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Macon WR. Competing hematolymphoid classification schemes on deck. J Hematop 2022. [DOI: 10.1007/s12308-022-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Desai SH, Pederson L, LaPlant B, Mwangi R, Maurer M, Young JR, Macon WR, King RL, Wang Y, Cerhan JR, Feldman A, Inwards DJ, Micallef I, Johnston P, Porrata LF, Ansell SM, Habermann TM, Witzig TE, Nowakowski GS. PET2 response associated with survival in newly diagnosed diffuse large B-cell lymphoma: results of two independent prospective cohorts. Blood Cancer J 2022; 12:78. [PMID: 35504884 PMCID: PMC9065135 DOI: 10.1038/s41408-022-00649-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 03/14/2022] [Indexed: 02/07/2023] Open
Abstract
Studies evaluating Positron Emission Tomography scan after 2 cycles of chemotherapy (PET2) in newly diagnosed diffuse large B cell lymphoma (DLBCL) are heterogeneous in patient characteristics, treatments and have conflicting results. Here we report association of PET2 with outcomes in two large independent prospective cohorts of newly diagnosed DLBCL pts treated with two RCHOP-based regimens. The discovery cohort consisted of pts enrolled in single arm phase 2 MC078E study of lenalidomide with RCHOP (R2CHOP). The validation cohort consisted of RCHOP-treated pts from the Molecular Epidemiology Resource (MER) cohort. Pts who received 3-6 cycles of therapy and had PET2 were included in the study. Patients who progressed on PET2 were excluded. Revised response criteria 2007 were used to define PET2 response PET2 positive (PET2 + ) pts had inferior EFS [24-month EFS 45.5% vs 87.9%, HR 4.0, CI95 (2.1-7.9), p < 0.0001) with a trend towards lower OS [24-months OS 77% vs 94.8%, HR 2.0, CI95 (0.9-4.8), P = 0.1] than PET2 negative (PET2-) pts in MC078E cohort. PET2 + pts had an inferior EFS (24 month EFS 48.7% vs 81.6%, HR 2.9, CI95 2.0-4.2, p < 0.0001) and OS (24-month OS 68.6% vs 88.1%, HR 2.3, CI95: 1.5-3.5, p < 0.0001) in the MER cohort. These results were consistent regardless of age, sex and in the subgroup of advanced stage and high-risk international prognostic index (IPI). For MER, PET2 + pts also had higher odds of positive end of treatment PET (OR: 17.3 (CI95 7.9-37.7), p < 0.001). PET2 is an early predictor DLBCL pts at high risk of progression and death in two independent prospective cohorts. PET2-guided risk-adapted strategies may improve outcomes, and should be explored in clinical trials.
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Affiliation(s)
- Sanjal H. Desai
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Levi Pederson
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Betsy LaPlant
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Raphael Mwangi
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Matthew Maurer
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Jason R. Young
- grid.417467.70000 0004 0443 9942Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Jacksonville, FL USA
| | - William R. Macon
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Rebecca L. King
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Yucai Wang
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - James R. Cerhan
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - Andrew Feldman
- grid.66875.3a0000 0004 0459 167XDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN USA
| | - David J. Inwards
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Ivana Micallef
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Patrick Johnston
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Luis F. Porrata
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Stephen M. Ansell
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Thomas M. Habermann
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Thomas E. Witzig
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Grzegorz S. Nowakowski
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
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Ravindran A, Macon WR, Rech KL. Histiocyte-rich pseudotumor - a post-chemotherapy radiologic dilemma. J Hematop 2022; 15:45-46. [PMID: 38358600 DOI: 10.1007/s12308-022-00482-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/24/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Aishwarya Ravindran
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Karen L Rech
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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King RL, Khurana A, Mwangi R, Fama A, Ristow KM, Maurer MJ, Macon WR, Ansell SM, Bennani NN, Kudva YC, Walker RC, Watt KD, Schwab TR, Kushwaha SS, Cerhan JR, Habermann TM. Clinicopathologic Characteristics, Treatment, and Outcomes of Post-transplant Lymphoproliferative Disorders: A Single-institution Experience Using 2017 WHO Diagnostic Criteria. Hemasphere 2021; 5:e640. [PMID: 34514344 PMCID: PMC8423401 DOI: 10.1097/hs9.0000000000000640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/09/2021] [Indexed: 12/31/2022] Open
Abstract
The World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues (WHO 2017) included updated criteria for diagnosis and classification of post-transplant lymphoproliferative disorders (PTLDs). This study evaluated the clinicopathologic spectrum using WHO 2017 criteria and adult PTLD patients' outcomes over 30 years between 1987 and 2017 at Mayo Clinic (Rochester, MN). Patients were retrospectively reviewed for clinical features, outcomes, and diagnostic pathology material and classified based on WHO 2017 criteria. A total of 227 patients were diagnosed with PTLD, with a median time from transplant to PTLD of 45 months. PTLD occurred >1 year after transplant in 149 (66%) patients. Monomorphic PTLD was the most common subtype (173, 76%), with diffuse large B cell lymphoma as the commonest morphology (n = 137). Epstein-Barr virus was positive in 61% of total cases and 90% of PTLD that developed within 1 year from transplant. The median event-free survival (EFS) and overall survival for the entire cohort were 21 months (95% confidence interval [CI]: 9-35) and 82 months (95% CI: 39-115), respectively. The EFS or overall survival was not impacted by Epstein-Barr virus status but differed based on WHO subtypes and year of diagnosis. Management changed over time with increased use of rituximab or chemotherapy + immunosuppression reduction as initial therapy. When compared to the matched general population and de novo diffuse large B cell lymphoma, patients not achieving EFS 24 status (no progression/treatment or death within 24 mo of diagnosis) had a worse standardized mortality ratio 16.75 (95% CI: 13.91-20) versus SMR 1.72 (95% CI: 1.26-2.28) in those who achieved EFS24. Cause of death was mostly attributed to non-lymphoma-related causes in those achieving EFS 24.
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Affiliation(s)
- Rebecca L. King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Arushi Khurana
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Angelo Fama
- Hematology, Azienda Unità Sanitaria Locale di Reggio Emilia - IRCCS, Italy
| | - Kay M. Ristow
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew J. Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - William R. Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - N. Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yogish C. Kudva
- Department of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
| | - Randall C. Walker
- Department of Infectious Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Kymberly D. Watt
- Division of Gastroenterology/Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas R. Schwab
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Sudhir S. Kushwaha
- 9Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - James R. Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
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Arushi Khurana, Mwangi R, Ansell SM, Habermann TM, Cerhan JR, Strouse C, Link BK, Wang Y, King RL, Macon WR, Villasboas JC, Witzig TE, Maurer MJ, Nowakowski GS. Patterns of therapy initiation during the first decade for patients with follicular lymphoma who were observed at diagnosis in the rituximab era. Blood Cancer J 2021; 11:133. [PMID: 34274939 PMCID: PMC8286048 DOI: 10.1038/s41408-021-00525-0] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022] Open
Abstract
Immediate treatment for asymptomatic, low-tumor burden follicular lymphoma (FL) has not shown an overall survival benefit over "watch and wait" (W/W) strategy. We estimated incidence of treatment initiation at specific time points and assessed its association with the presence of any criteria such as GELF, BNLI, GITMO at diagnosis. FL patients managed by W/W strategy were identified from the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma SPORE between 2002 and 2015. Cumulative incidence estimates of treatment initiation were calculated using transformation (as the first event) and death as competing risks. 401 FL patients were identified on W/W strategy. At a median follow-up of 8 years, 256 (64%) initiated treatment. For patients on the W/W strategy for 5 years, the likelihood of treatment initiation in the next 5 years was 12% compared to 43% at diagnosis unlike transformation rates which remained steady. Patients with any of popular treatment criteria at diagnosis did not have increased therapy initiation rates (44% vs. 42%) during the first 5 years or lymphoma-related death rates at 10 years (6% vs. 7%). Identifying biological differences in patients with early vs. late or no progression is a critical next step in understanding outcomes in W/W patients.
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Affiliation(s)
| | - Raphael Mwangi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - James R Cerhan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Brian K Link
- Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - Yucai Wang
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Matthew J Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Macon WR. SARS-CoV-2/COVID-19 pandemic produces a new paradigm for international hematopathology meetings. J Hematop 2021; 14:95. [PMID: 34025816 PMCID: PMC8126508 DOI: 10.1007/s12308-021-00456-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Nowakowski GS, Hong F, Scott DW, Macon WR, King RL, Habermann TM, Wagner-Johnston N, Casulo C, Wade JL, Nagargoje GG, Reynolds CM, Cohen JB, Khan N, Amengual JE, Richards KL, Little RF, Leonard JP, Friedberg JW, Kostakoglu L, Kahl BS, Witzig TE. Addition of Lenalidomide to R-CHOP Improves Outcomes in Newly Diagnosed Diffuse Large B-Cell Lymphoma in a Randomized Phase II US Intergroup Study ECOG-ACRIN E1412. J Clin Oncol 2021; 39:1329-1338. [PMID: 33555941 PMCID: PMC8078264 DOI: 10.1200/jco.20.01375] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/08/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Lenalidomide combined with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) (R2CHOP) in untreated diffuse large B-cell lymphoma (DLBCL) has shown promising activity, particularly in the activated B-cell-like (ABC) subtype. Eastern Cooperative Oncology Group (ECOG)-ACRIN trial E1412 was a randomized phase II study comparing R2CHOP versus R-CHOP in untreated DLBCL. PATIENTS AND METHODS Patients with newly diagnosed DLBCL, stage II bulky-IV disease, International Prognostic Index (IPI) ≥ 2, and ECOG performance status ≤ 2 were eligible and randomly assigned 1:1 to R2CHOP versus R-CHOP for six cycles. Tumors were analyzed using the NanoString Lymph2Cx for cell of origin. The primary end point was progression-free survival (PFS) in all patients with the co-primary end point of PFS in ABC-DLBCL. Secondary end points included overall response rate (ORR), complete response (CR) rate, and overall survival (OS). RESULTS Three hundred forty-nine patients were enrolled; 280 patients (145 R2CHOP and 135 R-CHOP) were evaluable: 94 were ABC-DLBCL, 122 germinal center B-cell-like-DLBCL, 18 unclassifiable, and 46 unknowns. Baseline characteristics were well-balanced between arms, and the median age was 66 (range, 24-92); 70% of patients had stage IV disease; 34%, 43%, and 24% had IPI 2, 3, and 4 or 5, respectively. Myelosuppression was more common in the R2CHOP arm. The ORR and CR rate were 92% and 68% in R-CHOP and 97% (P = .06) and 73% (P = .43) in the R2CHOP arm, respectively. The median follow-up was 3.0 years; R2CHOP was associated with a 34% reduction in risk of progression or death versus R-CHOP (hazard ratio [HR], 0.66 95% CI, 0.43 to 1.01) and 3-year PFS of 73% versus 61%, one-sided P = .03, and an improvement in OS (83% and 75% at 3 years; HR, 0.67; one-sided P = .05). The PFS HR for R2CHOP was 0.67 for ABC-DLBCL, one-sided P = .1. CONCLUSION In this signal-seeking study, the addition of lenalidomide to R-CHOP (R2CHOP) improved outcomes in newly diagnosed DLBCL including patients with ABC-DLBCL.
