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Sabatini PJB, Bridgers J, Huang S, Downs G, Zhang T, Sheen C, Park N, Kridel R, Marra MA, Steidl C, Scott DW, Karsan A. Multisite clinical cross-validation and variant interpretation of a next generation sequencing panel for lymphoid cancer prognostication. J Clin Pathol 2024:jcp-2023-209262. [PMID: 38182402 DOI: 10.1136/jcp-2023-209262] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024]
Abstract
AIMS Genomic sequencing of lymphomas is under-represented in routine clinical testing despite having prognostic and predictive value. Clinical implementation is challenging due to a lack of consensus on reportable targets and a paucity of reference samples. We organised a cross-validation study of a lymphoma-tailored next-generation sequencing panel between two College of American Pathologists (CAP)-accredited clinical laboratories to mitigate these challenges. METHODS A consensus for the genomic targets was discussed between the two institutes based on recurrence in diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukaemia and T-cell lymphomas. Using the same genomic targets, each laboratory ordered libraries independently and a cross-validation study was designed to exchange samples (8 cell lines and 22 clinical samples) and their FASTQ files. RESULTS The sensitivity of the panel when comparing different library preparation and bioinformatic workflows was between 97% and 99% and specificity was 100% when a 5% limit of detection cut-off was applied. To evaluate how the current standards for variant classification of tumours apply to lymphomas, the Association for Molecular Pathology/American Society of Clinical Oncology/CAP and OncoKB classification systems were applied to the panel. The majority of variants were assigned a possibly actionable class or likely pathogenic due to more limited evidence in the literature. CONCLUSIONS The cross-validation study highlights the benefits of sample and data exchange for clinical validation and provided a framework for reporting the findings in lymphoid malignancies.
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Affiliation(s)
- Peter J B Sabatini
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Advanced Molecular Diagnostic Laboratory, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Josh Bridgers
- BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Shujun Huang
- BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Gregory Downs
- Advanced Molecular Diagnostic Laboratory, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tong Zhang
- Advanced Molecular Diagnostic Laboratory, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Clare Sheen
- Advanced Molecular Diagnostic Laboratory, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nicole Park
- Advanced Molecular Diagnostic Laboratory, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Robert Kridel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Marco A Marra
- Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | | | - David W Scott
- Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Aly Karsan
- BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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2
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Grants JM, May C, Bridgers J, Huang S, Gillis S, Meissner B, Boyle M, Ben-Neriah S, Hung S, Duns G, Hilton L, Gerrie AS, Marra M, Kridel R, Sabatini PJB, Steidl C, Scott DW, Karsan A. Chronic Lymphocytic Leukemia IGHV Somatic Hypermutation Detection by Targeted Capture Next-Generation Sequencing. Clin Chem 2024; 70:273-284. [PMID: 38175592 DOI: 10.1093/clinchem/hvad147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Somatic hypermutation (SHM) status of the immunoglobulin heavy variable (IGHV) gene plays a crucial role in determining the prognosis and treatment of patients with chronic lymphocytic leukemia (CLL). A common approach for determining SHM status is multiplex polymerase chain reaction and Sanger sequencing of the immunoglobin heavy locus; however, this technique is low throughput, is vulnerable to failure, and does not allow multiplexing with other diagnostic assays. METHODS Here we designed and validated a DNA targeted capture approach to detect immunoglobulin heavy variable somatic hypermutation (IGHV SHM) status as a submodule of a larger next-generation sequencing (NGS) panel that also includes probes for ATM, BIRC3, CHD2, KLHL6, MYD88, NOTCH1, NOTCH2, POT1, SF3B1, TP53, and XPO1. The assay takes as input FASTQ files and outputs a report containing IGHV SHM status and V allele usage following European Research Initiative on CLL guidelines. RESULTS We validated the approach on 35 CLL patient samples, 34 of which were characterized using Sanger sequencing. The NGS panel identified the IGHV SHM status of 34 of 35 CLL patients. We showed 100% sensitivity and specificity among the 33 CLL samples with both NGS and Sanger sequencing calls. Furthermore, we demonstrated that this panel can be combined with additional targeted capture panels to detect prognostically important CLL single nucleotide variants, insertions/deletions, and copy number variants (TP53 copy number loss). CONCLUSIONS A targeted capture approach to IGHV SHM detection can be integrated into broader sequencing panels, allowing broad CLL prognostication in a single molecular assay.
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Affiliation(s)
- Jennifer M Grants
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Christina May
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Josh Bridgers
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Shujun Huang
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Sierra Gillis
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Barbara Meissner
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | | | - Stacy Hung
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Gerben Duns
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Laura Hilton
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
| | - Marco Marra
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter J B Sabatini
- Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, BC Cancer Centre, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Aly Karsan
- Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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3
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Steidl C, Kridel R, Binkley M, Morton LM, Chadburn A. The pathobiology of select adolescent young adult lymphomas. EJHaem 2023; 4:892-901. [PMID: 38024596 PMCID: PMC10660115 DOI: 10.1002/jha2.785] [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] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 12/01/2023]
Abstract
Lymphoid cancers are among the most frequent cancers diagnosed in adolescents and young adults (AYA), ranging from approximately 30%-35% of cancer diagnoses in adolescent patients (age 10-19) to approximately 10% in patients aged 30-39 years. Moreover, the specific distribution of lymphoid cancer types varies by age with substantial shifts in the subtype distributions between pediatric, AYA, adult, and older adult patients. Currently, biology studies specific to AYA lymphomas are rare and therefore insight into age-related pathogenesis is incomplete. This review focuses on the paradigmatic epidemiology and pathogenesis of select lymphomas, occurring in the AYA patient population. With the example of posttransplant lymphoproliferative disorders, nodular lymphocyte-predominant Hodgkin lymphoma, follicular lymphoma (incl. pediatric-type follicular lymphoma), and mediastinal lymphomas (incl. classic Hodgkin lymphoma, primary mediastinal large B cell lymphoma and mediastinal gray zone lymphoma), we here illustrate the current state-of-the-art in lymphoma classification, recent molecular insights including genomics, and translational opportunities. To improve outcome and quality of life, international collaboration in consortia dedicated to AYA lymphoma is needed to overcome challenges related to siloed biospecimens and data collections as well as to develop studies designed specifically for this unique population.
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Affiliation(s)
- Christian Steidl
- Centre for Lymphoid CancerBC CancerVancouverBritish ColumbiaCanada
| | - Robert Kridel
- Princess Margaret Cancer Centre ‐ University Health NetworkTorontoOntarioCanada
| | - Michael Binkley
- Department of Radiation OncologyStanford UniversityStanfordCaliforniaUSA
| | - Lindsay M. Morton
- Radiation Epidemiology BranchDivision of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - Amy Chadburn
- Department of Pathology and Laboratory MedicineWeill Cornell MedicineNew YorkNew YorkUSA
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4
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Cherniawsky H, Ting E, Zhang JZ, Xu W, Prica A, Bhella S, Yang C, Kridel R, Vijenthira A, Kukreti V, Crump M, Kuruvilla J. Very late relapse in Hodgkin lymphoma: Characterizing an understudied population. Clin Lymphoma Myeloma Leuk 2023; 23:838-843. [PMID: 37562990 DOI: 10.1016/j.clml.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Very late relapse (VLR) occurring >5 years after initial diagnosis is an uncommon event in the management of Hodgkin lymphoma (HL). Limited information regarding risk factors and optimal therapy is available. PATIENTS AND METHODS We reviewed patients treated for HL at Princess Margaret Cancer Centre, Toronto, Ontario Canada between January 01, 1999 and 31 December 31, 2018. RESULTS Thirty-two patients experienced VLR. Median time to first relapse was 7.2 years. Most patients were treated with CMT both at initial diagnosis and relapse. Male gender (P = .04) and increased age at initial diagnosis (P = .008; HR 1.09 (95% CI: 1.02-1.15)) were identified as risk factors for inferior survival on univariate analysis. Stage, histology, treatment modality and risk assessment at diagnosis or relapse did not have a significant impact on survival outcomes. ASCT at first relapse had no impact on time to second progression (HR 1.72; 95% CI, 0.35-8.53; P = .51) or overall survival from first relapse (HR 1.55; 95% CI, 0.3-8.03; P = .6). CONCLUSION Our data aligns with the limited information available in VLR HL suggesting the negative impact of age and male gender on this rare event. Additionally, our data did not show benefit of ASCT at first relapse in terms of survival outcomes in this population, though this analysis is limited by small sample size. Further study of optimal therapy to prevent and treat VL in the era of novel agents is critical.
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Affiliation(s)
- Hannah Cherniawsky
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Esther Ting
- Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, NSW, Australia
| | - Jasper Zhongyuan Zhang
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Biostatistics Department, University Health Networks, Toronto, Ontario, Canada
| | - Anca Prica
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sita Bhella
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Chloe Yang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Robert Kridel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Abirami Vijenthira
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Vishal Kukreti
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Michael Crump
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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5
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Hilton LK, Ngu HS, Collinge B, Dreval K, Ben-Neriah S, Rushton CK, Wong JC, Cruz M, Roth A, Boyle M, Meissner B, Slack GW, Farinha P, Craig JW, Gerrie AS, Freeman CL, Villa D, Rodrigo JA, Song K, Crump M, Shepherd L, Hay AE, Kuruvilla J, Savage KJ, Kridel R, Karsan A, Marra MA, Sehn LH, Steidl C, Morin RD, Scott DW. Relapse Timing Is Associated With Distinct Evolutionary Dynamics in Diffuse Large B-Cell Lymphoma. J Clin Oncol 2023; 41:4164-4177. [PMID: 37319384 PMCID: PMC10852398 DOI: 10.1200/jco.23.00570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Diffuse large B-cell lymphoma (DLBCL) is cured in more than 60% of patients, but outcomes remain poor for patients experiencing disease progression or relapse (refractory or relapsed DLBCL [rrDLBCL]), particularly if these events occur early. Although previous studies examining cohorts of rrDLBCL have identified features that are enriched at relapse, few have directly compared serial biopsies to uncover biological and evolutionary dynamics driving rrDLBCL. Here, we sought to confirm the relationship between relapse timing and outcomes after second-line (immuno)chemotherapy and determine the evolutionary dynamics that underpin that relationship. PATIENTS AND METHODS Outcomes were examined in a population-based cohort of 221 patients with DLBCL who experienced progression/relapse after frontline treatment and were treated with second-line (immuno)chemotherapy with an intention-to-treat with autologous stem-cell transplantation (ASCT). Serial DLBCL biopsies from a partially overlapping cohort of 129 patients underwent molecular characterization, including whole-genome or whole-exome sequencing in 73 patients. RESULTS Outcomes to second-line therapy and ASCT are superior for late relapse (>2 years postdiagnosis) versus primary refractory (<9 months) or early relapse (9-24 months). Diagnostic and relapse biopsies were mostly concordant for cell-of-origin classification and genetics-based subgroup. Despite this concordance, the number of mutations exclusive to each biopsy increased with time since diagnosis, and late relapses shared few mutations with their diagnostic counterpart, demonstrating a branching evolution pattern. In patients with highly divergent tumors, many of the same genes acquired new mutations independently in each tumor, suggesting that the earliest mutations in a shared precursor cell constrain tumor evolution toward the same genetics-based subgroups at both diagnosis and relapse. CONCLUSION These results suggest that late relapses commonly represent genetically distinct and chemotherapy-naïve disease and have implications for optimal patient management.
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Affiliation(s)
- Laura K. Hilton
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Henry S. Ngu
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Brett Collinge
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kostiantyn Dreval
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Christopher K. Rushton
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jasper C.H. Wong
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Manuela Cruz
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Andrew Roth
- Department of Molecular Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Barbara Meissner
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey W. Craig
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciara L. Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Diego Villa
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judith A. Rodrigo
- Department of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Leukemia/BMT Program of BC, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Kevin Song
- Department of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Leukemia/BMT Program of BC, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michael Crump
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queens University, Kingston, Ontario, Canada
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Annette E. Hay
- Canadian Cancer Trials Group, Queens University, Kingston, Ontario, Canada
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - John Kuruvilla
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Kridel
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Aly Karsan
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Marco A. Marra
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan D. Morin
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
- Canada's Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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He MY, Tong KI, Bakhtiari M, Hawkins RW, Liu T, Zeng Y, Ghanem N, He HH, Kridel R. Abstract 1757: Characterizing novel immunomodulating interactions for potentiating HDAC3 inhibition in non-Hodgkin lymphoma. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1757] [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: 04/07/2023]
Abstract
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma and represents a highly heterogeneous and aggressive disease. Up to 40% of all DLBCL patients experience treatment failure after the standard immunochemotherapy R-CHOP. Defining novel therapeutic strategies is therefore a pressing need. Reduced acetylation at histone 3 lysine 27 (H3K27ac) represents a pathogenetic hallmark of DLBCL and selective histone deacetylase 3 inhibition (HDAC3i) has recently emerged as a viable strategy to reverse abnormal epigenetic signatures and induce strong anti-tumor effects by increasing H3K27ac. Despite this compelling rationale, the overall response remains suboptimal, suggesting unrecognized mechanisms of resistance. To unbiasedly uncover sensitizers, we performed a genome-wide CRISPR screen and identified knockout (KO) of the top candidate GNAS (encoding G-protein α subunit, Gαs) for sensitizing resistant DLBCL cells to HDAC3i. The sensitizing effects on reduced viable cell number were only observed in GNAS KO cells treated with HDAC3i, but not in the control cells (“synthetic lethality”). We have validated this sensitizing phenotype in multiple resistant cell lines including three human DLBCL cell lines and one mouse B-cell lymphoma cell line. Interestingly, we showed that the sensitization was not related to the canonical G-protein functions but to novel regulatory mechanisms in viral mimicry activation and chromatin modification. Compared with the control conditions, the interaction between GNAS KO and HDAC3i has been linked with differential chromatin accessibility and endogenous retrovirus expression, upregulated double-stranded RNA expression, and increased phosphorylation of TBK1 whose activation plays a vital role in antiviral immune responses. Strikingly, a selective TBK1 degrader completely and specifically rescued the sensitizing phenotype in GNAS KO cells treated with HDAC3i, confirming the critical role of TBK1 in inducing sensitization. Furthermore, we identified potential immune interactions by exploring the clinical data from tumor samples of 309 DLBCL patients that low GNAS expression was correlated with cytokine and inflammatory signaling as well as stromal cell interactions in the tumor microenvironment, altogether associated with longer overall survival. These observations were aligned with our results in the mouse xenograft and allograft tumor experiments that GNAS KO with/without HDAC3i led to differential phenotypes. Overall, our research uncovers novel immunomodulating activities for potentiating the efficacy of epigenetic agents in non-Hodgkin lymphoma. This expands our understanding of novel interactions between immune and epigenetic regulation in lymphoma biology and provides new therapeutic opportunities for patients with resistant lymphoma who have poor prognoses and limited treatment options.
Citation Format: Michael Y. He, Kit I. Tong, Mehran Bakhtiari, Ryder Whittaker Hawkins, Ting Liu, Yong Zeng, Noorhan Ghanem, Housheng Hansen He, Robert Kridel. Characterizing novel immunomodulating interactions for potentiating HDAC3 inhibition in non-Hodgkin lymphoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1757.
