Circulating microRNAs in Cerebrospinal Fluid and Plasma: Sensitive Tool for Detection of Secondary CNS Involvement, Monitoring of Therapy and Prediction of CNS Relapse in Aggressive B-NHL Lymphomas

Simple Summary

Lymphoma involving the central nervous system and CNS relapse present diagnostic and predictive challenges. Its diagnosis is based on conventional methods with low sensitivity and/or specificity. More powerful tools for its early detection, response evaluation, and CNS relapse prediction are needed. MicroRNAs are short post-transcriptional gene regulators that are remarkably stable and detectable extracellularly in body fluids. We evaluated the diagnostic and predictive potential of circulating oncogenic microRNAs (oncomiRs) in CSF and plasma for the detection of secondary CNS involvement in aggressive B-NHL lymphomas, as well as for detection and prediction of their CNS relapse. Our findings indicate that the evaluation of oncogenic microRNAs in CSF and plasma potentially provides a sensitive tool for the early detection of secondary CNS lymphoma, the monitoring and estimating of treatment efficacy, and the prediction and early detection of CNS relapse.

Abstract

Lymphoma with secondary central nervous system (CNS) involvement represents one of the most aggressive malignancies, with poor prognosis and high mortality. New diagnostic tools for its early detection, response evaluation, and CNS relapse prediction are needed. We analyzed circulating microRNAs in the cerebrospinal fluid (CSF) and plasma of 162 patients with aggressive B-cell non-Hodgkin’s lymphomas (B-NHL) and compared their levels in CNS-involving lymphomas versus in systemic lymphomas, at diagnosis and during treatment and CNS relapse. We identified a set of five oncogenic microRNAs (miR-19a, miR-20a, miR-21, miR-92a, and miR-155) in CSF that detect, with high sensitivity, secondary CNS lymphoma involvement in aggressive B-NHL, including DLBCL, MCL, and Burkitt lymphoma. Their combination into an oncomiR index enables the separation of CNS lymphomas from systemic lymphomas or nonmalignant controls with high sensitivity and specificity, and high Receiver Operating Characteristics (DLBCL AUC = 0.96, MCL = 0.93, BL = 1.0). Longitudinal analysis showed that oncomiR levels reflect treatment efficacy and clinical outcomes, allowing their monitoring and prediction. In contrast to conventional methods, CSF oncomiRs enable detection of early and residual CNS involvement, as well as parenchymal involvement. These circulating oncomiRs increase 1–4 months before CNS relapse, allowing its early detection and improving the prediction of CNS relapse risk in DLBCL. Similar effects were detectable, to a lesser extent, in plasma.

The quality of life following allogeneic hematopoietic stem cell transplantation - a multicenter retrospective study

Although allogeneic haematopoietic stem cell transplantation (allo-HSCT) offers a unique curative potential, it may be connected with high treatment-related morbidity and mortality. Besides many organ complications, allo-HSCT may significantly affect quality of life (QOL).

PATIENTS AND METHODS

Between January 2011 and December 2012, five hundred and ninety patients (pts) from 6 transplant centers in the Czech Republic filled in the questionnaire for the quantitative measurement of QOL using Functional Assessment of Cancer Therapy-General (FACT-G) version 4. Study cohort characteristics were as follows: 325 males, 340 pts received myeloablative conditioning, 383 pts received PBPC, representation of diagnoses; acute leukemia (n=270), bone marrow failure (n=36), chronic myeloid leukemia (n=74), myelodysplastic/myeloproliferative syndrom (n=110), lymphoproliferative disease (n=93). The median age at allo-HSCT was 43 years (range: 1.7 - 71.0), the median time from allo-HSCT to questionnaire completing was 3.8 years (range: - 0.2 - 21.6). The earliest allo-HSCT was performed in November 1989, the last in September 2012. In this retrospective study, we investigated the impact of various factors on the QOL after allo-HSCT: age, gender, diagnosis, type of conditioning, time from diagnosis to allo-HSCT, disease stage, graft type, donor type, time from allo-HSCT to questionnaire completing, GVHD, relapse. Only data from patients who were more than 3 months after allo-HSCT were used for the multivariate analysis. The overall results of the total FACT-G score (median=85.0; range: 29-108) as well as the results of each specific dimension - PWB (median=23.0; range: 5-28), SWB (median=24.0; range: 7-28), EWB (median= 19.0; range: 4-24), FWB (mean=21.0; range: 2-28) showed a value in the highest quartile of the possible evaluation. In multivariate analysis, an inferior QOL score was reported for patients with aGVHD (p=0.002), cGVHD (p<0.001), QOL decreased with increasing age (p=0.048) and increased with time elapsed since allo-HSCT (p<0.001).Allogeneic HSCT represents an important intervention into the overall integrity of the organism. In particular, the development of GVHD can cause very serious organ, but also mental problems which can significantly reduce the QOL. The QOL is steadily increasing with increasing interval from allo-HSCT but improvement and disappearance of these complications may take many years, and sometimes these effects may probably persist permanently.

