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  • 1
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 1361-1361
    Abstract: Transformation of follicular lymphoma (FL) to a more aggressive clinical and histological phenotype, typically diffuse large B-cell lymphoma (DLBCL), occurs frequently. It is associated with a number of recurrent genomic insults, including the acquisition of TP53 mutations in a subset of patients (pts). The use of novel agents targeting p53 and mdm2 appears attractive given the resistance of transformed DLBCL to conventional therapies. Tailoring these therapies will require precise characterisation of mutation status and functional consequence in transformation. The frequency and temporal relationship of TP53 mutation gain to transformation was analysed in DNA from sequentially collated lymph node biopsies taken pre and post transformation (n=91) obtained from 29 pts. A median of 3 samples (range 2–5) was available from each pt (13 taken at FL presentation). Transformation was documented a median of 3.8 years (range 0.2 to 15.2) from diagnosis, and median follow up from diagnosis for all pts at the time of analysis was 6.7 years (range 2 to 19.1). The entire coding sequence of TP53 was screened by PCR, fluorescent-SSCP and sequencing. Loss of heterozygosity (LOH) was examined at 5 common polymorphic sites with in TP53. Immunocytochemistry for p53, mdm2 and p21 was performed on slides obtained from 77 available paraffin blocks. Ten mutations were detected in 8 pts (28%), of which 5 were missense. The remaining was accounted for by two nonsense mutations, a splice mutation, a branch site mutation and a single base insertion. All mutations were within the genomic region covered by primer sets exon 5–7 inclusive. Mutated TP53 was first documented only at the time of histologic transformation in 4 pts, in the remainder latency between documentation in FL sample and transformation was variable (0.5–6 years). For pts with mutations, time from documentation to death ranged from 1 month-12 years (median 37 months), with 2 pts alive 8.5 and 13.5 years following initial documentation. LOH occurred in 2 pts, both at the time of transformation and was associated with short survival (1 and 17 months). Overall survival from diagnosis or histological transformation was not significantly different between pts with mutated TP53 and wtTP53. Five TP53 mutated pts. recurred post transformation (either with FL or DLBCL); in 4 pts the identical mutation was detected at this time. p53 staining was positive in 82% (9/11) of biopsies with missense mutations, and negative in 71% (45/63) with wtTP53. Mdm2 expression was predominantly centroblastic in FL and was correspondingly higher in DLBCL samples (mean 72%; 95% CI 68–76%) compared to FL (mean 58%; 95% confidence interval: 54–62%) (p & lt;0.001). Mdm2 expression did not correlate with TP53 mutation status. Expression of p21 antigen was positive in 19/71 (27%) cases and did not correlate with histology. Absence of p21 occurred in both wtTP53 (66%) and mutated TP53 (94%) samples. TP53 mutations were associated with transformation in only a subset of pts; the potential of individual mutations to induce phenotypic change was variable and thus may influence the potential success of novel TP53 directed therapies.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
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    detail.hit.zdb_id: 80069-7
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  • 2
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 24, No. 31 ( 2006-11-01), p. 5052-5059
    Abstract: To examine the immune microenvironment in diagnostic follicular lymphoma (FL) biopsies and evaluate its prognostic significance. Patients and Methods Immunohistochemistry was used to study numbers and location of cells staining positive for immune cell markers CD4, CD7, CD8, CD25, CD68, forkhead box protein P3 (FOXP3), T-cell intracellular antigen-1, and Granzyme B in tissue microarrays of paraffin-embedded, diagnostic lymph node biopsies taken from 59 FL patients who lived less than 5 years (short-survival group; n = 34) and more than 15 years (long-survival group; n = 25). Results CD4 and FOXP3 expression were significantly different between the two groups. Samples from the long-survival group were more likely than those from the short-survival group to have CD4 + staining cells and to have FOXP3-positive cells in a perifollicular location. Conclusion This study has identified differences in immune cell composition of the diagnostic FL lymph node immune microenvironment and these have the potential for use as prognostic biomarkers in a routine histopathology setting.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2006
    detail.hit.zdb_id: 2005181-5
    detail.hit.zdb_id: 604914-X
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  • 3
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 603-603
