more frequent in double-hit lymphomas with IG as the MYC translocation partner, and were associated with higher MYC protein expression and poor patient survival. DLBCL with MYC/BCL2-DH and those with BCL2 translocation alone are most likely derived from follicular lymphoma or its precursor lesion, and acquisition of MYC pathogenic mutations may augment MYC function, resulting in aggressive clinical behaviour.
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Affiliation(s)
- Francesco Cucco
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Sharon Barrans
- Haematological Malignancy Diagnostic Service, St James' University Hospital, Leeds, UK
| | - Chulin Sha
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | | | - Simon Crouch
- Department of Health Sciences, University of York, York, UK
| | - Rachel Dobson
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Zi Chen
- Department of Pathology, University of Cambridge, Cambridge, UK
| | | | - Matthew A Care
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Thomas Cummin
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Josh Caddy
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Hongxiang Liu
- Haematopathology and Oncology Diagnostics Service, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Anne Robinson
- Haematopathology and Oncology Diagnostics Service, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - Jude Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute, London, UK
| | - Daniel Painter
- Department of Health Sciences, University of York, York, UK
| | | | - Eve Roman
- Department of Health Sciences, University of York, York, UK
| | - Reuben Tooze
- Haematological Malignancy Diagnostic Service, St James' University Hospital, Leeds, UK
| | - Catherine Burton
- Haematological Malignancy Diagnostic Service, St James' University Hospital, Leeds, UK
| | - Andrew J Davies
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | - Peter W M Johnson
- Cancer Research UK Centre and Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Ming-Qing Du
- Department of Pathology, University of Cambridge, Cambridge, UK.
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17
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Rosenwald A, Bens S, Advani R, Barrans S, Copie-Bergman C, Elsensohn MH, Natkunam Y, Calaminici M, Sander B, Baia M, Smith A, Painter D, Pham L, Zhao S, Ziepert M, Jordanova ES, Molina TJ, Kersten MJ, Kimby E, Klapper W, Raemaekers J, Schmitz N, Jardin F, Stevens WBC, Hoster E, Hagenbeek A, Gribben JG, Siebert R, Gascoyne RD, Scott DW, Gaulard P, Salles G, Burton C, de Jong D, Sehn LH, Maucort-Boulch D. Prognostic Significance of MYC Rearrangement and Translocation Partner in Diffuse Large B-Cell Lymphoma: A Study by the Lunenburg Lymphoma Biomarker Consortium. J Clin Oncol 2019; 37:3359-3368. [PMID: 31498031 DOI: 10.1200/jco.19.00743] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE MYC rearrangement (MYC-R) occurs in approximately 10% of diffuse large B-cell lymphomas (DLBCLs) and has been associated with poor prognosis in many studies. The impact of MYC-R on prognosis may be influenced by the MYC partner gene (immunoglobulin [IG] or a non-IG gene). We evaluated a large cohort of patients through the Lunenburg Lymphoma Biomarker Consortium to validate the prognostic significance of MYC-R (single-, double-, and triple-hit status) in DLBCL within the context of the MYC partner gene. METHODS The study cohort included patients with histologically confirmed DLBCL morphology derived from large prospective trials and patient registries in Europe and North America who were uniformly treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy or the like. Fluorescence in situ hybridization for the MYC, BCL2, BCL6, and IG heavy and light chain loci was used, and results were correlated with clinical outcomes. RESULTS A total of 5,117 patients were identified of whom 2,383 (47%) had biopsy material available to assess for MYC-R. MYC-R was present in 264 (11%) of 2,383 patients and was associated with a significantly shorter progression-free and overall survival, with a strong time-dependent effect within the first 24 months after diagnosis. The adverse prognostic impact of MYC-R was only evident in patients with a concurrent rearrangement of BCL2 and/or BCL6 and an IG partner (hazard ratio, 2.4; 95% CI, 1.6 to 3.6; P < .001). CONCLUSION The negative prognostic impact of MYC-R in DLBCL is largely observed in patients with MYC double hit/triple-hit disease in which MYC is translocated to an IG partner, and this effect is restricted to the first 2 years after diagnosis. Our results suggest that diagnostic strategies should be adopted to identify this high-risk cohort, and risk-adjusted therapeutic approaches should be refined further.
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Affiliation(s)
- Andreas Rosenwald
- University of Würzburg and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Susanne Bens
- Ulm University and Ulm University Medical Center, Ulm, Germany
| | | | | | | | - Mad-Helenie Elsensohn
- Hospices Civils de Lyon and Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France
| | - Yaso Natkunam
- Stanford University School of Medicine, Stanford, CA
| | | | - Birgitta Sander
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Luu Pham
- Stanford Cancer Institute, Stanford, CA
| | - Shuchun Zhao
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Marie José Kersten
- Amsterdam University Medical Center, Amsterdam, the Netherlands.,University of Amsterdam and Lymphoma and Myeloma Center Amsterdam, Amsterdam, the Netherlands
| | - Eva Kimby
- Karolinska Institutet, Stockholm, Sweden
| | | | - John Raemaekers
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | | | | | - Eva Hoster
- Ludwig Maximilian University of Munich, Munich, Germany
| | - Anton Hagenbeek
- Amsterdam University Medical Center, Amsterdam, the Netherlands.,University of Amsterdam and Lymphoma and Myeloma Center Amsterdam, Amsterdam, the Netherlands
| | | | - Reiner Siebert
- Ulm University and Ulm University Medical Center, Ulm, Germany
| | | | | | | | | | | | - Daphne de Jong
- Amsterdam University Medical Center, Amsterdam, the Netherlands.,Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | | | - Delphine Maucort-Boulch
- Hospices Civils de Lyon and Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France
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18
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Barrans S, Painter D, van Hoppe S, Smith A, Sha C, Cucco F, Du M, Westhead D, Davies A, Johnson P, Roman E, Burton C. DEFINING BURKITT-LIKE LYMPHOMA WITH 11Q ABERRATION IN A SPECIALISED UK HAEMATOPATHOLOGY DIAGNOSTIC SERVICE. Hematol Oncol 2019. [DOI: 10.1002/hon.101_2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S. Barrans
