Nutritional ecology of a prototypical generalist predator, the red fox (Vulpes vulpes)

Generalist species, which exploit a wide range of food resources, are expected to be able to combine available resources as to attain their specific macronutrient ratio (percentage of caloric intake of protein, lipids and carbohydrates). Among mammalian predators, the red fox Vulpes vulpes is a widespread, opportunistic forager: its diet has been largely studied, outlining wide variation according to geographic and climatic factors. We aimed to check if, throughout the species' European range, diets vary widely in macronutrient composition or foxes can combine complementary foods to gain the same nutrient intake. First, we assessed fox's intake target in the framework of nutritional geometry. Secondly, we aimed to highlight the effects of unbalanced diets on fox density, which was assumed as a proxy for Darwinian fitness, as assessed in five areas of the western Italian Alps. Unexpectedly, the target macronutrient ratio of the fox (52.4% protein-, 38.7% lipid- and 8.9% carbohydrate energy) was consistent with that of hypercarnivores, such as wolves and felids, except for carbohydrate intakes in urban and rural habitats. The inverse relation between density and the deviation of observed macronutrient ratios from the intake target suggests that fox capability of surviving in a wide range of habitats may not be exempt from fitness costs and that nutrient availability should be regarded among the biotic factors affecting animal abundance and distribution.

Single-Step IGHV Next-Generation Sequencing Detects Clonality and Somatic Hypermutation in Lymphoid Malignancies: A Phase III Diagnostic Accuracy Study

BACKGROUND

Multiplex PCR based on consensus primers followed by capillary electrophoresis and Sanger sequencing are considered as the gold standard method for the evaluation of clonality and somatic hypermutation in lymphoid malignancies. As an alternative, the next-generation sequencing (NGS) of immune receptor genes has recently been proposed as a solution, due to being highly effective and sensitive. Here, we designed a phase III diagnostic accuracy study intended to compare the current gold standard methods versus the first commercially available NGS approaches for testing immunoglobulin heavy chain gene rearrangements.

METHODS

We assessed IGH rearrangements in 68 samples by means of both the NGS approach (LymphoTrack® IGH assay, and LymphoTrack® IGH somatic hypermutation assay, run on Illumina MiSeq) and capillary electrophoresis/Sanger sequencing to assess clonality and somatic hypermutations (SHM).

RESULTS

In comparison to the routine capillary-based analysis, the NGS clonality assay had an overall diagnostic accuracy of 96% (63/66 cases). Other studied criteria included sensitivity (95%), specificity (100%), positive predictive value (100%) and negative predictive value (75%). In discrepant cases, the NGS results were confirmed by a different set of primers that provided coverage of the IGH leader sequence. Furthermore, there was excellent agreement of the SHM determination with both the LymphoTrack® FR1 and leader assays when compared to the Sanger sequencing analysis (84%), with NGS able to assess the SHM rate even in cases where the conventional approach failed.

CONCLUSION

Overall, conventional Sanger sequencing and next-generation-sequencing-based clonality and somatic hypermutation analyses gave comparable results. For future use in a routine diagnostic workflow, NGS-based approaches should be evaluated prospectively and an analysis of cost-effectiveness should be performed.

Follicular Lymphoma Microenvironment Traits Associated with Event-Free Survival

The majority of patients with Follicular Lymphoma (FL) experience subsequent phases of remission and relapse, making the disease "virtually" incurable. To predict the outcome of FL patients at diagnosis, various clinical-based prognostic scores have been proposed; nonetheless, they continue to fail for a subset of patients. Gene expression profiling has highlighted the pivotal role of the tumor microenvironment (TME) in the FL prognosis; nevertheless, there is still a need to standardize the assessment of immune-infiltrating cells for the prognostic classification of patients with early or late progressing disease. We studied a retrospective cohort of 49 FL lymph node biopsies at the time of the initial diagnosis using pathologist-guided analysis on whole slide images, and we characterized the immune repertoire for both quantity and distribution (intrafollicular, IF and extrafollicular, EF) of cell subsets in relation to clinical outcome. We looked for the natural killer (CD56), T lymphocyte (CD8, CD4, PD1) and macrophage (CD68, CD163, MA4A4A)-associated markers. High CD163/CD8 EF ratios and high CD56/MS4A4A EF ratios, according to Kaplan-Meier estimates were linked with shorter EFS (event-free survival), with the former being the only one associated with POD24. In contrast to IF CD68+ cells, which represent a more homogeneous population, higher in non-progressing patients, EF CD68+ macrophages did not stratify according to survival. We also identify distinctive MS4A4A+CD163-macrophage populations with different prognostic weights. Enlarging the macrophage characterization and combining it with a lymphoid marker in the rituximab era, in our opinion, may enable prognostic stratification for low-/high-grade FL patients beyond POD24. These findings warrant validation across larger FL cohorts.

Staphylococcus aureus adlb gene is associated with high prevalence of intramammary infection in dairy herds of northern Italy: A cross-sectional study

Staphylococcus aureus is a major mastitis pathogen in dairy cattle worldwide, responsible for substantial economic losses. Environmental factors, milking routine, and good maintenance of milking equipment have been described as important factors to prevent intramammary infections (IMI). Staphylococcus aureus IMI can be widespread within the farm or the infection can be limited to few animals. Several studies have reported that Staph. aureus genotypes differ in their ability to spread within a herd. In particular, Staph. aureus belonging to ribosomal spacer PCR genotype B (GTB)/clonal complex 8 (CC8) is associated with high within-herd prevalence of IMI, whereas other genotypes are generally associated with individual cow disease. The adlb gene seems to be strictly related to Staph. aureus GTB/CC8, and is a potential marker of contagiousness. We investigated Staph. aureus IMI prevalence in 60 herds in northern Italy. In the same farms, we assessed specific indicators linked to milking management (e.g., teat condition score and udder hygiene score) and additional milking risk factors for IMI spread. Ribosomal spacer-PCR and adlb-targeted PCR were performed on 262 Staph. aureus isolates, of which 77 underwent multilocus sequence typing. In most of the herds (90%), a predominant genotype was identified, especially Staph. aureus CC8 (30%). In 19 of 60 herds, the predominant circulating Staph. aureus was adlb-positive and the observed IMI prevalence was relevant. Moreover, the adlb gene was detected only in genotypes of CC8 and CC97. Statistical analysis showed a strong association between the prevalence of Staph. aureus IMI, the specific CCs, and carriage of adlb, with the predominant circulating CC and presence of the gene alone explaining the total variation. Interestingly, the difference in the odds ratio obtained in the models for CC8 and CC97 suggests that it is carriage of the adlb gene, rather than the circulation of these CCs per se, that leads to higher within-herd prevalence of Staph. aureus. In addition, the model showed that environmental and milking management factors had no or minimal effect on Staph. aureus IMI prevalence. In conclusion, the circulation of adlb-positive Staph. aureus strains within a herd has a strong effect on the prevalence of IMI. Thus, adlb can be proposed as a genetic marker of contagiousness for Staph. aureus IMI in cattle. However, further analyses using whole-genome sequencing are required to understand the role of genes other than adlb that may be involved in the mechanisms of contagiousness of Staph. aureus strains associated with high prevalence of IMI.