    Abstract: The median survival of FL is 10 years, but has a heterogeneous clinical course and some patients die rapidly from disease, while others survive for decades. Global gene array of FL diagnostic LNs has distinguished immune cell-associated signatures associated with good and poor prognosis. The goal of this study was to attempt to validate the gene array data at the protein level as well as assess the ability to discriminate prognostic groups based upon immunohistochemistry of diagnostic lymph nodes. TMAs were constructed of 1mm cores from initial diagnostic LNs from two groups of FL patients. The first group selected were 35 patients who survived & lt;5 yrs from diagnosis (median survival 2 yrs; median age 61 yrs; median stage 4; median FLIPI 3). The second group selected were 25 patients who survived & gt;15 yrs from diagnosis (median survival 20 yrs; median age 46 yrs; median stage 3; median FLIPI 2). Patients in both groups received a variety of standard treatments. Immunohistochemisrty was performed on the TMAs using a panel of antibodies detecting antigens associated with T-cells, including (CD4, CD8α, CD7, CD25, TIA-1, CD45RO, FOXP3) and macrophages including CD68, CD163. The immune infiltrates were scored for immunophenotype, frequency and peri- and inter-follicular distribution. Of the panels completed to date, incidence of FOXP3, perifollicular CD4 and perifollicular CD7 showed greatest discrimination between the two patient groups. CD4, CD7 and FOXP3 in prognostic patient groups Antigen expression Good Prognosis Pts Poor Prognosis Pts Perifollicular CD4 & gt;5 cells/hpf 18/23 cases (78%) & gt;5 cells/hpf 18/35 cases (51%) & lt;5 cells/hpf 5/23 cases (22%) & lt;5 cells/hpf 17/35 cases (49%) Perifollicular CD7 & gt;5 cells/hpf 22/23 cases (96%) & gt;5 cells/hpf 26/34 cases (76%) & lt;5 cells/hpf 1/23 cases (4%) & lt;5 cells/hpf 8/34 cases (24%) FoxP3 & gt;5 cells/hpf 21/24 cases (87%) & gt;5 cells/hpf 21/32 cases (66%) & lt;5 cells/hpf 3/24 cases (13%) & lt;5 cells/hpf 11/32 cases (34%) To further validate this training set, we interrogated this panel on a further test set of 33 diagnostic and relapse samples from FL patients to assess predictors of outcome on a TMA. Increased detection of CD4 or CD7 cells in a perifollicular pattern correctly predicted better outcome in 67% and 58% cases respectively. Here we demonstrate that not only the cell number and cell type, but also the distribution of the immune infiltrate has prognostic significance. Moreover, unlike gene expression profiling, immunohistochemistry can readily be applied in a diagnostic setting in routine histopathology. It is highly likely that the ability to discriminate between these two prognostic groups at diagnosis will influence patient treatment algorithms.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 4
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 2822-2822
    Abstract: Follicular lymphoma (FL) is a clinically heterogeneous disease requiring the need for easily quantifiable prognostic biomarkers. Micro-vessel density has been shown to have prognostic significance in some, but not all studies. Previous analyses has been based on simple numerical assessment of vessels within histological sections, providing a relatively thin (3–5μm) ‘snap-shot’ of what is a three-dimensional, branching network. This inherent limitation, coupled with methodological variation in its assessment, has lead to conflicting results and uncertainty of its prognostic value in many malignancies including follicular lymphoma. To determine if assessment of true tumor neovascularisation through angiogenic sprouting may be of more clinical relevance, we performed immunostaining with two routinely used endothelial cell markers (CD31 and CD34) in an established FL tissue microarray (TMA). After initial analysis, we focused attention on the vessels at the smallest end of the spectrum seen within routine thickness sections. These represent small, single staining structures no greater than 30 μm2 in area. We subsequently used extended focal imaging within thicker sections to trace these vascular structures and confirmed them to be blind-ending angiogenic sprouts. Diagnostic biopsies taken from patients at the extremes of survival of FL were analysed with respect to numbers of these sprouts, and revealed higher angiogenic activity in patients who died from lymphoma progression less than 5 years after diagnosis compared with those surviving greater than 15 years (p=0.025). This effect was only seen with CD31 and not CD34. Image overlay analysis of serial sections demonstrated that lymphatic vessels highlighted with LYVE-1, a specific lymphatic endothelial marker were positive with CD31 and negative for CD34. However, no differences between number or extent of sprouting of lymphatic vessels were seen in the two prognostic groups; therefore revealing