- HMDS; Leeds Cancer Centre; Leeds United Kingdom
| | - D. Painter
- ECSG; Health Sciences, University of York; York United Kingdom
| | | | - A. Smith
- ECSG; Health Sciences, University of York; York United Kingdom
| | - C. Sha
- School of Molecular and Cellular Biology (Faculty of Biological Sciences); University of Leeds; Leeds United Kingdom
| | - F. Cucco
- Department of Pathology; University of Cambridge; Cambridge United Kingdom
| | - M. Du
- Department of Pathology; University of Cambridge; Cambridge United Kingdom
| | - D. Westhead
- School of Molecular and Cellular Biology (Faculty of Biological Sciences); University of Leeds; Leeds United Kingdom
| | - A. Davies
- Faculty of Medicine; University of Southampton; Southampton United Kingdom
| | - P. Johnson
- Faculty of Medicine; University of Southampton; Southampton United Kingdom
| | - E. Roman
- ECSG; Health Sciences, University of York; York United Kingdom
| | - C. Burton
- HMDS; Leeds Cancer Centre; Leeds United Kingdom
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19
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Korfi K, Araf S, Bewicke-Copley F, Kumar E, Cummin T, Ashton-Key M, Barrans S, Van Hoppe S, Burton C, Elshiekh M, Rule S, Crosbie N, Clear A, Calaminici M, Menon G, Sha C, Bentley M, Nagano A, Davies A, Painter D, Smith A, Okosun J, Gribben J, Naresh K, Westhead D, Wang J, Johnson P, Fitzgibbon J. LONGITUDINAL ANALYSES OF DIAGNOSTIC-RELAPSE BIOPSIES OF DIFFUSE LARGE B CELL LYMPHOMA SUGGEST THAT RELAPSE IS MEDIATED BY DISTINCT MECHANISMS IN ABC AND GCB LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.100_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- K. Korfi
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - S. Araf
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - F. Bewicke-Copley
- Centre for Molecular Oncology; Barts Cancer Institute; London United Kingdom
| | - E. Kumar
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - T. Cummin
- Cancer Research UK Centre; University of Southampton; Southampton United Kingdom
| | - M. Ashton-Key
- Cellular Pathology; University Hospital Southampton NHS Foundation Trust; Southampton United Kingdom
| | - S. Barrans
- HMDS; Leeds Teaching Hospitals NHS Trust; Leeds United Kingdom
| | - S. Van Hoppe
- HMDS; Leeds Teaching Hospitals NHS Trust; Leeds United Kingdom
| | - C. Burton
- HMDS; Leeds Teaching Hospitals NHS Trust; Leeds United Kingdom
| | - M. Elshiekh
- Cellular & Molecular Pathology; Imperial College NHS Trust & Imperial College London; London United Kingdom
| | - S. Rule
- Department of Haematology; Derriford Hospital, University of Plymouth; Plymouth United Kingdom
| | - N. Crosbie
- Department of Haematology; University Hospitals Plymouth NHS Trust; Plymouth United Kingdom
| | - A. Clear
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - M. Calaminici
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - G. Menon
- Haemato-Oncology Diagnostic Service; Liverpool Clinical Laboratories; Liverpool United Kingdom
| | - C. Sha
- School of Molecular and Cellular Biology; University of Leeds; Leeds United Kingdom
| | - M. Bentley
- School of Molecular and Cellular Biology; University of Leeds; Leeds United Kingdom
| | - A. Nagano
- Centre for Molecular Oncology; Barts Cancer Institute; London United Kingdom
| | - A. Davies
- Cancer Research UK Centre; University of Southampton; Southampton United Kingdom
| | - D. Painter
- Epidemiology and Cancer Statistics Group; University of York; York United Kingdom
| | - A. Smith
- Epidemiology and Cancer Statistics Group; University of York; York United Kingdom
| | - J. Okosun
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - J. Gribben
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
| | - K.N. Naresh
- Cellular & Molecular Pathology; Imperial College NHS Trust & Imperial College London; London United Kingdom
| | - D. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds United Kingdom
| | - J. Wang
- Centre for Molecular Oncology; Barts Cancer Institute; London United Kingdom
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton United Kingdom
| | - J. Fitzgibbon
- Centre for Haemato-Oncology; Barts Cancer Institute; London United Kingdom
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20
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Kane E, Painter D, Smith A, Crouch S, Oliver S, Patmore R, Roman E. The impact of rheumatological disorders on lymphomas and myeloma: a report on risk and survival from the UK's population-based Haematological Malignancy Research Network. Cancer Epidemiol 2019; 59:236-243. [PMID: 30844679 PMCID: PMC6452783 DOI: 10.1016/j.canep.2019.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Autoimmune inflammatory disease increases the risk of diffuse large B-cell lymphoma (DLBCL) and marginal zone lymphoma (MZL), but findings for other mature B-cell malignancies are equivocal. Furthermore, it has been suggested that the increase in DLBCL is due to the activated B-cell (ABC) subtype; but data on this, and the impact of inflammatory co-morbidities on survival, are sparse and contradictory. METHODS Data are from an established UK population-based cohort. Patients (n = 6834) diagnosed between 01/2009 and 08/2015 are included; DLBCL (n = 1771), myeloma (n = 1760), chronic lymphocytic leukaemia (CLL, n = 1580), MZL (n = 936), and follicular lymphoma (FL, n = 787). Information on rheumatological disorders and deaths was obtained by record-linkage to nationally compiled Hospital Episode Statistics, with age-and sex-matched individuals (n = 68,340) from the same catchment population (˜4 million people) providing the comparator. RESULTS Significantly increased risks for DLBCL (OR = 2.3, 95% CI 1.8-2.8) and MZL (OR = 2.0, 95% CI 1.5-2.7) were found for those with rheumatological disorders; the site distribution of those with/without rheumatological conditions differing for DLBCL (p = 0.007) and MZL (p = 0.002). No increases in risk were observed for the remaining mature B-cell malignancies, and no associations with survival were detected for DLBCL (age-adjusted HR = 1.2, 95% CI 0.9-1.6) or MZL (age-adjusted HR = 1.0, 95% CI 0.6-1.9). Furthermore, whilst our findings provide evidence for an association with rheumatological disease severity for DLBCL, they offer little support for the notion that the association is driven by an increase in the incidence of the ABC subtype. CONCLUSION Our findings support the hypothesis that the chronic activation and proliferation of specific B-cell populations which characterize autoimmune disease increase the potential for the lymphomagenic events that lead to DLBCL and MZL in both males and females; but have no impact on the development of CLL, FL or MM, or on survival.