Myeloid Nuclear Differentiation Antigen (MNDA): an aid in differentiating lymphoplasmayctic lymphoma and splenic marginal zone lymphoma in bone marrow biopsies at presentation

The differential diagnosis between lymphoplasmacytic lymphoma (LPL) and marginal zone B-cell lymphoma, particularly splenic type (SMZL) can be challenging on onset bone marrow biopsy (BMB) since morphology and phenotype are not specific and clinical features can overlap or be mildly developed at diagnosis. The LPL-specific L265P mutation in the MYD88 gene is not available in all laboratories and genetic aberrancies identified in SMZL (del7q, mutations of NOTCH2 and KLF2) are seldom searched in routine practice. The study aim is to investigate the potential role of MNDA expression in this specific differential diagnosis. We report MNDA reactivity in 559 small B-cell lymphoma (SBCL) patients including bone marrow biopsies from 90 LPL and 91 SMZL. MYD88 p.Leu265Pro mutation status was assessed and confirmed as positive in 24 of 90 LPL cases, which served as the test set. MNDA staining was negative in 23/24 LPL cases in the test set (96%). In the 157 remaining cases (66 LPL, 91 SMZL), which served as validation set, the MYD88 p.Leu265Pro mutation was unavailable and MNDA was more frequently expressed in SMZL (p<0.00001). In addition, immunohistochemical features more consistent with SMZL (i.e. presence of CD23+ follicular dendritic cell meshworks, polytypic plasma cells, DBA44 reactivity) were more often present in MNDA positive cases (statistically significant for 2 such parameters). On the widest case-series so far published focusing on LPL and SMZL immunohistochemical diagnosis at onset on BMB, we demonstrated that MNDA expression significantly support the diagnosis of SMZL. This observation may be of particular help in cases where the MYD88 p.Leu265Pro mutational status and/or SMZL-related genetic aberrations are unavailable.

Deep Sequencing of Immunoglobulin Genes Identifies a Very Low Percentage of Monoclonal B Cells in Primary Cutaneous Marginal Zone Lymphomas with CD30-Positive Hodgkin/Reed–Sternberg-like Cells

The spectrum of cutaneous CD30-positive lymphoproliferative disorders encompasses both inflammatory and neoplastic conditions. CD30+ Hodgkin and Reed–Sternberg-like cells have been occasionally reported in primary cutaneous marginal zone lymphoma, where they are thought to represent a side neoplastic component within a dominant background of lymphomatous small B cells. Herein, we describe the histological and molecular findings of three cases of primary cutaneous marginal zone lymphomas with CD30+ H/RS cells, in which next-generation sequencing analysis revealed the clonal population to consist in less than 5% of the cutaneous B-cell infiltrate, providing a thought-provoking focus on a possible main role for CD30+ cells in primary cutaneous marginal zone lymphoproliferations.

Short communication: Characterization of Staphylococcus aureus from bulk tank milk of dairy cattle in Lombardy (northern Italy)

Staphylococcus aureus is one of the most important pathogens causing mastitis in cattle, and it is responsible for economic losses in dairy herds worldwide. The PCR amplification of the 16S-23S rRNA intergenic spacer (ribosomal spacer PCR, RS-PCR) allows a rapid classification of the strains in genotypes and genotypic clusters (CL), which are characterized by different epidemiological and clinical properties. Both RS-PCR and multi-locus sequence typing (MLST) were performed on strains isolated from bovine bulk tank milk (BTM) collected from dairy herds located in the Lombardy region (northern Italy), to outline the distribution of Staph. aureus genotypes in this geographical area. Out of 844 examined samples, 398 were positive for Staph. aureus, with a variable count (cfu/mL) Up to 8 colonies from each sample were genotyped. A total of 1,101 Staph. aureus strains were analyzed with RS-PCR, and only a selection of them (n = 86), in relation to their frequency and geographical origin, underwent MLST. This study revealed 8 major genotypic clusters (CLB, CLC, CLR, CLS, CLI, CLF, CLAO, and CLZ), of which Staph. aureus CLB (29.3%) was the most common. Samples of BTM positive for CLB had a Staph. aureus cfu/mL count significantly higher than the non-CLB positive ones. Our MLST analysis showed genotypes already known as bovine-associated in literature, such as clonal complexes CC8, CC97, and CC151. The same selection of 86 strains was also analyzed for the presence of the adlb gene, which was recently proposed as a possible marker of contagiousness. Most Staph. aureus belonging to CLB or CC8 carried the adlb gene (85%), whereas this gene was detected in only 9% of non-CLB strains (CLAA, CLBI, CLBJ, CLS). In conclusion, the present study confirms that Staph. aureus CLB, which is recognized as a contagious genotype, is a particularly relevant agent of intramammary infection in dairy cows in Lombardy, and indirectly supports the idea that adlb can be a possible marker of contagiousness of isolates.

Minimal residual disease (MRD) in non‐Hodgkin lymphomas: Interlaboratory reproducibility on marrow samples with very low levels of disease within the FIL (Fondazione Italiana Linfomi) MRD Network

In 2009, the four laboratories of the Fondazione Italiana Linfomi (FIL) minimal residual disease (MRD) Network started a collaborative effort to harmonize and standardize their methodologies at the national level, performing quality control (QC) rounds for follicular lymphoma (FL) and mantle cell lymphoma (MCL) MRD assessment. In 16 QC rounds between 2010 and 2017, the four laboratories received 208 bone marrow (BM) samples (126 FL; 82 MCL); 187 were analyzed, according to the EuroMRD Consortium guidelines, by both nested (NEST) polymerase chain reaction (PCR) and real-time quantitative (RQ) PCR for BCL2/IGH MBR or IGHV rearrangements. Here, we aimed at analyzing the samples that challenged the interlaboratory reproducibility and data interpretation. Overall, 156/187 BM samples (83%) were concordantly classified as NEST+/RQ+ or NEST-/RQ- by all the four laboratories. The remaining 31 samples (17%) resulted alternatively positive and negative in the interlaboratory evaluations, independently of the method and the type of rearrangement, and were defined "borderline" (brd) samples: 12 proved NEST brd/RQ brd, 7 NEST-/RQ brd, 10 NEST brd/RQ positive not quantifiable (PNQ), and 2 NEST brd/RQ-. Results did not change even increasing the number of replicates/sample. In 6/31 brd samples, droplet digital PCR (ddPCR) was tested and showed no interlaboratory discordance. Despite the high interlaboratory reproducibility in the MRD analysis obtained and maintained by the QC round strategy, samples with the lowest MRD levels can still represent a challenge: 17% (31/187) of our samples showed discordant results in interlaboratory assessments, with 6.4% (12/187) remained brd even applying the two methods. Thus, although representing a minority, brd samples are still problematic, especially when a clinically oriented interpretation of MRD results is required. Alternative, novel methods such as ddPCR and next-generation sequencing have the potential to overcome the current limitations.