true vascular angiogenic sprouting seen with CD31 analysis, and demonstrating that these vascular angiogenic sprouts express CD31, but less frequently express CD34. We further characterised these angiogenic sprouts using double-labelling immunofluorescence to assess pericyte coverage. Results indicated there was largely no pericyte coverage of these vascular structures, suggesting that these vessels may be targeted using anti-angiogenic therapy and not protected by pericytes. The increased angiogenic activity seen in the poorer prognostic subgroup was seen only in the inter-follicular regions and not in the neoplastic follicles. It is therefore unlikely that the increased vascularisation is a direct result of tumour cell- driven angiogenesis as a closer spatial relationship between tumour cells and vessels would be expected. Previous studies have highlighted that increased lymphoma-associated macrophages are associated with adverse outcome; their role in promoting angiogenesis has been well studied. We therefore used automated image analysis to assess numbers of CD163+, an M2 type macrophage marker identifying a subset of lymphoma-associated macrophages. Although there was no difference in absolute number of macrophages seen between the two groups, there was a positive correlation between number of these cells and extent of angiogenic sprouting. Last, we assessed the impact of angiogenic sprouting and time to transformation and identified a trend towards increased angiogenic activity in those patients who transformed within three years of diagnosis. In summary, we have used an improved gauge of angiogenic activity by quantifying angiogenic sprouts in TMA and in routine histological sections, and highlighted the impact of angiogenesis on survival and time to transformation in patients with FL. Further investigation into the mechanisms driving increased angiogenesis and its subsequent impact on survival is currently being undertaken in a validation series using a TMA of 450 patients with FL at our institution.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 5
    In: Blood, American Society of Hematology, Vol. 115, No. 24 ( 2010-06-17), p. 5053-5056
    Abstract: Follicular lymphoma has considerable clinical heterogeneity, and there is a need for easily quantifiable prognostic biomarkers. Microvessel density has been shown to be a useful prognostic factor based on numerical assessment of vessel numbers within histologic sections in some studies, but assessment of tumor neovascularization through angiogenic sprouting may be more relevant. We therefore examined the smallest vessels, single-staining structures measuring less than 30 μm2 in area, seen within histologic sections, and confirmed that they were neovascular angiogenic sprouts using extended focal imaging. Tissue microarrays composing diagnostic biopsies from patients at the extremes of survival of follicular lymphoma were analyzed with respect to numbers of these sprouts. This analysis revealed higher angiogenic activity in the poor prognostic group and demonstrated an association between increased sprouting and elevated numbers of infiltrating CD163+ macrophages within the immediate microenvironment surrounding the neovascular sprout.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2010
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 6
    In: British Journal of Haematology, Wiley, Vol. 144, No. 5 ( 2009-03), p. 716-725
    Abstract: The t(14;18)(q32;q21) chromosomal translocation induces BCL2 protein overexpression in most follicular lymphomas. However the expression of BCL2 is not always homogeneous and may demonstrate a variable degree of heterogeneity. This study analysed BCL2 protein expression pattern in 33 cases of t(14;18)‐positive follicular lymphomas using antibodies against two different epitopes (i.e. the widely used antibody BCL2/124 and an alternative antibody E17). 16/33 (49%) cases demonstrated strong BCL2 expression. In 10/33 (30%) cases, BCL2 expression was heterogeneous and in some of these, its loss appeared to be correlated with cell proliferation, as indicated by Ki67 expression. Double immunofluorescence labelling confirmed an inverse BCL2/Ki67 relationship, where in 24/28 (86%) cases cellular expression of BCL2 and Ki67 was mutually exclusive. In addition, seven BCL2 ‘pseudo‐negative’ cases were identified in which immunostaining was negative with antibody BCL2/124, but positive with antibody E17. Genomic DNA sequencing of these ‘pseudo‐negative’ cases demonstrated eleven mutations in four cases and nine of these were missense mutations. It can be concluded that in follicular lymphomas, despite carrying the t(14;18) translocations, BCL2 protein expression may be heterogeneous and loss of BCL2 could be related to cell proliferation. Secondly, mutations in translocated BCL2 genes appear to be common and may cause BCL2 pseudo‐negative immunostaining.