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MESH Headings
- Aged
- Aged, 80 and over
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell
- Lymphoma/epidemiology
- Lymphoma/mortality
- Lymphoma/pathology
- Lymphoma, B-Cell, Marginal Zone/epidemiology
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, Follicular/epidemiology
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Multiple Myeloma/epidemiology
- Multiple Myeloma/mortality
- Multiple Myeloma/pathology
- Rheumatic Diseases/epidemiology
- Rheumatic Diseases/mortality
- Rheumatic Diseases/pathology
- United Kingdom/epidemiology
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Affiliation(s)
- Eleanor Kane
- Department of Health Sciences, University of York, York, UK.
| | - Daniel Painter
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Crouch
- Department of Health Sciences, University of York, York, UK
| | - Steven Oliver
- Department of Health Sciences, University of York, York, UK; Hull York Medical School, York, UK
| | | | - Eve Roman
- Department of Health Sciences, University of York, York, UK
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21
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Painter D, Barrans S, Lacy S, Smith A, Crouch S, Westhead D, Sha C, Patmore R, Tooze R, Burton C, Roman E. Cell-of-origin in diffuse large B-cell lymphoma: findings from the UK's population-based Haematological Malignancy Research Network. Br J Haematol 2018; 185:781-784. [PMID: 30408148 DOI: 10.1111/bjh.15619] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Daniel Painter
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Sharon Barrans
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Stuart Lacy
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Alexandra Smith
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Simon Crouch
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - David Westhead
- Bioinfomatics Group, Institute of Molecular and Cellular Biology, University of Leeds, Leeds, UK
| | - Chulin Sha
- Bioinfomatics Group, Institute of Molecular and Cellular Biology, University of Leeds, Leeds, UK
| | - Russell Patmore
- Queen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals, Cottingham, UK
| | - Reuben Tooze
- Section of Experimental Haematology, University of Leeds, Leeds, UK
| | - Cathy Burton
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Eve Roman
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
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22
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Burton C, Barrans S, Van Hoppe S, Sha C, Taylor J, Evans P, Painter D, Smith A, Crouch S, Goodlad J, Roman E, Westhead D, Davies A, Johnson P. GENE EXPRESSION PROFILING AND MUTATION ANALYSIS CAN AID TREATMENT DECISION MAKING IN AGGRESSIVE B CELL LYMPHOMA PATIENTS. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - C. Sha
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | | | - P. Evans
- HMDS; Leeds Cancer Centre; Leeds UK
| | - D. Painter
- Epidemiology & Cancer Statistics Group; University of York; York UK
| | - A. Smith
- Epidemiology & Cancer Statistics Group; University of York; York UK
| | - S. Crouch
- Epidemiology & Cancer Statistics Group; University of York; York UK
| | | | - E. Roman
- Epidemiology & Cancer Statistics Group; University of York; York UK
| | - D. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - A. Davies
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - P.W. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
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23
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Goodlad J, van Hoppe S, Ahmed S, Barrans S, Painter D, Care M, Taylor J, Evans P, Bentley M, Tooze R, Smith A, Crouch S, Roman E, Westhead D, Burton C. Molecular analysis of primary cutaneous diffuse large B-cell lymphoma, leg type. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - S. Ahmed
- HMDS; Leeds Cancer Centre; Leeds UK
| | | | - D. Painter
- Epidemiology and Cancer Statistics; University of York; York UK
| | - M. Care
- Institute of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | | | - P. Evans
- HMDS; Leeds Cancer Centre; Leeds UK
| | - M. Bentley
- Institute of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - R.M. Tooze
- Institute of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - A. Smith
- Epidemiology and Cancer Statistics; University of York; York UK
| | - S. Crouch
- Epidemiology and Cancer Statistics; University of York; York UK
| | - E. Roman
- Epidemiology and Cancer Statistics; University of York; York UK
| | - D.R. Westhead
- Institute of Molecular and Cellular Biology; University of Leeds; Leeds UK
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Burton C, Sha C, Barrans S, Jack A, Painter D, Smith A, Roman E, Crouch S, Care M, Tooze R, Westhead D. A category-free approach to prognostic modelling in aggressive non-Hodgkin B cell lymphomas based on large patient databases. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C. Burton
- Leeds Cancer Centre; Haematology Malignancy Diagnostic Service; Leeds UK
| | - C. Sha
- University of Leeds; Institute of Molecular and Cellular Biology; Leeds UK
| | - S. Barrans
- Leeds Cancer Centre; Haematology Malignancy Diagnostic Service; Leeds UK
| | - A. Jack
- Leeds Cancer Centre; Haematology Malignancy Diagnostic Service; Leeds UK
| | - D. Painter
- University of York; Epidemiology and Cancer Statistics Group; York UK
| | - A. Smith
- University of York; Epidemiology and Cancer Statistics Group; York UK
| | - E. Roman
- University of York; Epidemiology and Cancer Statistics Group; York UK
| | - S. Crouch
- University of York; Epidemiology and Cancer Statistics Group; York UK
| | - M. Care
- University of Leeds; Leeds Institute of Cancer and Pathology; Leeds UK
| | - R. Tooze
- University of Leeds; Leeds Institute of Cancer and Pathology; Leeds UK
| | - D. Westhead
- University of Leeds; Institute of Molecular and Cellular Biology; Leeds UK
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Smith A, Crouch S, Lax S, Li J, Painter D, Howell D, Patmore R, Jack A, Roman E. Lymphoma incidence, survival and prevalence 2004-2014: sub-type analyses from the UK's Haematological Malignancy Research Network. Br J Cancer 2015; 112:1575-84. [PMID: 25867256 PMCID: PMC4453686 DOI: 10.1038/bjc.2015.94] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/06/2015] [Accepted: 02/15/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Population-based information about cancer occurrence and survival are required to inform clinical practice and research; but for most lymphomas data are lacking. METHODS Set within a socio-demographically representative UK population of nearly 4 million, lymphoma data (N=5796) are from an established patient cohort. RESULTS Incidence, survival (overall and relative) and prevalence estimates for >20 subtypes are presented. With few exceptions, males tended to be diagnosed at younger ages and have significantly (P<0.05) higher incidence rates. Differences were greatest at younger ages: the <15 year male/female rate ratio for all subtypes combined being 2.2 (95% CI 1.3-3.4). These gender differences impacted on prevalence; most subtype estimates being significantly (P<0.05) higher in males than females. Outcome varied widely by subtype; survival of patients with nodular lymphocyte predominant Hodgkin lymphoma approached that of the general population, whereas less than a third of those with other B-cell (e.g., mantle cell) or T-cell (e.g., peripheral-T) lymphomas survived for ≥5 years. No males/female survival differences were detected. CONCLUSIONS Major strengths of our study include completeness of ascertainment, world-class diagnostics and generalisability. The marked variations demonstrated confirm the requirement for 'real-world' data to inform aetiological hypotheses, health-care planning and the future monitoring of therapeutic changes.
