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Nemes K, Bens S, Johann PD, Steinbügl M, Gruhle M, Kachanov D, Teleshova M, Hauser P, Simon T, Tippelt S, Eberl W, Woessmann W, Kratz C, Abbink F, Hernáiz-Driever P, Eyrich M, Sumerauer D, Milde T, Reinhard H, Leipold A, de Wetering MV, Gil-da-Costa MJ, Ebetsberger-Dachs G, Marques CH, Bauer N, Biassoni V, Meneses CF, Knirsch S, Lauten M, Gerber NU, Chada M, Kerl K, Lemmer A, Heidrun B, Kuhlen M, Furtwängler R, Kordes U, Schneppenheim R, Vokuhl C, Hasselblatt M, Kröncke T, Bison B, Melchior P, Timmermann B, Gerss J, Siebert R, Frühwald MC. NFB-13. Rhabdoid Tumor Predisposition Syndrome (RTPS) – Finding Evidence by systematic Analyses. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.475] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Individuals with rhabdoid tumor predisposition syndrome (RTPS1 – SMARCB1, RTPS2 – SMARCA4) have a propensity to develop malignant rhabdoid tumors (MRT). Affected patients typically present < age 12 months with synchronous tumors (SYN) exhibiting an unusually aggressive clinical behavior. Due to the rarity of RTPS, standards for management are evolving. METHODS: Clinical, genetic, and treatment data of 90 patients with RTPS from 16 countries were analyzed (2004 – 2020). Therapy followed the EU-RHAB recommendations. Tumors and matching blood samples were investigated for SMARCB1 and/or SMARCA4 mutations using FISH, MLPA and sequencing. DNA-methylation subgroups were determined using DNA methylation arrays. RESULTS: The median age at diagnosis of 52 girls and 38 boys was 5.5 months (0 – 203). 55.5% (50/90) of patients presented with an atypical teratoid/rhabdoid tumor (ATRT), 23.5% (21/90) demonstrated SYN, and 21% (19/90) extracranial MRT. RTPS1 was present in 84-, RTPS2 in six patients. In 77% (65/84) complete data on SMARCB1 mutational status were generated. Methylation subgroup status was available in 59% (40/68) of ATRT or SYN. The 5-year overall- (OS) and event free survival rates of patients with RTPS1 were 19.8 ± 4.8% and 15 ± 4.2%, respectively. Age < 1 year at diagnosis (10.1±4.3% vs. 46.7±11.1%), presence of SYN (5.3±5.1% vs. 24.8±6%), histological diagnosis (ATRT vs. eMRT/RTK/SYN) (26.8±7.1% vs. 11.9±5.6%), localized disease (34.5±8 vs. 8.3±4.6%), and presence of PGV at C-terminal (33±8.6% vs. 9.4±5.3%) were significant prognostic factors for 5-year OS in univariate analysis. INTERPRETATION: In the largest cohort of patients with RTPS, predictors significant for positive outcome could be detected: age > 1 year, absence of SYN, histological diagnosis ATRT, localized disease and PGV located at C-terminal. In our research project, we aim to characterize the complete pheno- and genotype of patients with RTPS to develop a risk score including surveillance recommendation.
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Affiliation(s)
- Karolina Nemes
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
| | - Susanne Bens
- Institute of Human Genetics, Ulm University & Ulm University Medical Center , Ulm , Germany
| | - Pascal D Johann
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany, Heidelberg , Germany
| | - Mona Steinbügl
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
| | - Miriam Gruhle
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
| | - Denis Kachanov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology , Moscow , Russian Federation
| | - Margarita Teleshova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology , Moscow , Russian Federation
| | - Peter Hauser
- BAZ County Hospital and University Teaching Hospital, Velkey László Child’s Health Center , Miskolc , Hungary
| | - Thorsten Simon
- Department of Pediatric Hematology and Oncology, University Children's Hospital of Cologne , Cologne , Germany
| | - Stephan Tippelt
- Department of Pediatric Hematology and Oncology, Pediatrics III, University Hospital of Essen , Essen , Germany
| | - Wolfgang Eberl
- Department of Hematology and Oncology, Center for Child and Adolescent Medicine, Städtisches Klinikum Braunschweig gGmbH , Braunschweig , Germany
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf , Hamburg , Germany
| | - Christian Kratz
- Department of Pediatric Hematology and Oncology, Children's Hospital of Hannover , Hannover , Germany
| | - Floor Abbink
- Department of Pediatric Hematology and Oncology, VU University Medical Center , Amsterdam , Netherlands
| | - Pablo Hernáiz-Driever
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pediatric Oncology and Hematology , Berlin , Germany
| | - Matthias Eyrich
- Department of Pediatric Hematology and Oncology, University Würzburg, Würzburg , Würzburg , Germany
| | - David Sumerauer
- Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol , Prague , Czech Republic
| | - Till Milde
- Hopp Children’s Cancer Center (KiTZ), Heidelberg, Germany; Clinical Cooperation Unit (CCU) Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK) , Heidelberg , Germany
- Pediatric Oncology, Hematology, and Immunology, Center for Child and Adolescent Medicine, Heidelberg University Hospital , Heidelberg , Germany
| | - Harald Reinhard
- Department of Pediatric Hematology and Oncology, Asklepios Hospital Sankt Augustin , Sankt, Augustin , Germany
| | | | | | - Maria João Gil-da-Costa