    Type of Medium: Online Resource
    ISSN: 0007-1048 , 1365-2141
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2009
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    detail.hit.zdb_id: 1475751-5
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  • 7
    In: Histopathology, Wiley, Vol. 56, No. 5 ( 2010-04), p. 617-626
    Abstract: Masir N, Jones M, Lee A M, Goff L K, Clear A J, Lister A, Marafioti T & Mason D Y
(2010) Histopathology 56 , 617–626 The expression of Bcl‐2 by proliferating cells varies in different categories of B‐cell lymphoma Aims:  To investigate the relationship between Bcl‐2 protein expression and cell proliferation at single‐cell level in B‐cell lymphomas using double‐labelling techniques. Methods and results:  The relationship between Bcl‐2 protein expression and cell proliferation was explored in 124 cases of B‐cell lymphoma using double immunofluorescence labelling for Bcl‐2 and Ki67. In follicular lymphoma, marginal zone lymphoma and a subset of chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL), neoplastic cells tended to lose Bcl‐2 when they are in cell cycle. This pattern is usually maintained in both follicular lymphoma and CLL/SLL when they undergo high‐grade transformation. In mantle cell lymphoma, diffuse large B‐cell lymphoma and a subset of CLL/SLL, the inverse relationship (between Bcl‐2 and Ki67) was not observed, i.e. the proliferating cells tended to show co‐expression of Bcl‐2. Conclusions:  In low‐grade lymphomas, including those that are transformed, Bcl‐2 expression is lost when cell proliferate. However, in more aggressive tumours (i.e. mantle cell and de novo diffuse large B‐cell lymphomas) the inverse Bcl‐2/Ki67 relationship was not observed. It would be of interest to explore the clinical implications in lymphoma of the presence and absence of the inverse Bcl‐2/Ki67 pattern.
    Type of Medium: Online Resource
    ISSN: 0309-0167 , 1365-2559
    URL: Issue
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    Language: English
    Publisher: Wiley
    Publication Date: 2010
    detail.hit.zdb_id: 2006447-0
    detail.hit.zdb_id: 131914-0
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  • 8
    In: Haematologica, Ferrata Storti Foundation (Haematologica), Vol. 102, No. 8 ( 2017-08), p. 1413-1423
    Type of Medium: Online Resource
    ISSN: 0390-6078 , 1592-8721
    Language: English
    Publisher: Ferrata Storti Foundation (Haematologica)
    Publication Date: 2017
    detail.hit.zdb_id: 2333-4
    detail.hit.zdb_id: 2030158-3
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  • 9
    In: Blood, American Society of Hematology, Vol. 118, No. 21 ( 2011-11-18), p. 1654-1654
    Abstract: Abstract 1654 Background: Mantle cell lymphoma (MCL) is an incurable, aggressive subtype of non-Hodgkin lymphoma in which there is a need for novel targeted therapies. Activation of the PI3K-Akt pathway and its role in the pathogenesis of MCL has been highlighted in a number of studies. Constitutive activation of the PI3K pathway inactivates GSK-3β, a downstream target of Akt, that can phosphorylate cyclin D1 resulting in its nuclear export. There is also evidence that cyclin D1 mRNA stability and translation is enhanced by this pathway. The class Ia PI3K p110 catalytic subunit isoforms α, β and δ are primarily implicated in oncogenesis. While the PI3K p110δ isoform is known to be enriched in lymphocytes, a gain of PIK3CA (the gene encoding PI3K p110α) copy number has been shown to be a frequent alteration in MCL. The expression and relative importance of the individual Class Ia PI3K isoforms has not been documented in this disease. With the development of isoform selective inhibitors, this is an important issue that needs to be addressed. Aims: We studied the expression of class Ia PI3K isoforms in primary MCL with relation to morphological variants and disease status. We also compared the efficacy of PI3K inhibition in MCL cell lines and primary samples using two novel inhibitors, GDC-0941(predominantly p110α/δ-selective) and CAL-101 (δ-selective), both of which are in early phase clinical trials. Methods: Tissue microarrays were constructed from triplicate 1mm cores from 144 MCL biopsies and 16 tonsil controls. The levels of p110α, p110β and p110δ isoforms were