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Affiliation(s)
- Michael Y. He
- 1UHN Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kit I. Tong
- 1UHN Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Ting Liu
- 1UHN Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Yong Zeng
- 1UHN Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Robert Kridel
- 1UHN Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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7
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Hilton LK, Ngu HS, Collinge B, Dreval K, Ben-Neriah S, Rushton CK, Wong JC, Cruz M, Roth A, Boyle M, Meissner B, Slack GW, Farinha P, Craig JW, Gerrie AS, Freeman CL, Villa D, Crump M, Shepherd L, Hay AE, Kuruvilla J, Savage KJ, Kridel R, Karsan A, Marra MA, Sehn LH, Steidl C, Morin RD, Scott DW. Relapse timing is associated with distinct evolutionary dynamics in DLBCL. medRxiv 2023:2023.03.06.23286584. [PMID: 36945587 PMCID: PMC10029038 DOI: 10.1101/2023.03.06.23286584] [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] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is cured in over 60% of patients, but outcomes are poor for patients with relapsed or refractory disease (rrDLBCL). Here, we performed whole genome/exome sequencing (WGS/WES) on tumors from 73 serially-biopsied patients with rrDLBCL. Based on the observation that outcomes to salvage therapy/autologous stem cell transplantation are related to time-to-relapse, we stratified patients into groups according to relapse timing to explore the relationship to genetic divergence and sensitivity to salvage immunochemotherapy. The degree of mutational divergence increased with time between biopsies, yet tumor pairs were mostly concordant for cell-of-origin, oncogene rearrangement status and genetics-based subgroup. In patients with highly divergent tumors, several genes acquired exclusive mutations independently in each tumor, which, along with concordance of genetics-based subgroups, suggests that the earliest mutations in a shared precursor cell constrain tumor evolution. These results suggest that late relapses commonly represent genetically distinct and chemotherapy-naïve disease.
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Affiliation(s)
- Laura K. Hilton
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Henry S. Ngu
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Brett Collinge
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kostiantyn Dreval
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Christopher K. Rushton
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Jasper C.H. Wong
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Manuela Cruz
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Andrew Roth
- Department of Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Barbara Meissner
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey W. Craig
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ciara L. Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Diego Villa
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michael Crump
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada
- Department of Medicine, Queens University, Kingston, ON, Canada
| | - Annette E. Hay
- Canadian Cancer Trials Group, Queens University, Kingston, ON, Canada
- Department of Medicine, Queens University, Kingston, ON, Canada
| | - John Kuruvilla
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Kridel
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Aly Karsan
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Marco A. Marra
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ryan D. Morin
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer Research Institute, Vancouver, BC, Canada
| | - David W. Scott
- Centre for Lymphoid Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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8
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Lackraj T, Ben Barouch S, Medeiros JJF, Pedersen S, Danesh A, Bakhtiari M, Hong M, Tong K, Joynt J, Arruda A, Minden MD, Kuruvilla J, Bhella S, Kukreti V, Crump M, Prica A, Chen C, Deng Y, Xu W, Pugh TJ, Keating A, Dick JE, Abelson S, Kridel R. Clinical significance of clonal hematopoiesis in the setting of autologous stem cell transplantation for lymphoma. Am J Hematol 2022; 97:1538-1547. [PMID: 36087071 DOI: 10.1002/ajh.26726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/09/2022] [Accepted: 09/01/2022] [Indexed: 01/31/2023]
Abstract
Autologous stem cell transplantation (ASCT) remains a key therapeutic strategy for treating patients with relapsed or refractory non-Hodgkin and Hodgkin lymphoma. Clonal hematopoiesis (CH) has been proposed as a major contributor not only to the development of therapy-related myeloid neoplasms but also to inferior overall survival (OS) in patients who had undergone ASCT. Herein, we aimed to investigate the prognostic implications of CH after ASCT in a cohort of 420 lymphoma patients using ultra-deep, highly sensitive error-correction sequencing. CH was identified in the stem cell product samples of 181 patients (43.1%) and was most common in those with T-cell lymphoma (72.2%). The presence of CH was associated with a longer time to neutrophil and platelet recovery. Moreover, patients with evidence of CH had inferior 5-year OS from the time of first relapse (39.4% vs. 45.8%, p = .043) and from the time of ASCT (51.8% vs. 59.3%, p = .018). The adverse prognostic impact of CH was not due to therapy-related myeloid neoplasms, the incidence of which was low in our cohort (10-year cumulative incidence of 3.3% vs. 3.0% in those with and without CH, p = .445). In terms of specific-gene mutations, adverse OS was mostly associated with PPM1D mutations (hazard ratio (HR) 1.74, 95% confidence interval (CI) 1.13-2.67, p = .011). In summary, we found that CH is associated with an increased risk of non-lymphoma-related death after ASCT, which suggests that lymphoma survivors with CH may need intensified surveillance strategies to prevent and treat late complications.
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Affiliation(s)
- Tracy Lackraj
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sharon Ben Barouch
- Institute of Hematology, Assuta Ashdod Medical Center, Ashdod, Israel.,Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jessie J F Medeiros
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Pedersen
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Arnavaz Danesh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mehran Bakhtiari
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael Hong
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Kit Tong
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jesse Joynt
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrea Arruda
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mark D Minden
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - John Kuruvilla
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sita Bhella
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Vishal Kukreti
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael Crump
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anca Prica
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Christine Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Yangqing Deng
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Armand Keating
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - John E Dick
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sagi Abelson
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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9
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Suleman A, Liu J, Hicks LK, Drori AK, Crump M, Kridel R, Prica A, Berinstein N. Methotrexate cytarabine thiotepa rituximab (MATRix) chemoimmunotherapy for primary central nervous system lymphoma: a Toronto experience. Haematologica 2022; 108:1186-1189. [PMID: 36453110 PMCID: PMC10071115 DOI: 10.3324/haematol.2022.282014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Indexed: 12/04/2022] Open
Abstract
Not available.
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Affiliation(s)
| | - Jiajia Liu
- Faculty of Medicine, University of Toronto
| | - Lisa K Hicks
- Faculty of Medicine, University of Toronto; Division of Medical Oncology and Hematology, St. Michael's Hospital
| | | | - Michael Crump
- Faculty of Medicine, University of Toronto; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre
| | - Robert Kridel
- Faculty of Medicine, University of Toronto; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre
| | - Anca Prica
- Faculty of Medicine, University of Toronto; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre
| | - Neil Berinstein
- Faculty of Medicine, University of Toronto; Sunnybrook Health Sciences Centre, Odette Cancer Centre
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10
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Manji F, Bhella S, Kridel R, Kukreti V, Kuruvilla J, Prica A, Crump M. Clinical utility of interim CT scans in patients receiving chemoimmuntherapy for first line treatment of follicular lymphoma. Leuk Lymphoma 2022; 63:3402-3408. [PMID: 36166635 DOI: 10.1080/10428194.2022.2123226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/26/2023]
Abstract
Interim imaging with computed tomography (iCT) to assess response is common during frontline chemoimmunotherapy for follicular lymphoma (FL), but there is little evidence of its utility. We retrospectively reviewed outcomes of iCT in 190 patients with biopsy-proven FL who received first-line chemoimmunotherapy from 2003-2018. Most iCTs showed partial response (PR, 83%), with a minority showing complete response (CR, 8%) or stable disease (5%). Seven patients (4%) had radiographic disease progression (PD) on iCT; on repeat biopsy, four had another malignancy identified and three had transformation to DLBCL. Only one had asymptomatic PD. The 3-year PFS of all patients was 74% (median follow up 75 months). Patients with PR on iCT had similar 3-year PFS and OS as those with CR. In conclusion, iCT has limited utility in identifying patients with asymptomatic early progression during first-line treatment. Patients with PD mid-treatment warrant biopsy to identify histologic transformation or other malignancies.
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Affiliation(s)
- Farheen Manji
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sita Bhella
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert Kridel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vishal Kukreti
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Kuruvilla
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anca Prica
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Crump
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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11
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Mentz M, Keay W, Strobl CD, Antoniolli M, Adolph L, Heide M, Lechner A, Haebe S, Osterode E, Kridel R, Ziegenhain C, Wange LE, Hildebrand JA, Shree T, Silkenstedt E, Staiger AM, Ott G, Horn H, Szczepanowski M, Richter J, Levy R, Rosenwald A, Enard W, Zimber-Strobl U, von Bergwelt-Baildon M, Hiddemann W, Klapper W, Schmidt-Supprian M, Rudelius M, Bararia D, Passerini V, Weigert O. PARP14 is a novel target in STAT6 mutant follicular lymphoma. Leukemia 2022; 36:2281-2292. [PMID: 35851155 PMCID: PMC9417990 DOI: 10.1038/s41375-022-01641-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 12/02/2022]
Abstract
The variable clinical course of follicular lymphoma (FL) is determined by the molecular heterogeneity of tumor cells and complex interactions within the tumor microenvironment (TME). IL-4 producing follicular helper T cells (TFH) are critical components of the FL TME. Binding of IL-4 to IL-4R on FL cells activates JAK/STAT signaling. We identified STAT6 mutations (STAT6MUT) in 13% of FL (N = 33/258), all clustered within the DNA binding domain. Gene expression data and immunohistochemistry showed upregulation of IL-4/STAT6 target genes in STAT6MUT FL, including CCL17, CCL22, and FCER2 (CD23). Functionally, STAT6MUT was gain-of-function by serial replating phenotype in pre-B CFU assays. Expression of STAT6MUT enhanced IL-4 induced FCER2/CD23, CCL17 and CCL22 expression and was associated with nuclear accumulation of pSTAT6. RNA sequencing identified PARP14 -a transcriptional switch and co-activator of STAT6- among the top differentially upregulated genes in IL-4 stimulated STAT6MUT lymphoma cells and in STAT6MUT primary FL cells. Quantitative chromatin immunoprecipitation (qChIP) demonstrated binding of STAT6MUT but not STAT6WT to the PARP14 promotor. Reporter assays showed increased IL-4 induced transactivation activity of STAT6MUT at the PARP14 promotor, suggesting a self-reinforcing regulatory circuit. Knock-down of PARP14 or PARP-inhibition abrogated the STAT6MUT gain-of-function phenotype. Thus, our results identify PARP14 as a novel therapeutic target in STAT6MUT FL.
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Affiliation(s)
- Michael Mentz
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
- Research Unit Gene Vectors, Helmholtz- Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - William Keay
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Carolin Dorothea Strobl
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Martina Antoniolli
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Louisa Adolph
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Michael Heide
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Axel Lechner
- Department of Otolaryngology, Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Sarah Haebe
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
- Division of Oncology, Department of Medicine, School of Medicine, Stanford, CA, USA
| | - Elisa Osterode
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Robert Kridel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Christoph Ziegenhain
- Anthropology and Human Genomics, Faculty of Biology, Ludwig-Maximilians-University, Munich, Germany
| | - Lucas Esteban Wange
- Anthropology and Human Genomics, Faculty of Biology, Ludwig-Maximilians-University, Munich, Germany
| | - Johannes Adrian Hildebrand
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Tanaya Shree
- Division of Oncology, Department of Medicine, School of Medicine, Stanford, CA, USA
| | - Elisabeth Silkenstedt
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Annette M Staiger
- Department of Clinical Pathology, Robert Bosch Hospital, Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Tübingen, Germany
| | - German Ott
- Department of Clinical Pathology, Robert Bosch Hospital, Stuttgart, Germany
| | - Heike Horn
- Department of Clinical Pathology, Robert Bosch Hospital, Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Tübingen, Germany
| | - Monika Szczepanowski
- Institute of Pathology, Hematopathology Section, University of Schleswig-Holstein, Kiel, Germany
| | - Julia Richter
- Institute of Pathology, Hematopathology Section, University of Schleswig-Holstein, Kiel, Germany
| | - Ronald Levy
- Division of Oncology, Department of Medicine, School of Medicine, Stanford, CA, USA
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg and Comprehensive Cancer Centre Mainfranken, Würzburg, Germany
| | - Wolfgang Enard
- Division of Oncology, Department of Medicine, School of Medicine, Stanford, CA, USA
| | - Ursula Zimber-Strobl
- Research Unit Gene Vectors, Helmholtz- Center Munich, German Research Center for Environmental Health, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
- German Cancer Consortium (DKTK), Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
- German Cancer Consortium (DKTK), Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfram Klapper
- Institute of Pathology, Hematopathology Section, University of Schleswig-Holstein, Kiel, Germany
| | - Marc Schmidt-Supprian
- German Cancer Consortium (DKTK), Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Experimental Hematology, School of Medicine, Center for Translational Cancer Research (TranslaTUM), Technical University of Munich, Munich, Germany
| | - Martina Rudelius
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Deepak Bararia
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Verena Passerini
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany
| | - Oliver Weigert
- Department of Medicine III, Laboratory for Experimental Leukemia and Lymphoma Research (ELLF), Ludwig-Maximilians-University (LMU) Hospital, Munich, Germany.
- German Cancer Consortium (DKTK), Munich, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
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12
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Ben Barouch S, Bhella S, Kridel R, Kukreti V, Prica A, Crump M, Kuruvilla J. Long-term follow up of relapsed/refractory non-Hodgkin lymphoma patients treated with single-agent selinexor – a retrospective, single center study. Leuk Lymphoma 2022; 63:1879-1886. [DOI: 10.1080/10428194.2022.2047674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sharon Ben Barouch
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
- Division of Hematology, Assuta Ashdod University Hospital, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Sita Bhella
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Robert Kridel
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Vishel Kukreti
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Anca Prica
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Michel Crump
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John Kuruvilla
- Department of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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13
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Isaev K, Liu T, Bakhtiari M, Tong K, Goswami R, Lam B, Lungu I, Krzyzanowski PM, Oza A, Dhani N, Prica A, Crump M, Kridel R. In-depth characterization of intratumoral heterogeneity in refractory B-cell non-Hodgkin lymphoma through the lens of a Research Autopsy Program. Haematologica 2022; 108:196-206. [PMID: 35734926 PMCID: PMC9827161 DOI: 10.3324/haematol.2022.280900] [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: 02/23/2022] [Indexed: 02/05/2023] Open
Abstract
Intratumoral heterogeneity (ITH) provides the substrate for tumor evolution and treatment resistance, yet is remarkably understudied in lymphoma, due to the often limited amount of tissue that gets sampled during the routine diagnostic process, generally from a single nodal or extranodal site. Furthermore, the trajectory of how lymphoma, and especially non-Hodgkin lymphoma, spreads throughout the human body remains poorly understood. Here, we present a detailed characterization of ITH by applying whole-genome sequencing to spatially separated tumor samples harvested at the time of autopsy (n=24) and/or diagnosis (n=3) in three patients presenting with refractory B-cell non-Hodgkin lymphoma. Through deconvolution of bulk samples into clonal mixtures and inference of phylogenetic trees, we found evidence that polyclonal seeding underlies tumor dissemination in lymphoma. We identify mutation signatures associated with ancestral and descendant clones. In our series of patients with highly refractory lymphoma, the determinants of resistance were often harbored by founding clones, although there was also evidence of positive selection of driver mutations, likely under the influence of therapy. Lastly, we show that circulating tumor DNA is suitable for the detection of ancestral mutations but may miss a significant proportion of private mutations that can be detected in tissue. Our study clearly shows the existence of intricate patterns of regional and anatomical evolution that can only be disentangled through multi-regional tumor tissue profiling.
