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Identification of distinct subgroups of EBV-positive post-transplant diffuse large B-cell lymphoma.

EBV阳性移植后弥漫性大B细胞淋巴瘤不同亚型的识别

Morscio J,Finalet Ferreiro J,Vander Borght S,Bittoun E,Gheysens O,Dierickx D,Verhoef G,Wlodarska I,Tousseyn T
阅读:1159 Modern PathologyMar 2017; 30 (3): 316 - 469:370-381 

Abstract

Post-transplantation lymphoproliferative disorder is an aggressive complication of transplantation, most frequently of diffuse large B-cell lymphoma morphology and associated with Epstein-Barr virus (EBV) infection/reactivation. In this study the microenvironment of EBV(+) (n=23) and EBV(-) (n=9) post-transplant non-germinal center B-cell diffuse large B-cell lymphoma was characterized. Of EBV(+) cases somatic hypermutation analysis, gene expression profiling, and extensive phenotyping were performed. Our results demonstrated variable cytotoxic T-cell infiltration and significantly increased CD163(+) M2 macrophage infiltration in EBV(+) compared with EBV(-) post-transplant diffuse large B-cell lymphoma. On the basis of IgM staining and hypermutation analysis, two EBV(+) post-transplant diffuse large B-cell lymphoma subgroups were identified: IgM(+) tumors lacking somatic hypermutations and IgM(-) tumors harboring somatic hypermutations. IgM(-) tumors arose late following transplantation (median interval: 16 months), mainly in kidney recipients. IgM(+) tumors on the other hand arose early (median interval: 3 months, P-value=0.0032), almost exclusively following stem cell transplantation and were associated with worse outcome (median survival 1 month for IgM(+) versus 41 months for IgM(-) tumors, log-rank/Wilcoxon P-value 0.07/0.04). Notably, IgM(+) tumors were characterized by plasma cell features (monotypic kappa/lambda expression, high MUM1 expression, and partial CD138 expression) and a high proliferation index. Consistent with the plasma cell phenotype, unfolded protein response signaling was upregulated. In contrast, IgM(-) EBV(+) post-transplant diffuse large B-cell lymphoma did not express kappa, lambda, IgD, or CD138 and expressed limited MUM1. In these tumors T-cell signaling was enhanced associated with increased T-cell infiltration compared with IgM(+) cases. Overall, our results allow further molecular classification of EBV(+) post-transplant diffuse large B-cell lymphoma and provide a rationale for the use of subtype-specific-targeted therapies (eg, bortezomib in IgM(+) tumors). Our findings also provide a biological basis for the clinical differences between post-transplant lymphoproliferative disorder following solid organ and stem cell transplantation, which are regarded as different disorders.

摘要

移植后淋巴组织增殖性疾病是移植相关的侵袭性并发症,大多数为弥漫性大B细胞淋巴瘤的形态并与Epstein-Barr病毒(EBV)感染/激活相关。这项研究关注EBV(+)(n = 23)和EBV(-)(n = 9)的移植后非生发中心B细胞弥漫性大B细胞淋巴瘤的微环境特征。对EBV(+)病例进行了体细胞超突变分析、基因表达谱及广泛的表型研究。我们的研究结果表明,较之于EBV(-)的病例, EBV(+)移植后弥漫性大B细胞淋巴瘤,有数量不等的细胞毒性T细胞浸润和显著增加的CD163(+)M2巨噬细胞浸润。基于IgM染色和超突变分析,可将EBV(+)移植后弥漫性大B细胞淋巴瘤分为2个亚型:缺乏体细胞超突变的IgM(+)肿瘤和具有体细胞超突变的IgM(-)肿瘤。IgM(-)肿瘤在移植后迟发(平均间隔时间16个月),主要发生在肾移植受者。另一方面IgM(+)肿瘤移植后早期发生(平均间隔时间3个月,P 值= 0.0032),几乎无一例外的为造血干细胞移植后,且预后差(中位生存期IgM阳性的为1个月,IgM阴性的41个月)。值得注意的是,IgM(+)的肿瘤具有浆细胞特征(κ/λ限制性表达,高表达MUM1,部分表达CD138)和高增殖指数。与浆细胞表型一致,未折叠蛋白的反应信号上调。与此相反,IgM(-)EBV(+)移植后弥漫性大B细胞淋巴瘤不表达κ、λ、IgD或CD138,表达有限的MUM1。较之于IgM(+)的病例,这些肿瘤由于T细胞浸润增加,T细胞信号被增强。总之,我们的研究结果表明可对EBV(+)移植后弥漫性大B细胞淋巴瘤进一步行分子分类,并为亚型特异性靶向治疗(如IgM阳性的肿瘤可应用硼替佐米)的应用提供了一个合理的理由。我们的研究结果也提供了与实体器官移植和干细胞移植相关的(这被视为不同的疾病)移植后淋巴组织增生性疾病临床差异的生物学基础。


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