then determined by immunohistochemistry using isoform-specific antibodies. The in vitro effect of PI3K inhibitors on cell viability and apoptosis was studied in 4 MCL cell lines, (Jeko-1, Granta519, REC-1 and JVM-2), and 15 primary MCL samples. Expression of the class Ia PI3K isoforms and changes in downstream targets of PI3K were determined by western blotting. Results: P110δ was expressed at a consistently higher level in MCL samples and normal tonsil controls compared to the α and β isoforms, while p110β expression was weak and significantly lower than p110α expression. On comparing expression of isoforms at diagnosis and relapse, p110α expression was significantly increased beyond 1st relapse compared to diagnostic biopsies (p=0.04) and tonsil controls (p=0.02), an observation that was even more apparent in 6 paired samples [p=0.008, median IHC score 19.6 (5.0−53.2) at diagnosis vs. 91.5 (38.6 − 129) beyond 1st relapse]. No significant change was found in the expression of p110β or p110δ between diagnostic and relapse samples. There was no significant difference in expression levels of the 3 isoforms between blastoid and non-blastoid morphological variants. Expression of both the p110α and δ isoforms was detected by western blotting in 4 MCL cell lines, but only Jeko-1 cells were sensitive to inhibition with GDC-0941. CAL-101 produced little or no apoptosis in all 4 cell lines. In primary MCL samples, GDC-0941 was consistently more potent than CAL-101, with decrease in cell viability of 32 vs. 20% at 1μM (p=0.15), 51 vs. 25% at 5μM (p=0.02) and 67 vs. 35% at 10μM (p 〈 0.0001) GDC-0941 and CAL-101 respectively. GDC-0941 was also able to partially overcome the stimulatory effect of sCD40L and IL4 on primary MCL samples. Western blotting showed a consistent reduction in the phosphorylation of Akt and GSK-3β in sensitive MCL cells. Conclusion: Our studies demonstrate that although p110δ is the most consistently expressed isoform, the expression of the p110α subunit increases significantly in multiply relapsed MCL. This observation, in combination with significantly greater in vitro sensitivity of MCL primary samples to GDC-0941, compared to the p110δ-selective inhibitor CAL-101, provides strong evidence for further evaluation of GDC-0941 in this disease. Disclosures: Gribben: Roche: Honoraria; Celgene: Honoraria; GSK: Honoraria; Mundipharma: Honoraria; Gilead: Honoraria; Pharmacyclics: Honoraria. Joel:Astra Zeneca: Research Funding; Intellikine: Research Funding.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2011
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 10
    In: Blood, American Society of Hematology, Vol. 114, No. 21 ( 2009-11-19), p. 4713-4720
    Abstract: An important hallmark of cancer progression is the ability of tumor cells to evade immune recognition. Understanding the relationship between neoplastic cells and the immune microenvironment should facilitate the design of improved immunotherapies. Here we identify impaired T-cell immunologic synapse formation as an active immunosuppressive mechanism in follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL). We found a significant reduction in formation of the F-actin immune synapse in tumor-infiltrating T cells (P 〈 .01) from lymphoma patients compared with age-matched healthy donor cells. Peripheral blood T cells exhibited this defect only in patients with leukemic-phase disease. Moreover, we demonstrate that this T-cell defect is induced after short-term tumor cell contact. After 24-hour coculture with FL cells, previously healthy T cells showed suppressed recruitment of critical signaling proteins to the synapse. We further demonstrate repair of this defect after treatment of both FL cells and T cells with the immunomodulatory drug lenalidomide. Tissue microarray analysis identified reduced expression of the T-cell synapse signature proteins, including the cytolytic effector molecule Rab27A associated with poor prognosis, in addition to reduced T-cell numbers and activity with disease transformation. Our results highlight the importance of identifying biomarkers and immunotherapeutic treatments for repairing T-cell responses in lymphoma.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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