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Affiliation(s)
| | - Fangxin Hong
- Department of Data Sciences, Dana Farber Cancer Institute, Boston, MA
| | - David W. Scott
- British Columbia Cancer Center for Lymphoid Cancer, Vancouver, Canada
| | | | | | | | | | | | | | | | | | | | - Nadia Khan
- Fox Case Cancer Center, Philadelphia, PA
| | | | | | | | | | | | | | - Brad S. Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO
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Liebow M, Larson MC, Thompson CA, Nowakowski GS, Call TG, Macon WR, Kay NE, Habermann TM, Slager SL, Cerhan JR. Aspirin and other nonsteroidal anti-inflammatory drugs, statins and risk of non-Hodgkin lymphoma. Int J Cancer 2021; 149:535-545. [PMID: 33644854 DOI: 10.1002/ijc.33541] [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] [Received: 10/09/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 12/21/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) and statin drugs may protect against the development of non-Hodgkin lymphoma (NHL), but data are limited, particularly for NHL subtypes. Furthermore, some in vitro, animal and epidemiologic data suggest there may be a synergistic effect of these two agents, but there has been no test of this hypothesis in NHL. We evaluated the self-reported use of NSAIDs and statins in a clinic-based study of 1703 NHL patients and 2199 frequency-matched controls. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for potential confounding variables. We observed an inverse association of regular use of low-dose aspirin with risk of NHL (OR = 0.82; 95% CI 0.70-0.96) that was stronger with longer duration of use (P < .01). There were no associations for use of regular or extra-strength aspirin, ibuprofen, other NSAIDs, statins or other cholesterol-lowering drugs with NHL risk, while an inverse association with COX-2 inhibitors was equivocal. There was also no interaction of low-dose aspirin and statins on NHL risk. Inverse associations of similar magnitude to all NHL were observed for regular use of low-dose aspirin with diffuse large B-cell, follicular, marginal zone and all other lymphomas, although not all associations were statistically significant. In conclusion, low-dose aspirin but not regular/extra strength aspirin, other NSAIDs or statin use was associated with lower risk of NHL. Beyond the potential for the primary prevention of NHL, these data also point to a role of anti-platelet or other effects of low-dose aspirin in lymphomagenesis that warrant follow-up.
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Affiliation(s)
- Mark Liebow
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Melissa C Larson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie A Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Grzegorz S Nowakowski
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy G Call
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William R Macon
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Neil E Kay
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M Habermann
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Susan L Slager
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James R Cerhan
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Macon WR. A radiology survey and sub-sub-specialization in hematopathology. J Hematop 2021. [DOI: 10.1007/s12308-021-00444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hartert KT, Wenzl K, Krull JE, Manske M, Sarangi V, Asmann Y, Larson MC, Maurer MJ, Slager S, Macon WR, King RL, Feldman AL, Gandhi AK, Link BK, Habermann TM, Yang ZZ, Ansell SM, Cerhan JR, Witzig TE, Nowakowski GS, Novak AJ. Targeting of inflammatory pathways with R2CHOP in high-risk DLBCL. Leukemia 2021; 35:522-533. [PMID: 32139889 PMCID: PMC7483252 DOI: 10.1038/s41375-020-0766-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/17/2020] [Accepted: 02/12/2020] [Indexed: 02/06/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma, and front line therapies have not improved overall outcomes since the advent of immunochemotherapy. By pairing DNA and gene expression data with clinical response data, we identified a high-risk subset of non-GCB DLBCL patients characterized by genomic alterations and expression signatures capable of sustaining an inflammatory environment. These mutational alterations (PIM1, SPEN, and MYD88 [L265P]) and expression signatures (NF-κB, IRF4, and JAK-STAT engagement) were associated with proliferative signaling, and were found to be enriched in patients treated with RCHOP that experienced unfavorable outcomes. However, patients with these high-risk mutations had more favorable outcomes when the immunomodulatory agent lenalidomide was added to RCHOP (R2CHOP). We are the first to report the genomic validation of a high-risk phenotype with a preferential response towards R2CHOP therapy in non-GCB DLBCL patients. These conclusions could be translated to a clinical setting to identify the ~38% of non-GCB patients that could be considered high-risk, and would benefit from alternative therapies to standard RCHOP based on personalized genomic data.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Female
- Follow-Up Studies
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Lenalidomide/administration & dosage
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prednisone/administration & dosage
- Prognosis
- Retrospective Studies
- Rituximab/administration & dosage
- Survival Rate
- Vincristine/administration & dosage
- Young Adult
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Affiliation(s)
| | - Kerstin Wenzl
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Yan Asmann
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Melissa C Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Susan Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L King
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Brian K Link
- Division of Hematology, Oncology, and Bone & Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | | | | | | | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Anne J Novak
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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Habermann TM, Khurana A, Lentz R, Schmitz JJ, von Bormann AG, Young JR, Hunt CH, Christofferson SN, Nowakowski GS, McCullough KB, Horna P, Wood AJ, Macon WR, Kurtin PJ, Lester SC, Stafford SL, Chamarthy U, Khan F, Ansell SM, King RL. Analysis and impact of a multidisciplinary lymphoma virtual tumor board. Leuk Lymphoma 2020; 61:3351-3359. [PMID: 32967496 DOI: 10.1080/10428194.2020.1817432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim is to prospectively evaluate the impact of a multidisciplinary lymphoma virtual tumor board. The utility of multi-site interactive lymphoma-specific tumor boards has not been reported. The Mayo Clinic Lymphoma Tumor Board is a component of the International Mayo Clinic Care Network (MCCN). The format includes the clinical case presentation, presentation of radiology and hematopathology findings by the appropriate subspecialist, proposed treatment options, review of the literature pertinent to the case, pharmacy contributions, and discussion followed by recommendations. Three hundred and nine consecutive highly selected real-time cases with a diagnosis of lymphoma were presented at the Mayo Clinic Lymphoma Tumor Board from January 2014 to June 2018 and decisions were prospectively tracked to assess its impact on the treatment decisions. A total of 309 cases were prospectively evaluated. One hundred and forty (45.3%) cases had some changes made or recommended. The total changes suggested were 179, as some cases had more than one recommendation. There were 93 (30%) clinical management recommendations, 45 (14.6%) additional testing recommendations, 29 (9.4%) pathology changes, and 6 (1.9%) radiology changes. In an electronic evaluation process, 93% of the responders reported an improvement in knowledge and competence, and 100% recommended no change in format of the board. A multidisciplinary lymphoma tumor board approach was found to have a meaningful impact on lymphoma patients while enhancing interdisciplinary interactions and education for multiple levels of the clinical care team.
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Affiliation(s)
- Thomas M Habermann
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arushi Khurana
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ruth Lentz
- Division of Hematology, Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jason R Young
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Pedro Horna
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Adam J Wood
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Paul J Kurtin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Scott L Stafford
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Ushrasree Chamarthy
- Department of Medical Oncology and Hematology, Sparrow Cancer Center, Lansing, MI, USA
| | - Faraz Khan
- Department of Hematology-Oncology, American Hospital Dubai, Dubai, United Arab Emirates
| | - Stephen M Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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St-Pierre F, Broski SM, LaPlant BR, Ristow K, Macon WR, Habermann TM, Witzig TE. Bone involvement on PET/CT predicts event-free survival in follicular lymphoma Grade 3B. Br J Haematol 2020; 191:e41-e43. [PMID: 33460052 DOI: 10.1111/bjh.16974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Stephen M Broski
- Department of Radiology, Division of Nuclear Radiology, Mayo Clinic, Rochester, MN, USA
| | - Betsy R LaPlant
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kay Ristow
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Thomas M Habermann
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Thomas E Witzig
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Salama ME, Macon WR, Pantanowitz L. Is the Time Right to Start Using Digital Pathology and Artificial Intelligence for the Diagnosis of Lymphoma? J Pathol Inform 2020; 11:16. [PMID: 33033653 PMCID: PMC7513776 DOI: 10.4103/jpi.jpi_16_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
| | | | - Liron Pantanowitz
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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St-Pierre F, Broski SM, LaPlant B, Ristow K, Macon WR, Habermann TM, Witzig TE. Association between bone involvement on PET/CT and event free survival (EFS) in follicular lymphoma (FL) grade 3b. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e20068] [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
e20068 Background: FL grade 3B (FL3B) is an aggressive subtype of FL with a distinct morphologic, cytogenetic and immunohistochemical profile that is associated with higher mortality compared to other subtypes of FL. FL3B is a rare disease, and data regarding its prognostication beyond grading is lacking. Recent data suggests that spleen and extranodal (EN) involvement on PET/CT predict early clinical failure in FL grades 1-3A[1]. We aimed to determine the incidence of spleen and EN involvement on PET/CT in FL3B, and whether these can predict EFS. Methods: Patients with untreated FL3B diagnosed between 2003-2016, with available pre-treatment PET/CT, were identified using the Mayo Clinic Lymphoma Database and the University of Iowa/Mayo Clinic Lymphoma SPORE database. 27 patients were included in this analysis. All but two patients received treatment with immunochemotherapy. Associations with outcomes were assessed using EFS, defined as disease progression, relapse, transformation, or death. Results: 11/27 (40.7%) of patients had EN involvement on PET/CT. The most common EN site was bone, in 8/27 (29.5%) of patients. Soft tissue involvement was present in 4/27 (14.8%) of patients. Liver, brain, and endometrial involvement were each noted once. 11/27 (40.7%) of patients had spleen involvement on PET/CT. Presence of bone involvement as detected on PET/CT was associated with lower EFS (p = 0.02). EN involvement was associated with a trend toward a lower EFS but statistical significance was not reached likely secondary to low numbers in this cohort. Results in the table are compared to results obtained from our analysis in patients with FL grade 1-3A[1]. Conclusions: Bone involvement on pre-treatment PET/CT in FL3B was associated with early clinical failure in this small cohort of 27 patients. EN involvement at diagnosis may also be associated with poorer outcomes. These findings are similar to our analysis of a large (n = 613) cohort of patients with FL grade 1-3A. These findings may aid in the prognostication of patients with newly diagnosed FL3B, to guide therapy in select higher risk patients. [Table: see text]
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18
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Guerra-Bauman F, LaPlant B, Macon WR, Witzig TE, Farooq U, Nowakowski GS, Feldman T. Phase I/II study of R-ICE (rituximab-ifosfamide-carboplatin-etoposide) with lenalidomide (R2-ICE) in patients with first-relapse/primary refractory diffuse large B-cell lymphoma (DLBCL) in academic and community cancer research united (ACCRU) network. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps8073] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Abstract
TPS8073 Background: Response rates to salvage immunochemotherapy in patients with DLBCL relapsing after or refractory (R/R DLBCL) to front line therapy remain unsatisfactory. Lenalidomide (Len) has significant single agent activity in relapsed/refractory DLBCL. The addition of lenalidomide (Len) days 1-7 to rituximab plus ifosfamide-carboplatin-etoposide (RICE) was shown to be feasible with promising efficacy in phase 1b study (Feldman T, et al. BJH, 2014). We developed phase I/II study to evaluate the safety and efficacy of the addition of Len (extended to 14 day schedule) to RICE (R2-ICE) for R/R-DLBCL patients who are candidates for stem cell transplant. Methods: The phase I portion was designed to determine the maximally tolerated dose Len in combination with RICE using the standard cohort 3+3 design. The escalation dose levels were 15 mg and 20 mg daily x 14 days. Prophylactic aspirin and growth factor support is mandatory. After 2 cycles of therapy response is evaluated with a PET/CT scan; the responding patients are eligible for 1-2 additional cycles of R2ICE as a bridging before HDC/SCT. The estimated overall response rate for two cycles of R-ICE in R/R DLBCL to RCHOP was estimated to be approximate 45%. We hypothesize that the addition of lenalidomide in the relapse setting could increase the overall response rate by approximately 20%. The one-stage design with an interim analysis being utilized in phase 2 requires 45 evaluable patients (one sided alpha = 0.09, power 90%). For Phase I, all types of B-cell lymphomas were eligible. For phase II portion only DLBCL patients are eligible per central pathology review. Other eligibility criteria include: received one line of previous anti-lymphoma therapy, ≥ 2 weeks from completion of prior anti-lymphoma therapy, candidate for HDC and SCT, adequate organ (creatinine clearance ≥ 60ml/min by Cockcroft-, total bilirubin ≤ 2 × ULN) and bone marrow function (ANC) ≥1500/mm3; platelet count ≥75,000/mm3). The use of steroids and/or rituximab up to 1 week prior to registration for management of symptoms is allowed. 9 patients cleared phase 1 without DLT and dose of 20 mg days 1 -14 was recommend for phase 2 part (RP2D) of the study. The phase 2 study passed interim futility analysis and accrual continues. Correlatives include cell of origin by Nanostring, Myc/bcl2 expression and by FISH and minimal residual disease. PET scans are centrally reviewed including metabolic tumor volume. Clinical trial information: NCT02628405 .