- Pediatric Oncology Department, University Hospital S. João, Alameda Hernani Monteiro , Porto , Portugal
| | - Georg Ebetsberger-Dachs
- Department of Paediatrics and Adolescent Medicine, Kepler University Hospital , Linz , Austria
| | | | - Nina Bauer
- Department of Hematology and Oncology, Helios Hospital Krefeld , Krefeld , Germany
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | - Clarice Franco Meneses
- Clinical Pharmacy Division, Hospital de Clínicas de Porto Alegre , Porto Alegre , Brazil
| | - Stephanie Knirsch
- Pediatrics (Oncology, Hematology, and Immunology), Klinikum Stuttgart , Olgahospital, Stuttgart , Germany
| | - Melchior Lauten
- Department of Pediatrics, Pediatric Hematology and Oncology, University of Lübeck, Lübeck, Germany
| | - Nicolas U Gerber
- University Children's Hospital of Zurich , Zurich, Zurich , Switzerland
| | - Martin Chada
- Department of Pediatric Oncology and Hematology, Center of Child and Adolescent Medicine, University Hospital Erlangen , Erlangen , Germany
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Münster , Münster , Germany
| | - Andreas Lemmer
- Pediatric Oncology Center, Helios Klinikum , Erfurt , Germany
| | - Boztug Heidrun
- St. Anna Kinderspital and Children's Cancer Research Institute, Department of Paediatrics, Medical University of Vienna , Vienna , Austria
| | - Michaela Kuhlen
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
| | - Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, University of Saarland , Homburg , Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf , Hamburg , Germany
| | - Reiner Schneppenheim
- Department of Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf , Hamburg , Germany
| | - Christian Vokuhl
- Department of Pathology, Section of Pediatric Pathology, University Hospital Bonn , Bonn , Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster , Münster , Germany
| | - Thomas Kröncke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Medical Center Augsburg , Augsburg , Germany
| | - Brigitte Bison
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Medical Center Augsburg , Augsburg , Germany
| | - Patrick Melchior
- Department of Radiation Oncology, University of Saarland , Homburg , Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Germany, German Cancer Consortium (DKTK) , Essen , Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster , Münster , Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University & Ulm University Medical Center , Ulm , Germany
| | - Michael C Frühwald
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
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Nemes K, Johann PD, Steinbügl M, Gruhle M, Bens S, Kachanov D, Teleshova M, Peter H, Simon T, Tippelt S, Eberl W, Chada M, Lopez VSM, Grigull L, Hernáiz-Driever P, Eyrich M, Pears J, Milde T, Reinhard H, Leipold A, de Wetering MV, João Gil-da-Costa M, Ebetsberger-Dachs G, Kerl K, Lemmer A, Boztug H, Furtwängler R, Kordes U, Siebert R, Vokuhl C, Hasselblatt M, Bison B, Kröncke T, Melchior P, Timmermann B, Gerss J, Frühwald MC. ATRT-05. Infants and newborns with atypical teratoid/rhabdoid tumors (ATRT) and extracranial malignant rhabdoid tumors: a unique and challenging population. Neuro Oncol 2022. [PMCID: PMC9164973 DOI: 10.1093/neuonc/noac079.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION: Malignant rhabdoid tumors (MRT) predominantly affect infants. Patients below six months represent a particularly challenging group: intensity of therapy is limited by toxicity to developing organs. Information on prognostic factors, toxicity and long term outcome is sparse. METHODS: Clinical, genetic, and treatment data of 100 patients (less than 6 months at diagnosis) from 13 European countries were analyzed (2005-2020). Tumors and matching blood samples were examined for SMARCB1 mutations using FISH, MLPA and Sanger sequencing. DNA-methylation subgroups (ATRT-TYR, ATRT-SHH, and ATRT-MYC) were determined using DNA methylation arrays. RESULTS: A total of 45 patients presented with ATRT, 29 with extracranial, extrarenal (eMRT) and 9 with renal rhabdoid tumors (RTK). Seventeen patients demonstrated synchronous tumors (SYN). Distant metastases at diagnosis (M+) were present in 27% (26/97). A germline mutation (GLM) was detected in 55% (47/86). Methylation subgroup status was available in 50% (31/62) of ATRT or SYN (SHH=13, TYR=13, MYC=4, SHH+TYR=1). The 5-year overall- (OS) and event free survival (EFS) rates were 23.5±4.6% and 19±4.1%, respectively. Male sex (11±5% vs. 35.8±7.4%), M+ (6.1±5.4% vs. 36.2±7.4%), presence of SYN (7.1±6.9% vs. 26.6±5.3%) and -GLM (7.7±4.2% vs. 45.7±8.6%) were significant prognosticators of 5-year OS, in univariate analysis. Molecular subgroup and survival analyses confirmed the previously described survival advantage of ATRT-TYR. In an adjusted multivariate model clinical factors that influence prognosis were: male sex [HR: 2.1 (1.2 – 3.6)], M+ [3.3 (1.8 – 6)], GLM [HR: 2 (1.1 – 3.6)] and maintenance therapy [HR: 0.3 (0.1 – 0.8)]. CONCLUSION: In this large cohort of homogenously treated infants with MRT, significant predictors of outcome were sex, M+, GLM and maintenance therapy. We confirm the need to stratify which patient group benefits from multimodal treatment, and which patients need novel therapeutic strategies. Biomarker-driven tailored trials may be a key option.