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Affiliation(s)
- A Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - S Crouch
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - S Lax
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - J Li
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - D Painter
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - D Howell
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - R Patmore
- Queens Centre for Oncology, Castle Hill Hospital, Hull HU16 5JQ, UK
| | - A Jack
- St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | - E Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
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Smith AG, Painter D, Howell DA, Evans P, Smith G, Patmore R, Jack A, Roman E. Determinants of survival in patients with chronic myeloid leukaemia treated in the new era of oral therapy: findings from a UK population-based patient cohort. BMJ Open 2014; 4:e004266. [PMID: 24435897 PMCID: PMC3902525 DOI: 10.1136/bmjopen-2013-004266] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/03/2013] [Accepted: 12/05/2013] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To examine contemporary survival patterns in the general population of patients diagnosed with chronic myeloid leukaemia (CML), and to identify patient groups with less than optimal outcomes. DESIGN Prospective population-based cohort. SETTING The UK's Haematological Malignancy Research Network (catchment population 3.6 million, with >2000 new haematological malignancies diagnosed annually). PARTICIPANTS All patients newly diagnosed with CML, from September 2004 to August 2011 and followed up to 31 March 2013. MAIN OUTCOME MEASURE Incidence and survival. RESULTS With a median diagnostic age of 59 years, the CML age standardised (European) incidence was 0.9/100 000 (95% CIs 0.8 to 0.9), 5-year overall survival was 78.9% (72.3 to 84.0) and 5-year relative survival 88.6% (81.0 to 93.3). The efficacy of treatment across all ages was clearly demonstrated; the relative survival curves for those under 60 and over 60 years being closely aligned. Survival findings were similar for men and women, but varied with deprivation; the age and sex adjusted HR being 3.43 (1.89 to 6.22) for deprivation categories 4-5 (less affluent) versus 1-3 (more affluent). None of these differences were attributable to the biological features of the disease. CONCLUSIONS When therapy is freely provided, population-based survival for CML is similar to that reported in clinical trials, and age loses its prognostic significance. However, although most of the patients with CML now experience close to normal lifespans, those living in more deprived areas tend to have poorer outcomes, despite receiving the same clinical care. A significant improvement in overall population outcomes could be achieved if these socioeconomic differences, which may reflect the treatment compliance, could be eliminated.
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Affiliation(s)
- A G Smith
- Department of Health Sciences, University of York, York, UK
| | - D Painter
- Department of Health Sciences, University of York, York, UK
| | - D A Howell
- Department of Health Sciences, University of York, York, UK
| | - P Evans
- Haematological Malignancy Diagnostic Service, St James University Hospital, Leeds, UK
| | - G Smith
- St. James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - R Patmore
- Queens Centre for Oncology, Castle Hill Hospital, Hull, UK
| | - A Jack
- Haematological Malignancy Diagnostic Service, St James University Hospital, Leeds, UK
| | - E Roman
- Department of Health Sciences, University of York, York, UK
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Painter D, Travis S, Dux P, Mattingley J. Feature-based enhancement of visual stimuli at task-irrelevant locations. J Vis 2011. [DOI: 10.1167/11.11.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Dunckley P, Wise RG, Aziz Q, Painter D, Brooks J, Tracey I, Chang L. Cortical processing of visceral and somatic stimulation: Differentiating pain intensity from unpleasantness. Neuroscience 2005; 133:533-42. [PMID: 15896917 DOI: 10.1016/j.neuroscience.2005.02.041] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 02/08/2005] [Accepted: 02/09/2005] [Indexed: 11/25/2022]
Abstract
Visceral and somatic pain perception differs in several aspects: poor localization of visceral pain and the ability of visceral pain to be referred to somatic structures. The perception of pain intensity and affect in visceral and somatic pain syndromes is often different, with visceral pain reported as more unpleasant. To determine whether these behavioral differences are due to differences in the central processing of visceral and somatic pain, non-invasive imaging tools are required to examine the neural correlates of visceral and somatic events when the behavior has been isolated and matched for either unpleasantness or pain intensity. In this study we matched the unpleasantness of somatic and visceral sensations and imaged the neural representation of this perception using functional magnetic resonance imaging in 10 healthy right-handed subjects. Each subject received noxious thermal stimuli to the left foot and midline lower back and balloon distension of the rectum while being scanned. Stimuli were matched to the same unpleasantness rating, producing mild-moderate pain intensity for somatic stimuli but an intensity below the pain threshold for the visceral stimuli. Visceral stimuli induced deactivation of the perigenual cingulate bilaterally with a relatively greater activation of the right anterior insula-i.e. regions encoding affect. Somatic pain induced left dorso-lateral pre-frontal cortex and bilateral inferior parietal cortex activation i.e. regions encoding spatial orientation and assessing perceptual valence of the stimulus. We believe that the observed patterns of activation represent the differences in cortical process of interoceptive (visceral) and exteroceptive (somatic) stimuli when matched for unpleasantness.
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Affiliation(s)
- P Dunckley
- Department of Human Anatomy and Genetics, University of Oxford, South Parks Road, Oxford OX1 3QX, UK
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Morgan M, Koorey D, Painter D, Findlay M, Newland R, Chapuis P, Solomon M. p53 and DCC immunohistochemistry in curative rectal cancer surgery. Int J Colorectal Dis 2003; 18:188-95. [PMID: 12673482 DOI: 10.1007/s00384-002-0434-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2002] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS In rectal cancer altered expression of p53 or DCC may be indicative of poor patient prognosis. This study determined by immunohistochemistry the tumour status of p53 protein and DCC protein in patients with rectal cancer who had a curative resection and were followed-up prospectively and examined the correlation to clinical and pathology variables. PATIENTS AND METHODS The study included 171 who had a curative resection for rectal cancer: 88 at Concord Hospital (CH) followed up for a mean of 11 years and 83 at Royal Prince Alfred Hospital (RPAH) followed up prospectively for a mean of 4.3 years. Specimens were assessed by immunohistochemical assay of p53 expression ( n=170) and of DCC expression ( n=168). RESULTS p53 over-expression was demonstrated in 58% of CH tumours and 59% of RPAH tumours. Absence of normal DCC expression was demonstrated in 66% of CH tumours and 52% of RPAH tumours. On both separate and combined analysis of these groups there were no significant associations by univariate analysis between p53 expression or DCC expression or combinations of p53 and DCC expression and the pathology variables: extent of penetration through bowel wall, lymph node involvement, presence of venous invasion, and tumour differentiation. CONCLUSION The immunohistochemical p53 and DCC status of rectal tumours was not associated with other clinical or pathology variables, nor predictive of outcome.