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Affiliation(s)
| | | | | | | | - Umar Farooq
- University of Iowa Carver College of Medicine, Iowa City, IA
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Gile J, Ruan G, Abeykoon J, McMahon MM, Macon WR, Witzig TE. Hypomagnesemia is associated with an increased risk of early clinical failure in patients with Burkitt lymphoma. Leuk Lymphoma 2020; 61:2274-2276. [PMID: 32364025 DOI: 10.1080/10428194.2020.1759056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jennifer Gile
- Division of Hematology Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gordon Ruan
- Division of Hematology Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jithma Abeykoon
- Division of Hematology Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Molly McMahon
- Division of Endocrinology and Metabolism Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas E Witzig
- Division of Hematology Department of Medicine, Mayo Clinic, Rochester, MN, USA
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20
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St-Pierre F, Broski SM, LaPlant BR, Maurer MJ, Ristow K, Thanarajasingam G, Macon WR, Habermann TM, Witzig TE. Fluorodeoxyglucose-Positron Emission Tomography Predicts Bone Marrow Involvement in the Staging of Follicular Lymphoma. Oncologist 2020; 25:689-695. [PMID: 32319706 DOI: 10.1634/theoncologist.2019-0952] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/30/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Standard bone marrow biopsy (BMB) and bone involvement with follicular lymphoma (FL) on positron emission tomography (PET)/computed tomography (CT) both predict early clinical failure in FL. The key clinical question is whether PET/CT findings can obviate the need for BMB. The goal of this study was to determine the value of PET/CT in determining bone involvement in FL, using posterior iliac crest BMB as the gold standard. MATERIALS AND METHODS A total of 548 patients with newly diagnosed grade 1-3A FL were included. The presence, pattern, and location of bone involvement, spleen involvement, and standardized uptake values (SUVs) in the L3 vertebral body were recorded for all patients and compared with the BMB report. RESULTS Excluding patients with focal bone lesions on PET/CT, the sensitivity and specificity of PET/CT in detecting bone or marrow involvement, compared with BMB, were 53% and 88%, respectively. The sensitivity and specificity of spleen involvement on PET/CT in predicting a positive BMB were 55% and 86%, respectively. An L3 SUVmax of less than 2.0 resulted in a negative predictive value (NPV) of 96% for marrow involvement on BMB; an L3 SUVmean below 1.4 resulted in an NPV of 100%. CONCLUSION In newly diagnosed FL, PET/CT-detected bone and splenic involvement is highly specific for a positive BMB, and very low SUV values (<2.0 SUVmax and < 1.4 SUVmean ) in the lumbar spine have a high NPV for a negative BMB. Routine BMB may be obviated in these patients. BMB remains necessary to definitively exclude bone marrow involvement in a large majority of patients with a negative PET. IMPLICATIONS FOR PRACTICE Predicting early clinical failure in follicular lymphoma (FL) is important but difficult. Bone marrow involvement by FL is associated with early clinical failure, and determining this involvement is a key component of the initial staging. This study highlights that in certain patients, positron emission tomography/computed tomography is sufficient in determining bone or marrow involvement, without the need for a confirmatory bone marrow biopsy (BMB). An algorithm is provided based on these findings to help clinicians determine which patients would benefit from BMB and when it can be avoided.
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Affiliation(s)
| | - Stephen M Broski
- Department of Radiology, Division of Nuclear Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Betsy R LaPlant
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Kay Ristow
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gita Thanarajasingam
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - William R Macon
- Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M Habermann
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas E Witzig
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
PURPOSE We aimed to describe the clinical and histologic findings in a few enucleation cases with intraocular lymphoma. METHODS Retrospective review of pathology files from a 22-year period identified cases with intraocular lymphoma among all enucleation specimens. Patient demographics, clinical findings, laboratory results, radiographic studies, and indication for enucleation were abstracted from electronic health records; slides were reviewed. RESULTS Four patients (three women and one man; age range, sixth through eighth decades of life) underwent enucleation with a final diagnosis of intraocular lymphoma. Two patients with primary vitreoretinal large B-cell lymphomas had been treated for refractory uveitis. Specimens showed retinal and subretinal infiltrates by atypical large B-lymphocytes and rare neoplastic cells in the vitreous. The remaining two patients had systemic lymphoproliferative disorders. One patient had chronic lymphocytic leukemia and floaters in his eye; vitreoretinal lymphoma developed, consistent with intraocular Richter transformation. The other had diffuse large B-cell lymphoma in remission; however, blurred vision developed, she was treated for panuveitis without improvement, and was later found to have ocular involvement by diffuse large B-cell lymphoma. CONCLUSION Our series details the unusual circumstances when an eye is removed for intraocular lymphoma. Different patterns of ocular tissue involvement were observed when we compared primary and secondary lymphomas.
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Affiliation(s)
- Sam T Albadri
- Departments of Laboratory Medicine and Pathology; and
| | | | | | | | - Diva R Salomao
- Departments of Laboratory Medicine and Pathology; and
- Ophthalmology, Mayo Clinic, Rochester, Minnesota
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22
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Blessing MM, Blackburn PR, Krishnan C, Harrod VL, Barr Fritcher EG, Zysk CD, Jackson RA, Milosevic D, Nair AA, Davila JI, Balcom JR, Jenkins RB, Halling KC, Kipp BR, Nageswara Rao AA, Laack NN, Daniels DJ, Macon WR, Ida CM. Desmoplastic Infantile Ganglioglioma: A MAPK Pathway-Driven and Microglia/Macrophage-Rich Neuroepithelial Tumor. J Neuropathol Exp Neurol 2019; 78:1011-1021. [DOI: 10.1093/jnen/nlz086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/29/2019] [Indexed: 12/11/2022] Open
Abstract
Abstract
MAPK pathway activation has been recurrently observed in desmoplastic infantile ganglioglioma/astrocytoma (DIG/DIA) with reported disproportionally low mutation allele frequencies relative to the apparent high tumor content, suggesting that MAPK pathway alterations may be subclonal. We sought to expand the number of molecularly profiled cases and investigate if tumor cell composition could account for the observed low mutation allele frequencies. Molecular (targeted neuro-oncology next-generation sequencing/RNA sequencing and OncoScan microarray) and immunohistochemical (CD68-PGM1/CD163/CD14/CD11c/lysozyme/CD3/CD20/CD34/PD-L1) studies were performed in 7 DIG. Activating MAPK pathway alterations were identified in 4 (57%) cases: 3 had a BRAF mutation (V600E/V600D/V600_W604delinsDQTDG, at 8%–27% variant allele frequency) and 1 showed a TPM3-NTRK1 fusion. Copy number changes were infrequent and nonrecurrent. All tumors had at least 30% of cells morphologically and immunophenotypically consistent with microglial/macrophage lineage. Two subtotally resected tumors regrew; 1 was re-excised and received adjuvant treatment (chemotherapy/targeted therapy), with clinical response to targeted therapy only. Even with residual tumor, all patients are alive (median follow-up, 83 months; 19–139). This study further supports DIG as another MAPK pathway-driven neuroepithelial tumor, thus expanding potential treatment options for tumors not amenable to surgical cure, and suggests that DIG is a microglia/macrophage-rich neuroepithelial tumor with frequent low driver mutation allele frequencies.
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Affiliation(s)
- Melissa M Blessing
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Patrick R Blackburn
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Chandra Krishnan
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Virginia L Harrod
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Emily G Barr Fritcher
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Christopher D Zysk
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Rory A Jackson
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Dragana Milosevic
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Asha A Nair
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Jaime I Davila
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Jessica R Balcom
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Robert B Jenkins
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Kevin C Halling
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Benjamin R Kipp
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Amulya A Nageswara Rao
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Nadia N Laack
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - David J Daniels
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - William R Macon
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
| | - Cristiane M Ida
- Departments of Laboratory Medicine and Pathology, Health Sciences Research, Pediatrics, Radiation Oncology, and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and Departments of Pathology and Neuro-Oncology, Dell Children’s Medical Center, Austin, Texas
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Skala SL, Ye JC, Stumph J, Macon WR, Quinones FR, Khachaturov V, Ketterling RP, Dewar R. Combined Tumors in Hematolymphoid Neoplasms: Case Series of Histiocytic and Langerhans Cell Sarcomas Arising From Low-Grade B-Cell Lymphoma. Clin Pathol 2019; 12:2632010X19878410. [PMID: 31633108 PMCID: PMC6769199 DOI: 10.1177/2632010x19878410] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
Abstract
We report an index case of histiocytic sarcoma arising in a 70-year-old patient with long-standing chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The patient presented in 2017 with painful, enlarging swelling of the left neck. He had remote history of cutaneous squamous cell carcinoma with no sign of recurrence, and his CLL/SLL was thought to be in remission. Computed tomography showed mild splenomegaly and multifocal lymphadenopathy including a 3-cm left neck mass. Biopsy of the left neck mass showed CLL/SLL with associated histiocytic sarcoma. Flow cytometry demonstrated a B cell neoplasm with CLL/SLL phenotype. Despite radiation therapy, he expired 3 months after presentation. Two similar cases (CLL/SLL and histiocytic sarcoma, follicular lymphoma and Langerhans cell sarcoma) from another institution are also illustrated. The pathological features of combined tumors in lymphoid neoplasms, a general framework to the work-up to determine interrelatedness of tumor components, and the clinical relevance are discussed.