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Affiliation(s)
- Karolina Nemes
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
| | - Pascal D Johann
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Mona Steinbügl
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
| | - Miriam Gruhle
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
| | - Susanne Bens
- Institute of Human Genetics, Ulm University & Ulm University Medical Center , Ulm , Germany
| | - Denis Kachanov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology , Moscow , Russian Federation
| | - Margarita Teleshova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology , Moscow , Russian Federation
| | - Hauser Peter
- BAZ County Hospital and University Teaching Hospital, Velkey László Child’s Health Center , Miskolc , Hungary
| | - Thorsten Simon
- Department of Pediatric Hematology and Oncology, University Children's Hospital of Cologne , Cologne , Germany
| | - Stephan Tippelt
- Department of Pediatric Hematology and Oncology, Pediatrics III, University Hospital of Essen , Essen , Germany
| | - Wolfgang Eberl
- Department of Hematology and Oncology, Center for Child and Adolescent Medicine, Städtisches Klinikum Braunschweig gGmbH , Braunschweig , Germany
| | - Martin Chada
- Department of Pediatric Oncology and Hematology, Center of Child and Adolescent Medicine, University Hospital Erlangen , Erlangen , Germany
| | - Vicente Santa-Maria Lopez
- Department of Pediatric Oncology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat , Barcelona , Spain
| | - Lorenz Grigull
- Department of Pediatric Hematology and Oncology, Children's Hospital of Hannover , Hannover , Germany
| | - Pablo Hernáiz-Driever
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Pediatric Oncology and Hematology , Berlin , Germany
| | - Matthias Eyrich
- Department of Pediatric Hematology and Oncology, University Würzburg , Würzburg , Germany
| | - Jane Pears
- Children’s Health Ireland at Crumlin , Dublin , Ireland
| | - Till Milde
- Hopp Children’s Cancer Center (KiTZ), Heidelberg, Germany; Clinical Cooperation Unit (CCU) Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK) , Heidelberg , Germany
- Pediatric Oncology, Hematology and Immunology, Center for Child and Adolescent Medicine, Heidelberg University Hospital , Heidelberg , Germany
| | - Harald Reinhard
- Department of Pediatric Hematology and Oncology, Asklepios Hospital Sankt Augustin , Sankt Augustin , Germany
| | | | | | - Maria João Gil-da-Costa
- Pediatric Oncology Department, University Hospital S. João, Alameda Hernani Monteiro , Porto , Portugal
| | - Georg Ebetsberger-Dachs
- Department of Paediatrics and Adolescent Medicine, Kepler University Hospital , Linz , Austria
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Münster , Münster , Germany
| | - Andreas Lemmer
- Pediatric Oncology Center, Helios Klinikum , Erfurt , Germany
| | - Heidrun Boztug
- St. Anna Kinderspital and Children's Cancer Research Institute, Department of Paediatrics, Medical University of Vienna , Vienna , Austria
| | - Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, University of Saarland , Homburg , Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf , Hamburg , Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University & Ulm University Medical Center , Ulm , Germany
| | - Christian Vokuhl
- Department of Pathology, Section of Pediatric Pathology, University Hospital Bonn , Bonn , Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster , Münster , Germany
| | - Brigitte Bison
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Medical Center Augsburg , Augsburg , Germany
| | - Thomas Kröncke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Medical Center Augsburg , Augsburg , Germany
| | - Patrick Melchior
- Department of Radiation Oncology, University of Saarland , Homburg, Homburg , Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Germany, German Cancer Consortium (DKTK) , Essen , Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster , Münster , Germany
| | - Michael C Frühwald
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg , Augsburg , Germany
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Dörr JR, Thorwarth A, Mizia-Malarz A, Radke J, Tietze A, Hernáiz-Driever P, Horn D, Gratopp A, Eggert A, Deubzer HE. Germline Mutations Including the Rare Pathogenic Variant c.3206delC in the ATM Gene Cause Ataxia Teleangiectasia-Associated Primary Central Nervous System Lymphoma. Children (Basel) 2021; 8:children8060469. [PMID: 34199532 PMCID: PMC8229184 DOI: 10.3390/children8060469] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
We here report the case of a 2-year-old patient with a primary central nervous system lymphoma of B-cell origin. Due to their past medical history of repeated respiratory tract infections and the marked chemotherapy-associated toxicity and infectious comorbidity, we suspected that the patient also suffered from an inherited immune deficiency disorder. Despite the lack of classical pathognomonic symptoms for ataxia teleangiectasia and missing evidence for a cancer predisposition syndrome in the family, genetic testing identified biallelic germline mutations, including the rare pathogenic variant c.3206delC (p.Pro1069Leufs*2), in the ataxia telangiectasia-mutated (ATM) gene. The case highlights the importance of searching for immune deficiency disorders associated with primary central nervous system lymphoma before treatment initiation and the urgent need to develop novel treatment strategies for cancer patients with underlying immunodeficiency syndromes.
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Affiliation(s)
- Jan R. Dörr
- Department of Pediatric Hematology and Oncology, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (J.R.D.); (A.T.); (P.H.-D.); (A.E.)
- Berliner Institut für Gesundheitsforschung (BIH), 10178 Berlin, Germany;
| | - Anne Thorwarth
- Department of Pediatric Hematology and Oncology, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (J.R.D.); (A.T.); (P.H.-D.); (A.E.)
| | - Agnieszka Mizia-Malarz
- Department of Pediatric Oncology, Hematology and Chemotherapy, Upper Silesia Children’s Care Health Center, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Josefine Radke
- Berliner Institut für Gesundheitsforschung (BIH), 10178 Berlin, Germany;
- Department of Neuropathology, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany
- German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung; DKTK), Partner Site Berlin, 10115 Berlin, Germany
- German Cancer Research Center Heidelberg (Deutsches Krebsforschungszentrum; DKFZ), 69120 Heidelberg, Germany
| | - Anna Tietze
- Department of Neuroradiology, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Pablo Hernáiz-Driever
- Department of Pediatric Hematology and Oncology, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (J.R.D.); (A.T.); (P.H.-D.); (A.E.)
| | - Denise Horn
- Institute of Medical Genetics and Human Genetics, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Alexander Gratopp
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
- Correspondence: (A.G.); (H.E.D.)
| | - Angelika Eggert
- Department of Pediatric Hematology and Oncology, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (J.R.D.); (A.T.); (P.H.-D.); (A.E.)
