ALBERT

Description: Introduction: Rituximab (Rtx) is an anti-CD20 monoclonal antibody that is clinically active in B-cell chronic lymphocytic leukemia (B-CLL). In vitro and in vivo data indicate that Rtx mediates its biologic effect through multiple mechanisms including apoptosis, complement dependent cytotoxicity (CDC), and antibody dependent cellular cytotoxicity (ADCC). Objetive: To study in vitro sensitivity to apoptosis by Rtx of isolated cells obtained from B-CLL patients Binet stage A, in the presence of complement from different sources and correlate with CD20 and CD59 molecules expression. Methods: PBMCs were isolated from peripheral blood samples by centrifugation on a Ficoll/Hypaque gradient and cryopreserved in liquid nitrogen. Cells from 21 patients were cultured at 1X106 cells/ml in RPMI 1640 culture medium supplemented with 20% AB serum or 10% heat inactivated fetal calf serum (FCSi) with increasing quantities of rabbit complement (RC) added as a source of complement. Apoptosis was determined by Annexin V-FITC Apoptosis Detection Kit. The absolute number of CD20 and CD59 molecules pretreatment was measured using DAKO QIFIKIT (DAKO Denmark). Comparison of apoptosis and antigen expression between models of culture was performed by the t Student test and U-Mann Whitney respectively. Results: Incubation of cells with AB alone, FCSi with rabbit complement (RC) or Rtx alone did not induce cell death. A Rtx dose-response study was first performed. Rituximab was added at 1ug/ml, 10ug/ml, 50ug/ml and increasing quantities of RC (10, 30, 60 and 120ul/well). The effect was doses dependent for both Rtx and RC. A discriminant cytotoxic effect was observed with 10 μg/mL Rtx in the presence of 60 ul RC. Cells treated with Rtx 100ug/ml and AB serum for 24 hours caused apoptosis in 52% of patients (11/21 with median of 7%)(Model A). However, when cells from these patients were treated with Rtx, FCSi and RC, at much lower concentration, 10ug/ml and 60ul RC, cell death was observed in 69% of patients (13/21 with median of 37%) (Model B) p

Description: Splenic marginal zone lymphoma (SMZL) is an indolent B cell malignancy whose diagnosis is based on lymphocyte morphology, immunophenotype and marrow and/or splenic histology. Unlike other lymphomas, there is not a common chromosomal translocation specific for SMZL, and genetic prognostic factors are poorly defined. To investigate the pattern of genomic aberrations in SMZL, we applied comparative genomic hybridization to BAC microarrays (array CGH) to a well characterized series of 75 SMZL specimens. We applied two different 1 Mb-resolution BAC arrays: UCSF HumArray 3.2 and a novel array CGH platform developed at Univ. of Salamanca. These arrays allowed us to detect DNA copy number changes across the genome with high accuracy in 67 of 75 patient samples. Data were compared with our previous array CGH studies of 170 samples from different B-cell lymphoma subgroups. FISH studies for IGH, IGK and IGL translocations and 7q deletion were performed on tissue microarrays in 24 cases. Of the 67 samples, 19 (28%) showed a normal genomic profile. The median number of genomic aberrations per tumor was 2.2 (1.3 gains and 0.9 losses), which was lower than the rates detected in other lymphoma subgroups (diffuse large cell lymphoma, 6.4; mantle cell lymphoma, 6; follicular lymphoma, 4.5) and comparable to MALT lymphomas (2 abnormalities per tumor). SMZL cells showed a genomic pattern characterized by gain of chromosomes 3q24-q29 (18%), 6p (9%), 12q (9%), and 18q (4%) and loss of 7q32 (34%), 8p21-p23 (13%), 17p13 (10%) at P53 locus and 6q21-q27 (9%). Notably, no alterations of the P16/ARF (9p21) or MYC loci (8q24) were detected. Correlation of array CGH data with conventional cytogenetics, FISH and LOH studies revealed a high concordance. Detailed mapping of 7q deletions delineated a consensus region of loss of 3 Mb in 7q32. This 7q deletion was almost exclusive to SMZL, being observed in only 5 of 170 non-SMZL B-cell lymphomas (p=0.0000001). Four cases presented IG-translocation. Mutation of IGH was observed in 62% and correlated with a complex karyotype (61 vs. 13%; p=0,0008) whereas unmutated IGH correlated with the deletion of 7q (56 vs. 23%; p=0,01). Among the various genomic abnormalities, only the deletion of 8p or the presence of a complex karyotype correlated with inferior overall survival (OS) (median OS, 58 vs. 110 months, p=0,004; and 60 vs. 105 months, p=0,01; respectively). In summary, array CGH has defined a pattern of genomic aberrations in SMZL that differs from other B-cell lymphoma subgroups and that may predict overall survival. Because the deletion of 7q32 is the most distinctive genetic marker in SMZL, the identification of a putative tumor suppressor gene inactivated within the region of deletion seems mandatory.