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Affiliation(s)
- Stephanie L Skala
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jing C Ye
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Stumph
- Michigan Pathology Specialists, Spectrum Health, Grand Rapids, MI, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Vadim Khachaturov
- Michigan Pathology Specialists, Spectrum Health, Grand Rapids, MI, USA
| | - Rhett P Ketterling
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rajan Dewar
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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24
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Macon WR. SOLAHP: a fledgling organization rapidly taking flight. J Hematop 2019. [DOI: 10.1007/s12308-019-00370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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25
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St‐Pierre F, Broski SM, LaPlant BR, Ristow K, Maurer MJ, Macon WR, Habermann TM, Ansell SM, Thompson CA, Micallef INM, Nowakowski GS, Witzig TE. Detection of extranodal and spleen involvement by FDG-PET imaging predicts adverse survival in untreated follicular lymphoma. Am J Hematol 2019; 94:786-793. [PMID: 31006875 DOI: 10.1002/ajh.25493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 01/03/2023]
Abstract
Predicting early clinical failure in patients with untreated follicular lymphoma (FL) is important but difficult. This study aimed to determine the incidence and patterns of extranodal (EN) and spleen disease using PET/CT, and assess their utility in predicting early clinical failure. PET/CT images from 613 cases of untreated FL (2003-2016) were reviewed. The location and number of EN sites, patterns of bone involvement, and splenic involvement were recorded. Outcomes were assessed using event-free survival (EFS), overall survival (OS), and early clinical failure at 24 months (EFS24). So, 49% (301/613) of patients had PET/CT-detected EN involvement, and 28% (171/613) had spleen involvement. The presence of ≥2 EN sites, spleen, bone or soft tissue involvement all predicted failure to achieve EFS24. Presence of ≥2 EN sites and bone involvement pattern were also predictive of OS in a univariate analysis. In a multivariate analysis with FLIPI-2 factors, spleen involvement, pattern of bone involvement, and soft tissue involvement independently predicted a lower EFS (HR 1.49 (1.11-2.00), P = .007; HR 1.71 (1.10-2.65), P = .017; and HR 1.67 (1.06-2.62), P = .026, respectively). When the multivariate analysis was performed using PRIMA-PI factors (marrow and B2M), the number of EN sites was an independent prognostic factor for inferior OS (HR 2.28; P = .05). Baseline PET/CT identifies EN involvement in nearly half of patients with untreated FL. The presence of ≥2 EN sites, bone, soft tissue, or splenic involvement predicts early clinical failure. These results, when combined with other factors, may better identify high-risk patients and guide therapy.
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Affiliation(s)
| | - Stephen M. Broski
- Department of Radiology, Division of Nuclear RadiologyMayo Clinic Rochester Minnesota
| | - Betsy R. LaPlant
- Department of Health Sciences Research, Division of Biomedical Statistics and InformaticsMayo Clinic Rochester Minnesota
| | - Kay Ristow
- Department of Medicine, Division of HematologyMayo Clinic Rochester Minnesota
| | - Matthew J. Maurer
- Department of Health Sciences Research, Division of Biomedical Statistics and InformaticsMayo Clinic Rochester Minnesota
| | - William R. Macon
- Department of Laboratory MedicineMayo Clinic Rochester Minnesota
| | - Thomas M. Habermann
- Department of Medicine, Division of HematologyMayo Clinic Rochester Minnesota
| | - Stephen M. Ansell
- Department of Medicine, Division of HematologyMayo Clinic Rochester Minnesota
| | - Carrie A. Thompson
- Department of Medicine, Division of HematologyMayo Clinic Rochester Minnesota
| | | | | | - Thomas E. Witzig
- Department of Medicine, Division of HematologyMayo Clinic Rochester Minnesota
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Peterson JF, Pitel BA, Smoley SA, Vasmatzis G, Smadbeck JB, Greipp PT, Ketterling RP, Macon WR, Baughn LB. Elucidating a false-negative MYC break-apart fluorescence in situ hybridization probe study by next-generation sequencing in a patient with high-grade B-cell lymphoma with IGH/MYC and IGH/BCL2 rearrangements. Cold Spring Harb Mol Case Stud 2019; 5:a004077. [PMID: 31160360 PMCID: PMC6549546 DOI: 10.1101/mcs.a004077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/18/2019] [Accepted: 03/27/2019] [Indexed: 12/15/2022] Open
Abstract
The identification of MYC rearrangements in several mature B-cell neoplasms is critical for diagnostic and prognostic purposes. Commercially available fluorescence in situ hybridization (FISH) probe sets, including IGH/MYC dual-color dual-fusion (D-FISH) and MYC break-apart probes (BAPs), serve as the primary methodology utilized to detect MYC rearrangements. However, performing either IGH/MYC D-FISH or MYC BAP FISH studies in isolation has been reported to result in false-negative results because of the complex nature of 8q24 rearrangements involving the MYC gene region. We report a 60-yr-old male with newly diagnosed high-grade B-cell lymphoma with a negative MYC BAP study, but with positive BCL2 and BCL6 BAP studies. Per our current laboratory algorithm to concurrently interrogate the MYC gene region with both MYC BAP and IGH/MYC D-FISH probe sets, we performed IGH/MYC D-FISH studies and detected an IGH/MYC fusion. To further characterize the discrepant MYC results obtained by FISH, a next-generation sequencing strategy, mate-pair sequencing (MPseq), was performed and revealed a small insertion (∼200 kb) of the IGH locus downstream from the MYC gene that was undetectable by MYC BAP studies. This case highlights the importance of utilizing both IGH/MYC D-FISH and MYC BAP sets to detect potential cryptic MYC rearrangements and also demonstrates the power of MPseq to characterize complex structural rearrangements and copy-number abnormalities unappreciable by FISH.
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Affiliation(s)
- Jess F Peterson
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Beth A Pitel
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Stephanie A Smoley
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - George Vasmatzis
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - James B Smadbeck
- Center for Individualized Medicine-Biomarker Discovery, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Patricia T Greipp
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Rhett P Ketterling
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - William R Macon
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | - Linda B Baughn
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
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St-Pierre F, Broski SM, LaPlant B, Ristow K, Maurer MJ, Macon WR, Habermann TM, Ansell SM, Thompson CA, Micallef INM, Nowakowski GS, Witzig TE. Extranodal (EN) and spleen disease by FDG-PET/CT is associated with early clinical failure in untreated follicular lymphoma (FL). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7554] [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
7554 Background: Predicting early clinical failure in patients with untreated FL is important but difficult. Lymphoma involvement of EN sites is better detected by FDG-PET/CT than CT alone, but PET parameters are not part of the usual predictive indices. We aimed to determine the incidence and patterns of spleen and EN disease using PET/CT, and learn if they are useful in predicting early clinical failure. Methods: PET/CT images from 613 cases of newly diagnosed FL between 2003 – 2016 were retrospectively reviewed. The location, pattern, and number of EN sites, as well as splenic involvement, were recorded. Associations with outcomes were assessed using event-free survival (EFS) and overall survival (OS). Results: 49% (301/613) of patients had PET/CT-detected EN involvement, and 28% (171/613) had spleen involvement. Presence of ≥2 EN sites, spleen, bone, or soft tissue involvement, as well as a multifocal on diffuse pattern of bone involvement by imaging, were univariate predictors of EFS; presence of ≥2 EN sites and bone involvement pattern were also predictive of OS. In a multivariate analysis with FLIPI-2 factors, spleen involvement, pattern of bone involvement, and soft tissue involvement independently predicted a lower EFS (Table). When the multivariate analysis was performed using PRIMA-PI factors, the presence of ≥2 EN sites was an adverse independent prognostic factor for OS (HR 2.28; 95% CI 1.01-5.18; p=0.05). Conclusions: Baseline PET/CT identifies EN and spleen sites of disease that can predict early clinical failure of FL. These results may be useful to better identify high-risk patients and guide appropriate therapy. [Table: see text]
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28
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Castellino A, Pulido JS, Johnston PB, Ristow KM, Nora Bennani N, Inwards DJ, Macon WR, Micallef INM, King RL, Salomao DR, Witzig TE, Habermann TM, Nowakowski GS. Role of systemic high-dose methotrexate and combined approaches in the management of vitreoretinal lymphoma: A single center experience 1990-2018. Am J Hematol 2019; 94:291-298. [PMID: 30516868 DOI: 10.1002/ajh.25350] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 12/26/2022]
Abstract
Vitreoretinal lymphoma (VRL) management remains a challenge. We present 72 patients with VRL, diagnosed at Mayo Clinic between 1990-2018. Three nondiffuse large B-cell lymphoma (DLBCL) histology cases were excluded. Among 69 DLBCL, 33 patients had primary VRL (PVRL), 18 concurrent intraocular and central nervous system (CNS) or systemic disease and 18 secondary VRL. Patients received intraocular chemotherapy (intraocular injections of rituximab or metothrexate or steroids or in combination), radiotherapy, systemic or combined systemic plus intraocular treatment in 9, 10, 35, and 15 cases, respectively. Among primary and concurrent VRL, median failure free survival (FFS), CNS relapse-free survival (CNS-RFS) and overall survival (OS) were: 1.8, 4.9, and 4.1 years, respectively; among PVRL, median FFS, CNS-RFS, and OS were: 2.6 year, Not Reached and 9.3 year, respectively. No CNS relapse occurred beyond 4 years in PVRL. Median OS for patients diagnosed between 1990 and 1999 vs between 2000 and 2018 was 1.5 vs 9.4 years, respectively (P = .0002). OS was significantly higher in PVRL, as compared with concurrent VRL (P = .04). Previous immunosuppression and poor performance status were predictive of worse outcome. In PVRL, a combined systemic and intraocular therapy showed higher FFS (P = .002) and CNS-RFS (P = .003), but no differences in OS. Among 18 secondary VRL, at a median follow-up of 1.1 year after vitreoretinal relapse, median FFS and OS were 0.3 and 1.3 years. An improvement in survival of VRL has been observed over the decades. PVRL should undergo combined systemic and intraocular chemotherapy to prevent CNS progression.