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Affiliation(s)
- M Morgan
- University of Sydney Surgical Outcomes Research Centre and Department of Colorectal Surgery, Royal Prince Alfred and Concord Hospitals, Sydney, Australia
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Orange SJ, Painter D, Horvath J, Yu B, Trent R, Hennessy A. Placental endothelial nitric oxide synthase localization and expression in normal human pregnancy and pre-eclampsia. Clin Exp Pharmacol Physiol 2003; 30:376-81. [PMID: 12859429 DOI: 10.1046/j.1440-1681.2003.03844.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. The aim of the present study was to investigate whether pre-eclampisa, a state of placental hypoxia, is associated with placental abnormalities in the amount, distribution and expression of endothelial nitric oxide synthase (eNOS). 2. Localization and intensity of eNOS was determined by immunohistochemistry using an antibody specific for eNOS. The amount of eNOS mRNA expression was determined by reverse transcription-polymerase chain reaction (RT-PCR) and the densitometry of gel bands was expressed as a ratio of the band density of the housekeeping gene beta2-microglobulin. 3. Endothelial NOS staining was localized to syncytiotrophoblast cells within the villi and decidual trophoblast cells. It was not present in the endothelium of terminal villous vessels. There was no significant difference in eNOS villous or decidual staining intensity between normal pregnancy (NP; n = 12), pre-eclampsia (n = 14), or gestational hypertension (GH; n = 4). Staining for eNOS was not significantly different in the decidua compared with the villi in NP, GH or pre-eclampsia. Within the decidua, the depth of eNOS staining was similar in NP, pre-eclampisa and GH. 4. There was no significant difference in eNOS mRNA expression between NP (0.70 +/- 0.11), pre-eclampsia (0.5 +/- 0.07) or GH (0.69 +/- 0.26). 5. These findings suggest that the amount of eNOS in the placenta is not deficient in pre-eclampsia, excluding a possible pathogenic role for eNOS in this disease. Furthermore, placental hypoxia, which is associated with pre-eclampsia, did not induce an upregulation of eNOS
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Affiliation(s)
- S J Orange
- Statewide Renal Services and Department of Molecular and Clinical Genetics, Royal Prince Alfred Hosipital, Camperdown, New South Wales, Australia.
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Saw RPM, Koorey D, Painter D, Gallagher PJ, Solomon MJ. p53, DCC and thymidylate synthase as predictors of survival after resection of hepatic metastases from colorectal cancer. Br J Surg 2002; 89:1409-15. [PMID: 12390383 DOI: 10.1046/j.1365-2168.2002.02222.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatic metastasis from colorectal cancer is a common problem. Hepatic resection offers the only chance of cure. Prognosis of patients following hepatic resection is currently based on clinicopathological factors (of both the primary cancer and the hepatic metastasis), which do not accurately predict the subsequent behaviour of the tumour. The aim of this study was to evaluate three molecular genetic markers - p53, DCC (deleted in colonic cancer) and thymidylate synthase - in both the primary colorectal tumour and the resected hepatic metastases, and to determine their correlation, if any, with survival in patients with resected hepatic metastases from colorectal cancer. METHODS Sixty-three patients with hepatic metastases and 40 corresponding colorectal primary tumours were studied using immunohistochemical staining for p53, DCC and thymidylate synthase, as well as p53 gene mutations using polymerase chain reaction-single-stranded conformational polymorphism (PCR-SSCP) analysis. The results were correlated with survival. RESULTS There was no correlation between p53, DCC or thymidylate synthase immunohistochemical staining, or between p53 PCR-SSCP analysis, and survival for either hepatic metastases or the colorectal primary tumour. CONCLUSION Prediction of prognosis in patients having resection of hepatic metastases from colorectal cancer continues to be problematic. Other genetic markers or combination of markers need to be evaluated.
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Affiliation(s)
- R P M Saw
- University of Sydney Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Nanashima A, Pillay P, Verran DJ, Painter D, Nakasuji M, Crawford M, Shi L, Ross AG. Analysis of initial poor graft function after orthotopic liver transplantation: experience of an australian single liver transplantation center. Transplant Proc 2002; 34:1231-5. [PMID: 12072325 DOI: 10.1016/s0041-1345(02)02639-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- A Nanashima
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
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Nanashima A, Pillay P, Crawford M, Nakasuji M, Verran DJ, Painter D. Analysis of postrevascularization syndrome after orthotopic liver transplantation: the experience of an Australian liver transplantation center. J Hepatobiliary Pancreat Surg 2002; 8:557-63. [PMID: 11956908 DOI: 10.1007/s005340100025] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE We investigated the causes and examined patient outcomes following the postrevascularization syndrome (PRS) during orthotopic liver transplantation (OLTx). METHODS PRS was defined as a fall in the mean arterial pressure at 5 min after revascularization to less than 70% of the baseline and lasting for 5 min. Data from 100 adult patients who underwent OLTx between January 1998 and September 2000 were analyzed. Analyzed data included donor and recipient demographic data, recipient operative and postoperative courses, and recipient outcome. RESULTS Twenty-nine patients (29%) exhibited PRS during OLTx (PRS group). There was a higher incidence of older donors (>50 years) in the PRS group (48% vs 23%; P < 0.05). Postrevascularization hyperkalemia and metabolic acidosis were observed in both the PRS and non-PRS groups. Transaminase and lactate levels after revascularization were significantly higher in the PRS group ( P < 0.05). Alkaline phosphatase and gamma-glutamyl transpeptidase levels on day 7 tended to be higher in the PRS group; although the difference was not significant (p > or = 0.05). Serum creatinine was significantly elevated on day 7 in the PRS group ( P < 0.01). CONCLUSIONS Our results indicate that PRS following OLTx tended to be more common in liver allografts from older donors and was associated with posttransplantation liver and renal dysfunction.
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Affiliation(s)
- A Nanashima
- Australian National Liver Transplantation Unit (ANLTU), Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW 2050, Australia
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Morgan MJ, Koorey DJ, Painter D, Findlay M, Tran K, Stevens G, Solomon MJ. Histological tumour response to pre-operative combined modality therapy in locally advanced rectal cancer. Colorectal Dis 2002; 4:177-183. [PMID: 12780612 DOI: 10.1046/j.1463-1318.2002.00330.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND: Pre-operative combined modality therapy (CMT) is used in locally advanced rectal cancer. Its use affects the clinicopathological staging based on the resected specimen. Assessment of the tumour response in the resected specimen may provide prognostic information. This study was undertaken to determine the histological response to pre-operative chemoradiation and to assess the interobserver reliability of a newly developed tumour response grading system for rectal cancer. METHODS: Pre-operative biopsy specimens and the resected specimens of 21 patients with low rectal cancer were assessed. The patients underwent pre-operative CMT consisting of radiotherapy (45 Gy) with 5-FU either as a continuous infusion or as a bolus intravenous infusion with leucovorin. After four to six weeks tumour response was assessed by comparing pre-operative transrectal ultrasound (TRUS) findings (uT1-4, uN0-1) with postoperative histopathological assessment (pT1-4, pN0-1) using UICC TNM characteristics. Tumour response was defined as a decrease in T status. The histological response to CMT was based on the tumour regression grade (TRG) and ranged from fibrosis extending through the rectal wall with no residual cancer (TRG 1), to no evidence of tumour response (TRG 5). Inter-observer reliability was assessed using weighted and unweighted kappa statistics. RESULTS: Local downstaging was demonstrated in 11/21 (52%) of patients. Three of 21 patients had a TRG 1 response. Thirteen of 21 (62%) patients had TRG 1-3 responses to CMT. There was no significant correlation between local downstaging and TRG. The interobserver correlation coefficient for assessment of TRG was 0.88 (unweighted kappa). CONCLUSIONS: Local downstaging by pre-operative CMT can be demonstrated if pre-operative TRUS staging is compared to standard pathology staging in patients with rectal cancer. Local downstaging is not directly related to histologic response as assessed by TRG. Inter-observer reporting of tumour regression grade (TRG) is reliable.