- Berliner Institut für Gesundheitsforschung (BIH), 10178 Berlin, Germany;
- German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung; DKTK), Partner Site Berlin, 10115 Berlin, Germany
- German Cancer Research Center Heidelberg (Deutsches Krebsforschungszentrum; DKFZ), 69120 Heidelberg, Germany
| | - Hedwig E. Deubzer
- Department of Pediatric Hematology and Oncology, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (J.R.D.); (A.T.); (P.H.-D.); (A.E.)
- Berliner Institut für Gesundheitsforschung (BIH), 10178 Berlin, Germany;
- German Cancer Consortium (Deutsches Konsortium für Translationale Krebsforschung; DKTK), Partner Site Berlin, 10115 Berlin, Germany
- German Cancer Research Center Heidelberg (Deutsches Krebsforschungszentrum; DKFZ), 69120 Heidelberg, Germany
- Experimental and Clinical Research Center (ECRC) of the Charité–Universitätsmedizin Berlin and the Max-Delbrück-Center for Molecular Medicine (MDC) in the Helmholtz Association, 13125 Berlin, Germany
- Correspondence: (A.G.); (H.E.D.)
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4
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Frühwald MC, Hasselblatt M, Nemes K, Bens S, Steinbügl M, Johann PD, Kerl K, Hauser P, Quiroga E, Solano-Paez P, Biassoni V, Gil-da-Costa MJ, Perek-Polnik M, van de Wetering M, Sumerauer D, Pears J, Stabell N, Holm S, Hengartner H, Gerber NU, Grotzer M, Boos J, Ebinger M, Tippelt S, Paulus W, Furtwängler R, Hernáiz-Driever P, Reinhard H, Rutkowski S, Schlegel PG, Schmid I, Kortmann RD, Timmermann B, Warmuth-Metz M, Kordes U, Gerss J, Nysom K, Schneppenheim R, Siebert R, Kool M, Graf N. Age and DNA methylation subgroup as potential independent risk factors for treatment stratification in children with atypical teratoid/rhabdoid tumors. Neuro Oncol 2021; 22:1006-1017. [PMID: 31883020 DOI: 10.1093/neuonc/noz244] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Controversy exists as to what may be defined as standard of care (including markers for stratification) for patients with atypical teratoid/rhabdoid tumors (ATRTs). The European Rhabdoid Registry (EU-RHAB) recruits uniformly treated patients and offers standardized genetic and DNA methylation analyses. METHODS Clinical, genetic, and treatment data of 143 patients from 13 European countries were analyzed (2009-2017). Therapy consisted of surgery, anthracycline-based induction, and either radiotherapy or high dose chemotherapy following a consensus among European experts. Fluorescence in situ hybridization, multiplex ligation-dependent probe amplification, and sequencing were employed for assessment of somatic and germline mutations in SWItch/sucrose nonfermentable related, matrix associated, actin dependent regulator of chromatin, subfamily B (SMARCB1). Molecular subgroups (ATRT-SHH, ATRT-TYR, and ATRT-MYC) were determined using DNA methylation arrays, resulting in profiles of 84 tumors. RESULTS Median age at diagnosis of 67 girls and 76 boys was 29.5 months. Five-year overall survival (OS) and event-free survival (EFS) were 34.7 ± 4.5% and 30.5 ± 4.2%, respectively. Tumors displayed allelic partial/whole gene deletions (66%; 122/186 alleles) or single nucleotide variants (34%; 64/186 alleles) of SMARCB1. Germline mutations were detected in 26% of ATRTs (30/117). The patient cohort consisted of 47% ATRT-SHH (39/84), 33% ATRT-TYR (28/84), and 20% ATRT-MYC (17/84). Age <1 year, non-TYR signature (ATRT-SHH or -MYC), metastatic or synchronous tumors, germline mutation, incomplete remission, and omission of radiotherapy were negative prognostic factors in univariate analyses (P < 0.05). An adjusted multivariate model identified age <1 year and a non-TYR signature as independent negative predictors of OS: high risk (<1 y + non-TYR; 5-y OS = 0%), intermediate risk (<1 y + ATRT-TYR or ≥1 y + non-TYR; 5-y OS = 32.5 ± 8.7%), and standard risk (≥1 y + ATRT-TYR, 5-y OS = 71.5 ± 12.2%). CONCLUSIONS Age and molecular subgroup status are independent risk factors for survival in children with ATRT. Our model warrants validation within future clinical trials.