Description: Mantle cell lymphoma (MCL) is a rare, aggressive subtype of B-cell non-Hodgkin lymphoma (B-NHL), characterized by t(11;14)(q13;q32). To identify recurrent genomic events involved in the pathogenesis of this malignancy, we used genome-wide comparative genomic hybridization (CGH) to 1.4 Mb. resolution BAC microarrays in 68 patients and 9 derived MCL cell lines; the genome profiles were compared to those from other B-NHL subtypes. Array-CGH defined a MCL genomic signature different from other B-cell lymphomas, including deletions of chromosomes 1p21.2-p12.3, 11q22.3 at ATM gene locus, 13q14.2 and 13q34, with coincident 10p12-BMI locus amplification and 10p14 deletion, along with a previously unidentified loss within 9q21-q22. Specific genomic alterations were associated with different subgroups of disease. Notably, 11 patients with non-nodal, leukemic MCL, defined on the basis of the absence at diagnosis of lymph node disease, showed a different genomic profile to nodal cases, including deletion of 8p21.2 at TRAIL receptor gene cluster (55 vs. 19%;p=0,01) and gain of 8q24.1 at MYC locus (46 vs. 14%;p=0,015). Additionally, leukemic MCL exhibited frequent IgVH mutation (64 vs. 21%;p=0,009) with preferential VH-39 use (36 vs. 4%;p=0,005), and followed a more indolent course, being 7 of 11 patients (64%) survivors for more than 3 years whereas only 15 of 55 patients (27%) in the nodal group experienced this long survival (median survial time, 42 vs. 18 months; p=0,02). The median overall survival (OS) for the patients in the series was 39 months (range, 0–115). Blastoid variant of MCL, increased number of genomic gains, and deletions of P16/INK4a and P53 genes correlated with poorer outcomes, whilst 1p21 loss was associated with prolonged survival (median OS, 70 vs. 31 months; p=0,02). In multivariate analysis, deletion of chromosome 9q21-q22, which has not been previously reported as a common change in MCL, was the strongest predictor for inferior survival (HR:6; CI:2,3–15,7). Last, the genotypes of 14 patients with MCL who were alive for more than 5 years since diagnosis showed deletion of 1p21 in seven cases (50%), but none exhibited deletions of 9q21-q22, 9p21.3-P16/INK4a or 17p13.1-P53. Our study illustrates the utility of array-CGH in MCL sub-classification and highlights the array genomic profile as the strongest indicator for predicting clinical outcome. The screening of this reduced BAC clone set either by FISH or custom-made array CGH devices could be reliably applied to the clinical diagnostics of MCL.

Description: Introduction: Chronic lymphocytic leukemia B (CLL-B) is the most frequent chronic lymphoproliferative disorder in western countries. The majority of patients are diagnosed in incipient Binet stage A. Some prognostic factors have been identified, as mutations in the genes coding for immunoglobulin variable regions (IgVH). Complementary somatic mutations in the BCL6 gene have been observed in 25% of CLL-B patients, although its clinical relevance remains unclear. Objective: To identify molecular markers of different patient groups of lymphoproliferative disorder through analysis of their proteomic profiles. Material and Methods: 15 samples of peripheral blood lymphocytes B from Binet stage A CLL-B patients were analyzed. Among them, 5 carried mutations in IgVH and BCL6 (M) genes, 5 had no mutations (IgVH, BCL6 (U)), and 5 with mutations in IgVH(M) but without mutations in BCL6(U). 100 μg of total proteins were isoelectrofocussed using DryStrips (13 cm, pI 4–7), followed by 15% SDS-PAGE, and Coomasie Blue staining. Image acquisition and analysis were performed with the Image Master Platinum software (Amersham Biosciences). Spots showing differential expression were subjected to automatic tryptic digestion. Proteins were identified by MALDI-TOF mass fingerprinting using the Protein Prospector software. Selected peptide ions were sequenced by collision-induced dissociation (CID) using an ESI-QTRAP instrument. Results: The mean number of spots per gel was 214, which showed a mean percentage matching among the three patient groups of 77%. Statistics of the 2D-IEF/SDS-PAGE separations of the total lymphocyte B protein from patients with different mutational status of their IgVH and BCL6 genes. IgVH, BCL6 (M) vs. IgVH(M), BCL6(U) IgVH (M), BCL6 (U) vs. IgVH, BCL6(U) IgVH, BCL6 (M) vs. IgVH, BCL6(U) (*) Test t of student. Spot media per gel 228/180 180/235 228/235 Matching percentage 80.2% 79.3% 70.5% Number of spots with p

