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Berendsen MR, van Bladel DA, Hesius E, Berganza Irusquieta C, Rijntjes J, van Spriel AB, van der Spek E, Pruijt JF, Kroeze LI, Hebeda KM, Croockewit S, Stevens WB, van Krieken JHJ, Groenen PJ, van den Brand M, Scheijen B. Clonal Relationship and Mutation Analysis in Lymphoplasmacytic Lymphoma/Waldenström Macroglobulinemia Associated With Diffuse Large B-cell Lymphoma. Hemasphere 2023; 7:e976. [PMID: 37928625 PMCID: PMC10621888 DOI: 10.1097/hs9.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023] Open
Abstract
Patients with lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) occasionally develop diffuse large B-cell lymphoma (DLBCL). This mostly results from LPL/WM transformation, although clonally unrelated DLBCL can also arise. LPL/WM is characterized by activating MYD88L265P (>95%) and CXCR4 mutations (~30%), but the genetic drivers of transformation remain to be identified. Here, in thirteen LPL/WM patients who developed DLBCL, the clonal relationship of LPL and DLBCL together with mutations contributing to transformation were investigated. In 2 LPL/WM patients (15%), high-throughput sequencing of immunoglobulin gene rearrangements showed evidence of >1 clonal B-cell population in LPL tissue biopsies. In the majority of LPL/WM patients, DLBCL presentations were clonally related to the dominant clone in LPL, providing evidence of transformation. However, in 3 patients (23%), DLBCL was clonally unrelated to the major malignant B-cell clone in LPL, of which 2 patients developed de novo DLBCL. In this study cohort, LPL displayed MYD88L265P mutation in 8 out of eleven patients analyzed (73%), while CXCR4 mutations were observed in 6 cases (55%). MYD88WT LPL biopsies present in 3 patients (27%) were characterized by CD79B and TNFAIP3 mutations. Upon transformation, DLBCL acquired novel mutations targeting BTG1, BTG2, CD79B, CARD11, TP53, and PIM1. Together, we demonstrate variable clonal B-cell dynamics in LPL/WM patients developing DLBCL, and the occurrence of clonally unrelated DLBCL in about one-quarter of LPL/WM patients. Moreover, we identified commonly mutated genes upon DLBCL transformation, which together with preserved mutations already present in LPL characterize the mutational landscape of DLBCL occurrences in LPL/WM patients.
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Affiliation(s)
| | - Diede A.G. van Bladel
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eva Hesius
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jos Rijntjes
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annemiek B. van Spriel
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Johannes F.M. Pruijt
- Department of Hematology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Leonie I. Kroeze
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Konnie M. Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sandra Croockewit
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wendy B.C. Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Blanca Scheijen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
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Berendsen MR, Bladel DAGV, Hesius E, de Groot FA, Kroeze LI, Rijntjes J, Luijks JACW, Hoevenaars B, Halilovic A, Nooijen P, Bladel EV, Jonge-Peeters SD, Lensen C, Pruijt H, van der Spek E, Vermaat JSP, Hess C, Hebeda KM, Stevens WBC, van Krieken JHJM, van den Brand M, Groenen PJTA, Scheijen B. Detection of Second Primary Lymphoma in Late Diffuse Large B-cell Lymphoma Recurrences. Mod Pathol 2023; 36:100119. [PMID: 36805792 DOI: 10.1016/j.modpat.2023.100119] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
Approximately one-third of patients with diffuse large B-cell lymphoma (DLBCL) relapse and often require salvage chemotherapy followed by autologous stem cell transplantation. In most cases, the clonal relationship between the first diagnosis and subsequent relapse is not assessed, thereby potentially missing the identification of second primary lymphoma. In this study, the clonal relationship of 59 paired DLBCL diagnoses and recurrences was established by next-generation sequencing-based detection of immunoglobulin gene rearrangements. Among 50 patients with interpretable results, 43 patients (86%) developed clonally related relapsed disease. This was observed in 100% of early recurrences (<2 years), 80% of the recurrences with an interval between 2 and 5 years, and 73% of late recurrences (≥5 years). On the other hand, 7 (14%) out of 50 patients displayed different dominant clonotypes in primary DLBCL and clinical recurrences, confirming the occurrence of second primary DLBCL; 37% of DLBCL recurrences that occurred ≥4 years after diagnosis were shown to be second primary lymphomas. The clonally unrelated cases were Epstein-Barr virus positive in 43% of the cases, whereas this was only 5% in the relapsed DLBCL cases. In conclusion, next-generation sequencing-based clonality testing in late recurrences should be considered in routine diagnostics to distinguish relapse from second primary lymphoma, as this latter group of patients with DLBCL may benefit from less-intensive treatment strategies.
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Affiliation(s)
- Madeleine R Berendsen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Diede A G van Bladel
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Eva Hesius
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fleur A de Groot
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leonie I Kroeze
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos Rijntjes
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen A C W Luijks
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brigiet Hoevenaars
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Altuna Halilovic
- Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Peet Nooijen
- Department of Pathology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Esther van Bladel
- Department of Hematology, Slingeland Hospital, Doetinchem, The Netherlands
| | | | - Chantal Lensen
- Department of Hematology, Bernhoven Hospital, Uden, The Netherlands
| | - Hans Pruijt
- Department of Hematology Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Joost S P Vermaat
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Corine Hess
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Konnie M Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wendy B C Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Han J M van Krieken
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Blanca Scheijen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands; Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands.
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Hesius E, Bunthof K, Steenbergen E, de Kort E, Klein I, Wetzels J. Monoclonal gammopathy of renal significance presenting with cryoglobulinemia type I associated severe thrombotic microangiopathy. Clin Kidney J 2022; 15:1425-1428. [PMID: 35756736 PMCID: PMC9217659 DOI: 10.1093/ckj/sfac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Indexed: 11/28/2022] Open
Abstract
We report a 53-year-old man who presented with acute renal failure. His medical history revealed a spondyloarthropathy, for which secukinumab was started recently, and a monoclonal gammopathy of unknown significance. Kidney function deteriorated despite the withdrawal of secukinumab and dialysis was started. In the serum, type 1 cryoglobulins were present and a kidney biopsy showed ischaemic glomeruli, with thrombosis of the larger interlobular arteries. Other causes of thrombotic microangiopathy were excluded. Bone marrow immunophenotyping showed 1% monoclonal plasma cells. A diagnosis of monoclonal gammopathy of renal significance was made. Haematological treatment resulted in haematological and renal response.
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Affiliation(s)
- Eva Hesius
- Radboudumc, Department of Hematology, Nijmegen, The Netherlands
| | - Kim Bunthof
- Radboudumc, Department of Nephrology, Nijmegen, The Netherlands
- Bravis Hospital, Department of Internal Medicine, Roosendaal, The Netherlands
| | | | | | - Inge Klein
- Slingeland Hospital, Department of Nephrology, Doetinchem, The Netherlands
| | - Jack Wetzels
- Radboudumc, Department of Nephrology, Nijmegen, The Netherlands
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