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Affiliation(s)
- Keren Isaev
- Princess Margaret Cancer Center - University Health Network
| | - Ting Liu
- Princess Margaret Cancer Center - University Health Network
| | | | - Kit Tong
- Princess Margaret Cancer Center - University Health Network
| | | | - Bernard Lam
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ilinca Lungu
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | | | - Amit Oza
- Princess Margaret Cancer Center - University Health Network
| | - Neesha Dhani
- Princess Margaret Cancer Center - University Health Network
| | - Anca Prica
- Princess Margaret Cancer Center - University Health Network
| | - Michael Crump
- Princess Margaret Cancer Center - University Health Network
| | - Robert Kridel
- Princess Margaret Cancer Center - University Health Network,R. Kridel
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14
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Yhim H, Eshet Y, Metser U, Lajkosz K, Cooper M, Prica A, Kukreti V, Bhella S, Lang N, Xu W, Rodin D, Hodgson D, Tsang R, Crump M, Kuruvilla J, Kridel R. Risk stratification for relapsed/refractory classical Hodgkin lymphoma integrating pretransplant Deauville score and residual metabolic tumor volume. Am J Hematol 2022; 97:583-591. [PMID: 35170780 DOI: 10.1002/ajh.26500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/31/2021] [Accepted: 02/07/2022] [Indexed: 11/09/2022]
Abstract
Pretransplant Deauville score (DS) is an imaging biomarker used for risk stratification in relapsed/refractory classical Hodgkin lymphoma (cHL). However, the prognostic value of residual metabolic tumor volume (rMTV) in patients with DS 4-5 has been less well characterized. We retrospectively assessed 106 patients with relapsed/refractory cHL who underwent autologous stem cell transplantation. Pretransplant DS was determined as 1-3 (59%) and 4-5 (41%), with a markedly inferior event-free survival (EFS) in patients with DS 4-5 (hazard ratio [HR], 3.14; p = .002). High rMTV41% (rMTVhigh , ≥4.4 cm3 ) predicted significantly poorer EFS in patients with DS 4-5 (HR, 3.70; p = .014). In a multivariable analysis, we identified two independent factors predicting treatment failure: pretransplant DS combined with rMTV41% and disease status (primary refractory vs. relapsed). These two factors allow to stratify patients into three groups with divergent 2-year EFS: 89% for low-risk (51%; relapsed disease and either pretransplant DS 1-3 or DS 4-5/rMTVlow ; HR 1), 65% for intermediate-risk (28%; refractory disease and either DS 1-3 or DS 4-5/rMTVlow ; HR 3.26), and 45% for high-risk (21%; DS 4-5/rMTVhigh irrespective of disease status; HR 7.61) groups. Pretransplant DS/rMTV41% combination and disease status predict the risk of post-transplant treatment failure and will guide risk-stratified approaches in relapsed/refractory cHL.
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Affiliation(s)
- Ho‐Young Yhim
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
- Department of Internal Medicine Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University‐Biomedical Research Institute of Jeonbuk National University Hospital Jeonju Republic of Korea
| | - Yael Eshet
- Joint Department of Medical Imaging, Princess Margaret Cancer Centre University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto Toronto Ontario Canada
| | - Ur Metser
- Joint Department of Medical Imaging, Princess Margaret Cancer Centre University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto Toronto Ontario Canada
| | - Katherine Lajkosz
- Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Matthew Cooper
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
- Faculty of Medicine Dalhousie University Halifax Nova Scotia Canada
| | - Anca Prica
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
| | - Vishal Kukreti
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
| | - Sita Bhella
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
| | - Noémie Lang
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Danielle Rodin
- Radiation Medicine Program Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
- Department of Radiation Oncology University of Toronto Toronto Ontario Canada
| | - David Hodgson
- Radiation Medicine Program Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
- Department of Radiation Oncology University of Toronto Toronto Ontario Canada
| | - Richard Tsang
- Radiation Medicine Program Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
- Department of Radiation Oncology University of Toronto Toronto Ontario Canada
| | - Michael Crump
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
| | - John Kuruvilla
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
| | - Robert Kridel
- Division of Medical Oncology and Hematology Princess Margaret Cancer Centre – University Health Network Toronto Ontario Canada
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15
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Xia D, Leon AJ, Yan J, Silva A, Bakhtiari M, Tremblay-LeMay R, Selvarajah S, Sabatini P, Diamandis P, Pugh T, Kridel R, Delabie J. DNA Methylation-Based Classification of Small B-Cell Lymphomas: A Proof-of-Principle Study. J Mol Diagn 2021; 23:1774-1786. [PMID: 34562613 DOI: 10.1016/j.jmoldx.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022] Open
Abstract
Although most small B-cell lymphomas (SBCLs) can be diagnosed using routine methods, challenges exist. For example, marginal zone lymphomas (MZLs) can be difficult to rule-in, in large part because no widely-used, sensitive, and specific biomarker is available for the marginal zone cell of origin. In this study, it was hypothesized that DNA methylation array profiling can assist with the classification of SBCLs, including MZLs. Extramedullary SBCLs, including challenging cases, were reviewed internally for pathology consensus and profiled. By combining the resulting array data set with data sets from other groups, a set of 26 informative probes was selected and used to train machine learning models to classify 4 common SBCLs: chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, mantle cell lymphoma, and MZL. Prediction probability cutoff was used to separate classifiable from unclassifiable cases, and show that the trained model was able to classify 95% of independent test cases (n = 264/279). The concordance between model predictions and pathology diagnoses was 99.6% (n = 262/263) among classifiable test cases. One validation reference test case was reclassified based on model prediction. The model was also used to predict the diagnoses of two challenging SBCLs. Although the differential examined and data on difficult cases are limited, these results support accurate methylation-based classification of SBCLs. Furthermore, high specificities of predictions suggest that methylation signatures can be used to rule-in MZLs.
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Affiliation(s)
- Daniel Xia
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
| | - Alberto Jose Leon
- Translational Genomics Laboratory, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Jiong Yan
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anjali Silva
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Vector Institute, Toronto, Ontario, Canada
| | | | - Rosemarie Tremblay-LeMay
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Shamini Selvarajah
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Peter Sabatini
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Division of Clinical Laboratory Genetics, University Health Network, Toronto, Ontario, Canada
| | - Phedias Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Pugh
- Translational Genomics Laboratory, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jan Delabie
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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16
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Abstract
Diffuse large B-cell lymphoma (DLBCL) is a highly heterogeneous disease and represents the most common subtype of lymphoma. Although 60-70% of all patients can be cured by the current standard of care in the frontline setting, the majority of the remaining patients will experience treatment resistance and have a poor clinical outcome. Numerous efforts have been made to improve the efficacy of the standard regimen by, for example, dose intensification or adding novel agents. However, these results generally failed to demonstrate significant clinical benefits. Hence, understanding treatment resistance is a pressing need to optimize the outcome of those patients. In this Review, we first describe the conceptual sources of treatment resistance in DLBCL and then provide detailed and up-to-date molecular insight into the mechanisms of resistance to the current treatment options in DLBCL. We lastly highlight the potential strategies for rationally managing treatment resistance from both the preventive and interventional perspectives.
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Affiliation(s)
- Michael Y He
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
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17
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Tong KI, Yoon S, Isaev K, Bakhtiari M, Lackraj T, He MY, Joynt J, Silva A, Xu MC, Privé GG, He HH, Tiedemann RE, Chavez EA, Chong LC, Boyle M, Scott DW, Steidl C, Kridel R. Combined EZH2 Inhibition and IKAROS Degradation Leads to Enhanced Antitumor Activity in Diffuse Large B-cell Lymphoma. Clin Cancer Res 2021; 27:5401-5414. [PMID: 34168051 DOI: 10.1158/1078-0432.ccr-20-4027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/24/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The efficacy of EZH2 inhibition has been modest in the initial clinical exploration of diffuse large B-cell lymphoma (DLBCL), yet EZH2 inhibitors are well tolerated. Herein, we aimed to uncover genetic and pharmacologic opportunities to enhance the clinical efficacy of EZH2 inhibitors in DLBCL. EXPERIMENTAL DESIGN We conducted a genome-wide sensitizing CRISPR/Cas9 screen with tazemetostat, a catalytic inhibitor of EZH2. The sensitizing effect of IKZF1 loss of function was then validated and leveraged for combination treatment with lenalidomide. RNA sequencing (RNA-seq) and chromatin immunoprecipitation sequencing analyses were performed to elucidate transcriptomic and epigenetic changes underlying synergy. RESULTS We identified IKZF1 knockout as the top candidate for sensitizing DLBCL cells to tazemetostat. Treating cells with tazemetostat and lenalidomide, an immunomodulatory drug that selectively degrades IKAROS and AIOLOS, phenocopied the effects of the CRISPR/Cas9 screen. The combined drug treatment triggered either cell-cycle arrest or apoptosis in a broad range of DLBCL cell lines, regardless of EZH2 mutational status. Cell-line-based xenografts also showed slower tumor growth and prolonged survival in the combination treatment group. RNA-seq analysis revealed strong upregulation of interferon signaling and antiviral immune response signatures. Gene expression of key immune response factors such as IRF7 and DDX58 were induced in cells treated with lenalidomide and tazemetostat, with a concomitant increase of H3K27 acetylation at their promoters. Furthermore, transcriptome analysis demonstrated derepression of endogenous retroviruses after combination treatment. CONCLUSIONS Our data underscore the synergistic interplay between IKAROS degradation and EZH2 inhibition on modulating epigenetic changes and ultimately enhancing antitumor effects in DLBCL.
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Affiliation(s)
- Kit I Tong
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sharon Yoon
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Keren Isaev
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mehran Bakhtiari
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tracy Lackraj
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael Y He
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jesse Joynt
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada
| | - Anjali Silva
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Vector Institute, Toronto, Ontario, Canada
| | - Maria C Xu
- University of Toronto Schools, Ontario, Canada
| | - Gilbert G Privé
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Housheng Hansen He
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Rodger E Tiedemann
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Ontario, Canada
| | - Elizabeth A Chavez
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Lauren C Chong
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. .,Institute of Medical Science, University of Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Ontario, Canada
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18
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Manji F, Bhella S, Kridel R, Kukreti V, Kuruvilla J, Prica A, Crump M. CLINICAL UTILITY OF INTERIM CT SCANS IN PATIENTS RECEIVING CHEMOIMMUNOTHERAPY FOR FIRST LINE TREATMENT OF FOLLICULAR LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.35_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- F. Manji
- Princess Margaret Cancer Centre Department of Medical Oncology and Hematology Toronto Canada
| | - S. Bhella
- Princess Margaret Cancer Centre Department of Medical Oncology and Hematology Toronto Canada
| | - R. Kridel
- Princess Margaret Cancer Centre Department of Medical Oncology and Hematology Toronto Canada
| | - V. Kukreti
- Princess Margaret Cancer Centre Department of Medical Oncology and Hematology Toronto Canada
| | - J. Kuruvilla
- Princess Margaret Cancer Centre Department of Medical Oncology and Hematology Toronto Canada
| | - A. Prica
- Princess Margaret Cancer Centre Department of Medical Oncology and Hematology Toronto Canada
| | - M. Crump
- Princess Margaret Cancer Centre Department of Medical Oncology and Hematology Toronto Canada
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19
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Lebel E, Jain MD, Prica A, Kukreti V, Kridel R, Laister RC, Meng L, Delabie J, Weiss J, Panzarella T, Crump M, Kuruvilla J. PROSPECTIVE VALIDATION OF RECIL RESPONSE CRITERIA: RESULTS OF OBINUTUZUMAB‐GDP AS SALVAGE PRIOR TO AUTOLOGOUS STEM CELL TRANSPLANT IN AGGRESSIVE B CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.97_2881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- E. Lebel
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - M. D. Jain
- Moffitt Cancer Center Department of Blood and Marrow Transplant and Cellular Immunotherapy Tampa Florida USA
| | - A. Prica
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - V. Kukreti
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - R. Kridel
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - R. C. Laister
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - L. Meng
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - J. Delabie
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - J. Weiss
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - T. Panzarella
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - M. Crump
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - J. Kuruvilla
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
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20
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Lang N, De la Torre A, Kridel R, Prica A, Crump M, Kukreti V, Kuruvilla J, Tsang R, Hodgson D, Rodin D, Bhella S. PRIMARY CENTRAL NERVOUS SYSTEM POST‐TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (CNS‐PTLD): A 20 YEARS RETROSPECTIVE SINGLE CENTER EXPERIENCE. Hematol Oncol 2021. [DOI: 10.1002/hon.70_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- N. Lang
- Princess Margaret Hospital Haematology Toronto Canada
| | | | - R. Kridel
- Princess Margaret Hospital Haematology Toronto Canada
| | - A. Prica
- Princess Margaret Hospital Haematology Toronto Canada
| | - M. Crump
- Princess Margaret Hospital Haematology Toronto Canada
| | - V. Kukreti
- Princess Margaret Hospital Haematology Toronto Canada
| | - J. Kuruvilla
- Princess Margaret Hospital Haematology Toronto Canada
| | - R. Tsang
- Princess Margaret Hospital Haematology Toronto Canada
| | - D. Hodgson
- Princess Margaret Hospital Haematology Toronto Canada
| | - D. Rodin
- Princess Margaret Hospital Haematology Toronto Canada
| | - S. Bhella
- Princess Margaret Hospital Haematology Toronto Canada
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21
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Fehr M, Lang N, Rubio L, Güsewell S, Templeton A, Aeppli S, Tsang R, Hodgson D, Moccia A, Bargetzi M, Caspar C, Brülisauer DMA, Ebnöther M, Fischer N, Prica A, Kukreti V, Ghilardi G, Krasniqi F, Mey UJ, Mingrone W, Novak U, Richter P, Kridel R, Rodin D, Rütti M, Schmidt A, Stenner F, Voegeli M, Zander T, Crump M, Hitz F, Kuruvilla J. PROGNOSTIC FACTORS IN ELDERLY PATIENTS WITH CLASSICAL HODGKIN LYMPHOMA ‐ A JOINT ANALYSIS OF TWO CLINICAL DATABASES. Hematol Oncol 2021. [DOI: 10.1002/hon.113_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Fehr
- Cantonal Hospital St. Gallen, Medical Oncology and Haematology St. Gallen Switzerland
| | - N Lang
- Hôpitaux Universitaires Genève, Department of Oncology Genève Switzerland
| | - L Rubio
- Manchester Royal Infirmary, Haematology Manchester UK
| | - S Güsewell
- Cantonal Hospital St. Gallen, Clinical Trials Unit St. Gallen Switzerland
| | - A.J. Templeton
- Claraspital Basel, Oncology and Haematology Basel Switzerland
| | - S Aeppli
- Cantonal Hospital St. Gallen, Medical Oncology and Haematology St. Gallen Switzerland
| | - R Tsang
- Princess Margaret Cancer Centre, Medical Oncology and Haematology Toronto Canada
| | - D Hodgson
- Princess Margaret Cancer Centre, Medical Oncology and Haematology Toronto Canada
| | - A Moccia
- Oncology Institute of Southern Switzerland, Department of Medical Oncology Bellinzona Switzerland
| | - M Bargetzi
- Cantonal Hospital Aarau, Haematology Aarau Switzerland
| | - C Caspar
- Cantonal Hospital Baden, Oncology und Haematology Baden Switzerland
| | | | - M Ebnöther
- Claraspital Basel, Oncology and Haematology Basel Switzerland
| | - N Fischer
- Cantonal Hospital Winterthur, Medical Oncology and Haematology Winterthur Switzerland
| | - A Prica
- Princess Margaret Cancer Centre, Medical Oncology and Haematology Toronto Canada
| | - V Kukreti
- Princess Margaret Cancer Centre, Medical Oncology and Haematology Toronto Canada
| | - G Ghilardi
- Oncology Institute of Southern Switzerland, Haematology Bellinzona Switzerland
| | - F Krasniqi
- University Hospital Basel, Oncology Basel Switzerland
| | - U. J Mey
- Cantonal Hospital Grisons, Oncology and Haematology Chur Switzerland
| | - W Mingrone
- Cantonal Hospital Olten, Centre for Oncology Olten Switzerland
| | - U Novak
- University Hospital Bern, Medical Oncology Bern Switzerland
| | - P Richter
- Cantonal Hospital Grisons, Oncology and Haematology Chur Switzerland
| | - R Kridel
- Princess Margaret Cancer Centre, Medical Oncology and Haematology Toronto Canada
| | - D Rodin
- Princess Margaret Cancer Centre, Radiation Oncology Toronto Switzerland
| | - M Rütti
- Hospital Wil, Medicine Wil Switzerland
| | - A Schmidt
- Stadtspital Triemli, Medical Oncology und Haematology Zürich Switzerland
| | | | - M Voegeli
- Cantonal Hospital Baselland, Oncology and Haematology Liestal Switzerland
| | - T Zander
- Cantonal Hospital Luzern, Medical Oncology Luzern Switzerland
| | - M Crump
- Princess Margaret Cancer Centre, Medical Oncology and Haematology Toronto Canada
| | - F Hitz
- Cantonal Hospital St. Gallen, Medical Oncology and Haematology St. Gallen Switzerland
| | - J Kuruvilla
- Princess Margaret Cancer Centre, Medical Oncology and Haematology Toronto Canada
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22
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Manji F, Bhella S, Prica AA, Kridel R, Kukreti V, Kuruvilla J, Crump M. Clinical utility of interim CT scans in patients receiving bendamustine and rituximab for first line treatment of follicular lymphoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e19565] [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: 11/20/2022] Open
Abstract
e19565 Background: Interim imaging with computed tomography scanning (CT) has been performed during most clinical trials of chemoimmunotherapy in patients with follicular lymphoma (FL) receiving first line systemic therapy. Based on this, interim imaging is commonly performed, but there is little evidence of its utility in clinical practice. Methods: The objective of this study was to retrospectively review outcomes of interim CTs (iCT) in adult patients with biopsy proven FL (grade 1-3a, 3b excluded) who received first line therapy with bendamustine and rituximab (BR) at Princess Margaret Cancer Centre from January 1 2013- December 31 2018. Baseline patient characteristics at diagnosis and treatment were retrieved from a prospectively populated database, and results of interim, end of treatment and end of maintenance therapy (if applicable) imaging were assessed. Disease response was assessed using Lugano response criteria as partial response (PR), complete response (CR), stable disease (SD) or progressive disease (PD). Descriptive statistics and Kaplan Meier Survival functions with a log rank test were used to analyze the data. The study was approved by the Princess Margaret Research Ethics Board. Results: A total of 108 patients were identified: mean age at diagnosis 61 years (IQR 52.4-69.5), 83% with stage III/IV disease, 27.8% bulky ( > 10cm) and median FLIPI score 2. Median follow up was 55.9 months (6.6-100.1 months). Of them, 101 patients (93.5%) had interim imaging done between cycle 2 and cycle 5 , most commonly CT scan (n = 98, 97.0%). The majority of iCTs showed a PR (n = 81, 80.1%), with a minority showing a CR (n = 11, 10.9%) and SD (n = 2, 1.9%). Seven patients had PD noted on iCT. Four patients had a second malignancy identified on biopsy of lesions found on iCT (thymoma, poorly differentiated carcinoma, lung adenocarcinoma and spindle cell tumour), 2 of whom were symptomatic at the time of iCT. Three patients had biopsy proven transformation to diffuse large B cell lymphoma (DLBCL); 2 were symptomatic at the time of iCT and only 1 had asymptomatic PD. The 3 year progression free survival (PFS) for all patients was 87.55%. Patients with a PR on iCT had similar 3 year PFS compared to those with CR (87.25% vs 90.00%, p = .52) as well as overall survival (94.80% vs 88.89%, p = .88). Conclusions: In this cohort, iCT was not useful for identifying patients with asymptomatic early progression of FL during treatment with BR. The majority of patients receiving systemic treatment for FL have at least a PR to BR on iCT, which is not associated with inferior PFS or OS compared to those with CR. Patients with symptomatic or asymptomatic PD during treatment warrant biopsy to identify histologic transformation or other malignancies. The rate of second cancers identified on iCT will be further explored in a cohort of FL patients treated with R-CVP and R-CHOP.