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Affiliation(s)
- M. J Morgan
- University of Sydney, Royal Prince Alfred Hospital, Sydney NSW Australia, Department of Surgery, Royal Prince Alfred Hospital, Sydney NSW Australia, Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney NSW Australia, Department of Pathology, Royal Prince Alfred Hospital, Sydney NSW Australia, Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney NSW Australia, Wellington Cancer Centre, Wellington Hospital, New Zealand
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Abstract
Macroregenerative nodules (MRN) have been detected with increased incidence in explanted livers since orthotopic liver transplantation (OLTx) has become a routine treatment for end-stage liver disease. Autopsy series suggest that MRN may be more common than once thought, and several studies point to the malignant potential of these lesions. With increasing waiting times for OLTx, the propensity for these premalignant lesions to arise in cirrhotic livers has important implications for the supervision of patients on OLTx waiting lists. We present here a striking example of a MRN and review a topic that is generating considerable interest.
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Affiliation(s)
- A Gurkan
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, Australia
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Coveney VA, Gepi-Attee S, Gröver D, Painter D. Suprapubic track pressure and force--deformation measurements in a (live) human subject and in animal models post-mortem. Proc Inst Mech Eng H 2001; 215:39-49. [PMID: 11323984 DOI: 10.1243/0954411011533517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Tests have been performed on animal models shortly post-mortem and on a healthy human subject in order to obtain estimates of the forces which act on suprapubic urinary catheters and similar devices and to develop an abdominal wall simulator. Such data and test methods are required for the systematic design of suprapubic devices because of the dual need to maintain the functionality of devices and to avoid excessive pressure on soft body tissue which could lead to ischaemia and in turn necrosis. In the post-mortem animal models, electrical excitation was applied to the abdominal wall in order to stimulate muscle activity. Two types of transducers were used: a soft membrane transducer (SMT) for pressure measurement and novel instrumented 'tongs' to determine indentation stiffness characteristics in the suprapubic track or artificial pathway created for a device. The SMT has been extensively used in the urethras and bladders of human subjects while the tongs were built specifically for these tests. Only the well-established SMT was used with the human subject; a peak pressure of 22 kPa was obtained. In the animal models the pressure profile given by the SMT had a peak whose position corresponded well with the estimated location of the rectus muscle measured on the fixed tissue section. The peak value was 5.5 kPa, comparable with values likely to cause necrosis if maintained for more than 1 day. Remarkably consistent indentation stiffness values were obtained with the instrumented tongs; all values were close to 0.45 N/mm (33 kPa/mm).
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Affiliation(s)
- V A Coveney
- Faculty of Engineering, University of the West of England, Coldharbour Lane, Frenchay, Bristol BS16 1QY, UK
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Verran DJ, Gurkan A, Dilworth P, Painter D, Chui A, Dorney S, Shun A, Koorey D, McCaughan G, Sheil AG. Inferior liver allograft survival from cadaveric donors >50 years of age? Clin Transplant 2001; 15:106-10. [PMID: 11264636 DOI: 10.1034/j.1399-0012.2001.150205.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The growing imbalance between the number of cadaveric organ donors and recipients has led to an increasing use of high-risk donors as an option to expand the donor pool. The aim of this study was to evaluate our experience with the use of older liver (donor>50 yr of age) allografts. The medical records, postreperfusion biopsies and laboratory results were reviewed of the 393 patients who underwent orthotopic liver transplantation between 1986 and 1997. The outcome of the 61 patients who received older livers (OL) was compared to that of the other 332 recipients. Increasing use of OL was evident from 1992 onwards. Recipients of OL were older than recipients of younger livers (YL, p<0.001) and more commonly had underlying chronic viral hepatitis (CVH) or fulminant hepatic failure (p<0.05). Patient and allograft survival were only slightly less in recipients of OL versus YL (p=NS). Although postperfusion biopsies showed more damage in OL than YL allografts (p<0.05), this was not associated with increased primary graft failure. OL allografts can be transplanted with acceptable results into recipients without the concern of early allograft loss. SUMMARY OF ARTICLE: This report of one centre's experience with 61 recipients of older donor liver allografts identifies recipient factors that may also have a negative impact on allograft outcome. These factors include a diagnosis of either CVH or fulminant hepatic failure at the time of transplantation. Postreperfusion biopsies of older donor allografts tend to show more damage, but this is not associated with primary non-function.
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Affiliation(s)
- D J Verran
- Australian Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
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Horvath L, Bayfield M, Clifford A, Painter D, Clarke S. Unusual presentations of germ cell tumors. Case 1. Recurrent laryngeal nerve palsyin mediastinal seminoma. J Clin Oncol 2001; 19:909-11. [PMID: 11157044 DOI: 10.1200/jco.2001.19.3.909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L Horvath
- Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia
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Evans A, Painter D, Feneley R. Blocked urinary catheters: nurses' preventive role. Nurs Times 2001; 97:37-8. [PMID: 11954507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Berdoukas V, Bohane T, Eagle C, Lindeman R, DeSilva K, Tobias V, Painter D, Fraser I. The Sydney Children's Hospital experience with the oral iron chelator deferiprone (L1). Transfus Sci 2000; 23:239-40. [PMID: 11099900 DOI: 10.1016/s0955-3886(00)00092-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- V Berdoukas
- Sydney Children's Hospital, Sydney, Australia
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Chui AK, Shi LW, Rao AR, Verran DJ, Painter D, Koorey D, McCaughan GW, Sheil AG. Donor fatty (steatotic) liver allografts in orthotopic liver transplantation: a revisit. Transplant Proc 2000; 32:2101-2. [PMID: 11120086 DOI: 10.1016/s0041-1345(00)01587-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A K Chui
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, University of Sydney, NSW, Camperdown, Australia
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Abstract
The prevalence of long-term catheterization in the adult population is of the order of 0.03-0.07%, rising to 0.5% in those over 75 years and 2% in those over 85 years old. Studies have shown that the prevalence of urinary incontinence increases with age and is higher in females. Little is known about the costs of long-term catheterization, which have consequences for care decisions. A pilot study was conducted to test (a) the applicability in the UK of a methodology developed in the USA for measuring the cost of long-term catheterization in community-based patients, and (b) the feasibility of using it in larger-scale community-based studies. The study made use of the method developed in the USA by Wagner and Hu (1998) to assess the true costs in the population. Patients were selected in order to represent as broad as possible a range of underlying disease processes and social circumstances. Eight patients were selected, drawn from 3 distinct groups of patients. The pilot study demonstrated wide variation in direct costs for 7 patients living in the community over a 3-month period, ranging from pound 118.80 to pound 2585.26. Since staffing is - for the most part - the most significant cost element, this indicates significant variation in levels of need. Resources deployed for one nursing procedure clearly impact on opportunities to undertake other procedures. An understanding of the costs of any procedure is necessary in order to make best use of the limited resources available.