First Italian birth after cryopreserved ovarian tissue transplantation in a patient affected by non-Hodgkin's lymphoma

This case report describes the first Italian live birth obtained by cryopreserved ovarian tissue transplantation in a woman affected by non-Hodgkin's lymphoma. Before anticancer treatments, several fertility preservation options were proposed. At 29 years the patient underwent laparoscopy for ovarian tissue cryopreservation. After treatments she experienced premature ovarian failure (POF) and asked for cryopreserved ovarian tissue transplantation. Before transplantation, ovarian samples were analyzed to assess neoplastic contamination and tissue quality. Two subsequent ovarian tissue transplantations were performed 4 and 7 years after cryopreservation. The follicle-stimulating hormone and luteinizing hormone reduction, estradiol increase and first menstrual cycle appeared 2 months after the second transplantation. The woman conceived spontaneously 5 months after the second transplantation. After 39 weeks of uneventful gestation, a healthy male baby was born. Ovarian tissue cryopreservation, thawing and transplantation successfully restored ovarian function and fertility after tissue storage.

Ficoll-hypaque separation vs whole blood lysis: Comparison of efficiency and impact on minimal residual disease analysis

INTRODUCTION

The high-throughput era remarkably changed molecular laboratory practice. Actually, the increasing number of processed samples requires to reduce the risk of operator biases, by automating or simplifying as much as possible both the analytical and the pre-analytical phases. Minimal residual disease (MRD) studies in hematology often require a simultaneous processing of many bone marrow and peripheral blood samples from patients enrolled in prospective, multicenter, clinical trials, monitored at several planned time points.

METHODS

In this study, we demonstrate that red blood cell lysis (RBL) pre-analytical procedure can replace the time-consuming Ficoll stratification as cell recovering step. Here, we show a MRD comparison study using both total white blood cells and mononuclear cells recovered by the 2 procedures from 46 follicular lymphoma (FL), 15 multiple myeloma (MM), and 11 mantle cell lymphoma (MCL) patients enrolled in prospective clinical trials.

RESULTS

The experiments were performed in the 4 laboratories of the Fondazione Italiana Linfomi (FIL) MRD Network and showed superimposable results, in terms of good correlation (R = 0.87) of the MRD data obtained by recovering blood cells by the 2 approaches.

CONCLUSION

Based on these results, the FIL MRD Network suggests to optimize the pre-analytical phases introducing RBL approach for cell recovery in the clinical trials including MRD analysis.

Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study

While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC (HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible.

Aberrant expression of CD10 and BCL6 in mantle cell lymphoma

AIMS

Mantle cell lymphoma (MCL) is characterized by distinctive histological and molecular features. Aberrant expression of BCL6 and CD10 has been reported occasionally, but the biological features of such cases are largely unknown. This study aimed to define the epidemiological, histological and cytogenetic characteristics of BCL6 and CD10-positive MCLs, also investigating possible biological features.

METHODS AND RESULTS

A total of 165 cases of cyclin D1 and t(11;14)(q13;q34)-positive MCLs were studied for CD10 and BCL6 immunohistochemical expression, which was documented in 26 of 165 (15.8%) cases (BCL6 17 of 165; CD10 11 of 165; BCL6 and CD10 co-expression two of 165). CD10-positivity was significantly more frequent in females (63.3%; P < 0.01). Either expression correlated significantly with higher mean proliferation index and higher prevalence of MUM1 positivity (P < 0.05). Fluorescence in-situ hybridization (FISH) for BCL6 (3q27) gene derangements was performed on the BCL6- and CD10-positive cases and 98 matched controls: amplifications were documented more frequently in BCL6-positive than -negative cases (50.0% versus 19.4% of cases) (P < 0.05). The mutational status of the variable immunoglobulin heavy chain genes (IGVH) was investigated by Sanger sequencing: five of the six successfully tested cases (83.3%) showed no somatic hypermutations.

CONCLUSIONS

Aberrant CD10 and BCL6 expression defines a subset of MCLs with higher mean Ki-67 index and higher prevalence of MUM1 expression. BCL6 protein positivity correlates with cytogenetic aberrations involving the BCL6 gene. Although examined successfully in few cases, the high prevalence of unmutated IGVH genes also points at a pregerminal cell origin for these phenotypically aberrant cases.

Minimal residual disease after conventional treatment significantly impacts on progression-free survival of patients with follicular lymphoma: the FIL FOLL05 trial

PURPOSE

The role of the minimal residual disease (MRD) in follicular lymphoma is still debated. In this study, we assessed whether the BCL2/IGH rearrangement could have a prognostic role in patients receiving R-CHOP, R-FM, or R-CVP.

EXPERIMENTAL DESIGN

DNAs from 415 patients among the 504 cases enrolled in the FOLL05 trial (NCT00774826) were centralized and assessed for the BCL2/IGH at diagnosis, at the end of treatment, and after 12 and 24 months.

RESULTS

At diagnosis, the molecular marker was detected in 53% of cases. Patients without molecular marker or with a low molecular tumor burden (<1 × 10(-4) copies) showed higher complete remission (CR) rate and longer progression-free survival (PFS; 3-year PFS 80% vs. 59%; P = 0.015). PFS was significantly conditioned by the PCR status at 12 and 24 months, with 3-year PFS of 66% for MRD(-) cases versus 41% for those MRD(+) at 12 months (P = 0.015), and 84% versus 50% at 24 months (P = 0.014). The MRD negativity at 12 and 24 months resulted in an improved PFS both in CR and in partial remission (PR) patients (3-year PFS = 72% for cases CR/PCR(-) vs. 32% for those CR/PCR(+) vs. 62% for those PR/PCR(-) and 25% for patients in PR/PCR(+); P = 0.001). The prognostic value of MRD at 12 and 24 months of follow-up was confirmed also in multivariate analysis.

CONCLUSIONS

In this study, standardized molecular techniques have been adopted and applied on bone marrow samples from a large cohort. Data reported show that the MRD detection is a powerful independent predictor of PFS in patients with follicular lymphoma receiving conventional chemoimmunotherapy.

Abstract 2362: Identification and characterization of pathogenetic pathways and potential therapeutic targets in tumors derived from histiocytes and follicular dendritic cells

Tumors derived from histiocytes and follicular dendritic cells (FDC) are extremely rare, constituting less than 1% of hematopoietic tumors. Among others, follicular dendritic cell sarcoma (FDC-S), histiocytic sarcoma (HS) , and Langerhans histiocytosis (LH) are the commonest types. The clinical course is variable from indolent to aggressive; however, the disease is more often incurable. Further, probably due to their rarity and complexity, the pathobiology of these tumor is nearly unknown at present, with only scattered studies being reported.

In this study, we investigated by gene expression profiling (GEP) and extensive immunohistochemistry (IHC) a relatively large series of cases, aiming 1) to identify and characterize functional pathways possibly involved in the pathogenesis of the disease, and 2) to unveil potential targets for novel treatments.

We studied by GEP FDC-S (N=30), LH (N=9), and HS (N=4) as well as non neoplastic cells including tissue microdissected FDC (N=5), CD1c+ myeloid dendritic cells (N=4), peripheral blood monocytes (N=8), and human cultured fibroblasts (N=3). All cases were studied with the Illumina DASL whole genome microarray. The same cases as well as and independent cohort was then used for IHC validation studies.

First, unsupervised approaches (principal component analysis and hierarchical clustering) indicated that tissue samples were distinct from cellular ones, while the different entities could not be clearly separated. Second, we found by supervised comparison (ANOVA, p&lt;0.05, fold change ≥2, FDR according to Benjamini-Hockeberg), the 3 tumor types could be discriminated. Particularly, the tumors differed for genes related to immune response (consistent with their histogenesis) and to intracellular signaling. In this regard, we found several oncogenic pathways to be differentially activated while others were consistently deregulated including those related to cellular adhesion, chemotaxis, angiogenesis and response to growth factors.

