Genomic complexity is associated with epigenetic regulator mutations and poor prognosis in diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphoma with high mutation burdens but a low response rate to immune checkpoint inhibitors. In this study, we performed targeted next-generation sequencing and fluorescent multiplex immunohistochemistry, and investigated the clinical significance and immunological effect of mutation numbers in 424 DLBCL patients treated with standard immunochemotherapy. We found that KMT2D and TP53 nonsynonymous mutations (MUT) were significantly associated with increased nonsynonymous mutation numbers, and that high mutation numbers (MUT^high) were associated with significantly poorer clinical outcome in germinal center B-cell-like DLBCL with wild-type TP53. To understand the underlying mechanisms, we identified a gene-expression profiling signature and the association of MUT^high with decreased T cells in DLBCL patients with wild-type TP53. On the other hand, in overall cohort, MUT^high was associated with lower PD-1 expression in T cells and PD-L1 expression in macrophages, suggesting a positive role of MUT^high in immune responses. Analysis in a whole-exome sequencing dataset of 304 patients deposited by Chapuy et al. validated the correlation of MUT-KMT2D with genomic complexity and the significantly poorer survival associated with higher numbers of genomic single nucleotide variants in activated B-cell-like DLBCL with wild-type TP53. Together, these results suggest that KMT2D inactivation or epigenetic dysregulation has a role in driving DLBCL genomic instability, and that genomic complexity has adverse impact on clinical outcome in DLBCL patients with wild-type TP53 treated with standard immunochemotherapy. The oncoimmune data in this study have important implications for biomarker and therapeutic studies in DLBCL.

Success rates in paediatric tympanoplasty

OBJECTIVE

To determine if the success of paediatric tympanoplasty is dependent on certain criteria, which are determinable prior to surgery.

DESIGN

Retrospective chart review.

SETTING

An academic paediatric otolaryngology department.

PATIENTS

Seventy-seven patients who had undergone tympanoplasty with or without ossicular reconstruction, but without mastoidectomy, between April 1997 and May 1999.

MAIN OUTCOME MEASURES

Status of the repaired tympanic membrane at last follow-up visit measured by otoscopic examination and with tympanometry.

RESULTS

Eighty-nine tympanoplasties were performed during this period. The age range was 2.9 to 22 years. The success rate was 75% overall. For patients younger than 11 years (n = 43), the success rate was 82%, and for those 11 to 18 years (n = 44), it was 74%, which was not significantly different. In 18 patients 7.5 years or younger, the success rate was 79%. Perforation location, size, presence of myringosclerosis, status of the other ear or nose, history of the perforation, surgical approach, middle ear findings, canal packing, and gender were not shown to be significantly different between successful and unsuccessful tympanoplasty groups.

CONCLUSION

These young patients had a good success rate post-tympanoplasty, which we believe reflects less severe disease. These results mitigate against delaying tympanoplasty in young children.

Correlation of findings at direct laryngoscopy and bronchoscopy with gastroesophageal reflux disease in children: a prospective study

OBJECTIVE

To correlate direct laryngoscopic and bronchoscopic findings with the presence of positive test results for gastroesophageal reflux disease (GERD) in children.

DESIGN

Prospective collection of structured data.

SETTING

An academic pediatric otolaryngology department.

PATIENTS

Seventy-seven consecutive patients who underwent direct laryngoscopy and bronchoscopy between June and October 1999.

INTERVENTIONS

During direct laryngoscopy and bronchoscopy, descriptions of 7 laryngeal and 6 cricotracheal findings were recorded on a 3-point scale (i.e., absent, mild, or severe). Medical records were later reviewed to obtain results of the following tests, if they were part of the record: gastric scintiscan, 24-hour pH probe monitoring, upper gastrointestinal tract series, and esophageal biopsy.

MAIN OUTCOME MEASURES

Correlation of mucosal abnormalities with the presence or absence of a positive test result for GERD.

RESULTS

Fifty (65%) of 77 patients had GERD diagnosed with at least 1 positive test result, 21 (27%) had no clinical symptoms and no positive GERD test results, and 5 (7%) had clinical symptoms but no positive test results. There were significant differences for total laryngeal and cricotracheal scores (P<.001) between the groups with positive and negative results. Significant differences were as follows: in the larynx-large lingual tonsil (P<.001), postglottic edema (P<.001), arytenoid edema (P<.001), ventricle obliteration (P =.03), and true vocal fold edema (P = .001), and in the cricotracheal region-general edema and erythema (P =.003) and blunting of the carina (P<.001). Severe arytenoid edema, postglottic edema, or enlargement of lingual tonsil were pathognomonic of GERD.

CONCLUSION

Many direct laryngoscopic and bronchoscopic findings correlate well with the diagnosis of GERD as determined by using other tests.