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Affiliation(s)
- Farheen Manji
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Sita Bhella
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anca A. Prica
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Vishal Kukreti
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Michael Crump
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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23
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Isaev K, Ennishi D, Hilton L, Skinnider B, Mungall KL, Mungall AJ, Bakhtiari M, Tremblay-LeMay R, Silva A, Ben-Neriah S, Boyle M, Villa D, Marra MA, Steidl C, Gascoyne RD, Morin R, Savage KJ, Scott DW, Kridel R. Molecular attributes underlying central nervous system and systemic relapse in diffuse large B-cell lymphoma. Haematologica 2021; 106:1466-1471. [PMID: 32817292 PMCID: PMC8094129 DOI: 10.3324/haematol.2020.255950] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Indexed: 01/20/2023] Open
Affiliation(s)
- Keren Isaev
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Daisuke Ennishi
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | | | - Brian Skinnider
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Karen L Mungall
- Canada Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Andrew J Mungall
- Canada Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Mehran Bakhtiari
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | | | - Anjali Silva
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | | | | | - Diego Villa
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Marco A Marra
- Canada Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | | | | | - Ryan Morin
- Simon Fraser University, Burnaby, BC, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
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24
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Jain N, Hartert K, Tadros S, Fiskus W, Havranek O, Ma MCJ, Bouska A, Heavican T, Kumar D, Deng Q, Moore D, Pak C, Liu CL, Gentles AJ, Hartmann E, Kridel R, Smedby KE, Juliusson G, Rosenquist R, Gascoyne RD, Rosenwald A, Giancotti F, Neelapu SS, Westin J, Vose JM, Lunning MA, Greiner T, Rodig S, Iqbal J, Alizadeh AA, Davis RE, Bhalla K, Green MR. Targetable genetic alterations of TCF4 ( E2-2) drive immunoglobulin expression in diffuse large B cell lymphoma. Sci Transl Med 2020; 11:11/497/eaav5599. [PMID: 31217338 DOI: 10.1126/scitranslmed.aav5599] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/31/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022]
Abstract
The activated B cell (ABC-like) subtype of diffuse large B cell lymphoma (DLBCL) is characterized by chronic activation of signaling initiated by immunoglobulin μ (IgM). By analyzing the DNA copy number profiles of 1000 DLBCL tumors, we identified gains of 18q21.2 as the most frequent genetic alteration in ABC-like DLBCL. Using integrative analysis of matched gene expression profiling data, we found that the TCF4 (E2-2) transcription factor gene was the target of these alterations. Overexpression of TCF4 in ABC-like DLBCL cell lines led to its occupancy on immunoglobulin (IGHM) and MYC gene enhancers and increased expression of these genes at the transcript and protein levels. Inhibition of TCF4 activity with dominant-negative constructs was synthetically lethal to ABC-like DLBCL cell lines harboring TCF4 DNA copy gains, highlighting these gains as an attractive potential therapeutic target. Furthermore, the TCF4 gene was one of the top BRD4-regulated genes in DLBCL cell lines. BET proteolysis-targeting chimera (PROTAC) ARV771 extinguished TCF4, MYC, and IgM expression and killed ABC-like DLBCL cells in vitro. In DLBCL xenograft models, ARV771 treatment reduced tumor growth and prolonged survival. This work highlights a genetic mechanism for promoting immunoglobulin signaling in ABC-like DLBCL and provides a functional rationale for the use of BET inhibitors in this disease.
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Affiliation(s)
- Neeraj Jain
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Keenan Hartert
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Saber Tadros
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Warren Fiskus
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ondrej Havranek
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Man Chun John Ma
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alyssa Bouska
- Department of Pathology and Immunology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Tayla Heavican
- Department of Pathology and Immunology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Dhiraj Kumar
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Qing Deng
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dalia Moore
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Christine Pak
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Chih Long Liu
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Andrew J Gentles
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Elena Hartmann
- Institute of Pathology, University of Würzburg, Würzburg 97080, Germany.,Comprehensive Cancer Center Mainfranken, Wurzburg 97080, Germany
| | - Robert Kridel
- Princess Margaret Cancer Center, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Karin Ekstrom Smedby
- Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, and Hematology Center, Karolinska University Hospital, Stockholm SE-171 76, Sweden
| | - Gunnar Juliusson
- Department of Laboratory Medicine, Stem Cell Center, Lund University, Lund SE-221 00, Sweden
| | - Richard Rosenquist
- Department of Molecular Medicine and Surgery, Karolinska Universitetssjukhuset, Stockholm SE-171 76, Sweden
| | - Randy D Gascoyne
- Center for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC V5Z 4E6, Canada
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg 97080, Germany.,Comprehensive Cancer Center Mainfranken, Wurzburg 97080, Germany
| | - Filippo Giancotti
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sattva S Neelapu
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jason Westin
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Julie M Vose
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Matthew A Lunning
- Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Timothy Greiner
- Department of Pathology and Immunology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Scott Rodig
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Javeed Iqbal
- Department of Pathology and Immunology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Ash A Alizadeh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - R Eric Davis
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kapil Bhalla
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Center for Cancer Epigenetics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael R Green
- Department of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. .,Center for Cancer Epigenetics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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25
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Calvente L, Tremblay-LeMay R, Xu W, Chan FC, Hong M, Zhang T, Yhim HY, Kuruvilla J, Crump M, Kukreti V, Prica A, Regier D, Marra MA, Karsan A, Steidl C, Scott DW, Sabatini P, Kridel R. Validation of the RHL30 digital gene expression assay as a prognostic biomarker for relapsed Hodgkin lymphoma. Br J Haematol 2020; 190:864-868. [PMID: 32510594 DOI: 10.1111/bjh.16777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/03/2020] [Indexed: 11/28/2022]
Abstract
Despite continuing improvements in the management of classical Hodgkin lymphoma (cHL), relapse remains associated with a risk of lymphoma-related mortality. The biological composition of relapse tumour biopsies shows interpatient variability, which can be leveraged to design prognostic biomarkers. Here, we validated the RHL30 assay, a previously reported gene expression model in an independent cohort of 41 patients with relapsed cHL. Patients classified as high-risk by the RHL30 assay had inferior failure-free survival (FFS) after autologous stem cell transplantation (2-year FFS 41% vs. 92%, P = 0·035). The RHL30 model is a robust biomarker that risk-stratifies patients considered for autologous stem cell transplantation.
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Affiliation(s)
- Lourdes Calvente
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Fong Chun Chan
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Michael Hong
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Tong Zhang
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Ho-Young Yhim
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - John Kuruvilla
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michael Crump
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Vishal Kukreti
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Anca Prica
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dean Regier
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Aly Karsan
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | | | - David W Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - Peter Sabatini
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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26
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Tang C, Espin-Garcia O, Prica A, Kurkreti V, Kridel R, Keating A, Patriquin CJ, Kuruvilla J, Crump M. Efficacy and safety of stem cell mobilization following gemcitabine, dexamethasone, cisplatin (GDP) salvage chemotherapy in patients with relapsed or refractory lymphoma. Leuk Lymphoma 2020; 61:2153-2160. [PMID: 32482114 DOI: 10.1080/10428194.2020.1762882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/24/2022]
Abstract
High-dose chemotherapy and autologous stem cell transplant (ASCT) remains a cornerstone of treatment in relapsed/refractory (R/R) aggressive-histology lymphomas. This retrospective study examined efficacy and safety of peripheral blood stem cell (PBSC) mobilization using cyclophosphamide/etoposide and GCSF (CE + GCSF, n = 129) versus gemcitabine, dexamethasone and cisplatin and GCSF (GDP + GCSF, n = 210). All patients received first salvage with GDP. Patients mobilized with CE + GCSF required fewer days of leukapheresis (median 1 vs 2 day; p = .001) and achieved higher total CD34+ yield than GDP + GCSF patients (8.5 vs 7.1 × 106 CD34+ cells/kg, p = .001). Rates of febrile neutropenia and CD34+ collection ≥5 × 106 CD34+ cells/kg were similar (OR 1.19, 95% CI: 0.54-2.6, p = .66). In multivariable analysis, days to engraftment and admission duration were not statistically different between the two mobilization strategies. While CE + GCSF appeared more efficacious for mobilization after GDP salvage, this did not translate to significant differences in clinical outcomes.
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Affiliation(s)
- Catherine Tang
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Anca Prica
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Vishal Kurkreti
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert Kridel
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Armand Keating
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Christopher J Patriquin
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada.,Toronto General Hospital, Toronto, Canada
| | - John Kuruvilla
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Michael Crump
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Toronto, Canada
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27
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Dheilly E, Battistello E, Katanayeva N, Sungalee S, Michaux J, Duns G, Wehrle S, Sordet-Dessimoz J, Mina M, Racle J, Farinha P, Coukos G, Gfeller D, Mottok A, Kridel R, Correia BE, Steidl C, Bassani-Sternberg M, Ciriello G, Zoete V, Oricchio E. Cathepsin S Regulates Antigen Processing and T Cell Activity in Non-Hodgkin Lymphoma. Cancer Cell 2020; 37:674-689.e12. [PMID: 32330455 DOI: 10.1016/j.ccell.2020.03.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 11/14/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
Genomic alterations in cancer cells can influence the immune system to favor tumor growth. In non-Hodgkin lymphoma, physiological interactions between B cells and the germinal center microenvironment are coopted to sustain cancer cell proliferation. We found that follicular lymphoma patients harbor a recurrent hotspot mutation targeting tyrosine 132 (Y132D) in cathepsin S (CTSS) that enhances protein activity. CTSS regulates antigen processing and CD4+ and CD8+ T cell-mediated immune responses. Loss of CTSS activity reduces lymphoma growth by limiting communication with CD4+ T follicular helper cells while inducing antigen diversification and activation of CD8+ T cells. Overall, our results suggest that CTSS inhibition has non-redundant therapeutic potential to enhance anti-tumor immune responses in indolent and aggressive lymphomas.
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Affiliation(s)
- Elie Dheilly
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, EPFL, Lausanne, 1015 Switzerland; Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland
| | - Elena Battistello
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, EPFL, Lausanne, 1015 Switzerland; Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland; Department of Computational Biology, University of Lausanne, 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland
| | - Natalya Katanayeva
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, EPFL, Lausanne, 1015 Switzerland; Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland
| | - Stephanie Sungalee
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, EPFL, Lausanne, 1015 Switzerland; Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland
| | - Justine Michaux
- Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland; Ludwig Institute for Cancer Research and Department of Oncology, University of Lausanne, Lausanne, Switzerland; Department of Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Gerben Duns
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada
| | - Sarah Wehrle
- Institute of Bioengineering, EPFL, 1015 Lausanne, Switzerland
| | | | - Marco Mina
- Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland; Department of Computational Biology, University of Lausanne, 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland
| | - Julien Racle
- Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland; Ludwig Institute for Cancer Research and Department of Oncology, University of Lausanne, Lausanne, Switzerland; Department of Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada
| | - George Coukos
- Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland; Ludwig Institute for Cancer Research and Department of Oncology, University of Lausanne, Lausanne, Switzerland; Department of Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - David Gfeller
- Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland; Ludwig Institute for Cancer Research and Department of Oncology, University of Lausanne, Lausanne, Switzerland; Department of Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Anja Mottok
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Germany
| | | | - Bruno E Correia
- Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland; Institute of Bioengineering, EPFL, 1015 Lausanne, Switzerland
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada
| | - Michal Bassani-Sternberg
- Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland; Ludwig Institute for Cancer Research and Department of Oncology, University of Lausanne, Lausanne, Switzerland; Department of Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Giovanni Ciriello
- Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland; Department of Computational Biology, University of Lausanne, 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland
| | - Vincent Zoete
- Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland; Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland; Ludwig Institute for Cancer Research and Department of Oncology, University of Lausanne, Lausanne, Switzerland; Molecular Modeling Group, SIB, Lausanne, Switzerland
| | - Elisa Oricchio
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, EPFL, Lausanne, 1015 Switzerland; Swiss Cancer Center Leman (SCCL), Lausanne, 1015 Switzerland.