We then compared each tumor type with the specific supposed counterpart (i.e. FDC-s vs. FDC; LH vs. myeloid DC; HS vs. monocytes) and identified genes and cellular programs deregulated in each of them. Interestingly, all tumors presented with consistent deregulation of previously unknown potential therapeutic targets, including PDGF/PDGFRs, PTEN, JAK/STAT, mTOR/AKT, and EGFR. Importantly, IHC confirmed GEP data and confirmed the activation of these selected pathways.

We defined for the first time the cellular programs deregulated in tumors derived from histiocytes and FDC and identified remarkable potential therapeutic targets. As appropriate experimental models (i.e. cell lines, animal models) are not available at present, international collaboration would be advisable to confirm these observation in large series before eventually moving to early phase clinical trials.

Citation Format: Pier-Paolo Piccaluga, Maura Rossi, Giovanna Motta, Sylvia Hartmann, Claudia Doering, Fabio Fuligni, Claudio Agostinelli, Maria Rosaria Sapienza, Maria Antonella Laginestra, Federica Melle, Maryam Etebari, Mohsen Navari, Anna Gazzola, Claudia Mannu, Clara Bertuzzi, Claudio Tripodo, Martin L. Hansmann, Fabio Facchetti, Stefano A Pileri. Identification and characterization of pathogenetic pathways and potential therapeutic targets in tumors derived from histiocytes and follicular dendritic cells. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2362. doi:10.1158/1538-7445.AM2014-2362

Abstract 5173: Identification of single-nucleotide variants by high-throughput RNA sequencing in endemic Burkitt Lymphoma

Endemic Burkitt lymphoma (eBL) constitutes the commonest cancer in children in Developing Countries, while the sporadic (sBL) and immunodeficiency associated BL (ID-BL) forms are mainly encountered in Western Countries. The molecular hallmark of three BL variants is the translocation of MYC proto-oncogene to the immunoglobulin-heavy [t(8;14)(q24;q32)] or one of the light chain genes [t(2;8)(p12; q24) and t(8;22)(q24; q11)], leading to constitutive MYC activation. However, additional genetic events contributes to BL pathogenesis, most of which have been studies in sBL only.

Here, we performed RNA Sequencing aiming to identify genetic changes possibly cooperating with MYC in the pathogenesis of eBL. We studied by RNA Sequencing (Illumina HiScanSQ) 21 eBL cases, collected at different African Institutions as discovery set. Total RNA was extracted with Trizol and libraries were prepared according to TruSeq RNA sample preparation v2 protocol. Sequence variants were obtained using the SAVI (Statistical Algorithm for Variant Identification) algorithm independently for each sample. Candidate somatic mutations were obtained by eliminating common germline variants and recurrence. To validate single-nucleotide variants (SNVs) we performed Sanger sequencing on these 21 cases. Further, we studied these SNVs by Sequenom Technology and Sanger sequencing on additional 24 eBL cases as validation set. 41 sBL and 8 ID-BL were also considered as controls.

We found 66 genes affected by 219 total SNVs with different frequency in 21 samples (range 2-22 for sample). We then focused on genes mutated in at least three samples and predicted to induce somatic protein-changing. We identified 25 genes affected by 172 total SNVs, that were recurrently mutated (min. 3/21 samples; max 11/21 samples). These included genes previously known to be involved in sBL, such as TP53, MYC, ID3, PCBP1 and TCF3 as well as genes involved in other lymphomas such as DDX3X and RHOA. The remaining 18 genes (AGAP6, APBB1IP, ARID1A, ASPSCR1, AVEN, CAD, CCNF, GPATCH4, HERC2, KPNA2, MTBP, MTERFD1, NEK9, NUP133,

PARP1, POLQ, SCFD2, TIGD1) were previously not related to BL, and resulted to be involved in several important molecular pathways as cell cycle progression, apoptosis, matrix remodelling, angiogenesis.

Sanger sequencing confirmed such SNVs with 100% accuracy in 21 cases of discovery set. Subsequently, we studied them in 24 independent cases of validation set by both Sanger sequencing and by mass spectrometry (Sequenom). We found that most eBL cases carried additional SNVs rather than MYC translocations. Noteworthy, we failed to find these mutations in sBL, confirming the concept that different pathogenetic events may contribute to the pathogenesis of BL subtypes.

In conclusion , we discovered new SNVs that might have a significant role in the pathogenesis of eBL. Functional experiments are required to definitely assess their impact.

Citation Format: Maria Antonella Laginestra, Francesco Abate, Maryam Etebari, Giulia De Falco, Fabio Fuligni, Maura Rossi, Sakellarios Zairis, Maria Rosaria Sapienza, Anna Gazzola, Claudia Mannu, Federica Melle, Claudio Agostinelli, Mohsen Navari, Cristiana Bellan, Sara Gazaneo, Lucia Mundo, Martin Ogwang, Valeria Calbi, Lorenzo Leoncini, Stefano A. Pileri, Raul Rabadan, Pier Paolo Piccaluga. Identification of single-nucleotide variants by high-throughput RNA sequencing in endemic Burkitt Lymphoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5173. doi:10.1158/1538-7445.AM2014-5173

Comparison of different DNA extraction methods from peripheral blood cells: advice from the Fondazione Italiana Linfomi Minimal Residual Disease Network

Genomic DNA extraction is a primary component of genomic research and diagnostic routine analysis. Recently, the importance of this process has been highlighted by the necessity to standardize the diagnostic procedure. In this regard, the Minimal Residual Disease (MRD) Network of the Fondazione Italiana Linfomi (FIL MRD Network) has performed a comparative study of four different commercially available kits for DNA extraction, applying them on a panel of cellular pellets, with the aim of defining possible technical recommendations in order to harmonize and standardize diagnostic procedures in the clinical setting. Overall, all four kits usually allowed the recovery of a significant quantity of high-quality DNA (in most conditions), although specific indications could be addressed for cellular pellets of different sizes.

Past, present and future treatment strategies in peripheral T-cell lymphomas

SUMMARY 

Nodal peripheral T-cell lymphomas (PTCLs) are very aggressive tumors characterized by poor response to conventional chemotherapy and dismal prognosis. Recent evidence has indicated that, at least for patients aged less than 60 years, frontline high-dose chemotherapy followed by autologous stem cell transplantation can be an effective strategy. Unfortunately, however, a significant fraction of patients cannot benefit from this approach, due to age, poor performance status or early relapse. In addition, a percentage of transplanted patients eventually relapse. In this article, based on their experience and on the most recent literature, the authors review the current concept on PTCL treatment, focusing on the most common PTCL nodal subtypes.