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Affiliation(s)
- Michael C Frühwald
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Martin Hasselblatt
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Karolina Nemes
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany.,Department of Pediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Bens
- Institute of Human Genetics, University of Ulm & University Hospital of Ulm, Ulm, Germany
| | - Mona Steinbügl
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Pascal D Johann
- Hopp Children's Cancer Center, German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Peter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Eduardo Quiroga
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Sevilla, Spain
| | - Palma Solano-Paez
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Sevilla, Spain
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS National Tumor Institute, Milan, Italy
| | - Maria Joao Gil-da-Costa
- Pediatric Hematology and Oncology Division, University Hospital S João Alameda Hernani Monteiro, Porto, Portugal
| | - Martha Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - David Sumerauer
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Jane Pears
- Department of Pediatric Haematology and Oncology Our Lady's Children's Hospital, Dublin, Ireland
| | - Niklas Stabell
- Pediatric Department, Oncology Unit, University Hospital of North Norway, Tromso, Norway
| | - Stefan Holm
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Joachim Boos
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Martin Ebinger
- Department of General Pediatrics, Hematology, and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Stefan Tippelt
- Department of Pediatric Hematology/Oncology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, University of Saarland, Homburg, Germany
| | - Pablo Hernáiz-Driever
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, corporate member of the Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Harald Reinhard
- Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University of Würzburg, Würzburg, Germany
| | - Irene Schmid
- Department of Pediatric Hematology and Oncology, Ludwig-Maximilian-University, Munich, Germany
| | | | - Beate Timmermann
- Particle Therapy Clinics at West German Proton Therapy, University Hospital Essen, Essen, Germany
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Karsten Nysom
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany.,Department of Pediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Reinhard Schneppenheim
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reiner Siebert
- Institute of Human Genetics, University of Ulm & University Hospital of Ulm, Ulm, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center, German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
| | - Norbert Graf
- Hopp Children's Cancer Center, German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
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Zheng T, Ghasemi DR, Okonechnikov K, Korshunov A, Sill M, Hübner JM, Maaß KK, Snuderl M, Gojo J, Schüller U, Gerber NU, Hernáiz-Driever P, Milde T, Sturm D, Chapman R, Grundy RG, von Deimling A, Jones DTW, Kool M, Pfister SM, Sahm F, Kawauchi D, Pajtler KW. EPEN-18. CROSS-SPECIES GENOMICS IDENTIFIES GLI2 AS AN ONCOGENE OF C11orf95 FUSION-POSITIVE SUPRATENTORIAL EPENDYMOMA. Neuro Oncol 2020. [PMCID: PMC7715864 DOI: 10.1093/neuonc/noaa222.156] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The majority of supratentorial ependymomas (ST-EPN) are driven by fusions between RELA and a zinc finger containing gene, C11orf95. Apart from fusions to the Hippo effector YAP1, which affects a small group of infant patients, the oncogenic mechanism of remaining ST-EPNs is unclear. Aiming at refining the molecular classification of ST-EPNs, we analyzed methylation profiles, RNA and DNA sequencing results as well as clinical data in a cohort of 617 ST-EPNs. Unsupervised clustering analysis of DNA methylation data revealed four distinct clusters that formed in addition to the known molecular groups ST-EPN-RELA and –YAP1. Tumors within these additional clusters were characterized by fusions of C11orf95 to numerous fusion partners different from RELA, e.g. MAML2, MAML3, NCOA2 and SS18, suggesting a general role of C11orf95 in tumorigenesis of ST-EPN. Transforming capacity of newly identified fusion genes was validated using an electroporation-based in vivo gene transfer technology. All fusion genes were sufficient to drive malignant transformation in the cerebral cortex of mice and resulting tumors faithfully recapitulated molecular characteristics of their human counterparts. We found that both, the partner gene and the zinc finger DNA binding domain of C11orf95, were essential to exert tumorigenesis. When exploring genes commonly upregulated in C11orf95 fusion-expressing tumors of human and murine origin, the Sonic Hedgehog effector gene Gli2 was identified as a promising downstream target. Subsequent co-expression of C11orf95:RELA and a dominant negative form of Gli2 indeed hampered tumorigenesis. We thus propose GLI2 as a potential therapeutic downstream target of C11orf95 fusion-dependent oncogenic signaling in ST-EPN.
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Affiliation(s)
- Tuyu Zheng
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David R Ghasemi
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Konstantin Okonechnikov
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Sill
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens-Martin Hübner
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kendra K Maaß
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matija Snuderl
- Division of Neuropathology, Department of Pathology, NYU Langone Health, New York, NY, USA
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ulrich Schüller
- Research Institute, Children’s Cancer Center Hamburg, Hamburg, Germany
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolas U Gerber
- Department of Oncology, University Children’s Hospital, Zurich, Switzerland
| | - Pablo Hernáiz-Driever
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Till Milde
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and CCU Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dominik Sturm
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Rebecca Chapman
- Children’s Brain Tumour Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Richard G Grundy
- Children’s Brain Tumour Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - David T W Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Sahm
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daisuke Kawauchi
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Bicochemistry and Celllar Biology, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Kristian W Pajtler
- Hopp Children’s Cancer Center Heidelberg (KiTZ) and Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany
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Ghasemi D, Okonechnikov K, Korshunov A, Sill M, Zheng T, Huebner J, Maass K, Benzel J, Snuderl M, Gojo J, Schüller U, Gerber N, Stoler I, Hernáiz-Driever P, Milde T, Sturm D, Chapman R, Grundy R, von Deimling A, Kawauchi D, Jones D, Kool M, Pfister S, Sahm F, Pajtler K. Abstract B71: Molecular heterogeneity and novel oncogenic fusions in RELA- and YAP1-negative supratentorial ependymoma. Cancer Res 2020. [DOI: 10.1158/1538-7445.pedca19-b71] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: One of the DNA methylation-based molecular subgroups of supratentorial ependymoma (ST-EPN), designated ST-EPN-RELA, mostly harbors fusions of the uncharacterized gene C11orf95 and RELA (ST-EPN-RELA). Rarely, no C11orf95-RELA fusion is detected in tumors predicted to belong to the ST-EPN-RELA group. With this study we aimed to refine the molecular classification of ST-EPN and to identify alternative oncogenic mechanisms in the absence of a classic fusion type.
Methods and Materials: In an unbiased approach, t-Distributed Stochastic Neighbor Embedding was applied to 53,468 DNA methylation profiles from brain tumors, other cancer types, and control tissues. Only samples clustering with a reference set of ST-EPN-RELA were selected for further analyses (n=614), including RNA- and/or DNA-panel sequencing, histopathologic reevaluation, and immunohistochemistry for L1CAM. Fusions were validated using RT-PCR on total RNA and Sanger sequencing. Clinical data were analyzed retrospectively for 150 patients.