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28
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Tobin JWD, Rule G, Colvin K, Calvente L, Hodgson D, Bell S, Dunduru C, Gallo J, Tsang ES, Tan X, Wong J, Pearce J, Campbell R, Tneh S, Shorten S, Ng M, Cochrane T, Tam CS, Abro E, Hawkes E, Hodges G, Kansara R, Talaulikar D, Gilbertson M, Johnston AM, Savage KJ, Villa D, Morris K, Ratnasingam S, Janowski W, Kridel R, Cheah CY, MacManus M, Matigian N, Mollee P, Gandhi MK, Hapgood G. Outcomes of stage I/II follicular lymphoma in the PET era: an international study from the Australian Lymphoma Alliance. Blood Adv 2019; 3:2804-2811. [PMID: 31570492 PMCID: PMC6784528 DOI: 10.1182/bloodadvances.2019000458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/04/2019] [Indexed: 01/17/2023] Open
Abstract
Management practices in early-stage (I/II) follicular lymphoma (FL) are variable and include radiation (RT), systemic therapy, or combined modality therapy (CMT). There is a paucity of data regarding maintenance rituximab in this cohort. We conducted an international retrospective study of patients with newly diagnosed early-stage FL staged with positron emission tomography (PET)-computed tomography and bone marrow biopsy. Three hundred sixty-five patients (stage I, n = 221), median age 63 years, treated from 2005-2017 were included, with a median follow-up of 45 months. Management included watchful waiting (WW; n = 85) and active treatment (n = 280). The latter consisted of RT alone (n = 171) or systemic therapy (immunochemotherapy [n = 63] or CMT [n = 46]). Forty-nine systemically treated patients received maintenance rituximab; 72.7% of stage I patients received RT alone, compared to 42.6% with stage II (P < .001). Active therapies yielded comparable overall response rates (P = .87). RT alone and systemic therapy without maintenance rituximab yielded similar progression-free survival (PFS) (hazard ratio [HR], 1.32; 95% confidence interval [CI], 0.77-2.34; P = .96). Maintenance rituximab improved PFS (HR, 0.24; 95% CI, 0.095-0.64; P = .017). The incidence of transformation was lower with systemic therapy compared to RT or WW (HR, 0.20; 95% CI, 0.070-0.61; P = .034). Overall survival was similar among all practices, including WW (P = .40). In the largest comparative assessment of management practices in the modern era, variable practices each resulted in similar excellent outcomes. Randomized studies are required to determine the optimal treatment in early-stage FL.
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Affiliation(s)
- Joshua W D Tobin
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gabrielle Rule
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Katherine Colvin
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Lourdes Calvente
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David Hodgson
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Stephen Bell
- Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia
| | - Chengetai Dunduru
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia
| | - James Gallo
- Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Erica S Tsang
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Xuan Tan
- Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Jonathan Wong
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Jessica Pearce
- Department of Haematology, Townsville Hospital, Townsville, QLD, Australia
| | - Robert Campbell
- Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia
| | - Shao Tneh
- Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Sophie Shorten
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Melissa Ng
- Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Constantine S Tam
- Department of Haematology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Emad Abro
- Department of Haematology, Mater Hospital Brisbane, Brisbane, QLD, Australia
| | - Eliza Hawkes
- Department of Oncology and Clinical Haematology, Austin Hospital, Melbourne, VIC, Australia
| | - Georgina Hodges
- Department of Haematology, Townsville Hospital, Townsville, QLD, Australia
| | - Roopesh Kansara
- Section of Medical Oncology and Haematology, University of Manitoba, Winnipeg, MB, Canada
| | - Dipti Talaulikar
- Department of Haematology, Canberra Hospital, Canberra, ACT, Australia
| | - Michael Gilbertson
- Department of Clinical Haematology, Monash Health, Melbourne, Victoria, Australia
| | - Anna M Johnston
- Department of Haematology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Kerry J Savage
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Diego Villa
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Kirk Morris
- Department of Haematology, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Sumi Ratnasingam
- Department of Haematology, Andrew Love Cancer Centre, University Hospital Geelong, Geelong, VIC, Australia
| | - Wojt Janowski
- Department of Haematology, Calvary Mater Health, Newcastle, NSW, Australia
| | - Robert Kridel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Nicholas Matigian
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Maher K Gandhi
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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29
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Nixon S, Bezverbnaya K, Maganti M, Gullane P, Reedijk M, Kuruvilla J, Prica A, Kridel R, Kukreti V, Bennett S, Rogalla P, Delabie J, Pintilie M, Crump M. Evaluation of Lymphadenopathy and Suspected Lymphoma in a Lymphoma Rapid Diagnosis Clinic. JCO Oncol Pract 2019; 16:e29-e36. [PMID: 31573831 DOI: 10.1200/jop.19.00202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lymphomas often present a diagnostic challenge, and for some a delay in diagnosis can negatively influence outcomes of therapy. We established a nurse practitioner-led lymphoma rapid diagnosis clinic (LRDC) with the goal of reducing wait times to definitive diagnosis. We examined the initial 30-month experience of the LRDC, and results were compared with time periods before implementation of the clinic to determine program impact. METHODS All patients referred to LRDC with suspicion of lymphoma from June 1, 2015 to Nov 30, 2017 were evaluated. Time from initial consultation to diagnosis was compared with patients diagnosed at our center with lymphoma in 2008 and 2012. Patient symptoms and relevant laboratory/imaging findings were collected to identify patterns of presentation and predictive factors for benign diagnoses. RESULTS Of the 126 patients evaluated, 66 (52%) had confirmation of lymphoma diagnosis. Median time to lymphoma diagnosis was 16 days for patients assessed in LRDC and 28 days for historical controls (P < .001). By univariable analysis, lymph node size greater than 3.4 cm and presence of mediastinal or abdominal adenopathy increased the likelihood of a diagnosis of malignancy, whereas younger age, being a nonsmoker, and prior rheumatologic condition were associated with a nonmalignant diagnosis. In multivariable analysis, lymph node size, age, and prior rheumatologic diagnosis remained significant. CONCLUSION Establishing a nurse practitioner-led LRDC was effective in shortening time to diagnosis of lymphoma. Younger age, smaller lymph node size, and prior rheumatologic disorder reduced the likelihood of a cancer diagnosis in our patient population.
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Affiliation(s)
- Shannon Nixon
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Ksenia Bezverbnaya
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Manjula Maganti
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Patrick Gullane
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Michael Reedijk
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - John Kuruvilla
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Anca Prica
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Vishal Kukreti
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Patrik Rogalla
- University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | - Jan Delabie
- University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | - Melania Pintilie
- University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | - Michael Crump
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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30
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Tobin JWD, Keane C, Gunawardana J, Mollee P, Birch S, Hoang T, Lee J, Li L, Huang L, Murigneux V, Fink JL, Matigian N, Vari F, Francis S, Kridel R, Weigert O, Haebe S, Jurinovic V, Klapper W, Steidl C, Sehn LH, Law SC, Wykes MN, Gandhi MK. Progression of Disease Within 24 Months in Follicular Lymphoma Is Associated With Reduced Intratumoral Immune Infiltration. J Clin Oncol 2019; 37:3300-3309. [PMID: 31461379 PMCID: PMC6881104 DOI: 10.1200/jco.18.02365] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [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] [Indexed: 12/02/2022] Open
Abstract
PURPOSE Understanding the immunobiology of the 15% to 30% of patients with follicular lymphoma (FL) who experience progression of disease within 24 months (POD24) remains a priority. Solid tumors with low levels of intratumoral immune infiltration have inferior outcomes. It is unknown whether a similar relationship exists between POD24 in FL. PATIENTS AND METHODS Digital gene expression using a custom code set—five immune effector, six immune checkpoint, one macrophage molecules—was applied to a discovery cohort of patients with early- and advanced-stage FL (n = 132). T-cell receptor repertoire analysis, flow cytometry, multispectral immunofluorescence, and next-generation sequencing were performed. The immune infiltration profile was validated in two independent cohorts of patients with advanced-stage FL requiring systemic treatment (n = 138, rituximab plus cyclophosphamide, vincristine, prednisone; n = 45, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone), with the latter selected to permit comparison of patients experiencing a POD24 event with those having no progression at 5 years or more. RESULTS Immune molecules showed distinct clustering, characterized by either high or low expression regardless of categorization as an immune effector, immune checkpoint, or macrophage molecule. Low programmed death-ligand 2 (PD-L2) was the most sensitive/specific marker to segregate patients with adverse outcomes; therefore, PD-L2 expression was chosen to distinguish immune infiltrationHI (ie, high PD-L2) FL biopsies from immune infiltrationLO (ie, low PD-L2) tumors. Immune infiltrationHI tissues were highly infiltrated with macrophages and expanded populations of T-cell clones. Of note, the immune infiltrationLO subset of patients with FL was enriched for POD24 events (odds ratio [OR], 4.32; c-statistic, 0.81; P = .001), validated in the independent cohorts (rituximab plus cyclophosphamide, vincristine, prednisone: OR, 2.95; c-statistic, 0.75; P = .011; and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone: OR, 7.09; c-statistic, 0.88; P = .011). Mutations were equally proportioned across tissues, which indicated that degree of immune infiltration is capturing aspects of FL biology distinct from its mutational profile. CONCLUSION Assessment of immune-infiltration by PD-L2 expression is a promising tool with which to help identify patients who are at risk for POD24.
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Affiliation(s)
- Joshua W D Tobin
- Mater Research, University of Queensland, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Colm Keane
- Mater Research, University of Queensland, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jay Gunawardana
- Mater Research, University of Queensland, Brisbane, QLD, Australia
| | - Peter Mollee
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Simone Birch
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Thanh Hoang
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Justina Lee
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Li Li
- Ochsner Health System, New Orleans, LA
| | - Li Huang
- Ochsner Health System, New Orleans, LA
| | | | - J Lynn Fink
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Nicholas Matigian
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Frank Vari
- Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - Santiyagu Francis
- Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Robert Kridel
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Oliver Weigert
- Laboratory for Experimental Leukemia and Lymphoma Research, Munich, Germany.,German Cancer Consortium, Munich Germany.,German Cancer Research Center, Heidelberg, Germany
| | - Sarah Haebe
- Laboratory for Experimental Leukemia and Lymphoma Research, Munich, Germany.,German Cancer Consortium, Munich Germany.,German Cancer Research Center, Heidelberg, Germany
| | - Vindi Jurinovic
- Laboratory for Experimental Leukemia and Lymphoma Research, Munich, Germany.,German Cancer Consortium, Munich Germany.,German Cancer Research Center, Heidelberg, Germany
| | | | - Christian Steidl
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Soi-Cheng Law
- Mater Research, University of Queensland, Brisbane, QLD, Australia
| | - Michelle N Wykes
- Queensland Institute of Medical Research, Brisbane, QLD, Australia
| | - Maher K Gandhi
- Mater Research, University of Queensland, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
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31
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Healy S, Ennishi D, Bashashati A, Saberi S, Hother C, Mottok A, Chan FC, Chong L, Kridel R, Boyle M, Meissner B, Aoki T, Takata K, Woolcock BW, Vigano E, Abraham L, Gold M, Telenius A, Farinha P, Slack G, Ben-Neriah S, Lai D, Zhang AW, Salehi S, Shulha HP, Chiu DS, Mostafavi S, Gerrie AS, Villa D, Sehn LH, Savage KJJ, Mungall AJJ, Weng AP, Bally M, Morin RD, Freue GVC, Connors JM, Marra MA, Shah SP, Gascoyne1 RD, Scott DW, Steidl C, Steidl U. Abstract 3480: TMEM30A loss-of-function mutations drive lymphomagenesis and confer therapeutically exploitable vulnerability in B-cell lymphoma. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3480] [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
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma subtype worldwide, accounting for 40% of all non-Hodgkin lymphomas. DLBCL presents as an aggressive disease requiring immediate treatment. Although significant improvement in outcome has been achieved, ~40% of patients still experience treatment failure. Here, we characterized the recurrent genetic alterations and transcriptomic signatures in diagnostic biopsies from a population registry-based cohort of 347 patients with de novo DLBCL uniformly treated with R-CHOP. This analysis revealed bi-allelic loss of function mutations of TMEM30A that were associated with favorable treatment outcome. TMEM30A is a chaperone protein, involved in maintaining the asymmetric distribution of phosphatidylethanolamine and phosphatidylserine, an integral component of the plasma membrane and “eat-me” signal recognized by macrophages. Using TMEM30A knockout systems by CRISPR genome editing techniques, we have functionally characterized this loss-of-function mutation in representative human and mouse DLBCL cell line models. We have discovered that TMEM30A loss is associated with increased B-cell signaling following antigen stimulation, including a two-fold increase in the diffusion rate of B-cell receptor (BCR) clustering, using high resolution Single Particle Tracking (SPT) technology. In addition, we have measured three-fold increase in chemotherapeutic drug accumulation in both knockout cell lines and randomly selected patient biopsies with TMEM30A biallelic loss. This observation was validated in a xenograft mouse model, which presented improved survival and limited tumor growth following vincristine treatment in mice injected with TMEM30A null DLBCL cell lines compared with native cell lines. This phenotype explains the improved prognosis observed in DLBCL patients following R-CHOP treatment. Furthermore, we have observed over two fold higher numbers of tumor-associated macrophages in B-cell lymphoma syngeneic mouse models with Tmem30a loss-of-function, prior to any form of treatment, suggesting the existence of “hot” and primed tumors. Our data highlight a multi-faceted role for TMEM30A and plasma membrane physiology in B-cell lymphomagenesis, and characterize intrinsic and extrinsic vulnerabilities of cancer cells that can be therapeutically exploited. Characterization of these mechanisms will address a missing link in the cancer field as related insights in lymphoma will outline therapeutic approaches that can be extended to cancer therapy in general.
Citation Format: Shannon Healy, Daisuke Ennishi, Ali Bashashati, Saeed Saberi, Christoffer Hother, Anja Mottok, Fong Chun Chan, Lauren Chong, Robert Kridel, Merrill Boyle, Barbara Meissner, Tomohiro Aoki, Katsuyoshi Takata, Bruce W. Woolcock, Elena Vigano, Libin Abraham, Michael Gold, Adele Telenius, Pedro Farinha, Graham Slack, Susana Ben-Neriah, Daniel Lai, Allen W. Zhang, Sohrab Salehi, Hennady P. Shulha, Derek S. Chiu, Sara Mostafavi, Alina S. Gerrie, Diego Villa, Laurie H. Sehn, Kerry J. J. Savage, Andrew J. J. Mungall, Andrew P. Weng, Marcel Bally, Ryan D. Morin, Gabriela V. Cohen Freue, Joseph M. Connors, Marco A. Marra, Sohrab P. Shah, Randy D. Gascoyne1, David W. Scott, Christian Steidl, Ulrich Steidl. TMEM30A loss-of-function mutations drive lymphomagenesis and confer therapeutically exploitable vulnerability in B-cell lymphoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3480.