The evolution of clonality testing in the diagnosis and monitoring of hematological malignancies

Currently, distinguishing between benign and malignant lymphoid proliferations is based on a combination of clinical characteristics, cyto/histomorphology, immunophenotype and the identification of well-defined chromosomal aberrations. However, such diagnoses remain challenging in 10-15% of cases of lymphoproliferative disorders, and clonality assessments are often required to confirm diagnostic suspicions. In recent years, the development of new techniques for clonality detection has allowed researchers to better characterize, classify and monitor hematological neoplasms. In the past, clonality was primarily studied by performing Southern blotting analyses to characterize rearrangements in segments of the IG and TCR genes. Currently, the most commonly used method in the clinical molecular diagnostic laboratory is polymerase chain reaction (PCR), which is an extremely sensitive technique for detecting nucleic acids. This technique is rapid, accurate, specific, and sensitive, and it can be used to analyze small biopsies as well as formalin-fixed paraffin-embedded samples. These advantages make PCR-based approaches the current gold standard for IG/TCR clonality testing. Since the completion of the first human genome sequence, there has been a rapid development of technologies to facilitate high-throughput sequencing of DNA. These techniques have been applied to the deep characterization and classification of various diseases, patient stratification, and the monitoring of minimal residual disease. Furthermore, these novel approaches have the potential to significantly improve the sensitivity and cost of clonality assays and post-treatment monitoring of B- and T-cell malignancies. However, more studies will be required to demonstrate the utility, sensitivity, and benefits of these methods in order to warrant their adoption into clinical practice. In this review, recent developments in clonality testing are examined with an emphasis on highly sensitive systems for improving diagnostic workups and minimal residual disease assessments.

Molecular profiling of blastic plasmacytoid dendritic cell neoplasm reveals a unique pattern and suggests selective sensitivity to NF-kB pathway inhibition

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare disease of controversial origin recently recognized as a neoplasm deriving from plasmacytoid dendritic cells (pDCs). Nevertheless, it remains an orphan tumor with obscure biology and dismal prognosis. To better understand the pathobiology of BPDCN and discover new targets for effective therapies, the gene expression profile (GEP) of 25 BPDCN samples was analyzed and compared with that of pDCs, their postulated normal counterpart. Validation was performed by immunohistochemistry (IHC), whereas functional experiments were carried out ex vivo. For the first time at the molecular level, we definitely recognized the cellular derivation of BPDCN that proved to originate from the myeloid lineage and in particular, from resting pDCs. Furthermore, thanks to an integrated bioinformatic approach we discovered aberrant activation of the NF-kB pathway and suggested it as a novel therapeutic target. We tested the efficacy of anti-NF-kB-treatment on the BPDCN cell line CAL-1, and successfully demonstrated by GEP and IHC the molecular shutoff of the NF-kB pathway. In conclusion, we identified a molecular signature representative of the transcriptional abnormalities of BPDCN and developed a cellular model proposing a novel therapeutic approach in the setting of this otherwise incurable disease.

Comparison of two real-time quantitative polymerase chain reaction strategies for minimal residual disease evaluation in lymphoproliferative disorders: correlation between immunoglobulin gene mutation load and real-time quantitative polymerase chain reaction performance

We compared two strategies for minimal residual disease evaluation of B-cell lymphoproliferative disorders characterized by a variable immunoglobulin heavy chain (IGH) genes mutation load. Twenty-five samples from chronic lymphocytic leukaemia (n = 18) or mantle cell lymphoma (n = 7) patients were analyzed. Based on IGH variable region genes, 22/25 samples carried > 2% mutations, 20/25 > 5%. In the IGH joining region genes, 23/25 samples carried > 2% mutations, 18/25 > 5%. Real-time quantitative polymerase chain reaction was performed on IGH genes using two strategies: method A utilizes two patient-specific primers, whereas method B employs one patient-specific and one germline primer, with different positions on the variable, diversity and joining regions. Twenty-three samples (92%) resulted evaluable using method A, only six (24%) by method B. Method B poor performance was specifically evident among mutated IGH variable/joining region cases, although no specific mutation load above, which the real-time quantitative polymerase chain reaction failed was found. The molecular strategies for minimal residual disease evaluation should be adapted to the B-cell receptor features of the disease investigated.

Molecular profiling improves classification and prognostication of nodal peripheral T-cell lymphomas: results of a phase III diagnostic accuracy study

PURPOSE

The differential diagnosis among the commonest peripheral T-cell lymphomas (PTCLs; ie, PTCL not otherwise specified [NOS], angioimmunoblastic T-cell lymphoma [AITL], and anaplastic large-cell lymphoma [ALCL]) is difficult, with the morphologic and phenotypic features largely overlapping. We performed a phase III diagnostic accuracy study to test the ability of gene expression profiles (GEPs; index test) to identify PTCL subtype.

METHODS

We studied 244 PTCLs, including 158 PTCLs NOS, 63 AITLs, and 23 ALK-negative ALCLs. The GEP-based classification method was established on a support vector machine algorithm, and the reference standard was an expert pathologic diagnosis according to WHO classification.

RESULTS

First, we identified molecular signatures (molecular classifier [MC]) discriminating either AITL and ALK-negative ALCL from PTCL NOS in a training set. Of note, the MC was developed in formalin-fixed paraffin-embedded (FFPE) samples and validated in both FFPE and frozen tissues. Second, we found that the overall accuracy of the MC was remarkable: 98% to 77% for AITL and 98% to 93% for ALK-negative ALCL in test and validation sets of patient cases, respectively. Furthermore, we found that the MC significantly improved the prognostic stratification of patients with PTCL. Particularly, it enhanced the distinction of ALK-negative ALCL from PTCL NOS, especially from some CD30+ PTCL NOS with uncertain morphology. Finally, MC discriminated some T-follicular helper (Tfh) PTCL NOS from AITL, providing further evidence that a group of PTCLs NOS shares a Tfh derivation with but is distinct from AITL.

CONCLUSION

Our findings support the usage of an MC as additional tool in the diagnostic workup of nodal PTCL.

Abstract 1951: miRNA expression profile of Blastic plasmacytoid dendritic cell neoplasm

Background:

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare neoplasm currently included among acute myeloid leukemias in the WHO classification. BPDCN is an orphan tumor characterized by an unknown biology with clinical aggressive course and dismal prognosis.

Only few studies explored its genetics, documenting a complex karyotype and sporadic genetic alterations. Unfortunately, data were based on a limited number of patients and lacked functional elucidation. Conversely, studies on the transcriptome only compared BPDCN with other leukemias, failing to identify pathogenetic events.

In this study we aimed to assess whether miRNA deregulation contribute to BPDCN pathogenesis and clinical behaviour.

Methods:

We studied by miRNA profiling (NanoString Technologies) 30 BPDCN samples, 9 normal plasmacytoid dendritic cell (pDCs) samples and the CAL-1 tumor cell line. In addition, 25 independent BPDCN cases were studied by qRT-PCR and IHC as validation. To investigate the functional consequences of miRNA deregulation, we also performed a global gene expression profile (GEP) analysis on the same cases by using the Illumina Whole Genome DASL Assay. We applied ANOVA and Student t-test to find genes and miRNAs differentially expressed between BPDCNs and normal pDCs. The selected miRNAs were further filtered based on their predicted impact on the GEP using Linear Discriminant Analysis, Spearman correlation and Gene Set Enrichment Analysis. Finally, the functional effects of selected miRNAs were assessed ex vivo on CAL-1 cell line.

Results:

We found that, according to the unsupervised analysis of miRNAs, BPDCN patients have a molecular signature well distinct from their normal counterpart.

The following supervised analysis identified a set of 114 miRNAs significantly deregulated whose aberrant expression might have a relevant impact on cancer-related cellular pathways.

Therefore, after validating their expression in an independent set of cases, we integrated the miRNA and mRNA expression profiles on the same patients, in order to assess the functional impact of deregulated miRNAs on gene expression profile.