Results: We identified one large and four satellite clusters. The large cluster (n=479; designated ST-EPN-RELA 1) and one of the satellite clusters (n=12; ST-EPN-RELA 2) predominantly contained samples with a calibrated score ≥ 0.9 for ST-EPN-RELA based on the current version of the Heidelberg Brain Tumor Classifier. Samples of the three other satellite clusters (n=41, n=17, and n=25 samples) contained 65.9%, 88.2%, and 96.0% of samples with a calibrated score < 0.9 for any methylation class, and were thus predicted as unclassifiable. These clusters were provisionally designated ST-EPN-RELA-like A, B, and C, and initial histologic diagnoses showed a wide spectrum of rare morphologies beside EPN, e.g., sarcoma and teratoma. Within clusters ST-EPN-RELA-like A and C, sequencing revealed fusions of C11orf95 with different partner genes, including MAML2 (n=14), MAML3 (n=2), and NCOA2 (n=7), while ST-EPN-RELA-like B included classic C11orf95-RELA fusions (n=11) in samples with initial diagnoses other than EPN. Copy number variation analysis showed clear differences between the clusters. L1CAM-positivity was observed in all groups. Within the cluster ST-EPN-RELA 1, samples separated according to fusion types, 1 versus 2/3. Analysis of clinical data showed significant differences in overall survival between cases with confirmed C11orf95-RELA fusion type 1 (n=25, median OS=88 months) and type 2/3 (n=20, median OS=67 months). Clinical data collection for the satellite clusters is currently ongoing.
Conclusion: Molecular refinement of ST-EPN-RELA revealed novel subgroups harboring fusions of C11orf95 with numerous fusion partners different from RELA, which will be included in the next update of the Heidelberg Classifier. Preliminary analysis suggests differences in clinical outcome related to the fusion type. Findings of this study will improve diagnostic accuracy and clinical management and need to be considered when developing targeted treatment strategies against ST-EPN.
Citation Format: D.R. Ghasemi, K. Okonechnikov, A. Korshunov, M. Sill, T. Zheng, J.M. Huebner, K.K. Maass, J. Benzel, M. Snuderl, J. Gojo, U. Schüller, N.U. Gerber, I. Stoler, P. Hernáiz-Driever, T. Milde, D. Sturm, R. Chapman, R.G. Grundy, A. von Deimling, D. Kawauchi, D.T.W. Jones, M. Kool, S.M. Pfister, F. Sahm, K.W. Pajtler. Molecular heterogeneity and novel oncogenic fusions in RELA- and YAP1-negative supratentorial ependymoma [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr B71.
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Affiliation(s)
- D.R. Ghasemi
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
| | - K. Okonechnikov
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
| | - A. Korshunov
- 3Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany,
- 4Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany,
| | - M. Sill
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
| | - T. Zheng
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
| | - J.M. Huebner
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
| | - K.K. Maass
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
- 5Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany,
| | - J. Benzel
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
| | - M. Snuderl
- 6Division of Neuropathology, Department of Pathology, NYU Langone Health, New York, NY,
| | - J. Gojo
- 7Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria,
| | - U. Schüller
- 8Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
- 9Research Institute, Children’s Cancer Center Hamburg, Hamburg, Germany,
- 10Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
| | - N.U. Gerber
- 11Department of Oncology, University Children’s Hospital, Zurich, Switzerland,
| | - I. Stoler
- 12Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany,
| | - P. Hernáiz-Driever
- 12Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany,
| | - T. Milde
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 5Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany,
- 13CCU Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany,
| | - D. Sturm
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 5Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany,
- 15Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R. Chapman
- 14Children’s Brain Tumour Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom,
| | - R.G. Grundy
- 14Children’s Brain Tumour Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom,
| | - A. von Deimling
- 3Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany,
- 4Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany,
| | - D. Kawauchi
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
| | - D.T.W. Jones
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 15Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M. Kool
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
| | - S.M. Pfister
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
- 5Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany,
| | - F. Sahm
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 3Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany,
- 4Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany,
| | - K.W. Pajtler
- 1Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany,
- 2Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany,
- 5Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany,
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Deng MY, Sill M, Chiang J, Schittenhelm J, Ebinger M, Schuhmann MU, Monoranu CM, Milde T, Wittmann A, Hartmann C, Sommer C, Paulus W, Gärtner J, Brück W, Rüdiger T, Leipold A, Jaunmuktane Z, Brandner S, Giangaspero F, Nozza P, Mora J, Morales la Madrid A, Cruz Martinez O, Hansford JR, Pietsch T, Tietze A, Hernáiz-Driever P, Stoler I, Capper D, Korshunov A, Ellison DW, von Deimling A, Pfister SM, Sahm F, Jones DTW. Molecularly defined diffuse leptomeningeal glioneuronal tumor (DLGNT) comprises two subgroups with distinct clinical and genetic features. Acta Neuropathol 2018; 136:239-253. [PMID: 29766299 DOI: 10.1007/s00401-018-1865-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [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: 03/14/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 12/20/2022]
Abstract
Diffuse leptomeningeal glioneuronal tumors (DLGNT) represent rare CNS neoplasms which have been included in the 2016 update of the WHO classification. The wide spectrum of histopathological and radiological features can make this enigmatic tumor entity difficult to diagnose. In recent years, large-scale genomic and epigenomic analyses have afforded insight into key genetic alterations occurring in multiple types of brain tumors and provide unbiased, complementary tools to improve diagnostic accuracy. Through genome-wide DNA methylation screening of > 25,000 tumors, we discovered a molecularly distinct class comprising 30 tumors, mostly diagnosed histologically as DLGNTs. Copy-number profiles derived from the methylation arrays revealed unifying characteristics, including loss of chromosomal arm 1p in all cases. Furthermore, this molecular DLGNT class can be subdivided into two subgroups [DLGNT methylation class (MC)-1 and DLGNT methylation class (MC)-2], with all DLGNT-MC-2 additionally displaying a gain of chromosomal arm 1q. Co-deletion of 1p/19q, commonly seen in IDH-mutant oligodendroglioma, was frequently observed in DLGNT, especially in DLGNT-MC-1 cases. Both subgroups also had recurrent genetic alterations leading to an aberrant MAPK/ERK pathway, with KIAA1549:BRAF fusion being the most frequent event. Other alterations included fusions of NTRK1/2/3 and TRIM33:RAF1, adding up to an MAPK/ERK pathway activation identified in 80% of cases. In the DLGNT-MC-1 group, age at diagnosis was significantly lower (median 5 vs 14 years, p < 0.01) and clinical course less aggressive (5-year OS 100, vs 43% in DLGNT-MC-2). Our study proposes an additional molecular layer to the current histopathological classification of DLGNT, of particular use for cases without typical morphological or radiological characteristics, such as diffuse growth and radiologic leptomeningeal dissemination. Recurrent 1p deletion and MAPK/ERK pathway activation represent diagnostic biomarkers and therapeutic targets, respectively-laying the foundation for future clinical trials with, e.g., MEK inhibitors that may improve the clinical outcome of patients with DLGNT.