Predicting axillary sentinel node status in patients with primary breast cancer

The aim of this study is to determine the combination of characteristics in early breast cancer that could estimate the risk of occurrence of metastatic cells in axillary sentinel lymph node(s). If we were able to reliably predict the presence or absence of axillary sentinel involvement, we could spare a considerable proportion of patients from axillary surgery without compromising therapeutic outcomes of their disease. The study is based on retrospective analysis of medical records of 170 patients diagnosed with primary breast cancer. These women underwent primary surgery of the breast and axilla in which at least one sentinel lymph node was obtained. Logistic regression has been employed to construct a model predicting axillary sentinel lymph node involvement using preoperative and postoperative tumor characteristics. Postoperative model uses tumor features obtained from definitive histology samples. Its predictive capability expressed by receiver operating characteristic curve is good, area under curve (AUC) equals to 0.78. The comparison between preoperative and postoperative results showed the only significant differences in values of histopathological grading; we have considered grading not reliably stated before surgery. In preoperative model only the characteristics available and reliably stated at the time of diagnoses were used. The predictive capability of this model is only fair when using the data available at the time of diagnosis (AUC = 0.66). We conclude, that predictive models based on postoperative values enable to reliably estimate the likelihood of occurrence of axillary sentinel node(s) metastases. This can be used in clinical practice in case surgical procedure is divided into two steps, breast surgery first and axillary surgery thereafter. Even if preoperative values were not significantly different from postoperative ones (except for grading), the preoperative model predictive capability is lower compared to postoperative values. The reason for this worse prediction was identified in imperfect preoperative diagnostic.

Abstract P1-01-33: Sentinel Lymph Node Biopsy in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy

Background: sentinel lymph node biopsy (SLNB) as a reliable surrogate for the standard axillary dissection has became a widely used staging method for patients with primary operable breast cancer. Neoadjuvant chemotherapy modifies the anatomical conditions in the breast and axilla and thus SLNB in patients treated with preoperative cytotoxic therapy still remains controversial technique generally not accepted as equivalent to standard axillary dissection. The primary aim of our study was to evaluate success rate for identification and isolation of sentinel node(s) as well as false negative rate of this procedure to declare whether or not SLNB technique is feasible also in patients with preoperative chemotherapy. The secondary aim was to identify factors that can influence the accuracy of this technique.

Methods: during the years 2005-2009 were in our institution diagnosed 1719 new patients with primary breast cancer. 465 of them started neoadjuvant chemotherapy in a curative manner with the intend to be followed by surgery. After completion of neoadjuvant chemotherapy was in 343 patients performed lymphatic mapping to be able to identify sentinel lymph node. In all of these subjects the attempt to identify sentinel node(s) was performed followed by standard axillary dissection without regard to the extent of surgery of the breast — this group of patients is analysed in this study.

Results: one or more sentinel lymph nodes were successfully dissected in 277 patients — thus reaching success rate of 80,8%. From the remaining

66 patients there were 54 (15,7%) in whom no radioactivity uptake could be detected in axilla. This success rate was strongly influenced by clinical lymph node status (higher success rate in node negative patients); it was also dependent on features of the tumor (more frequent identification rate associated with estrogen receptor positivity, lower proliferation index and absent lympho-vascular space invasion).and on the age of patients (sentinel mode(s) were more often found in patients under the age of 50). One or more sentinel lymph node was positive in 95 cases out of 271 subjects with identified sentinel nodes and at least one non-sentinel node (35,1%). In 53 patients (19,6%) sentinel node(s) were the only positive nodes in axillary basin. In 23 patients sentinel lymph node was negative even in the case of at least one non-sentinel node with detected malignant cells. This results in false negative rate of 19,5%. This false negativity was only marginally significantly different according to lympho-vascular space invasion (higher false negativity occurred in the absence of lymphovascular invasion, p = 0,048). The overall accuracy of SLNB to correctly predict axillary lymph node status is 91,5%, sensitivity is 80,5% and negative predictive value 86,9%.

Conclusion: detection rate as well as false negativity rate were in our study higher than corresponding values in patients without neoadjuvant chemotherapy and as such SLNB should not be recommended as surrogate to standard axillary dissection. On contrary we still believe that after necessary modifications of the technique SLNB can become a reliable predictor of axillary lymph node status in properly selected group of patients after preoperative cytotoxic therapy.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-01-33.