Pathway analysis of the predicted miRNA target genes, revealed that most of them were involved in the same gene ontology category: miRNAs synergic action appeared to strongly affect the biological process of programmed cell death.

We thus focused on miRNA-mRNA anti-correlations affecting the apoptotic pathway: we transfected specific mimics and inhibitors into CAL-1 cell line; we evaluated their functional impact by gene expression profile and, finally, we confirmed their relation with specific targets by Luciferase assay.

In conclusion, for the first time we investigated the miRNA profile of BPDCN, defining previously uncovered molecular mechanisms underlying the pathogenesis of the disease. Specifically, we found a subset of miRNAs significantly deregulated and highly affecting the apoptotic pathway.

Citation Format: Maria Rosaria Sapienza, Fabio Fuligni, Maria Antonella Laginestra, Maura Rossi, Luciano Cascione, Alessandro Laganà, Claudio Agostinelli, Maryam Etebari, Anna Gazzola, Claudia Mannu, Elena Sabattini, Francesco Bacci, Carlo Maria Croce, Stefano Aldo Pileri, Pier Paolo Piccaluga. miRNA expression profile of Blastic plasmacytoid dendritic cell neoplasm. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1951. doi:10.1158/1538-7445.AM2013-1951

Abstract 5275: miRNA profiling of peripheral T-cell lymphomas

Background: Peripheral T cell lymphomas not otherwise specified (PTCLs/NOS) are rare and aggressive tumors, whose molecular pathogenesis is poorly known and whose diagnosis is quite difficult. In fact, both morphology and phenotype largely overlap with those of other nodal PTCLs, including angioimmunoblastic T cell lymphoma (AITL) and anaplastic large cell lymphomas (ALCLs).

Here, we performed an extensive miRNA profiling of PTCLs in order to identify differentially expressed miRNA, either involved in their pathogenesis or potentially useful for their differential diagnosis.

Methods: We studied by miRNA profiling (TaqMan Array MicroRNA Cards A) 60 samples including PTCLs/NOS (N=25), AITLs (N=10), ALCLs (N=12) and normal T cells (N=13); in addition, 40 independent PTCL cases were studied by qRT-PCR as validation. Further, to assess the functional impact of deregulated miRNAs, we performed a global gene expression profile (GEP) analysis in the same cases by using the Illumina Whole Genome DASL Assay. ANOVA and Student t-test were performed to find genes and miRNAs differentially expressed between PTCLs and normal T cells or among PTCL subtypes, respectively. Differentially expressed miRNAs were further filtered based on their predicted impact on the GEP using Linear Discriminant Analysis, Spearman correlation and Gene Set Enrichment Analysis. A discriminant function based on linear combination of GEP signatures was then used to better distinguish different PTCLs subtypes. Finally, the functional effects of selected miRNA were assessed by transfection of specific mimic and inhibitors into PTCL cells and then evaluating the GEPs (functional GEP).

Findings: First, unsupervised analyses clearly discriminated PTCLs and normal T cells based on the miRNA expression patterns. Second, supervised analysis identified 256 miRNA differentiating the two groups (p&lt;0.05, FC ≥2, Bonferroni correction). To identify those miRNA more likely to impact the GEP of the tumors, we then performed a multi-step analysis integrating miRNA and GEP data. We identified 4 highly discriminant miRNA inversely correlated with different potential target genes. All 4 miRNA were confirmed by qPCR in a validation set, while their target genes were assessed by functional GEP confirming their impact.

Thereafter, we sought miRNAs differentially expressed in the PTCL subtypes, to be used as diagnostic markers. Based on ANOVA and subsequent linear discriminant analysis we identified 3 sets of miRNA able to efficiently distinguish PTCL/NOS vs. ALK-/ALCL (N=5 miRNA), ALK+/ALCL vs. ALK-/ALCL (N=4), and PTCL/NOS vs. AITL (N=8). Noteworthy, this novel molecular diagnostic tool was validated by qPCR in independent cases, demonstrating a remarkable diagnostic accuracy ranging between 85% and 95%.

In conclusion, miRNA profiling allowed to identify miRNA possibly involved in PTCL pathogenesis and to develop a novel diagnostic tool for the differential diagnosis of the commonest subtypes.

Citation Format: Maria Antonella Laginestra, Fabio Fuligni, Maura Rossi, Davide Gibellini, Maria Rosaria Sapienza, Anna Gazzola, Claudia Mannu, Elena Sabattini, Francesco Bacci, Claudio Agostinelli, Stefano Aldo Pileri, Pier Paolo Piccaluga. miRNA profiling of peripheral T-cell lymphomas. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5275. doi:10.1158/1538-7445.AM2013-5275

BCL10 down-regulation in peripheral T-cell lymphomas

The BCL10 gene encodes for a T-cell receptor signaling downstream protein involved in nuclear factor κB activation. It is expressed in normal lymphoid tissues and in several B-non Hodgkin lymphomas, its aberrant function being related to the pathogenesis of certain subtypes. Conversely, conflicting data are available concerning BCL10 expression in peripheral T cell lymphomas. We analyzed BCL10 expression in peripheral T cell lymphomas and correlated it with NFκB activation, proliferation, phenotypic aberration, and survival. First, gene expression analysis of 40 peripheral T cell lymphomas (28 peripheral T cell lymphomas/not otherwise specified, 6 anaplastic large cell lymphomas, and 6 angioimmunoblastic lymphomas), 4 reactive lymph nodes, and 20 samples of normal T-lymphocytes, showed significantly lower BCL10 gene expression in all tumors in comparison to normal samples, the lowest values being detected in anaplastic large cell lymphoma. Secondly, we studied the immunohistochemical expression of BCL10 in 52 peripheral T cell lymphomas/not otherwise specified on tissue microarrays. BCL10 was expressed in 10/52 cases (19%), not showing any significant correlation with either expression of Ki-67 and the T-cell markers or NFκB activation. Furthermore, BCL10 expression was not associated with peculiar gene expression profiles. Finally, we did not find significant correlations with progression free survival and overall survival, although a favorable trend was recorded in BCL10(+) cases. In conclusion, BCL10 was commonly down-regulated in peripheral T cell lymphomas, suggest the T-cell receptor signaling cascade for future characterization.

Targeted molecular therapy in peripheral T-cell lymphomas

Peripheral T-cell lymphomas (PTCLs) are rare neoplasms constituting a heterogeneous group of diseases. At present, available chemotherapy regimens that have improved outcomes in B-cell lymphomas appear to be less efficacious in the context of PTCLs and, thus, alternative strategies are warranted. In the last few years, based on the recent, deeper understanding of PTCL biology, several molecules and/or pathways have been proposed for targeted therapy in this setting, including surface antigens, tyrosine kinases, the NF-κB pathway, folate metabolism, histone modification and others. Of particular interest, histone deacetylase and proteasome inhibitors, as well as novel chemotherapeutic agents such as pralatrexate, have already demonstrated efficacy in PTCL therapy. In addition, a strong biological rationale and early clinical evidence supports the future study of tyrosine kinase inhibitors in this setting. In this article, the authors review the available literature on targeted therapy in PTCLs and also, based on their own experience, discuss potential opportunities in this intriguing area.