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Affiliation(s)
- Maximilian Y Deng
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), 69120, Heidelberg, Germany
- Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
| | - Jason Chiang
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital of Tübingen, Tübingen, Germany
| | - Martin Ebinger
- Department of Pediatric Hematology/Oncology, Children's University Hospital, Tübingen, Germany
| | - Martin U Schuhmann
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Camelia-Maria Monoranu
- Department of Neuropathology, Institute of Pathology, University of Würzburg, Comprehensive Cancer Center (CCC) Mainfranken, Würzburg, Germany
| | - Till Milde
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), 69120, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK), 69120, Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, 69120, Heidelberg, Germany
- KiTZ Clinical Trial Unit (ZIPO), 69120, Heidelberg, Germany
| | - Andrea Wittmann
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), 69120, Heidelberg, Germany
- Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School, Hannover, Germany
| | - Clemens Sommer
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Jutta Gärtner
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University of Göttingen Medical Center, Göttingen, Germany
| | - Wolfgang Brück
- Department of Neuropathology, University of Göttingen Medical Center, Göttingen, Germany
| | - Thomas Rüdiger
- Institute of Pathology, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Alfred Leipold
- Department of Pediatrics, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Zane Jaunmuktane
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sebastian Brandner
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
- Department of Neurodegeneration, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Felice Giangaspero
- IRCCS Neuromed, Pozzilli, Italy
- Department of Radiological, Oncological and Anatomo-pathological Science, Sapienza University of Rome, Rome, Italy
| | - Paolo Nozza
- Pathology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Jaume Mora
- Department of Pediatric Hemato-Oncology, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Spain
| | - Andres Morales la Madrid
- Department of Pediatric Hemato-Oncology, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Spain
| | - Ofelia Cruz Martinez
- Department of Pediatric Hemato-Oncology, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Spain
| | - Jordan R Hansford
- Department of Paediatrics, Children's Cancer Centre, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Torsten Pietsch
- Institute of Neuropathology, Brain Tumor Reference Center of the Society for Neuropathology and Neuroanatomy, University of Bonn Medical Center, Bonn, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Pablo Hernáiz-Driever
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Iris Stoler
- Department of Neuropathology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - David Capper
- Department of Neuropathology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium, German Cancer Research Center, 69120, Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - David W Ellison
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium, German Cancer Research Center, 69120, Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Felix Sahm
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium, German Cancer Research Center, 69120, Heidelberg, Germany.
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, 69120, Heidelberg, Germany.
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), 69120, Heidelberg, Germany.
- Pediatric Glioma Research Group, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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Weimann A, Cremer M, Hernáiz-Driever P, Zimmermann M. Delta-He, Ret-He and a New Diagnostic Plot for Differential Diagnosis and Therapy Monitoring of Patients Suffering from Various Disease-Specific Types of Anemia. Clin Lab 2016; 62:667-77. [PMID: 27215087 DOI: 10.7754/clin.lab.2015.150830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The present study was aimed to prove the usefulness of a new diagnostic plot (Hema-Plot), illustrating the relationship between the hemoglobin content of reticulocytes (Ret-He) as a marker of functional iron deficiency and the difference between the reticulocyte and erythrocyte hemoglobin content (Delta-He) as a marker of an impaired hemoglobinization of newly formed reticulocytes occurring during inflammatory processes, to differentiate between various disease-specific types of anemia. METHODS A complete blood and reticulocyte count was performed on routine EDTA blood samples from 345 patients with and without various disease-specific types of anemia using the Sysmex XN-9000 hematology analyzer: blood healthy newborns (n = 23), blood healthy adults (n = 31), patients suffering from anemia of chronic disease (ACD) due to diverse oncological, chronic inflammatory, or autoimmune diseases (total n = 138) with (n = 65) and without therapy (n = 73), patients with thalassemia and/or hemoglobinopathy (n = 18), patients with iron deficiency anemia (IDA) (n = 35), patients with a combination of ACD and IDA (n = 17), as well as patients suffering from sepsis (total n = 83) with (n = 32) and without therapy (n = 51). The results for Ret-He, Delta-He, and C-reactive protein (CRP) were statistically compared (Mann-Whitney U Test) between the particular patient groups and the diagnostic plots were drawn. RESULTS Delta-Hemoglobin showed a statistically significant difference between blood healthy newborns and blood healthy adults (p ≤ 0.05), while Ret-He and C-reactive protein did not. In addition, of all three biomarkers only Delta-He showed a statistically significant difference (p ≤ 0.05) between the ACD/IDA and IDA cohort. Delta-He, Ret-He, and CRP showed a statistically significant difference between patient cohorts with and without therapy suffering from ACD, ACD/IDA, and sepsis before and after medical therapy (p ≤ 0.05). The Hema-Plot illustrated the dynamic character of Ret-He and Delta-He, notably in inflammation-based types of anemia like ACD or ACD/ IDA. CONCLUSIONS Delta-He is a new biomarker clearly distinguishing between inflammation-based types of anemia before and after medical therapy, as well as between ACD/IDA and IDA. The new Hema-Plot is a helpful tool for differential diagnosis and disease-monitoring in various types of disease-specific anemia, especially in ACD and ACD/IDA. The Hema-Plot can be used to identify non-adherent patients or an insufficient therapy.