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Affiliation(s)
| | - Jose S. Pulido
- Department of Ophthalmology; Mayo Clinic; Rochester Minnesota
| | | | - Kay M. Ristow
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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29
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McPhail ED, Maurer MJ, Macon WR, Feldman AL, Kurtin PJ, Ketterling RP, Vaidya R, Cerhan JR, Ansell SM, Porrata LF, Nowakowski GS, Witzig TE, Habermann TM. Inferior survival in high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements is not associated with MYC/IG gene rearrangements. Haematologica 2018; 103:1899-1907. [PMID: 29903764 PMCID: PMC6278976 DOI: 10.3324/haematol.2018.190157] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 02/07/2018] [Accepted: 06/12/2018] [Indexed: 01/22/2023] Open
Abstract
High-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements (double-/triple-hit lymphoma) have an aggressive clinical course. We investigated the prognostic value of transformation from low-grade lymphoma, cytological features (high grade versus large cell), MYC rearrangement partners (immunoglobulin versus nonimmunoglobulin gene), and treatment. We evaluated 100 adults with double-/triple-hit lymphoma, reviewing cytological features; cell of origin; and rearrangements of MYC, BCL2, and BCL6 using MYC, BCL2, and BCL6 break-apart and IGH/MYC, IGL/MYC, IGK/MYC, and IGH/BCL2 dual-fusion interphase fluorescence in situ hybridization probes. Outcome analysis was restricted to patients with lymphoma, de novo or at transformation, who received anthracycline-based chemotherapy. Among them, 60% had high-grade cytological features; 91% had a germinal center B-cell phenotype, and 60% had a MYC/IG rearrangement. Germinal center B-cell phenotype was associated with BCL2 rearrangements (P<0.001). Mean (95% confidence interval) 5-year overall survival was 49% (37%–64%). Transformation from previously treated and untreated low-grade lymphoma was associated with inferior overall survival (hazard ratio, 2.99; P=0.008). Patients with high-grade cytological features showed a non-significant tendency to inferior outcome (hazard ratio, 2.32; P=0.09). No association was observed between MYC rearrangement partner and overall survival (hazard ratio, 1.00; P=0.99). Compared with patients receiving rituximab, cyclophosphamide, doxorubicin, and vincristine (R-CHOP) and dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (EPOCH-R), patients receiving rituximab, cyclophosphamide, vincristine, doxorubicin, methotrexate/ifosfamide, etoposide, and cytarabine (R-CODOX-M/IVAC) had a non-significant tendency to better overall survival (hazard ratio, 0.37; P=0.10). In conclusion, high-grade B-cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements had heterogeneous outcomes and MYC/IG rearrangements were not associated with inferior overall survival.
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Affiliation(s)
- Ellen D McPhail
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Matthew J Maurer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Paul J Kurtin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Rhett P Ketterling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Rakhee Vaidya
- Department of Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, NC
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Thomas E Witzig
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.,Division of Hematology, Mayo Clinic, Rochester, MN, USA
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30
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Thompson CA, Yost KJ, Maurer MJ, Allmer C, Farooq U, Habermann TM, Inwards DJ, Macon WR, Link BK, Rosenthal AC, Cerhan JR. Quality of life at diagnosis predicts overall survival in patients with aggressive lymphoma. Hematol Oncol 2018; 36:749-756. [PMID: 29862550 DOI: 10.1002/hon.2522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/20/2017] [Revised: 04/02/2018] [Accepted: 04/18/2018] [Indexed: 01/06/2023]
Abstract
Our aim was to evaluate whether quality of life (QOL) scores at diagnosis predict survival among patients with aggressive lymphoma. Newly diagnosed lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE and systematically followed for event-free and overall survival (OS). QOL was measured with the Functional Assessment of Cancer Treatment-General (FACT-G), which measures 4 domains: physical, social/family, emotional, and functional well-being (WB); a single item Linear Analogue Self-Assessment (LASA) measuring overall QOL; and a spiritual WB LASA. From 9/2002 to 12/2009, 701 patients with aggressive lymphoma who completed baseline QOL questionnaires were enrolled. At a median follow-up of 71 months (range 6-128), 316 patients (45%) had an event and 228 patients (33%) died. All baseline QOL measures but emotional WB were significantly associated with OS (all P < 0.04); of which all but LASA spiritual remained significant after adjusting for IPI and NHL subtype. The strongest associations were with total FACT-G (adjusted HR = 0.86, 95% CI: 0.79-0.94, P = 0.00062) and functional WB (adjusted HR = 0.88, 95% CI: 0.83-0.93, P < .0001). QOL LASA was associated with OS (adjusted HR = 0.92, 95% CI: 0.87-0.97, P = 0.0041). Patients with clinically deficient QOL (overall QOL ≤50) had a median OS of 92 months compared with 121 months for patients with QOL >50 (P = 0.0004). In this large sample of patients with aggressive lymphoma, we found that baseline QOL is independently predictive of OS. QOL should be assessed as a prognostic factor in patients with aggressive lymphoma.
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Affiliation(s)
- Carrie A Thompson
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Umar Farooq
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Thomas M Habermann
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - David J Inwards
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Brian K Link
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | - Allison C Rosenthal
- Department of Internal Medicine, Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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31
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Castellino A, LaPlant B, Pederson L, Chiappella A, Gaidano G, Macon WR, Tucci A, King RL, Congiu AG, Witzig TE, Vitolo U, Nowakowski GS. Long term follow-up (FU) of lenalidomide plus R-CHOP therapy in patients with newly diagnosed diffuse large b-cell lymphoma (DLBCL): Combined analysis from two phase 2 trials. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Annalisa Chiappella
- Division of Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy, Novara, Italy
| | | | - Alessandra Tucci
- SC Ematologia e Dipartimento di Oncologia Clinica, A.O. Spedali Civili, Brescia, Italy
| | - Rebecca L. King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | - Umberto Vitolo
- Division of Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
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32
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Scott DW, King RL, Staiger AM, Ben-Neriah S, Jiang A, Horn H, Mottok A, Farinha P, Slack GW, Ennishi D, Schmitz N, Pfreundschuh M, Nowakowski GS, Kahl BS, Connors JM, Gascoyne RD, Ott G, Macon WR, Rosenwald A. High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with diffuse large B-cell lymphoma morphology. Blood 2018; 131:2060-2064. [PMID: 29475959 PMCID: PMC6158813 DOI: 10.1182/blood-2017-12-820605] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [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: 12/20/2017] [Accepted: 02/13/2018] [Indexed: 01/07/2023] Open
Abstract
High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBL-DH/TH) is a newly defined entity in the latest World Health Organization Classification. Accurate diagnosis would appear to mandate fluorescence in situ hybridization (FISH) for all tumors with diffuse large B-cell lymphoma (DLBCL) morphology. We present the results of FISH, cell-of-origin, and immunohistochemistry (IHC) testing from 1228 DLBCL biopsies from 3 clinical trials and a population-based registry. HGBL-DH/TH made up 7.9% of the DLBCL, confined primarily to the germinal center B-cell-like (GCB; 13.3%) compared with activated B-cell-like (ABC; 1.7%) subtype (P < .001). HGBL-DH/TH with BCL2 rearrangement is a GCB phenomenon with no cases observed in 415 ABC DLBCL. A screening strategy restricting FISH testing to tumors of GCB subtype (by Lymph2Cx or Hans IHC) plus dual protein expression of MYC and BCL2 by IHC could limit testing to 11% to 14% of tumors, with a positive predictive value of 30% to 37%; however, this strategy would miss approximately one-quarter of tumors with HBGL-DH/TH with BCL2 rearrangement and one-third of all HGBL-DH/TH. These results provide accurate estimation of the proportion of HGBL-DH/TH among tumors with DLBCL morphology and allow determination of the impact of various methods available to screen DLBCL tumors for FISH testing.
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Affiliation(s)
- David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Annette M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tuebingen, Germany
| | - Susana Ben-Neriah
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - Aixiang Jiang
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Vancouver, Canada
| | - Heike Horn
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tuebingen, Germany
| | - Anja Mottok
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
- Institute of Pathology, Würzburg University and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Pedro Farinha
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - Graham W Slack
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - Daisuke Ennishi
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - Norbert Schmitz
- Department of Medicine, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Michael Pfreundschuh
- Department of Medicine, Hematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Grzegorz S Nowakowski
- Department of Internal Medicine I, Saarland University Medical School, Homburg/Saar, Germany
| | - Brad S Kahl
- Department of Oncology, Mayo Clinic, Rochester, MN; and
| | - Joseph M Connors
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, Canada
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Andreas Rosenwald
- Institute of Pathology, Würzburg University and Comprehensive Cancer Center Mainfranken, Würzburg, Germany
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33
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Maurer MJ, Ghesquières H, Link BK, Jais JP, Habermann TM, Thompson CA, Haioun C, Allmer C, Johnston PB, Delarue R, Micallef IN, Peyrade F, Inwards DJ, Ketterer N, Farooq U, Fitoussi O, Macon WR, Molina TJ, Syrbu S, Feldman AL, Slager SL, Weiner GJ, Ansell SM, Cerhan JR, Salles GA, Witzig TE, Tilly H, Nowakowski GS. Diagnosis-to-Treatment Interval Is an Important Clinical Factor in Newly Diagnosed Diffuse Large B-Cell Lymphoma and Has Implication for Bias in Clinical Trials. J Clin Oncol 2018; 36:1603-1610. [PMID: 29672223 DOI: 10.1200/jco.2017.76.5198] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Selection bias in clinical trials has consequences for scientific validity and applicability of study results to the general population. There is concern that patients with clinically aggressive disease may not have enrolled in recent diffuse large B-cell lymphoma (DLBCL) trials due to the consent process and the inability to delay therapy for eligibility evaluation. We have examined the diagnosis-to-treatment interval (DTI) and its association with clinical factors and outcome in a clinic-based observational cohort of patients with DLBCL from the United States. Validation of results was performed in an independent, clinical trial-based cohort from Europe. Patients and Methods Patients were prospectively enrolled in the University of Iowa and Mayo Clinic Specialized Programs of Research Excellence Molecular Epidemiology Resource (MER; N = 986) or the Lymphoma Study Association (LYSA) LNH-2003 clinical trials program (N = 1,444). All patients received anthracycline-based immunochemotherapy at initial diagnosis. Associations of DTI with clinical factors and outcome were examined. Outcome was assessed using event-free survival at 24 months from diagnosis (EFS24). Results Median (range) DTI was 15 days (0 to 155 days in the MER and 23 days (0 to 215 days) in LYSA. Shorter DTI was strongly associated with adverse clinical factors, including elevated lactate dehydrogenase levels, poor performance status, B symptoms, and higher International Prognostic Index in both cohorts (all P < .001). Longer DTI was associated with improved EFS24 in both the MER (per-week odds ratio, 0.80; 95% CI, 0.74 to .0.87) and LYSA (per-week odds ratio, 0.90; 95% CI, 0.86 to 0.94); association with EFS24 remained significant after adjustment for International Prognostic Index. Conclusion DTI is strongly associated with prognostic clinical factors and outcome in newly diagnosed DLBCL. DTI should be reported in all clinical trials of newly diagnosed DLBCL and future trials should take steps to avoid selection bias due to treatment delay.