Pathobiology of Epstein-Barr virus-driven peripheral T-cell lymphomas

In the present review, the authors described the pathobiological features of Epstein-Barr virus (EBV)-driven T/natural killer cell-derived malignancies. These rare tumors appear to be quite heterogeneous with regard to both clinical and pathologic features. Nonetheless, some elements, especially regarding the possible role of EBV (ie, genomic predisposition, pathogenesis, pattern of latency), are similar, enforcing the concept of a causative role for the virus. In clinical practice, although definitely rare in Western countries, the tumors are not exceptional; thus, they should be taken into account in the differential diagnosis of T-lymphoproliferative disorders, also considering the need for extremely prompt intervention. The prognosis of such tumors is generally poor using current approaches. A better understanding of their molecular pathogenesis may lead to significant therapeutic improvements. For example, the nuclear factor-KB pathway and platelet-derived growth factor receptor inhibition may represent 2 options to be tested in clinical trials.

Use of IGK gene rearrangement analysis for clonality assessment of lymphoid malignancies: a single center experience

Diagnosis of B-non Hodgkin lymphomas (NHLs) is based on clinical, morphological and immunohistochemi-cal features. However, in up to 10-15% of cases, analysis of immunoglobulin heavy (IGH) or light (IGK/IGL) chains genes is required to discriminate between malignant and reactive lymphoid proliferations. In this study, we evaluated the feasibility and efficiency of IGK analysis in the routine diagnostic of B-cell lymphoproliferative disorders (B-LD) when applied to formalin-fixed paraffin-embedded (FFPE) tissues. Clonality patterns were studied in 59 B-LD using the BIOMED-2 protocol for IGK assays, after failure of the IGH assay. PCR products were evaluated by both heterodu-plex and GeneScan analysis. IGK analysis was technically successful in all cases. Overall, it supported the histopa-thological suspicion in 52/59 cases (88%), the sensitivity and specificity being 83% and 80%, respectively. Further, positive and negative predictive values were 95% and 50%, respectively. Interestingly, among various lymphoma subtypes, marginal zone lymphoma and follicular lymphoma most frequently required IGK analysis. In conclusion, IGK study according to the BIOMED-2 protocol resulted feasible and extremely useful in supporting challenging diagnosis of B-LD even if applied on FFPE samples. Accordingly, when NHL is suspected, negative results at IGH analysis should not be considered as conclusive and further investigation of IGK is appropriate.

Pathobiology of acute lymphoblastic leukemia

In the present review, the authors described the pathobiological features of B- and T-ALL, which appear to be quite heterogeneous with regard to molecular pathogenesis. The last edition of the World Health Organization Classification considered this aspect by defining many entities based on genetic findings. This approach is not only important for prognostic stratification, but also in the near future will surely represent the basis for the definition of patient-specific therapeutic approaches. A striking example is Ph+ acute lymphoblastic leukemia (ALL), which until the advent of tyrosine kinase inhibitors (TKI) has been regarded as the most aggressive ALL. The use of imatinib, dasatinib, and possibly more recent inhibitors has dramatically changed the clinical scenario, offering new opportunities to patients, especially the elderly. Similarly, the use of FLT3 inhibitors in mixed lineage leukemia-positive cases, gamma-secretase inhibitors in T-ALL, novel TKI, and monoclonal antibodies may represent a successful approach in the future.

Peripheral T-cell lymphoma classification: the matter of cellular derivation

Peripheral T-cell lymphomas (PTCLs) represent approximately 12% of all non-Hodgkin's lymphomas in Western countries. They are quite heterogeneous as far as morphology and phenotype are concerned. Furthermore, until now, PTCLs could not be referred to specific normal counterparts, in contrast to B-cell-derived non-Hodgkin's lymphomas. In particular, in the last edition of the WHO classification of Tumors of the Hematopoietic and Lymphoid Tissues, for the majority of nodal PTCLs (including the not otherwise specified type and anaplastic large-cell lymphoma), the postulated cell of origin remained undefined. However, in the last few years, high-throughput genomic techniques, especially gene-expression profiling, have allowed us to better define the relationship between some entities and the different T-cell subpopulations. Consequently, it has become possible to clearly define, for example, the association between angioimmunoblastic T-cell lymphoma and T-follicular helper cells. In addition, within PTCLs/not otherwise specified, different subgroups were identified based on their similarity to different cellular counterparts, including T-helper, T-cytotoxic and T-follicular helper cells. In this article, based on their own experience as well as up-to-date literature, the authors revise the concept of PTCL classification by specially focusing on their cellular counterparts and discuss the possible clinical relevance of such an approach.

Systemic Epstein-Barr-virus-positive T cell lymphoproliferative childhood disease in a 22-year-old Caucasian man: A case report and review of the literature

INTRODUCTION

Systemic Epstein-Barr-virus-positive T cell lymphoproliferative disease of childhood is an extremely rare disorder, characterized by clonal proliferation of Epstein-Barr-virus-infected T cells with an activated cytotoxic phenotype. The disease is more frequent in Asia and South America, with only few cases reported in Western countries. A prompt diagnosis, though often difficult, is a necessity due to the very aggressive clinical course of the disease.

CASE PRESENTATION

We report the clinicopathological features of fulminant T cell lymphoproliferative disease that arose in the setting of acute primary Epstein-Barr virus infection. Our patient, a 23-year-old man, presented to our facility with persisting fever, hepatosplenomegaly and severe pancytopenia. On bone marrow biopsy, an abundant lymphoid infiltrate was observed. Immunophenotypic and molecular studies revealed that the atypical lymphoid cells displayed a CD8+, Epstein-Barr-encoded-RNA-positive T cell phenotype with clonal rearrangement of the T cell receptor genes, the final diagnosis being systemic Epstein-Barr-virus-positive T cell lymphoproliferative disease. On reviewing the literature we found only 14 similar cases, all presenting with very aggressive clinical courses and requiring extensive phenotyping and molecular techniques for final diagnosis.

CONCLUSION

Though extremely rare, this disease can occur in Europe, and a comprehensive diagnostic approach is thus recommended in all case of Epstein-Barr-virus-positive lymphoproliferative disorders. Unfortunately, at present no specific treatment is available; however, prompt administration of anti- Epstein-Barr virus treatment and rapid attempts to control the hemophagocytic syndrome are indicated.

Partial nodal involvement by marginal zone lymphoma. Use of IGK gene rearrangement analysis in diagnostic work-up

Nodal marginal zone lymphoma (NMZL) is an indolent B-cell lymphoma that originates from the marginal zone of B-cell follicles. The tumour is rather uncommon, and shares some morphologic and immunophenotypic similarities with the extranodal form of marginal zone lymphomas. However, diagnosis of NMZL implies the exclusion of lymphoplasmacytic lymphoma, follicular lymphoma, and lymph node involvement by extra nodal or splenic marginal zone B-cell lymphoma In addition, its distinction from reactive conditions, including T-zone hyperplasia, are sometimes problematic based on morphologic grounds. We describe a patient who presented with cervical and inguinal lymphadenopathies and high inflammation indexes. Bone marrow and lymph node biopsies were performed for definitive diagnosis. Bone marrow histological and immunophenotypic examinations were normal and excluded haematological disease. In contrast, lymph node evaluation showed some features compatible with a possible lymphoproliferative disorder, even though no definite diagnosis could be made based on morphologic and immunohistochemical investigation. In particular, the problem of a differential diagnosis between NMZL and a florid hyperplasia of monocytoid B-elements was posed. Thus, in order to assess the nature (neoplastic vs. reactive) of the lesion, molecular analysis of the immunoglobulin genes was performed by PCR. Notably, although no clonal rearrangements were revealed by IGHV@ analysis, further evaluation of the immunoglobulin light chain (IGKV@) confirmed the presence of a clonal B-cell population. Accordingly, a final diagnosis of NMZL was made. In conclusion, this case is a good example of the crucial role of complete molecular analysis in the diagnostic work up of lymphoproliferative disorders.