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Affiliation(s)
- Shannon Healy
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Saeed Saberi
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Anja Mottok
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Fong Chun Chan
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren Chong
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Robert Kridel
- 3University Health Network, Toronto, Ontario, Canada
| | - Merrill Boyle
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Tomohiro Aoki
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | - Elena Vigano
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Libin Abraham
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Gold
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Pedro Farinha
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Graham Slack
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Daniel Lai
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Sohrab Salehi
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Derek S. Chiu
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara Mostafavi
- 2University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Diego Villa
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | | | | | - Marcel Bally
- 1BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Ryan D. Morin
- 4Simon Fraser University, Vancouver, British Columbia, Canada
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Tang C, Espin-Garcia O, Prica A, Kukreti V, Kridel R, Keating A, Kuruvilla J, Crump M. EFFICIENCY AND SAFETY OF STEM CELL MOBILIZATION FOLLOWING GDP SALVAGE IN PATIENTS WITH RELAPSED OR REFRACTORY LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.112_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C. Tang
- Medical Oncology and Hematology; Princess Margaret Cancer Centre; Toronto Canada
| | - O. Espin-Garcia
- Biostatistics; Princess Margaret Cancer Centre; Toronto Canada
| | - A. Prica
- Medical Oncology and Hematology; Princess Margaret Cancer Centre; Toronto Canada
| | - V. Kukreti
- Medical Oncology and Hematology; Princess Margaret Cancer Centre; Toronto Canada
| | - R. Kridel
- Medical Oncology and Hematology; Princess Margaret Cancer Centre; Toronto Canada
| | - A. Keating
- Medical Oncology and Hematology; Princess Margaret Cancer Centre; Toronto Canada
| | - J. Kuruvilla
- Medical Oncology and Hematology; Princess Margaret Cancer Centre; Toronto Canada
| | - M. Crump
- Medical Oncology and Hematology; Princess Margaret Cancer Centre; Toronto Canada
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Ennishi D, Takata K, Béguelin W, Duns G, Mottok A, Farinha P, Bashashati A, Saberi S, Boyle M, Meissner B, Ben-Neriah S, Woolcock BW, Telenius A, Lai D, Teater M, Kridel R, Savage KJ, Sehn LH, Morin RD, Marra MA, Shah SP, Connors JM, Gascoyne RD, Scott DW, Melnick AM, Steidl C. Molecular and Genetic Characterization of MHC Deficiency Identifies EZH2 as Therapeutic Target for Enhancing Immune Recognition. Cancer Discov 2019; 9:546-563. [PMID: 30705065 DOI: 10.1158/2159-8290.cd-18-1090] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/21/2018] [Accepted: 01/28/2019] [Indexed: 12/21/2022]
Abstract
We performed a genomic, transcriptomic, and immunophenotypic study of 347 patients with diffuse large B-cell lymphoma (DLBCL) to uncover the molecular basis underlying acquired deficiency of MHC expression. Low MHC-II expression defines tumors originating from the centroblast-rich dark zone of the germinal center (GC) that was associated with inferior prognosis. MHC-II-deficient tumors were characterized by somatically acquired gene mutations reducing MHC-II expression and a lower amount of tumor-infiltrating lymphocytes. In particular, we demonstrated a strong enrichment of EZH2 mutations in both MHC-I- and MHC-II-negative primary lymphomas, and observed reduced MHC expression and T-cell infiltrates in murine lymphoma models expressing mutant Ezh2 Y641. Of clinical relevance, EZH2 inhibitors significantly restored MHC expression in EZH2-mutated human DLBCL cell lines. Hence, our findings suggest a tumor progression model of acquired immune escape in GC-derived lymphomas and pave the way for development of complementary therapeutic approaches combining immunotherapy with epigenetic reprogramming. SIGNIFICANCE: We demonstrate how MHC-deficient lymphoid tumors evolve in a cell-of-origin-specific context. Specifically, EZH2 mutations were identified as a genetic mechanism underlying acquired MHC deficiency. The paradigmatic restoration of MHC expression by EZH2 inhibitors provides the rationale for synergistic therapies combining immunotherapies with epigenetic reprogramming to enhance tumor recognition and elimination.See related commentary by Velcheti et al., p. 472.This article is highlighted in the In This Issue feature, p. 453.
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Affiliation(s)
- Daisuke Ennishi
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Katsuyoshi Takata
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Wendy Béguelin
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Gerben Duns
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Anja Mottok
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Pedro Farinha
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Ali Bashashati
- Molecular Oncology, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Saeed Saberi
- Molecular Oncology, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Barbara Meissner
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Bruce W Woolcock
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Adèle Telenius
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Daniel Lai
- Molecular Oncology, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Matt Teater
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Robert Kridel
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Ryan D Morin
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Marco A Marra
- Genome Science Centre, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Sohrab P Shah
- Molecular Oncology, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Ari M Melnick
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Christian Steidl
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada.
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Silva A, Bassim S, Sarkozy C, Mottok A, Lackraj T, Jurinovic V, Brodtkorb M, Lingjaerde OC, Sehn LH, Gascoyne RD, Weigert O, Steidl C, Kridel R. Convergence of risk prediction models in follicular lymphoma. Haematologica 2019; 104:e252-e255. [PMID: 30606786 DOI: 10.3324/haematol.2018.209031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Anjali Silva
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Sleiman Bassim
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | | | - Anja Mottok
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Germany
| | - Tracy Lackraj
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Vindi Jurinovic
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Germany
| | | | | | - Laurie H Sehn
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada
| | - Oliver Weigert
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Germany
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
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35
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Qu X, Li H, Braziel RM, Passerini V, Rimsza LM, Hsi ED, Leonard JP, Smith SM, Kridel R, Press O, Weigert O, LeBlanc M, Friedberg JW, Fang M. Genomic alterations important for the prognosis in patients with follicular lymphoma treated in SWOG study S0016. Blood 2019; 133:81-93. [PMID: 30446494 PMCID: PMC6318431 DOI: 10.1182/blood-2018-07-865428] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023] Open
Abstract
Although recent advances in molecular genetics have enabled improved risk classification of follicular lymphoma (FL) using, for example, the m7-FLIPI score, the impact on treatment has been limited. We aimed to assess the prognostic significance of copy-number aberrations (CNAs) and copy-neutral loss of heterozygosity (cnLOH) identified by chromosome genomic-array testing (CGAT) at FL diagnosis using prospectively collected clinical trial specimens from 255 patients enrolled in the SWOG study S0016. The impact of genomic aberrations was assessed for early progression (progressed or died within 2 years after registration), progression-free survival (PFS), and overall survival (OS). We showed that increased genomic complexity (ie, the total number of aberration calls) was associated with poor outcome in FL. Certain chromosome arms were critical for clinical outcome. Prognostic CNAs/cnLOH were identified: whereas early progression was correlated with 2p gain (P = .007; odds ratio [OR] = 2.55 [1.29, 5.03]) and 2p cnLOH (P = .005; OR = 10.9 [2.08, 57.2]), 2p gain specifically encompassing VRK2 and FANCL predicted PFS (P = .01; hazard ratio = 1.80 [1.14, 2.68]) as well as OS (P = .005; 2.40 [1.30, 4.40]); CDKN2A/B (9p) deletion correlated with worse PFS (P = .004, 3.50 [1.51, 8.28]); whereas CREBBP (16p) (P < .001; 6.70 [2.52, 17.58]) and TP53 (17p) (P < .001; 3.90 [1.85, 8.31]) deletion predicted worse OS. An independent cohort from the m7-FLIPI study was explored, and the prognostic significance of aberration count, and TP53 and CDKN2A/B deletion were further validated. In conclusion, assessing genomic aberrations at FL diagnosis with CGAT improves risk stratification independent of known clinical parameters, and provides a framework for development of future rational targeted therapies.
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Affiliation(s)
- Xiaoyu Qu
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hongli Li
- SWOG Statistical Center, Seattle, WA
| | - Rita M Braziel
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Verena Passerini
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | | | - John P Leonard
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, IL
| | - Robert Kridel
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, ON, Canada; and
| | - Oliver Press
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Oliver Weigert
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | | | - Min Fang
- Fred Hutchinson Cancer Research Center, Seattle, WA
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36
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Ennishi D, Jiang A, Boyle M, Collinge B, Grande BM, Ben-Neriah S, Rushton C, Tang J, Thomas N, Slack GW, Farinha P, Takata K, Miyata-Takata T, Craig J, Mottok A, Meissner B, Saberi S, Bashashati A, Villa D, Savage KJ, Sehn LH, Kridel R, Mungall AJ, Marra MA, Shah SP, Steidl C, Connors JM, Gascoyne RD, Morin RD, Scott DW. Double-Hit Gene Expression Signature Defines a Distinct Subgroup of Germinal Center B-Cell-Like Diffuse Large B-Cell Lymphoma. J Clin Oncol 2018; 37:190-201. [PMID: 30523716 DOI: 10.1200/jco.18.01583] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBL-DH/TH) has a poor outcome after standard chemoimmunotherapy. We sought to understand the biologic underpinnings of HGBL-DH/TH with BCL2 rearrangements (HGBL-DH/TH- BCL2) and diffuse large B-cell lymphoma (DLBCL) morphology through examination of gene expression. PATIENTS AND METHODS We analyzed RNA sequencing data from 157 de novo germinal center B-cell-like (GCB)-DLBCLs, including 25 with HGBL-DH/TH- BCL2, to define a gene expression signature that distinguishes HGBL-DH/TH- BCL2 from other GCB-DLBCLs. To assess the genetic, molecular, and phenotypic features associated with this signature, we analyzed targeted resequencing, whole-exome sequencing, RNA sequencing, and immunohistochemistry data. RESULTS We developed a 104-gene double-hit signature (DHITsig) that assigned 27% of GCB-DLBCLs to the DHITsig-positive group, with only one half harboring MYC and BCL2 rearrangements (HGBL-DH/TH- BCL2). DHITsig-positive patients had inferior outcomes after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone immunochemotherapy compared with DHITsig-negative patients (5-year time to progression rate, 57% and 81%, respectively; P < .001), irrespective of HGBL-DH/TH- BCL2 status. The prognostic value of DHITsig was confirmed in an independent validation cohort. DHITsig-positive tumors are biologically characterized by a putative non-light zone germinal center cell of origin and a distinct mutational landscape that comprises genes associated with chromatin modification. A new NanoString assay (DLBCL90) recapitulated the prognostic significance and RNA sequencing assignments. Validating the association with HGBL-DH/TH- BCL2, 11 of 25 DHITsig-positive-transformed follicular lymphomas were classified as HGBL-DH/TH- BCL2 compared with zero of 50 in the DHITsig-negative group. Furthermore, the DHITsig was shared with the majority of B-cell lymphomas with high-grade morphology tested. CONCLUSION We have defined a clinically and biologically distinct subgroup of tumors within GCB-DLBCL characterized by a gene expression signature of HGBL-DH/TH- BCL2. This knowledge has been translated into an assay applicable to routinely available biopsy samples, which enables exploration of its utility to guide patient management.
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Affiliation(s)
- Daisuke Ennishi
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Aixiang Jiang
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada.,2 Simon Fraser University, Burnaby, British Columbia, Canada
| | - Merrill Boyle
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Brett Collinge
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Bruno M Grande
- 2 Simon Fraser University, Burnaby, British Columbia, Canada
| | - Susana Ben-Neriah
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | | | - Jeffrey Tang
- 2 Simon Fraser University, Burnaby, British Columbia, Canada
| | - Nicole Thomas
- 2 Simon Fraser University, Burnaby, British Columbia, Canada
| | - Graham W Slack
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Pedro Farinha
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Katsuyoshi Takata
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Tomoko Miyata-Takata
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Jeffrey Craig
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Anja Mottok
- 3 Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Barbara Meissner
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Saeed Saberi
- 4 Molecular Oncology, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Ali Bashashati
- 4 Molecular Oncology, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Diego Villa
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Kerry J Savage
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Robert Kridel
- 5 Princess Margaret Cancer Center-University Health Network, Toronto, Ontario, Canada
| | - Andrew J Mungall
- 6 Genome Sciences Center, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marco A Marra
- 6 Genome Sciences Center, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Sohrab P Shah
- 4 Molecular Oncology, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Christian Steidl
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Joseph M Connors
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Randy D Gascoyne
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
| | - Ryan D Morin
- 2 Simon Fraser University, Burnaby, British Columbia, Canada
| | - David W Scott
- 1 British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, British Columbia, Canada
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37
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Okosun J, Kridel R, Fitzgibbon J. Rituximab as a first step in tackling transformation. Lancet Haematol 2018; 5:e326-e327. [PMID: 30078407 DOI: 10.1016/s2352-3026(18)30093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK.
| | - Robert Kridel
- Princess Margaret Cancer Centre-University Health Network, Toronto, ON, Canada
| | - Jude Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
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38
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Oricchio E, Katanayeva N, Donaldson MC, Sungalee S, Pasion JP, Béguelin W, Battistello E, Sanghvi VR, Jiang M, Jiang Y, Teater M, Parmigiani A, Budanov AV, Chan FC, Shah SP, Kridel R, Melnick AM, Ciriello G, Wendel HG. Genetic and epigenetic inactivation of SESTRIN1 controls mTORC1 and response to EZH2 inhibition in follicular lymphoma. Sci Transl Med 2018; 9:9/396/eaak9969. [PMID: 28659443 DOI: 10.1126/scitranslmed.aak9969] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/03/2017] [Accepted: 06/05/2017] [Indexed: 12/14/2022]
Abstract
Follicular lymphoma (FL) is an incurable form of B cell lymphoma. Genomic studies have cataloged common genetic lesions in FL such as translocation t(14;18), frequent losses of chromosome 6q, and mutations in epigenetic regulators such as EZH2 Using a focused genetic screen, we identified SESTRIN1 as a relevant target of the 6q deletion and demonstrate tumor suppression by SESTRIN1 in vivo. Moreover, SESTRIN1 is a direct target of the lymphoma-specific EZH2 gain-of-function mutation (EZH2Y641X ). SESTRIN1 inactivation disrupts p53-mediated control of mammalian target of rapamycin complex 1 (mTORC1) and enables mRNA translation under genotoxic stress. SESTRIN1 loss represents an alternative to RRAGC mutations that maintain mTORC1 activity under nutrient starvation. The antitumor efficacy of pharmacological EZH2 inhibition depends on SESTRIN1, indicating that mTORC1 control is a critical function of EZH2 in lymphoma. Conversely, EZH2Y641X mutant lymphomas show increased sensitivity to RapaLink-1, a bifunctional mTOR inhibitor. Hence, SESTRIN1 contributes to the genetic and epigenetic control of mTORC1 in lymphoma and influences responses to targeted therapies.