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Affiliation(s)
- A Evans
- Southmead Hospital, Westbury on Trym, Bristol, UK
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Painter D. The dissolution of urinary catheter encrustation. BJU Int 2000; 86:566. [PMID: 11203271 DOI: 10.1046/j.1464-410x.2000.00876-7.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Doughty AL, Zekry A, Spencer JD, Turhan S, Painter D, McCaughan GW. Spontaneous clearance of hepatitis C virus infection post-liver transplantation is associated with rapidly changing quasispecies: a single case report. Liver Transpl 2000; 6:648-53. [PMID: 10980067 DOI: 10.1053/jlts.2000.9740] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus (HCV) clearance post-liver transplantation is uncommon. This is a case report of a patient who, after liver transplantation, developed cholestatic hepatitis characterized by severe graft dysfunction, in conjunction with high viral load. This was, however, followed by viral clearance and normalization of allograft function. The clinical features of this case and the quasispecies patterns during the illness and the clearance periods are described. In addition, management implications in terms of immunosuppressive therapy are discussed.
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Affiliation(s)
- A L Doughty
- The A.W. Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales
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Jass JR, Iino H, Ruszkiewicz A, Painter D, Solomon MJ, Koorey DJ, Cohn D, Furlong KL, Walsh MD, Palazzo J, Edmonston TB, Fishel R, Young J, Leggett BA. Neoplastic progression occurs through mutator pathways in hyperplastic polyposis of the colorectum. Gut 2000; 47:43-9. [PMID: 10861263 PMCID: PMC1727952 DOI: 10.1136/gut.47.1.43] [Citation(s) in RCA: 196] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM Colorectal cancer has been described in association with hyperplastic polyposis but the mechanism underlying this observation is unknown. The aim of this study was to characterise foci of dysplasia developing in the polyps of subjects with hyperplastic polyposis on the basis of DNA microsatellite status and expression of the DNA mismatch repair proteins hMLH1, hMSH2, and hMSH6. MATERIALS AND METHODS The material was derived from four patients with hyperplastic polyposis and between one and six synchronous colorectal cancers. Normal (four), hyperplastic (13), dysplastic (13), and malignant (11) samples were microdissected and a PCR based approach was used to identify mutations at 10 microsatellite loci, TGFbetaIIR, IGF2R, BAX, MSH3, and MSH6. Microsatellite instability-high (MSI-H) was diagnosed when 40% or more of the microsatellite loci showed mutational bandshifts. Serial sections were stained for hMLH1, hMSH2, and hMSH6. RESULTS DNA microsatellite instability was found in 1/13 (8%) hyperplastic samples, in 7/13 (54%) dysplastic foci, and in 8/11 (73%) cancers. None of the MSI-low (MSI-L) samples (one hyperplastic, three dysplastic, two cancers) showed loss of hMLH1 expression. All four MSI-H dysplastic foci and six MSI-H cancers showed loss of hMLH1 expression. Loss of hMLH1 in MSI-H but not in MSI-L lesions showing dysplasia or cancer was significant (p<0.001, Fisher's exact test). Loss of hMSH6 occurred in one MSI-H cancer and one MSS focus of dysplasia which also showed loss of hMLH1 staining. CONCLUSION Neoplastic changes in hyperplastic polyposis may occur within a hyperplastic polyp. Neoplasia may be driven by DNA instability that is present to a low (MSI-L) or high (MSI-H) degree. MSI-H but not MSI-L dysplastic foci are associated with loss of hMLH1 expression. At least two mutator pathways drive neoplasia in hyperplastic polyposis. The role of the hyperplastic polyp in the histogenesis of sporadic DNA microsatellite unstable colorectal cancer should be examined.
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Affiliation(s)
- J R Jass
- Department of Pathology, University of Queensland, Mayne Medical School, Herston, Australia.
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Doran TJ, Geczy AF, Painter D, McCaughan G, Sheil AG, Süsal C, Opelz G. A large, single center investigation of the immunogenetic factors affecting liver transplantation. Transplantation 2000; 69:1491-8. [PMID: 10798776 DOI: 10.1097/00007890-200004150-00047] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Reports on the relevance of immunogenetic factors in liver transplantation are often conflicting or inconclusive. We have, therefore, investigated a range of factors that may underlie liver graft survival. METHODS The influences of HLA, flow cytometric, and enhanced cytotoxic crossmatching and immunoglobulin (Ig)A levels on graft survival, and acute and chronic rejection were investigated for a single center involving 446 patients over 13 years. RESULTS The effect of HLA mismatching on graft survival was significant (P<10(-2)) and was reversed in recipients with autoimmune diseases (P<0.5x10(-2)), whereas the effect of HLA mismatches on the level of acute rejection was detrimental in all recipients. There was a significant effect of a positive cytotoxic crossmatch on 3-month (P<10(-5)) and 1-year (P<10(-4)) graft survival, and an additional effect of the flow cytometric crossmatch was seen for chronic rejection (P<10(-2)) and acute rejection (P<10(-2)). Recipients with HLA-A1,B8,DRB1*0301 had higher levels of acute rejection (P<0.5x10(-2)), and recipients who received an ABO compatible-nonidentical transplant have a significantly higher risk (P<10(-2)) of developing chronic rejection. Finally, the beneficial effect of high serum IgA and, specifically, IgA anti Fab, seen in renal transplants was not evident in liver transplants, and in fact the opposite may be true, at least for acute rejection (P<0.5x10(-2)). CONCLUSIONS By separating the recipients with autoimmune disease from other patients and by including acute and chronic rejection as outcome parameters, we have used the power of a large single-centre study to delineate the significance of some of the important immunogenetic factors involved in liver transplantation.