Prognostic markers in peripheral T-cell lymphoma

Based on their own experience and knowledge of the literature, the authors review the pathobiological characteristics of peripheral T-cell lymphomas (PTCLs), focusing on the available prognostic indicators. The International Prognostic Index (IPI), which is based on age, performance status, lactate dehydrogenase [LDH], stage, and extranodal involvement, appears to be efficient as a prognostic index for PTCLs, at least in part and especially for certain PTCL subtypes. However, it is not so satisfactory for the two commonest PTCLs, PTCL not otherwise specified (PTCL/NOS) and angioimmunoblastic T-cell lymphoma (AITL), for which novel scores, possibly based on the biologic features of the tumors, have been explored. An Italian cooperative group proposed a revision of the IPI for PTCL unspecified (PTCL-U), the Prognostic Index for PTCL-U (PIT), which includes age, performance status, LDH, and bone marrow involvement. The PIT apparently offered some advantages, but they were not confirmed in subsequent studies. A clinical-biological score (the Bologna score) was then proposed, including tumor proliferation and clinical features (age, LDH, and performance status). This score appears promising and offers the intriguing advantage of integrating biological and clinical elements, but independent validation on a large series is still warranted. More recently, gene expression profiling has been used to identify novel molecular prognostic factors. In particular, inactivation of the NFκB pathway, high expression of proliferation-associated genes, and cytotoxic molecular phenotype seem to be associated with a worse outcome. So far, however, none of these indicators has been validated in an independent series. Finally, various reports have dealt specifically with the prognostication of NK-derived tumors, including nasal and nasal-type lymphomas. Both the IPI and dedicated models have turned out to be of prognostic relevance for these tumors. In conclusion, although the IPI is somewhat effective for PTCL prognostication, novel scores that are more refined and possibly disease-specific are warranted. The validation process for several models, including clinical-pathological and molecular models, is now ongoing.

CDKN1B/p27 expression in peripheral T cell lymphoma not otherwise specified

AIMS

Peripheral T cell lymphoma not otherwise specified (PTCL/NOS) is the commonest PTCL subtype. Recently, proliferation pathways have been found to be commonly altered in PTCL/NOS. CDKN1B/p27, a critical regulator of cell cycle and proliferation, has been suggested to be involved in T cell lymphomagenesis. This study aimed to evaluate the possible occurrence of CDKN1B/p27 aberrations in PTCL/NOS.

METHODS

CDKN1B/p27 expression at RNA and protein level by DNA and tissue microarrays, in 28 and 98 cases, respectively, was studied. Additionally, direct sequencing of CDKN1B in 81 PTCL/NOS was performed.

RESULTS

CDKN1B mRNA was similarly expressed in PTCL/NOS and normal T lymphocytes. In addition, structural abnormalities were not found; these included mutations and deletions in any exons, exon-intron junctions or regulatory regions. Furthermore, physiological expression of p27 in neoplastic cells was demonstrated by immunohistochemistry; this was mutually exclusive with Ki-67, as expected when the system is intact. Consistently, the expression of other molecules that are functionally related to CDKN1B/p27 in controlling cell cycle (including CCNE1) did not appear to be affected at either the mRNA or protein level. Finally, it was found that p27 expression was not significantly related with overall survival.

CONCLUSION

CDKN1B/p27 aberrations seem to be uncommon in PTCL/NOS pathogenesis.

Peripheral T cell lymphoma, not otherwise specified: the stuff of genes, dreams and therapies

Peripheral T cell lymphomas (PTCL) account for about 12% of lymphoid tumours worldwide. Almost half show such morphological and molecular variability as to hamper any further classification, and to justify their inclusion in a waste-basket category termed “not otherwise specified (NOS)”. The latter term is used for neoplasms with aggressive presentation, poor response to therapy and dismal prognosis. In contrast to B cell lymphomas, PTCL have been the subject of only a limited number of studies to elucidate their pathobiology and identify novel pharmacological approaches. Herewith, the authors revise the most recent contributions on the subject based on the experience they have gained in the extensive application of microarray technologies. PTCL/NOS are characterised by erratic expression of T cell associated antigens, including CD4 and CD52, which have recently been proposed as targets for ad hoc immunotherapies. PTCL/NOS also show variable Ki-67 marking, with rates >80% heralding a worse prognosis. Gene expression profiling studies have revealed that PTCL/NOS derive from activated T lymphocytes, more often of the CD4+ type, and bear a signature composed of 155 genes and related products that play a pivotal role in cell signalling transduction, proliferation, apoptosis and matrix remodelling. This observation seems to pave the way for the use of innovative drugs such as tyrosine kinase and histone deacetylase inhibitors whose efficacy has been proven in PTCL primary cell cultures. Gene expression profiling also allows better distinction of PTCL/NOS from angioimmunoblastic T cell lymphoma, the latter being characterised by follicular T helper lymphocyte derivation and CXCL13, PD1 and vascular endothelial growth factor expression.

Gene expression analysis of angioimmunoblastic lymphoma indicates derivation from T follicular helper cells and vascular endothelial growth factor deregulation

Angioimmunoblastic lymphoma (AILT) is the second most common subtype of peripheral T-cell lymphoma (PTCL) and is characterized by dismal prognosis. Thus far, only a few studies have dealt with its molecular pathogenesis. We performed gene expression profile (GEP) analysis of six AILT, six anaplastic large cell lymphomas (ALCL), 28 PTCL-unspecified (PTCL/U), and 20 samples of normal T lymphocytes (including CD4(+), CD8(+), and activated and resting subpopulations), aiming to (a) assess the relationship of AILT with other PTCLs, (b) establish the relationship between AILT and normal T-cell subsets, and (c) recognize the cellular programs deregulated in AILT possibly looking for novel potential therapeutic targets. First, we found that AILT and other PTCLs have rather similar GEP, possibly sharing common oncogenic pathways. Second, we found that AILTs are closer to activated CD4(+), rather than to resting or CD8(+) lymphocytes. Furthermore, we found that the molecular signature of follicular T helper cells was significantly overexpressed in AILT, reinforcing the idea that AILT may arise from such cellular counterpart. Finally, we identified several genes deregulated in AILT, including PDGFRA, REL, and VEGF. The expression of several molecules was then studied by immunohistochemistry on tissue microarrays containing 45 independent AILT cases. Notably, we found that the vascular endothelial growth factor (VEGF) was expressed not only by reactive cells, but also by neoplastic cells, and that nuclear factor-kappaB (NF-kappaB) activation is uncommon in AILT, as suggested by frequent exclusively cytoplasmic c-REL localization. Our study provides new relevant information on AILT biology and new candidates for possible therapeutic targets such as PDGFRA (platelet-derived growth factor alpha) and VEGF.