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Affiliation(s)
- Matthew J Maurer
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Hervé Ghesquières
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Brian K Link
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Jean-Philippe Jais
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Thomas M Habermann
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Carrie A Thompson
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Corinne Haioun
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Cristine Allmer
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Patrick B Johnston
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Richard Delarue
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Ivana N Micallef
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Frederic Peyrade
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - David J Inwards
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Nicolas Ketterer
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Umar Farooq
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Olivier Fitoussi
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - William R Macon
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Thierry J Molina
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Sergei Syrbu
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Andrew L Feldman
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Susan L Slager
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - George J Weiner
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Stephen M Ansell
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - James R Cerhan
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Gilles A Salles
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Thomas E Witzig
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Hervé Tilly
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
| | - Grzegorz S Nowakowski
- Matthew J. Maurer, Thomas M. Habermann, Carrie A. Thompson, Cristine Allmer, Patrick B. Johnston, Ivana N. Micallef, David J. Inwards, William R. Macon, Andrew L. Feldman, Susan L. Slager, Stephen M. Ansell, James R. Cerhan, Thomas E. Witzig, and Grzegorz S. Nowakowski, Mayo Clinic, Rochester, MN; Hervé Ghesquières and Gilles A. Salles, Université Claude Bernard, Lyon; Jean-Philippe Jais, Richard Delarue, Thierry J. Molina, Hopital Necker, Paris; Corinne Haioun, Groupe Hospitalier Mondor, Créteil; Frederic Peyrade, Centre Antoine Lacassagne, Nice; Olivier Fitoussi, Polyclinique Bordeaux Nord-Aquitaine, Bordeaux; Hervé Tilly, Centre de lutte Contre le Cancer Henri Becquerel, Rouen, France; Brian K. Link, Umar Farooq, Sergei Syrbu, and George J. Weiner, University of Iowa, Iowa City, IA; and Nicolas Ketterer, Clinique Bois-Cerf, Lausanne, Switzerland
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King RL, Nowakowski GS, Witzig TE, Scott DW, Little RF, Hong F, Gascoyne RD, Kahl BS, Macon WR. Rapid, real time pathology review for ECOG/ACRIN 1412: a novel and successful paradigm for future lymphoma clinical trials in the precision medicine era. Blood Cancer J 2018. [PMID: 29531316 PMCID: PMC5849886 DOI: 10.1038/s41408-018-0064-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/26/2023] Open
Abstract
ECOG/ACRIN 1412 (E1412) is a randomized, phase II open-label study of lenalidomide/RCHOP vs. RCHOP alone in adults with newly diagnosed de novo diffuse large B-cell lymphoma (DLBCL) and requires NanoString gene expression profiling (GEP) for cell-of-origin testing. Because of high ineligibility rate on retrospective expert central pathology review (ECPR), real-time (RT) ECPR was instituted to confirm diagnosis and ensure adequate tissue for GEP prior to study enrollment. Goal was notification of eligibility within 2 working days (WD). Initially, 208 patients were enrolled, 74 (35.6%) of whom were deemed ineligible by retrospective ECPR. After initiation of RT-ECPR, 219 patients were registered. Of these, 73 (33.3%) were ineligible and were declined enrollment; 47 (21.5% of total) had an ineligible diagnosis on RT-ECPR, and 26 (11.9% of total) had inadequate tissue. Because the 73 ineligible patients were never enrolled, no study slots were “lost” during this phase. Notification of eligibility occurred in an average of 1 WD (Range 0–4) with 97.3% within 2 WD. This novel RT-ECPR serves as a model for future lymphoma trials. Real-time ECPR can help to reduce costs and ensure that study slots accurately reflect the targeted population. In the precision-medicine era, rapid collection of relevant pathology/biomarker data is essential to trial success.
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Affiliation(s)
| | | | | | - David W Scott
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Richard F Little
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Brad S Kahl
- Washington University School of Medicine, St. Louis, MO, USA
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King BJ, Lehman JS, Macon WR, Sciallis GF. Red tattoo-related mycosis fungoides-like CD8+ pseudolymphoma. J Cutan Pathol 2017; 45:226-228. [DOI: 10.1111/cup.13089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/28/2017] [Accepted: 11/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Brian J. King
- Department of Dermatology; Mayo Clinic; Rochester Minnesota
| | - Julia S. Lehman
- Department of Dermatology; Mayo Clinic; Rochester Minnesota
- Department of Pathology; Mayo Clinic; Rochester Minnesota
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Cerhan JR, Link BK, Habermann TM, Maurer MJ, Feldman AL, Syrbu SI, Thompson CA, Farooq U, Novak AJ, Slager SL, Allmer C, Lunde JJ, Macon WR, Inwards DJ, Johnston PB, Micallef INM, Nowakowski GS, Ansell SM, Kay NE, Weiner GJ, Witzig TE. Cohort Profile: The Lymphoma Specialized Program of Research Excellence (SPORE) Molecular Epidemiology Resource (MER) Cohort Study. Int J Epidemiol 2017; 46:1753-1754i. [PMID: 29025017 PMCID: PMC5837578 DOI: 10.1093/ije/dyx119] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/04/2017] [Accepted: 06/12/2017] [Indexed: 01/13/2023] Open
Affiliation(s)
- James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Brian K Link
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA and
| | - Sergei I Syrbu
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Umar Farooq
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Julianne J Lunde
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA and
| | | | | | | | | | | | | | - George J Weiner
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Thanarajasingam G, Maurer MJ, Farooq U, Johnston PB, Thompson CA, Bennani NN, Ansell SM, Porrata LF, Macon WR, Syrbu SI, Cerhan JR, Habermann TM, Link BK, Witzig TE, Nowakowski GS. Event-free survival at 24 months captures central nervous system relapse of systemic diffuse large B-cell lymphoma in the immunochemotherapy era. Br J Haematol 2017; 183:149-152. [PMID: 28961306 DOI: 10.1111/bjh.14922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Umar Farooq
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA, USA
| | | | | | | | | | | | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sergei I Syrbu
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Brian K Link
- Division of Hematology, Oncology and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA, USA
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King RL, Nowakowski GS, Witzig TE, Scott DW, Little RF, Hong F, Gascoyne RD, Kahl BS, Macon WR. Rapid, real-time central pathology review for E1412: A novel and successful paradigm for future National Clinical Trials Network diffuse large B cell lymphoma studies. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
7547 Background: E1412 statistical design is based on results of lenalidomide/RCHOP (R2CHOP) vs RCHOP in ABC-DLBCL as determined by NanoString gene expression profiling (GEP). Central pathology review (CPR) was conducted to confirm diagnosis and to ensure adequate tissue for GEP. Initially, CPR occurred after randomization and treatment initiation. Due to high ineligibility rate (IR), the protocol was amended to include real-time CPR to determine patient eligibility prior to study enrollment. We describe the revision and how it affected the IR. Methods: Pre-amendment, CPR was done retrospectively. Post-amendment, CPR was done prior to enrollment, in real time, on a submitted tissue block, H&E, and CD20 slides. Based on CPR, if a diagnosis of DLBCL was confirmed, and sufficient tissue remained for GEP, a patient was deemed eligible and the submitter was notified by fax. Protocol goal was notification within 2 working days (WD) of receipt of materials at the CPR site. Results: Pre-amendment, 219 patients were enrolled. Material was typically received at the CPR site 6-9 months after patient registration. The IR with CPR was 36% for all those enrolled, and 26% for patients with adequate tissue for GEP. Post-amendment, 218 patients were submitted for CPR: 145 (67%) were eligible; 73 (33%) were ineligible. Reasons for ineligibility included insufficient tissue (n=27) or a diagnosis other than de novo DLBCL (n=46). Notification of eligibility occurred in a median of 2 WD (Mean 2 WD; Range 1-5 WD). 90% were notified within the protocol goal of 2 WD. GEP for all enrolled was completed within 6 weeks of CPR. Conclusions: The success of this novel, real-time CPR serves as a model for the future of NCTN DLBCL trials. When CPR is performed rapidly prior to enrollment, study slots may more accurately reflect the target population and eliminate excess costs. In the precision medicine era, rapid collection of relevant pathology and biomarker data is essential to trial success. Study Coordinated by ECOG-ACRIN Cancer Research Group (Robert L. Comis, MD and Mitchell D. Schnall, MD, PhD, Group Co-Chairs), supported by NCI grant # CA180820, CA180794, CA180790, CA180799, CA180833.
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Affiliation(s)
| | | | | | | | - Richard F. Little
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | | | | | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
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Epperla N, Pham AQ, Burnette BL, Wiseman GA, Habermann TM, Macon WR, Ansell SM, Inwards DJ, Micallef IN, Johnston PB, Markovic SN, Porrata LF, Colgan JP, Ristow KM, Nowakowski GS, Witzig TE. Risk of histological transformation and therapy-related myelodysplasia/acute myeloid leukaemia in patients receiving radioimmunotherapy for follicular lymphoma. Br J Haematol 2017; 178:427-433. [PMID: 28466487 DOI: 10.1111/bjh.14688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/02/2017] [Indexed: 01/15/2023]
Abstract
Histological transformation (HT) of follicular lymphoma (FL) to an aggressive lymphoma after chemotherapy remains a key issue. The incidence of HT after radioimmunotherapy (RIT) is unknown. This single institution study analysed the risk of HT in FL after treatment with yttrium-90 ibritumomab tiuxetan in 115 consecutive patients treated during 1987-2012. RIT was administered for progressive FL in 111 (97%) patients and as first-line therapy in the remaining 4. 28% (n = 32) had HT, occurring at a median of 60 months from diagnosis and 20 months after RIT. 48% (12/25) of patients who received fludarabine developed HT. The estimated 10-year risk of HT in the fludarabine and non-fludarabine groups was 67% and 26% respectively (P = 0·015). Only prior fludarabine was significantly associated with predicting the risk of HT after RIT. 8% (9/115) of patients developed therapy-related myelodysplastic syndrome/acute myeloid leukaemia (tMDS/AML) at a median of 41·4 months (range, 5-89). The estimated 10-year risk of tMDS/AML in non-fludarabine treated patients (n = 90) versus fludarabine treated (n = 25) was 13% and 29%, respectively. The estimated overall risk of FL undergoing HT at 10 years without fludarabine exposure appears similar to patients reported in the literature that have not received RIT. Patients with prior purine-analogue therapy are at significantly higher risk of HT.