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Affiliation(s)
- T J Doran
- Tissue Typing Laboratory, Australian Red Cross-Blood Service, North East Region, Sydney, NSW
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McGuinness PH, Painter D, Davies S, McCaughan GW. Increases in intrahepatic CD68 positive cells, MAC387 positive cells, and proinflammatory cytokines (particularly interleukin 18) in chronic hepatitis C infection. Gut 2000; 46:260-9. [PMID: 10644323 PMCID: PMC1727823 DOI: 10.1136/gut.46.2.260] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Upregulation of Th1 associated intrahepatic cytokines in chronic hepatitis C virus (HCV) infection should lead to a significant non-specific cellular immune response, a prerequisite for viral clearance. However, to date, the role of this non-specific response in HCV has been understudied. AIMS To analyse the intrahepatic macrophage activity in chronic HCV infection by immunostaining and by quantitation of cytokine mRNA. METHODS HCV positive liver tissues (chronic hepatitis, n=10; cirrhosis, n=5) were immunostained for CD68, MAC387, and semiquantitated by polymerase chain reaction for intrahepatic cytokine mRNAs (interferon gamma (IFNgamma), interleukin 1beta (IL-1beta), IL-6, IL-18, tumour necrosis factor alpha (TNFalpha), and macrophage inflammatory protein 1beta (MIP1beta)). HCV negative normal liver tissues (for cytokines, n=6; for immunostaining, n=5) were included as controls. RESULTS MAC387(+) cells were focally increased in areas of erosion at the limiting plate while lobular staining was minimal. CD68(+) staining was diffuse in both portal (increased in HCV) and lobular areas. The portal tract (mean) density of CD68(+) and MAC387(+) cells was significantly increased in patients with HCV compared with normal tissue. IFNgamma and IL-18 mRNA levels were highly correlated and significantly upregulated in chronic hepatitis and cirrhotic tissue versus controls. TNFalpha mRNA was upregulated in chronic hepatitis without cirrhosis, while IL-6 mRNA was significantly downregulated. IL-1beta, IL-6, and MIP1beta mRNA levels were significantly correlated with portal tract MAC387(+) cell density. CONCLUSIONS The significant upregulation of IFNgamma and IL-18 mRNA and significant correlations between IFNgamma and other proinflammatory cytokines, suggest a Th1/cell mediated intrahepatic immune response in chronic HCV infection. However, further clarification of the cellular sources of these cytokines is required.
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Affiliation(s)
- P H McGuinness
- The A W Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Australia
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Chui AK, Rao AR, McCaughan GW, Waugh R, Verran DJ, Koorey D, Painter D, Sheil AG. An active liver transplant programme for hepatocellular carcinoma in cirrhotic patients: is it justified? Clin Transplant 1999; 13:531-5. [PMID: 10617245 DOI: 10.1034/j.1399-0012.1999.130615.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Even at an early stage, hepatocellular carcinoma (HCC) in patients with cirrhosis is often deemed unresectable because of limited liver reserve. In these circumstances, liver transplantation (LTx) offers some hope for palliation or cure. The results of LTx for selected cirrhotic patients with HCC were analysed. The outcomes were compared with those of patients who underwent LTx for other forms of hepatic malignancy and those who underwent LTx for non-malignant conditions. Four hundred and eighty LTx were performed in 441 patients between January 1986 and December 1998. Twenty-eight LTx recipients (25 males, 3 females) of mean age 51 (14 63) yr had cirrhosis and HCC. Twenty-seven patients had underlying predisposing conditions (11 had hepatitis B, 10 had hepatitis C, 2 had hepatitis B and C, 1 had haemochromatosis, 1 had autoimmune hepatitis, 1 had alcoholic cirrhosis and 1 had alpha-1 antitrypsin deficiency). In 22 patients, HCC was diagnosed pre-LTx, and in 6 patients, the cancers were discovered incidentally. The average tumour size and number were 2.8 (0.4-11.5) cm and 1.3 (1-4), respectively. Two patients with known HCC died during and shortly after the LTx operation. Of the other patients, 3 died; 1 died of HCC recurrence 18 months post-LTx, 1 died of graft failure from recurrent hepatitis C and 1 died of fungal sepsis. Twenty-three (82%) patients survived to 22.5 (0.5-96) months post-LTx without HCC recurrence and with 1- and 3-yr actuarial patient survival rates of 87 and 76%, respectively. Equivalent survival rates of patients who underwent LTx for other malignancies (n = 11) were 82 and 46% (p = NS), and for those who underwent LTx for benign causes (n = 402), they were 77 and 73% (p = NS). All 15 patients with known HCC, who met the selection criteria now in use, survived. LTx can result in prolonged. cancer-free survival in a good proportion of patients with cirrhosis and HCC, particularly when the cancers are incidental, or when diagnosed pre-LTx, conforming to established selection criteria. An active LTx programme for this group of patients is justified.
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Affiliation(s)
- A K Chui
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, University of Sydney, NSW
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Selby WS, Painter D, Collins A, Faulkner-Hogg KB, Loblay RH. Persistent mucosal abnormalities in coeliac disease are not related to the ingestion of trace amounts of gluten. Scand J Gastroenterol 1999; 34:909-14. [PMID: 10522611 DOI: 10.1080/003655299750025390] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND It is expected that in patients with coeliac disease the small-bowel mucosal mucosa will return to normal if they adhere to a gluten-free diet (GFD). However, in many this is not the case. This study aims to determine whether this persistent villous atrophy (VA) could be due to continued ingestion of the trace amounts of gluten in 'gluten-free' foods, as defined by the WHO/FAO Codex Alimentarius. METHODS Duodenal biopsy specimens from 89 adults with long-standing coeliac disease were examined, and the findings correlated with their form of gluten-free diet. RESULTS In 51 subjects the duodenal specimen was normal, whereas in 38 there was villous atrophy (partial, 28; subtotal, 8; total, 2). There was no relationship between the presence or absence of VA and ingestion of either a GFD as defined by the Codex Alimentarius (Codex-GFD; 39 patients) or a GFD that contained no detectable gluten (NDG diet: 50 patients). Intraepithelial lymphocyte counts were higher, and lactase levels lower, in subjects with an abnormal biopsy specimen than in those in whom it was normal. However, within each of these biopsy groups there was no difference in these variables between patients on a Codex-GFD and those on an NDG-GFD. IgA antigliadin antibody was detected in 4 of 29 patients on a Codex-GFD and in 3 of 13 on a NDG-GFD (NS). CONCLUSION The persistent mucosal abnormalities seen in patients with coeliac disease on a GFD are not due to the ingestion of trace amounts of gluten. The consequences of these abnormalities have yet to be determined.
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Affiliation(s)
- W S Selby
- AW Morrow Gastroenterology and Liver Centre, Dept of Histopathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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50
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Sun J, Waring M, Wang L, Li L, Painter D, Johnston B, Horvat M, Kelly G, Sheil R. Engraftment of murine embryonic stem cells in neonatal rats. Transplant Proc 1998; 30:2935-7. [PMID: 9838294 DOI: 10.1016/s0041-1345(98)00876-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- J Sun
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, Australia
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