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Wagner S, Csatary CM, Gosztonyi G, Koch HC, Hartmann C, Peters O, Hernáiz-Driever P, Théallier-Janko A, Zintl F, Längler A, Wolff JEA, Csatary LK. Combined treatment of pediatric high-grade glioma with the oncolytic viral strain MTH-68/H and oral valproic acid. APMIS 2006; 114:731-43. [PMID: 17004977 DOI: 10.1111/j.1600-0463.2006.apm_516.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [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: 01/02/2023]
Abstract
The case of a 12-year-old boy with anaplastic astrocytoma of the left thalamus is reported. Postoperative irradiation and chemotherapy could not repress tumor progression; therefore, treatment was undertaken with an oncolytic virus, MTH-68/H, an attenuated strain of Newcastle disease virus (NDV), and valproic acid (VPA), an antiepileptic drug, which also has antineoplastic properties. This treatment resulted in a far-reaching regression of the thalamic glioma, but 4 months later a new tumor manifestation, an extension of the thalamic tumor, appeared in the wall of the IVth ventricle, which required a second neurosurgical intervention. Under continuous MTH-68/H - VPA administration the thalamic tumor remained under control, but the rhombencephalic one progressed relentlessly and led to the fatal outcome. In the final stage, a third tumor manifestation appeared in the left temporal lobe. The possible reasons for the antagonistic behavior of the three manifestations of the same type of glioma to the initially most successful therapy are discussed. The comparative histological study of the thalamic and rhombencephalic tumor manifestations revealed that MTH-68/H treatment induces, similar to in vitro observations, a massive apoptotic tumor cell decline. In the rhombencephalic tumor, in and around the declining tumor cells, NDV antigen could be demonstrated immunohistochemically, and virus particles have been found in the cytoplasm of tumor cells at electron microscopic investigation. These findings document that the oncolytic effect of MTH-68/H treatment is the direct consequence of virus presence and replication in the neoplastic cells. This is the first demonstration of NDV constituents in an MTH-68/H -treated glioma.
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Affiliation(s)
- Sabine Wagner
- Dept. of Pediatric Oncology, Krankenhaus der Barmherzigen Brüder, Klinik St. Hedwig, University of Regensburg
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Herms J, Neidt I, Lüscher B, Sommer A, Schürmann P, Schröder T, Bergmann M, Wilken B, Probst-Cousin S, Hernáiz-Driever P, Behnke J, Hanefeld F, Pietsch T, Kretzschmar HA. C-MYC expression in medulloblastoma and its prognostic value. Int J Cancer 2000; 89:395-402. [PMID: 11008200] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
To identify prognostic factors in medulloblastoma, a common malignant brain tumor of childhood, expression of the oncogene c-myc was examined at the mRNA level by in situ hybridization. c-myc mRNA expression was observed in 30 of 72 tumors (42%). The c-myc gene copy number was determined by quantitative PCR from genomic DNA of paraffin-embedded tumors. c-myc gene amplification was present in 5 of 62 cases (8.3%). Therefore, c-myc amplification was obviously not the cause of c-myc mRNA expression in most samples. Kaplan-Meier estimation revealed a significant correlation between c-myc mRNA expression and survival (total mean follow-up 4.6 +/- 3.6 years, log-rank p = 0.02). Multivariate logistic regression analysis including sex, age, histological type, degree of surgical resection and expression of synaptophysin, GFAP and c-myc, was carried out on 54 patients who received both radiotherapy and chemotherapy. The analysis identified expression of c-myc as an independent predictive factor of death from disease.
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Affiliation(s)
- J Herms
- Institut für Neuropathologie, Universität Göttingen, Göttingen, Germany.
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Herms J, Neidt I, Lüscher B, Sommer A, Schürmann P, Schröder T, Bergmann M, Wilken B, Probst-Cousin S, Hernáiz-Driever P, Behnke J, Hanefeld F, Pietsch T, Kretzschmar HA. C-MYC expression in medulloblastoma and its prognostic value. Int J Cancer 2000. [DOI: 10.1002/1097-0215(20000920)89:5<395::aid-ijc1>3.0.co;2-v] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Knüpfer MM, Hernáiz-Driever P, Poppenborg H, Wolff JE, Cinatl J. Valproic acid inhibits proliferation and changes expression of CD44 and CD56 of malignant glioma cells in vitro. Anticancer Res 1998; 18:3585-9. [PMID: 9858943] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Recently we were able to show that valproic acid (VPA) induces growth-arrest and differentiation of human neuroblastoma cells. Hence we investigated in vitro the antitumoral effects of VPA on malignant gliomas by determining cell proliferation and expression of CD56 and CD44 of human T98G, A172, 85HG66, 86HG39 and rat C6 cell lines. VPA at concentrations ranging from 0.1 to 1 mM strongly inhibited proliferation of A172, 86HG39, 85HG66 and C6 cells in a dose-dependent manner, whereas T98G cell growth remained unchanged. All human glioma cells were highly positive for CD44, whereas CD56 was differently expressed. After 7 days of incubation with 1mM VPA CD56 expression was markedly increased in T98G, A172 and 85HG66 cells, whereas CD44 expression was decreased in all human cell lines. These data suggest that VPA has antitumoral effects on malignant glioma cells. Therefore we consider VPA as a potent therapeutic agent for treatment of these tumors.
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Affiliation(s)
- M M Knüpfer
- University Hospital, Department of Pediatric Hematology and Oncology, Leipzig, Germany.
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