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Affiliation(s)
- Narendranath Epperla
- Department of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anthony Q Pham
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - William R Macon
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Luis F Porrata
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Kay M Ristow
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
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Bennani NN, LaPlant BR, Ansell SM, Habermann TM, Inwards DJ, Micallef IN, Johnston PB, Porrata LF, Colgan JP, Markovic SN, Nowakowski GS, Macon WR, Reeder CB, Mikhael JR, Northfelt DW, Ghobrial IM, Witzig TE. Efficacy of the oral mTORC1 inhibitor everolimus in relapsed or refractory indolent lymphoma. Am J Hematol 2017; 92:448-453. [PMID: 28211162 DOI: 10.1002/ajh.24671] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 12/19/2022]
Abstract
Relapsed indolent lymphoma often becomes refractory to standard chemoimmunotherapy and requires new therapeutic strategies. Targeting the PI3K/mTOR pathway in several types of lymphoma has shown preclinical and clinical efficacy providing the rationale to test this strategy in the treatment of relapsed/refractory indolent lymphomas. We investigated in a phase II open label clinical trial the efficacy and safety of single agent everolimus, an inhibitor of mTORC1, in patients with relapsed/refractory indolent lymphomas. Eligible patients received oral everolimus 10 mg daily on a 28 day-cycle schedule. The primary endpoint was to evaluate the overall response rate (ORR) and safety of single-agent everolimus in this patient population. Fifty-five patients with indolent lymphoma were accrued. The median age was 67 years (range: 33-85) with a median of five prior therapies (range: 1-10). The ORR was 35% (19/55; 95% CI: 24-48%), with complete response unconfirmed in 4% (2/55), and partial response in 31% (17/55). The ORR was 61% (14/23) in the patients with FL. The median time to response was 2.3 months (range: 1.4-14.1), median duration of response of 11.5 months (95%-CI: 5.7-30.4), and a median progression-free survival of 7.2 months (95%-CI: 5.5-12.5). The most common toxicity was hematologic with grades 3-4 anemia, neutropenia, and thrombocytopenia documented in 15% (8/55), 22% (12/55), and 33% (18/55), respectively. There were no cases of febrile neutropenia, and eight patients discontinued therapy because of adverse events. Everolimus monotherapy is a valid therapeutic option in the relapsed and/or refractory indolent non-Hodgkin lymphoma patients and is well tolerated.
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Affiliation(s)
- N. Nora Bennani
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
| | - Betsy R. LaPlant
- Division of Biomedical Statistics and Bioinformatics, Department of Health Sciences ResearchMayo Clinic RochesterRochester Minnesota
| | - Stephen M. Ansell
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
| | - Thomas. M. Habermann
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
| | - David J. Inwards
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
| | - Ivana N. Micallef
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
| | - Patrick B. Johnston
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
| | - Luis F. Porrata
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
| | - Joseph P. Colgan
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
| | - Svetomir N. Markovic
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
| | | | - William R. Macon
- Division of Hematopathology, Department of Laboratory Medicine and PathologyMayo Clinic RochesterRochester Minnesota
| | - Craig B. Reeder
- Division of Hematology, Department of MedicineMayo Clinic ScottsdaleScottsdale Arizona
| | - Joseph R. Mikhael
- Division of Hematology, Department of MedicineMayo Clinic ScottsdaleScottsdale Arizona
| | - Donald W. Northfelt
- Division of Hematology, Department of MedicineMayo Clinic ScottsdaleScottsdale Arizona
| | - Irene M. Ghobrial
- Dana Farber Cancer Institute, Harvard Medical SchoolBoston Massachusetts
| | - Thomas E. Witzig
- Division of Hematology, Department of MedicineMayo Clinic RochesterRochester Minnesota
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Maurer MJ, Bachy E, Ghesquières H, Ansell SM, Nowakowski GS, Thompson CA, Inwards DJ, Allmer C, Chassagne-Clément C, Nicolas-Virelizier E, Sebban C, Lebras L, Sarkozy C, Macon WR, Feldman AL, Syrbu SI, Traverse-Glehan A, Coiffier B, Slager SL, Weiner GJ, Witzig TE, Habermann TM, Salles G, Cerhan JR, Link BK. Early event status informs subsequent outcome in newly diagnosed follicular lymphoma. Am J Hematol 2016; 91:1096-1101. [PMID: 27465588 DOI: 10.1002/ajh.24492] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 07/19/2016] [Accepted: 07/22/2016] [Indexed: 11/06/2022]
Abstract
Recent advances in follicular lymphoma (FL) have resulted in prolongation of overall survival (OS). Here we assessed if early events as defined by event-free survival (EFS) at 12 and 24 months from diagnosis (EFS12/EFS24) can inform subsequent OS in FL. 920 newly diagnosed grade 1-3A FL patients enrolled on the University of Iowa/Mayo Clinic Lymphoma SPORE Molecular Epidemiology Resource (MER) from 2002-2012 were initially evaluated. EFS was defined as time from diagnosis to progression, relapse, re-treatment, or death due to any cause. OS was compared to age-and-sex-matched survival in the general US population using standardized mortality ratios (SMR) and 95% confidence intervals (CI). We used a cohort of 412 FL patients from two Lyon, France hospital registries for independent replication. Patients who failed to achieve EFS12 had poor subsequent OS (MER SMR = 3.72, 95%CI: 2.78-4.88; Lyon SMR = 8.74, 95%CI: 5.41-13.36). Conversely, patients achieving EFS12 had no added mortality beyond the background population (MER SMR = 0.73, 95%CI: 0.56-0.94, Lyon SMR = 1.02, 95%CI: 0.58-1.65). Patients with early events after immunochemotherapy had especially poor outcomes (EFS12 failure: MER SMR = 17.63, 95%CI:11.97-25.02, Lyon SMR = 19.10, 95%CI:9.86-33.36; EFS24 failure: MER SMR = 13.02, 95%CI:9.31-17.74, Lyon SMR = 7.22, 95%CI:4.13-11.74). In a combined dataset of all patients from both cohorts, baseline FLIPI was no longer informative in EFS12 achievers. Reassessment of patient status at 12 months from diagnosis in follicular lymphoma patients, or at 24 months in patients treated with immunochemotherapy, is a strong predictor of subsequent overall survival in FL. Early event status provides a simple, clinically relevant endpoint for studies assessing outcome in FL. Am. J. Hematol. 91:1096-1101, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Matthew J. Maurer
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Emmanuel Bachy
- Department of Hematology; Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud and Université Claude Bernard; Lyon France
| | - Hervé Ghesquières
- Department of Hematology; Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud and Université Claude Bernard; Lyon France
- Department of Medical Oncology; Centre Léon Bérard; Lyon France
| | | | | | | | | | - Cristine Allmer
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | | | | | | | - Laure Lebras
- Department of Hematology; Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud and Université Claude Bernard; Lyon France
| | - Clementine Sarkozy
- Department of Hematology; Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud and Université Claude Bernard; Lyon France
| | - William R. Macon
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Andrew L. Feldman
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | | | - Alexandra Traverse-Glehan
- Department of Pathology; Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud and Université Claude Bernard; Lyon France
| | - Bertrand Coiffier
- Department of Hematology; Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud and Université Claude Bernard; Lyon France
| | - Susan L. Slager
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - George J. Weiner
- Department of Hematology; Oncology and Blood and Marrow Transplantation, University of Iowa; Iowa City IA
| | | | - Thomas M. Habermann
- Department of Hematology; Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud and Université Claude Bernard; Lyon France
| | - Gilles Salles
- Department of Hematology; Hospices Civils De Lyon, Centre Hospitalier Lyon-Sud and Université Claude Bernard; Lyon France
| | - James R. Cerhan
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Brian K. Link
- Department of Hematology; Oncology and Blood and Marrow Transplantation, University of Iowa; Iowa City IA
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Breitenstein MK, O’Byrne MM, Feldman AL, Thompson CA, Macon WR, Nowakowski GS, Ansell SM, Slager SL, Habermann TM, Cerhan JR. Abstract 1762: Body mass index shows etiologic heterogeneity for risk of diffuse large B-cell lymphoma (DLBCL) subtype defined by cell-of-origin. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-1762] [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
Background. DLBCL is the most common non-Hodgkin lymphoma (NHL) subtype in western countries and is known to be clinically heterogeneous. Gene expression profiling has identified two major, biologically distinctive DLBCL subtypes on the basis of their cell-of-origin (COO): the germinal center B-cell (GCB) - characterized by BCL2 rearrangement and C-REL amplification, and activated B-cell (ABC) - characterized by constitutive activation of the NF-kB pathway. Recently, the InterLymph Subtypes Project identified medical history, lifestyle, and family history risk factors for DLBCL using a large pooled analysis of case-control studies. In this study we evaluated these same risk factors for etiologic heterogeneity as defined by DLBCL COO.
Methods. For this analysis we used a clinic-based study of newly diagnosed NHL cases and frequency matched controls, enrolled from 2002-2012, with 474 DLBCL cases and 2203 controls. COO was determined clinically using the Hans algorithm, which is based on immunohistochemistry markers using formalin-fixed, paraffin-embedded tumor tissue. Amongst DLBCL cases 107 were ABC, 207 were GCB, and 160 were missing subtype (tissue unavailable). Risk factor data, including body mass index (BMI), smoking, alcohol use, any allergy, asthma, blood transfusion, diabetes, rheumatoid arthritis, sun exposure, lived on a farm and family history of hematologic malignancy, were collected from self-administered questionnaires. Polytomous logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals for ABC and GCB subtypes, adjusted for age and sex.
Results. The mean age of cases was 60.4 years with 53% male; the mean age of controls was 61.6 years and 53% male. We identified a strong positive association for BMI with risk of ABC but not GBC DLBCL (p-heterogeneity 0.025). Compared to BMI 18.5-24.9 kg/m2, those with a BMI of 25.0-29.9 (OR = 1.65; 0.93-2.93) or 30+ (OR = 2.61; 1.48-4.62) were at increased risk of ABC DLBCL. There was no association for a BMI of 25.0-29.9 (OR = 0.91; 0.63-1.31) or 30+ (OR = 1.21; 0.83-1.76) with GCB DLBCL. There was no evidence of significant heterogeneity between ABC and GCB DLBCL for the other risk factors that we evaluated. Further adjustment of the BMI association for educational level, smoking, and alcohol only slightly attenuated these findings.
Conclusions. We observed a strong positive association of BMI with ABC but not GCB DLBCL. In contrast, other evaluated risk factors showed no heterogeneity by COO. While BMI has not been clearly associated with NHL overall, there has been evidence for an association with DLBCL. The etiologic heterogeneity we observed for ABC DLBCL is notable as BMI is also a strong risk factor for multiple myeloma, another post-germinal center B-cell malignancy. While requiring replication, our findings suggest BMI may influence B-cell neoplasia through effect on post-germinal center pathways.
Citation Format: Matthew K. Breitenstein, Megan M. O’Byrne, Andrew L. Feldman, Carrie A. Thompson, William R. Macon, Grzegorz S. Nowakowski, Stephen M. Ansell, Susan L. Slager, Thomas M. Habermann, James R. Cerhan. Body mass index shows etiologic heterogeneity for risk of diffuse large B-cell lymphoma (DLBCL) subtype defined by cell-of-origin. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1762.