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Affiliation(s)
- Elisa Oricchio
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.
| | - Natalya Katanayeva
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Maria Christine Donaldson
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Stephanie Sungalee
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Joyce P Pasion
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Wendy Béguelin
- Division of Hematology/Oncology, Weill Cornell Medical College, Cornell University, 1300 York Avenue, New York, NY 10065, USA
| | - Elena Battistello
- Swiss Institute for Experimental Cancer Research (ISREC), School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.,Department of Computational Biology, University of Lausanne, 1005 Lausanne, Switzerland
| | - Viraj R Sanghvi
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Man Jiang
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Yanwen Jiang
- Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
| | - Matt Teater
- Institute for Computational Biomedicine, Weill Cornell Medical College, Cornell University, New York, NY 10065, USA
| | - Anita Parmigiani
- Department of Human and Molecular Genetics, Goodwin Research Laboratories, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Andrei V Budanov
- Department of Human and Molecular Genetics, Goodwin Research Laboratories, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA.,School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Pearse Street, Dublin 2, Ireland
| | - Fong Chun Chan
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia V5Z 1L3, Canada.,Bioinformatics Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sohrab P Shah
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Molecular Oncology, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Robert Kridel
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia V5Z 1L3, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ari M Melnick
- Division of Hematology/Oncology, Weill Cornell Medical College, Cornell University, 1300 York Avenue, New York, NY 10065, USA
| | - Giovanni Ciriello
- Department of Computational Biology, University of Lausanne, 1005 Lausanne, Switzerland
| | - Hans-Guido Wendel
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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39
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Alig S, Jurinovic V, Pastore A, Bararia D, Häbe S, Hellmuth JC, Kridel R, Gascoyne R, Schmidt C, Zöllner AK, Buske C, Dreyling M, Unterhalt M, Hiddemann W, Hoster E, Weigert O. Impact of age on genetics and treatment efficacy in follicular lymphoma. Haematologica 2018; 103:e364-e367. [PMID: 29545350 DOI: 10.3324/haematol.2018.187773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Stefan Alig
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Vindi Jurinovic
- Department of Medicine III, University Hospital, LMU Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Germany
| | | | - Deepak Bararia
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Sarah Häbe
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Johannes C Hellmuth
- Department of Medicine III, University Hospital, LMU Munich, Germany.,Department of Medicine, Division of Hematology & Medical Oncology, Weill Cornell Medicine, NY, USA
| | - Robert Kridel
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre - University Health Network, Toronto, ON, Canada
| | - Randy Gascoyne
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, BC Cancer Agency, Vancouver, BC, Canada
| | - Christian Schmidt
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | | | - Christian Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital Ulm, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Michael Unterhalt
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, LMU Munich, Germany.,German Cancer Consortium (DKTK), Munich, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Hoster
- Department of Medicine III, University Hospital, LMU Munich, Germany.,Institute for Medical Informatics, Biometry and Epidemiology, LMU Munich, Germany
| | - Oliver Weigert
- Department of Medicine III, University Hospital, LMU Munich, Germany .,German Cancer Consortium (DKTK), Munich, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
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40
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Steiner R, Kridel R, Giostra E, McKee T, Achermann R, Mueller N, Manuel O, Dickenmann M, Schuurmans MM, de Leval L, Fehr T, Tinguely M, Binet I, Cogliatti S, Haralamvieva E, Koller M, The Swiss Transplant Cohort Study Stcs, Dietrich PY. Low 5-year cumulative incidence of post-transplant lymphoproliferative disorders after solid organ transplantation in Switzerland. Swiss Med Wkly 2018. [PMID: 29518251 DOI: 10.4414/smw.2018.14596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a potentially life-threatening complication of transplantation occurring in the setting of immunosuppression and oncogenic viral infections. However, little is known about the cumulative incidence, histological subtypes, risk determinants and outcome of PTLD in solid organ transplant (SOT) recipients in Switzerland. METHODS This retrospective observational study investigated adult SOT recipients from two sequential cohorts, the pre-SCTS (Swiss Transplant Cohort Study) series, with data collected from January 1986 to April 2008, and the STCS series, with data collected from May 2008 to December 2014 in Switzerland. SOT recipients were cross-referenced with the data of all the patients with a lymphoma diagnosis in each transplant centre and with the data of the Swiss Transplant Cohort Study (STCS) to determine the cumulative incidence of PTLD, pre-therapeutic clinical features, clinical course and outcome. Kaplan-Meier analysis was performed for overall survival after PTLD. RESULTS We identified 79 cases of PTLD during the study period in the two cohorts: pre-STCS from 1986 to 2008 (n = 62) and STCS from 2008 to 2014 (n = 17). Histological subgroups included: early lesions (pre-STCS n = 2, STCS n = 0); polymorphic PTLD (pre-STCS n = 8, STCS n = 7); monomorphic PTLD (pre-STCS n = 47, STCS n = 10), and Hodgkin's lymphoma (pre-STCS n = 5, STCS n = 0). Median time to PTLD diagnosis was 90 months (range 3-281 months) and 14 months (range 2-59 months) in the pre-STCS and STCS cohorts, respectively. Median follow-up after transplantation was 141 months for the pre-STCS patients and 33 months for the STCS patients. Cumulative incidences of PTLD during the STCS period at 0.5, 1 and 5 years were 0.17% (95% confidence interval 0.07-0.46%), 0.22% (0.09-0.53%) and 0.96% (0.52-1.80%), respectively. For the pre-STCS case series, it was not possible to estimate the incidence rate of PTLD. Survival after PTLD diagnosis was 80% (68-87%) at 1 year and 56% (42-68%) at 5 years for the pre-STCS and STCS cohorts combined. CONCLUSIONS At 5 years, the cumulative incidence of PTLD, regardless of the organ transplanted, was only 0.96% in the STCS cohort, which is lower than that reported in the literature.
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Affiliation(s)
- Raphael Steiner
- Centre of Oncology, University Hospitals of Geneva, Switzerland
| | - Robert Kridel
- Princess Margaret Cancer Centre - UHN, Toronto, Ontario, Canada
| | - Emiliano Giostra
- Hepatogastroenterology, Geneva University Hospital, Geneva, Switzerland
| | - Thomas McKee
- Division of Haematology, Department of Patho-Immunology, Geneva University Medical Centre, Geneva, Switzerland
| | | | - Nicolas Mueller
- Swiss Transplant Cohort Study (STCS) / Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Switzerland
| | - Oriol Manuel
- Swiss Transplant Cohort Study (STCS) / Infectious Disease Service, Department of Medicine, Lausanne University Hospital (CHUV), Switzerland
| | - Michael Dickenmann
- Swiss Transplant Cohort Study (STCS) / Division of Transplantation Immunology and Nephrology, Basel University Hospital, Switzerland
| | | | - Laurence de Leval
- Institute of Pathology, Lausanne University Hospital (CHUV), Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubuenden, Chur,and Division of Nephrology, University Hospital Zurich, Switzerland
| | | | - Isabelle Binet
- Swiss Transplant Cohort Study (STCS) / Nephrology/Transplantation Medicine, Kantonsspital, St Gallen, Switzerland
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41
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Chan FC, Lim E, Kridel R, Steidl C. Novel insights into the disease dynamics of B-cell lymphomas in the Genomics Era. J Pathol 2018; 244:598-609. [DOI: 10.1002/path.5043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Fong Chun Chan
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Emilia Lim
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre; University Health Network; Toronto Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver British Columbia Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
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42
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Hung SS, Meissner B, Chavez EA, Ben-Neriah S, Ennishi D, Jones MR, Shulha HP, Chan FC, Boyle M, Kridel R, Gascoyne RD, Mungall AJ, Marra MA, Scott DW, Connors JM, Steidl C. Assessment of Capture and Amplicon-Based Approaches for the Development of a Targeted Next-Generation Sequencing Pipeline to Personalize Lymphoma Management. J Mol Diagn 2018; 20:203-214. [PMID: 29429887 DOI: 10.1016/j.jmoldx.2017.11.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/24/2017] [Accepted: 11/03/2017] [Indexed: 01/30/2023] Open
Abstract
Targeted next-generation sequencing panels are increasingly used to assess the value of gene mutations for clinical diagnostic purposes. For assay development, amplicon-based methods have been preferentially used on the basis of short preparation time and small DNA input amounts. However, capture sequencing has emerged as an alternative approach because of high testing accuracy. We compared capture hybridization and amplicon sequencing approaches using fresh-frozen and formalin-fixed, paraffin-embedded tumor samples from eight lymphoma patients. Next, we developed a targeted sequencing pipeline using a 32-gene panel for accurate detection of actionable mutations in formalin-fixed, paraffin-embedded tumor samples of the most common lymphocytic malignancies: chronic lymphocytic leukemia, diffuse large B-cell lymphoma, and follicular lymphoma. We show that hybrid capture is superior to amplicon sequencing by providing deep more uniform coverage and yielding higher sensitivity for variant calling. Sanger sequencing of 588 variants identified specificity limits of thresholds for mutation calling, and orthogonal validation on 66 cases indicated 93% concordance with whole-genome sequencing. The developed pipeline and assay identified at least one actionable mutation in 91% of tumors from 219 lymphoma patients and revealed subtype-specific mutation patterns and frequencies consistent with the literature. This pipeline is an accurate and sensitive method for identifying actionable gene mutations in routinely acquired biopsy materials, suggesting further assessment of capture-based assays in the context of personalized lymphoma management.
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Affiliation(s)
- Stacy S Hung
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Barbara Meissner
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Elizabeth A Chavez
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Daisuke Ennishi
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Martin R Jones
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Hennady P Shulha
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Fong Chun Chan
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Merrill Boyle
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Robert Kridel
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew J Mungall
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Marco A Marra
- Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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43
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Mottok A, Jurinovic V, Farinha P, Rosenwald A, Ott G, Klapper W, Boesl M, Hiddemann W, Steidl C, Connors J, Sehn L, Gascoyne R, Hoster E, Weigert O, Kridel R. FOXP1
EXPRESSION IS INVERSELY CORRELATED WITH EZH2
MUTATION STATUS AND PREDICTS POOR FAILURE-FREE SURVIVAL IN FOLLICULAR LYMPHOMA TREATED WITH RITUXIMAB AND CHEMOTHERAPY. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- A. Mottok
- Centre for Lymphoid Cancer; BC Cancer Agency; Vancouver Canada
| | - V. Jurinovic
- Institute for Medical Informatics and Epidemiology; Ludwig Maximilians University; Munich Germany
| | - P. Farinha
- Centre for Lymphoid Cancer; BC Cancer Agency; Vancouver Canada
| | - A. Rosenwald
- Institute of Pathology; University of Würzburg; Würzburg Germany
| | - G. Ott
- Department of Pathology; Robert-Bosch-Hospital; Stuttgart Germany
| | - W. Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry; Christian-Albrechts-University Kiel; Kiel Germany
| | - M. Boesl
- Medical Department III; University Hospital of the Ludwig Maximilians University; Munich Germany
| | - W. Hiddemann
- Medical Department III; University Hospital of the Ludwig Maximilians University; Munich Germany
| | - C. Steidl
- Centre for Lymphoid Cancer; BC Cancer Agency; Vancouver Canada
| | - J.M. Connors
- Centre for Lymphoid Cancer; BC Cancer Agency; Vancouver Canada
| | - L.H. Sehn
- Centre for Lymphoid Cancer; BC Cancer Agency; Vancouver Canada
| | - R.D. Gascoyne
- Centre for Lymphoid Cancer; BC Cancer Agency; Vancouver Canada
| | - E. Hoster
- Institute for Medical Informatics and Epidemiology; Ludwig Maximilians University; Munich Germany
| | - O. Weigert
- Medical Department III; University Hospital of the Ludwig Maximilians University; Munich Germany
| | - R. Kridel
- Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre - University Health Network; Toronto Canada
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44
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Alig S, Jurinovic V, Dreyling M, Pastore A, Kridel R, Gascoyne R, Hiddemann W, Unterhalt M, Hoster E, Weigert O. HIGHER MUTATIONAL BURDEN BUT DOES NOT IMPACT TREATMENT EFFICACY IN FOLLICULAR LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- S. Alig
- Medical Department III; Ludwig-Maximilians-University; Munich Germany
| | - V. Jurinovic
- Medical Department III & Institute for Medical Informatics, Biometry and Epidemiology; Ludwig-Maximilians-University; Munich Germany
| | - M. Dreyling
- Medical Department III; Ludwig-Maximilians-University; Munich Germany
| | - A. Pastore
- Human Oncology and Pathogenesis Program; Memorial Sloan Kettering Cancer Center; New York USA
| | - R. Kridel
- Division of Medical Oncology and Hematology; Princess Margaret Cancer Centre - University Health Network; Toronto Canada
| | - R. Gascoyne
- Centre for Lymphoid Cancer & Department of Pathology and Laboratory Medicine, BC Cancer Agency; Vancouver Canada
| | - W. Hiddemann
- Medical Department III; Ludwig-Maximilians-University; Munich Germany
| | - M. Unterhalt
- Medical Department III; Ludwig-Maximilians-University; Munich Germany
| | - E. Hoster
- Medical Department III & Institute for Medical Informatics, Biometry and Epidemiology; Ludwig-Maximilians-University; Munich Germany
| | - O. Weigert
- Medical Department III; Ludwig-Maximilians-University; Munich Germany
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45
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Kridel R, Telio D, Villa D, Sehn LH, Gerrie AS, Shenkier T, Klasa R, Slack GW, Tan K, Gascoyne RD, Connors JM, Savage KJ. Diffuse large B-cell lymphoma with testicular involvement: outcome and risk of CNS relapse in the rituximab era. Br J Haematol 2016; 176:210-221. [DOI: 10.1111/bjh.14392] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/31/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Robert Kridel
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - David Telio
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Diego Villa
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Tamara Shenkier
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Richard Klasa
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Pathology; British Columbia Cancer Agency; Vancouver BC Canada
| | - King Tan
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Randy D. Gascoyne
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Pathology; British Columbia Cancer Agency; Vancouver BC Canada
| | - Joseph M. Connors
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
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46
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Gravelle P, Do C, Franchet C, Mueller S, Oberic L, Ysebaert L, Larocca LM, Hohaus S, Calmels MN, Frenois FX, Kridel R, Gascoyne RD, Laurent G, Brousset P, Valitutti S, Laurent C. Impaired functional responses in follicular lymphoma CD8 +TIM-3 + T lymphocytes following TCR engagement. Oncoimmunology 2016; 5:e1224044. [PMID: 27990323 DOI: 10.1080/2162402x.2016.1224044] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 05/18/2016] [Revised: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 12/31/2022] Open
Abstract
Upregulation of T cell immunoglobulin-3 (TIM-3) has been associated with negative regulation of the immune response in chronic infection and cancer, including lymphoma. Here, we investigated the possible correlation between TIM-3 expression by ex vivo cytotoxic T cells (CTL) from follicular lymphoma (FL) biopsies and their functional unresponsiveness that could limit the favorable impact of CTL on disease progression. We report a high percentage of CD8+TIM-3+T cells in lymph nodes of FL patients. When compared to their CD8+TIM-3- counterparts, CD8+TIM-3+ T cells exhibited defective cytokine production following TCR engagement. Furthermore, CD8+TIM-3+ T cells display ex vivo markers of lytic granule release and remain unresponsive to further TCR-induced activation of the lytic machinery. Although confocal microscopy showed that TIM-3 expression on CD8+ T cells correlated with minor alterations of immunological synapse, a selective reduction of ERK signaling in CD8+TIM-3+T cells was observed by phospho-flow analysis. Finally, short relapse-free survival despite rituximab(R)-chemotherapy was observed in patients with high content of TIM-3+ cells and a poor infiltrate of granzyme B+ T cells in FL lymph nodes. Together, our data indicate that, besides selective TCR early signaling defects, TIM-3 expression correlates with unresponsiveness of ex vivo CD8+ T cells in FL. They show that scores based on the combination of exhaustion and cytolytic markers in FL microenvironment might be instrumental to identify patients at early risk of relapses following R-chemotherapy.