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Nowakowski GS, Ansell SM, Witzig TE, Macon WR, Ristow K, Colgan J, Inwards DJ, Johnston PB, Klebig R, Lin Y, Micallef INM, Markovic S, Porrata LF, Thompson CA, Habermann TM. Participation in clinical trials to improve outcomes of patients with relapsed lymphoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7523] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yi Lin
- Mayo Clinic, Rochester, MN
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Tracy SI, Maurer MJ, Witzig TE, Drake M, Ansell SM, Nowakowski GS, Thompson CA, Inwards DJ, Johnston PB, Micallef INM, Allmer C, Macon WR, Weiner GJ, Slager SL, Habermann TM, Link BK, Cerhan JR. Association of vitamin D insufficiency with inferior prognosis in follicular lymphoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e19067] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
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Maurer MJ, Jais JP, Ghesquières H, Witzig TE, Hong F, Haioun C, Thompson CA, Thieblemont C, Micallef IN, Porrata LF, Ribrag V, Nowakowski GS, Casasnovas O, Bologna S, Morschhauser F, Morrison VA, Peterson BA, Macon WR, Copie-Bergman C, Feldman AL, Syrbu SI, Kurtin PJ, Gascoyne RD, Li H, Allmer C, Kahl BS, Ansell SM, Slager SL, Link BK, Salles G, Habermann TM, Tilly H, Cerhan JR. Personalized risk prediction for event-free survival at 24 months in patients with diffuse large B-cell lymphoma. Am J Hematol 2016; 91:179-84. [PMID: 26492520 DOI: 10.1002/ajh.24223] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 12/17/2022]
Abstract
We recently defined event-free survival at 24 months (EFS24) as a clinically relevant outcome for patients with DLBCL. Patients who fail EFS24 have very poor overall survival, while those who achieve EFS24 have a subsequent overall survival equivalent to that of the age- and sex-matched general population. Here, we develop and validate a clinical risk calculator (IPI24) for EFS24. Model building was performed on a discovery dataset of 1,348 patients with DLBCL and treated with anthracycline-based immunochemotherapy. A multivariable model containing age, Ann Arbor stage, normalized serum LDH, ALC, ECOG performance status, bulky disease, and sex was identified. The model was then applied to an independent validation dataset of 1,177 DLBCL patients. The IPI24 score estimates the probability of failing to achieve the EFS24 endpoint for an individual patient. The IPI24 model showed superior discriminatory ability (c-statistic = 0.671) in the validation dataset compared to the IPI (c-statistic = 0.649) or the NCCN-IPI (c-statistic = 0.657). After recalibration of the model on the combined dataset, the median predicted probability of failing to achieve EFS24 was 36% (range, 12-88%), and the IPI24 showed an EFS24 gradient in all IPI groups. The IPI24 also identified a significant percentage of patients with high risk disease, with over 20% of patients having a 50% or higher risk of failing to achieve EFS24. The IPI24 provides an individual patient level probability of achieving the clinically relevant EFS24 endpoint. It can be used via electronic apps.
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Affiliation(s)
- Matthew J. Maurer
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Jean-Philippe Jais
- Department of Biostatistics; Necker Hospital, INSERM UMRS 872, AP-HP; Paris France
| | - Hervé Ghesquières
- Department of Medical Oncology; Centre Léon Bérard; Lyon France
- Centre National De La Recherche Scientifique (CNRS), Unite Mixte De Recherche (UMR); Université Claude Bernard; Lyon France
| | | | - Fangxin Hong
- Department of Biostatistics & Computational Biology; Harvard T.H. Chan; Boston Massachusetts
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Henri Mondor Hospital; Université Paris-Est; Créteil France
| | | | | | | | | | - Vincent Ribrag
- Department of Medical Oncology; Institut Gustave Roussy; Villejuif France
| | | | | | - Serge Bologna
- Department of Hematology; Centre Hospitalier Nancy-Brabois; Vandoeuvre France
| | - Franck Morschhauser
- Department of Hematology; Centre Hospitalier Régional Universitaire De Lille; Lille France
| | - Vicki A. Morrison
- Department of Medicine; University of Minnesota; Minneapolis Minnesota
- Veterans Affairs Medical Center; Minneapolis Minnesota
| | - Bruce A. Peterson
- Department of Medicine; University of Minnesota; Minneapolis Minnesota
| | - William R. Macon
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | | | - Andrew L. Feldman
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Sergei I. Syrbu
- Department of Pathology; University of Iowa College of Medicine; Iowa City Iowa
| | - Paul J. Kurtin
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Randy D. Gascoyne
- Centre for Lymphoid Cancers; British Columbia Cancer Agency; Vancouver British Columbia Canada
| | - Hailun Li
- Department of Biostatistics & Computational Biology; Harvard T.H. Chan; Boston Massachusetts
| | - Cristine Allmer
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Brad S. Kahl
- Department of Medicine; Washington University, St. Louis; Missouri
| | | | - Susan L. Slager
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Brian K. Link
- Department of Pathology; University of Iowa College of Medicine; Iowa City Iowa
| | - Gilles Salles
- Centre National De La Recherche Scientifique (CNRS), Unite Mixte De Recherche (UMR); Université Claude Bernard; Lyon France
- Department of Hematology; Hospices Civils De Lyon; Pierre Benite France
| | | | - Hervé Tilly
- Department of Hematology; INSERM U918, IRIB, Centre Henri Becquerel; Rouen France
| | - James R. Cerhan
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
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Al-Hamadani M, Habermann TM, Cerhan JR, Macon WR, Maurer MJ, Go RS. Non-Hodgkin lymphoma subtype distribution, geodemographic patterns, and survival in the US: A longitudinal analysis of the National Cancer Data Base from 1998 to 2011. Am J Hematol 2015; 90:790-5. [PMID: 26096944 DOI: 10.1002/ajh.24086] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/16/2022]
Abstract
The World Health Organization classification of non-Hodgkin lymphoma (NHL) was introduced in 2001. However, its incorporation into clinical practice is not well-described. We studied the distribution of NHL subtypes in adults diagnosed from 1998 to 2011, evaluated time trends, geo-demographic correlates, and changes in 5-year overall survival (OS). We obtained data prospectively collected by the National Cancer Data Base, which covers 70% of US cancer cases. There were 596,476 patients diagnosed with NHL. The major subtypes were diffuse large B-cell (32.5%), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; 18.6%), follicular (17.1%), marginal zone (8.3%), mantle cell (4.1%), peripheral T-cell not-otherwise-specified (1.7%), Burkitt (1.6%), hairy cell (1.1%), lymphoplasmacytic (1.1%), and NHL not-otherwise-specified (10.8%). Over the study period, the proportion of NHL not-otherwise-specified declined by half, while marginal zone lymphoma doubled. The distribution of major and rare NHL subtypes varied according to demographics but less so geographically or by type of treatment facility. We noted several novel findings among Hispanics (lower proportion of CLL/SLL, but higher Burkitt lymphoma and nasal NK/T-cell lymphoma), Asians (higher enteropathy-associated T-cell and angioimmunoblastic T-cell lymphomas), Blacks (higher hepatosplenic T-cell lymphoma), and Native Americans (similar proportions of CLL/SLL and nasal NK/T-cell lymphoma as Asians). With the exception of peripheral T-cell not-otherwise-specified and hairy cell leukemia, 5-year OS has improved for all the major NHL subtypes.
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Affiliation(s)
- Mohammed Al-Hamadani
- Department of Medical Research; Gundersen Medical Foundation; La Crosse Wisconsin
| | | | - James R. Cerhan
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - William R. Macon
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Rochester Minnesota
| | - Matthew J. Maurer
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Ronald S. Go
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Rochester Minnesota
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Affiliation(s)
| | | | - Randy D Gascoyne
- British Colombia Cancer Research Centre, Vancouver, British Columbia, Canada
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Cerhan JR, O'Bryne MM, Nowakowski GS, Call TG, Thompson CA, Shanafelt TD, Macon WR, Kay NE, Habermann TM, Slager SL, Liebow M. Abstract 877: Aspirin and other nonsteroidal anti-inflammatory drugs, statins, and risk of non-Hodgkin lymphoma. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-877] [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
Background. Non-steroidal anti-inflammatory drugs (NSAIDs) and statin drugs have been suggested as protective agents against the development of non-Hodgkin lymphoma (NHL), but data are limited, particularly for NHL subtypes. Further, some in vitro, animal and epidemiologic data suggest there may be a synergistic effect of these two agents in cancer prevention, but there has been no test of this hypothesis in NHL.
Methods. We evaluated the use of NSAIDs and statins in a clinic-based study of 1683 newly diagnosed cases and 2168 frequency matched controls enrolled from 2002-2012. Regular use (at least once/week for at least one year) of low dose (baby) aspirin, standard or extra strength aspirin, ibuprofen, other NSAIDs (e.g., naproxen, etc), COX-2 inhibitors, as well as statins or other cholesterol lowering drugs, was ascertained using a self-administered questionnaire. Frequency, amount and duration of use were also collected. Unconditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI), adjusted for age, sex, residence, education, body mass index, smoking history, alcohol use, and history of rheumatoid arthritis and osteoarthritis. Pathologic classification of NHL subtypes was centrally reviewed, and subtype-specific NHL risks were estimated using polychotomous logistic regression for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL, N = 495), diffuse large B-cell (DLBCL, N = 326), follicular (FL, N = 410) and marginal zone (MZL, N = 134) lymphomas.
Results. The mean age of cases was 61.8 years and 59% were men, while the mean age of controls was 61.6 years and 53% were men. We observed an inverse association of low dose aspirin use with risk of NHL (OR = 0.82; 95% CI 0.70-0.96), with stronger associations for more pills per day, longer duration of use and greater number of pill-years. In contrast, we observed no evidence of an association with NHL risk with use of regular or extra-strength aspirin, ibuprofen, other NSAIDs, or COX-2 inhibitors, nor use of statins or other cholesterol-lowering drugs. When we modeled the joint use of low dose aspirin and statins, the strongest inverse association was observed for low dose aspirin use only, followed by use of both aspirin and statins; there was no association with statin use only and no evidence for any interaction of low dose aspirin and statins on NHL risk. For low dose aspirin, the strongest inverse trends were observed for DLBCL, followed by FL and MZL, while there were no consistent associations for CLL/SLL.
Conclusions. We found a strong inverse association of low dose aspirin use with risk of NHL and the subtypes of DLBCL, FL, and MZL, but no association for regular/extra strength aspirin, other NSAIDs or statin use. While confirmation is needed, our findings for low dose aspirin but not use of other NSAIDs suggest that anti-platelet or other effects of low dose aspirin may be of etiologic significance in lymphomagenesis.
Citation Format: James R. Cerhan, Megan M. O'Bryne, Grzegorz S. Nowakowski, Timothy G. Call, Carrie A. Thompson, Tait D. Shanafelt, William R. Macon, Neil E. Kay, Thomas M. Habermann, Susan L. Slager, Mark Liebow. Aspirin and other nonsteroidal anti-inflammatory drugs, statins, and risk of non-Hodgkin lymphoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 877. doi:10.1158/1538-7445.AM2015-877
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Ferzoco RM, Cerhan JR, Maurer MJ, Allmer C, Yost KJ, Habermann TM, Ansell SM, Inwards DJ, Witzig TE, Porrata LF, Nowakowski GS, Macon WR, Towns JN, Farooq U, Link BK, Thompson CA. Exercise patterns and quality of life among survivors of aggressive lymphoma. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8555] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Umar Farooq
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
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Thompson CA, Maurer MJ, Allmer C, Ansell SM, Ferzoco RM, Habermann TM, Inwards DJ, Johnston PB, Klebig R, Macon WR, Micallef INM, Yost KJ, Farooq U, Link BK, Cerhan JR. QOL at 3 years after diagnosis in aggressive lymphoma survivors. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Umar Farooq
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brian K. Link
- University of Iowa Carver College of Medicine, Iowa City, IA
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