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Affiliation(s)
- Pauline Gravelle
- Centre de Physiopathologie de Toulouse Purpan, INSERM U1043, Toulouse, France; Département de Pathologie, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse, France; Laboratoire d'Excellence "TOUCAN," Toulouse, France; Program Hospitalo-Universitaire en Cancérologie "CAPTOR," Toulouse, France; CALYM Carnot Institute, Pierre-Bénite, France
| | - Catherine Do
- Institute for Cancer Genetics, Columbia University , New York, USA
| | - Camille Franchet
- Centre de Physiopathologie de Toulouse Purpan, INSERM U1043, Toulouse, France; Département de Pathologie, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Sabina Mueller
- Centre de Physiopathologie de Toulouse Purpan, INSERM U1043, Toulouse, France; Laboratoire d'Excellence "TOUCAN," Toulouse, France
| | - Lucie Oberic
- Program Hospitalo-Universitaire en Cancérologie "CAPTOR," Toulouse, France; Département d'Hématologie, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse, France
| | - Loïc Ysebaert
- Laboratoire d'Excellence "TOUCAN," Toulouse, France; Program Hospitalo-Universitaire en Cancérologie "CAPTOR," Toulouse, France; CALYM Carnot Institute, Pierre-Bénite, France; Université Toulouse III Paul-Sabatier, Toulouse, France; Département d'Hématologie, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse, France; Centre de Recherches en Cancérologie de Toulouse, INSERM UMR1037, Toulouse, France
| | - Luigi Maria Larocca
- Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore , Roma, Italy
| | - Stefan Hohaus
- Istituto di Ematologia, Università Cattolica del Sacro Cuore , Roma, Italy
| | | | - François-Xavier Frenois
- Département de Pathologie, Institut Universitaire du Cancer-Oncopole de Toulouse , Toulouse, France
| | - Robert Kridel
- Center for Lymphoid Cancer, BC Cancer Agency , Vancouver, BC, Canada
| | - Randy D Gascoyne
- Center for Lymphoid Cancer, BC Cancer Agency , Vancouver, BC, Canada
| | - Guy Laurent
- Laboratoire d'Excellence "TOUCAN," Toulouse, France; Program Hospitalo-Universitaire en Cancérologie "CAPTOR," Toulouse, France; CALYM Carnot Institute, Pierre-Bénite, France; Université Toulouse III Paul-Sabatier, Toulouse, France; Département d'Hématologie, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse, France; Centre de Recherches en Cancérologie de Toulouse, INSERM UMR1037, Toulouse, France
| | - Pierre Brousset
- Département de Pathologie, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse, France; Laboratoire d'Excellence "TOUCAN," Toulouse, France; Program Hospitalo-Universitaire en Cancérologie "CAPTOR," Toulouse, France; CALYM Carnot Institute, Pierre-Bénite, France; Université Toulouse III Paul-Sabatier, Toulouse, France; Centre de Recherches en Cancérologie de Toulouse, INSERM UMR1037, Toulouse, France
| | - Salvatore Valitutti
- Centre de Physiopathologie de Toulouse Purpan, INSERM U1043, Toulouse, France; Département de Pathologie, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse, France; Laboratoire d'Excellence "TOUCAN," Toulouse, France; Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Camille Laurent
- Centre de Physiopathologie de Toulouse Purpan, INSERM U1043, Toulouse, France; Département de Pathologie, Institut Universitaire du Cancer-Oncopole de Toulouse, Toulouse, France; Laboratoire d'Excellence "TOUCAN," Toulouse, France; Program Hospitalo-Universitaire en Cancérologie "CAPTOR," Toulouse, France; CALYM Carnot Institute, Pierre-Bénite, France; Université Toulouse III Paul-Sabatier, Toulouse, France; Centre de Recherches en Cancérologie de Toulouse, INSERM UMR1037, Toulouse, France
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47
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Affiliation(s)
- Robert Kridel
- Department of Lymphoid Cancer Research, BC Cancer Agency and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Christian Steidl
- Department of Lymphoid Cancer Research, BC Cancer Agency and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Randy D Gascoyne
- Department of Lymphoid Cancer Research, BC Cancer Agency and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
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48
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Pastore A, Jurinovic V, Kridel R, Hoster E, Staiger AM, Szczepanowski M, Pott C, Kopp N, Murakami M, Horn H, Leich E, Moccia AA, Mottok A, Sunkavalli A, Van Hummelen P, Ducar M, Ennishi D, Shulha HP, Hother C, Connors JM, Sehn LH, Dreyling M, Neuberg D, Möller P, Feller AC, Hansmann ML, Stein H, Rosenwald A, Ott G, Klapper W, Unterhalt M, Hiddemann W, Gascoyne RD, Weinstock DM, Weigert O. Integration of gene mutations in risk prognostication for patients receiving first-line immunochemotherapy for follicular lymphoma: a retrospective analysis of a prospective clinical trial and validation in a population-based registry. Lancet Oncol 2015; 16:1111-1122. [PMID: 26256760 DOI: 10.1016/s1470-2045(15)00169-2] [Citation(s) in RCA: 413] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Follicular lymphoma is a clinically and genetically heterogeneous disease, but the prognostic value of somatic mutations has not been systematically assessed. We aimed to improve risk stratification of patients receiving first-line immunochemotherapy by integrating gene mutations into a prognostic model. METHODS We did DNA deep sequencing to retrospectively analyse the mutation status of 74 genes in 151 follicular lymphoma biopsy specimens that were obtained from patients within 1 year before beginning immunochemotherapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). These patients were recruited between May 4, 2000, and Oct 20, 2010, as part of a phase 3 trial (GLSG2000). Eligible patients had symptomatic, advanced stage follicular lymphoma and were previously untreated. The primary endpoints were failure-free survival (defined as less than a partial remission at the end of induction, relapse, progression, or death) and overall survival calculated from date of treatment initiation. Median follow-up was 7·7 years (IQR 5·5-9·3). Mutations and clinical factors were incorporated into a risk model for failure-free survival using multivariable L1-penalised Cox regression. We validated the risk model in an independent population-based cohort of 107 patients with symptomatic follicular lymphoma considered ineligible for curative irradiation. Pretreatment biopsies were taken between Feb 24, 2004, and Nov 24, 2009, within 1 year before beginning first-line immunochemotherapy consisting of rituximab, cyclophosphamide, vincristine, and prednisone (R-CVP). Median follow-up was 6·7 years (IQR 5·7-7·6). FINDINGS We established a clinicogenetic risk model (termed m7-FLIPI) that included the mutation status of seven genes (EZH2, ARID1A, MEF2B, EP300, FOXO1, CREBBP, and CARD11), the Follicular Lymphoma International Prognostic Index (FLIPI), and Eastern Cooperative Oncology Group (ECOG) performance status. In the training cohort, m7-FLIPI defined a high-risk group (28%, 43/151) with 5-year failure-free survival of 38·29% (95% CI 25·31-57·95) versus 77·21% (95% CI 69·21-86·14) for the low-risk group (hazard ratio [HR] 4·14, 95% CI 2·47-6·93; p<0·0001; bootstrap-corrected HR 2·02), and outperformed a prognostic model of only gene mutations (HR 3·76, 95% CI 2·10-6·74; p<0·0001; bootstrap-corrected HR 1·57). The positive predictive value and negative predictive value for 5-year failure-free survival were 64% and 78%, respectively, with a C-index of 0·80 (95% CI 0·71-0·89). In the validation cohort, m7-FLIPI again defined a high-risk group (22%, 24/107) with 5-year failure-free survival of 25·00% (95% CI 12·50-49·99) versus 68·24% (58·84-79·15) in the low-risk group (HR 3·58, 95% CI 2·00-6·42; p<0.0001). The positive predictive value for 5-year failure-free survival was 72% and 68% for negative predictive value, with a C-index of 0·79 (95% CI 0·69-0·89). In the validation cohort, risk stratification by m7-FLIPI outperformed FLIPI alone (HR 2·18, 95% CI 1·21-3·92), and FLIPI combined with ECOG performance status (HR 2·03, 95% CI 1·12-3·67). INTERPRETATION Integration of the mutational status of seven genes with clinical risk factors improves prognostication for patients with follicular lymphoma receiving first-line immunochemotherapy and is a promising approach to identify the subset at highest risk of treatment failure. FUNDING Deutsche Krebshilfe, Terry Fox Research Institute.
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Affiliation(s)
- Alessandro Pastore
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Vindi Jurinovic
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Robert Kridel
- Department of Lymphoid Cancer Research and the Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Eva Hoster
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany; Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Annette M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany; University of Tübingen, Tübingen, Germany
| | - Monika Szczepanowski
- Haematopathology Section, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christiane Pott
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nadja Kopp
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Heike Horn
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany; Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany; University of Tübingen, Tübingen, Germany
| | - Ellen Leich
- Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Alden A Moccia
- Department of Lymphoid Cancer Research and the Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Anja Mottok
- Department of Lymphoid Cancer Research and the Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Ashwini Sunkavalli
- Center for Cancer Genome Discovery, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul Van Hummelen
- Center for Cancer Genome Discovery, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew Ducar
- Center for Cancer Genome Discovery, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daisuke Ennishi
- Department of Lymphoid Cancer Research and the Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Hennady P Shulha
- Department of Lymphoid Cancer Research and the Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Christoffer Hother
- Department of Lymphoid Cancer Research and the Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Joseph M Connors
- Department of Lymphoid Cancer Research and the Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Laurie H Sehn
- Department of Lymphoid Cancer Research and the Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Martin Dreyling
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Peter Möller
- Institute of Pathology, University of Ulm, Ulm, Germany
| | - Alfred C Feller
- Department of Pathology, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Martin L Hansmann
- Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany
| | - Harald Stein
- Berlin Reference Center for Lymphoma and Haematopathology, Berlin, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg, and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Wolfram Klapper
- Haematopathology Section, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michael Unterhalt
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Wolfgang Hiddemann
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany; Clinical Cooperative Group Leukemia, Helmholtz-Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Randy D Gascoyne
- Department of Lymphoid Cancer Research and the Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Oliver Weigert
- Department of Internal Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany; Clinical Cooperative Group Leukemia, Helmholtz-Center Munich, Munich, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany.
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49
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Scott DW, Mottok A, Ennishi D, Wright GW, Farinha P, Ben-Neriah S, Kridel R, Barry GS, Hother C, Abrisqueta P, Boyle M, Meissner B, Telenius A, Savage KJ, Sehn LH, Slack GW, Steidl C, Staudt LM, Connors JM, Rimsza LM, Gascoyne RD. Prognostic Significance of Diffuse Large B-Cell Lymphoma Cell of Origin Determined by Digital Gene Expression in Formalin-Fixed Paraffin-Embedded Tissue Biopsies. J Clin Oncol 2015; 33:2848-56. [PMID: 26240231 DOI: 10.1200/jco.2014.60.2383] [Citation(s) in RCA: 257] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the prognostic impact of cell-of-origin (COO) subgroups, assigned using the recently described gene expression-based Lymph2Cx assay in comparison with International Prognostic Index (IPI) score and MYC/BCL2 coexpression status (dual expressers). PATIENTS AND METHODS Reproducibility of COO assignment using the Lymph2Cx assay was tested employing repeated sampling within tumor biopsies and changes in reagent lots. The assay was then applied to pretreatment formalin-fixed paraffin-embedded tissue (FFPET) biopsies from 344 patients with de novo diffuse large B-cell lymphoma (DLBCL) uniformly treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) at the British Columbia Cancer Agency. MYC and BCL2 protein expression was assessed using immunohistochemistry on tissue microarrays. RESULTS The Lymph2Cx assay provided concordant COO calls in 96% of 49 repeatedly sampled tumor biopsies and in 100% of 83 FFPET biopsies tested across reagent lots. Critically, no frank misclassification (activated B-cell-like DLBCL to germinal center B-cell-like DLBCL or vice versa) was observed. Patients with activated B-cell-like DLBCL had significantly inferior outcomes compared with patients with germinal center B-cell-like DLBCL (log-rank P < .001 for time to progression, progression-free survival, disease-specific survival, and overall survival). In pairwise multivariable analyses, COO was associated with outcomes independent of IPI score and MYC/BCL2 immunohistochemistry. The prognostic significance of COO was particularly evident in patients with intermediate IPI scores and the non-MYC-positive/BCL2-positive subgroup (log-rank P < .001 for time to progression). CONCLUSION Assignment of DLBCL COO by the Lymph2Cx assay using FFPET biopsies identifies patient groups with significantly different outcomes after R-CHOP, independent of IPI score and MYC/BCL2 dual expression.
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Affiliation(s)
- David W Scott
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ.
| | - Anja Mottok
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Daisuke Ennishi
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - George W Wright
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Pedro Farinha
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Susana Ben-Neriah
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Robert Kridel
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Garrett S Barry
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Christoffer Hother
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Pau Abrisqueta
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Merrill Boyle
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Barbara Meissner
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Adele Telenius
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Kerry J Savage
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Laurie H Sehn
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Graham W Slack
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Christian Steidl
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Louis M Staudt
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Joseph M Connors
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Lisa M Rimsza
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
| | - Randy D Gascoyne
- David W. Scott, Anja Mottok, Daisuke Ennishi, Pedro Farinha, Susana Ben-Neriah, Robert Kridel, Garrett S. Barry, Christoffer Hother, Pau Abrisqueta, Merrill Boyle, Barbara Meissner, Adele Telenius, Kerry J. Savage, Laurie H. Sehn, Graham W. Slack, Christian Steidl, Joseph M. Connors, and Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; George W. Wright and Louis M. Staudt, National Cancer Institute, Bethesda, MD; and Lisa M. Rimsza, University of Arizona, Tucson, AZ
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50
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Kridel R, Xerri L, Gelas-Dore B, Tan K, Feugier P, Vawda A, Canioni D, Farinha P, Boussetta S, Moccia AA, Brice P, Chavez EA, Kyle AH, Scott DW, Sanders AD, Fabiani B, Slack GW, Minchinton AI, Haioun C, Connors JM, Sehn LH, Steidl C, Gascoyne RD, Salles G. The Prognostic Impact of CD163-Positive Macrophages in Follicular Lymphoma: A Study from the BC Cancer Agency and the Lymphoma Study Association. Clin Cancer Res 2015; 21:3428-35. [PMID: 25869385 DOI: 10.1158/1078-0432.ccr-14-3253] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/12/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE We aimed to assess the prognostic significance of follicular lymphoma-associated macrophages in the era of rituximab treatment and maintenance. EXPERIMENTAL DESIGN We applied immunohistochemistry for CD68 and CD163 to two large tissue microarrays (TMA). The first TMA included samples from 186 patients from the BC Cancer Agency (BCCA) who had been treated with first-line systemic treatment including rituximab, cyclophosphamide, vincristine, and prednisone. The second contained 395 samples from PRIMA trial patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, and randomized to rituximab maintenance or observation. Macrophage infiltration was assessed using Aperio image analysis. Each of the two cohorts was randomly split into training/validation sets. RESULTS An increased CD163-positive pixel count was predictive of adverse outcome in the BCCA dataset [5-year progression-free survival (PFS) 38% vs. 72%, respectively, P = 0.004 in the training cohort and 5-year PFS 29% vs. 61%, respectively, P = 0.004 in the validation cohort]. In the PRIMA trial, an increased CD163 pixel count was associated with favorable outcome (5-year PFS 60% vs. 44%, respectively, P = 0.011 in the training cohort and 5-year PFS 55% vs. 37%, respectively, P = 0.030 in the validation cohort). CONCLUSIONS CD163-positive macrophages predict outcome in follicular lymphoma, but their prognostic impact is highly dependent on treatment received.
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Affiliation(s)
- Robert Kridel
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Luc Xerri
- Département de bio-pathologie, Institut Paoli-Calmettes, Marseille, France
| | - Bénédicte Gelas-Dore
- Lymphoma Academic Research Organisation, Centre Hospitalier Lyon-Sud, Lyon, France
| | - King Tan
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Pierre Feugier
- Hematology, University Hospital, Vandoeuvre Les Nancy, France
| | - Ayesha Vawda
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Pedro Farinha
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Sami Boussetta
- Lymphoma Academic Research Organisation, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Alden A Moccia
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Elizabeth A Chavez
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Alastair H Kyle
- Medical Biophysics, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - David W Scott
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Ashley D Sanders
- Terry Fox Laboratory, BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Graham W Slack
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Corinne Haioun
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, Créteil and University Paris Est Créteil, France
| | - Joseph M Connors
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Christian Steidl
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada.
| | - Gilles Salles
- Hospices Civils de Lyon, Université Claude Bernard, Pierre-Bénite, France.
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