Description: p15 and p14/p16 tumor suppressor genes, have been reported to be frequently inactivated by various mechanisms in haematological malignancies such us MM. Alterations of these cell cycle inhibitors in MM display a close correlation with the cell cycle and clinical outcome. We have evaluated by real time quantitative RT-PCR (RQ-PCR) the expression of the p14/p16 and p15 genes in purified bone marrow plasma cells (PBMPC) from MM patients in order to evaluate the possible clinical, biological and prognostic significance of these cell cycle regulators. RNA extracted from purified BMPC from 53 untreated symptomatic MM and a pool of buffy coat from healthy donors (reference value) was analyzed by RQ-PCR using Assays-on-Demand gene expression mixes specific for p14/p16 and p15 genes in an ABI PRISM 7700 SDS (Applied Biosystems, Foster City, CA, USA). Values were corrected with a control gene (ABL). The relative quantification of gene expression was performed through the cycle threshold (CT) increment method. Patients were classified into different groups depending on gene expression values. Thus, according to p15 expression, 29% of patients (n=14) showed higher levels than the control and this group was characterized by the presence of good prognostic markers such us low Lactato dehidrogenase levels (LDH), low b2-microglobulin (B2M) and C-Reactive Protein (CRP) serum levels and absence of monoclonal proteinuria. Similar results were found for p14/p16 expression. Fifteen patients (28%) displayed a high p14/p16 expression and the group was also characterized by good prognostic features: low CRP, B2M and LDH levels. When p14/p16 and p15 genes were simultaneously analyzed, clinical and biological parameters showed a statistically significant correlation with gene expression. Thus patients with low gene expression had a high B2M (≥3 mg/dl) and high C-reactive protein (≥3 mg/dl). As far as survival was concerned, patients with a high p15 expression had a longer overall survival of 100% vs. 58% at 30 months (p=0,01), with the additional value that no deaths have been observed in any such patients. Similar results were observed for the group of patients displaying a high p14/p16 expression since they displayed a much better OS (100% vs. 63% at 30 months, p=0,02). Again, we should note that no deaths have been presented in this group. All these findings were much more evident when the three genes were simultaneously considered. Thus, within the group of 21 patients with at least one of the two genes overexpressed there have been no deaths vs. 11 among the 27 patients with low levels. This resulted in quite different OS curves for the two groups of patients (Figure 1) of 100% vs. 49% at 30 months (p=0,00). In conclusion, these genes significantly determine patients’ outcome thanks to their ability to classify them into different groups with different clinical, biological and outcome characteristics.

Description: Gene Expression Profiling through RNA arrays has provided new clues to Multiple Myeloma pathogenesis and prognostic pattern evaluation. Recently, ZHX2, CHC1L & RAN expression have been highlighted as key elements in MM. In the present paper, we have evaluated theses genes by real time quantitative RT-PCR (RQ-PCR) in purified plasma cells from 74 patients with plasma cell discrasias. MATERIAL AND METHODS: Purified Bone Marrow cells were obtained from the following patients: 6 MGUS, 7 smoldering MM, 59 newly diagnosed symptomatic MM patients and 2 Plasma cell leukemia (PCL). After RNA extraction, RQ-PCR of CHC1L(C), RAN(R) and ZHX2 (Z) genes was carried out using the standard protocol from TaqMan® gene expression Assays-on-Demand in an ABI-PRISM 7700 Sequence Detection System (Applied Biosystems, Foster City, CA, USA). Expression levels were normalized with ABL gene and expressed in n-fold times compared to the expression in a pool of RNA from mononuclear cells from healthy donors. The expression level of the different genes was evaluated for correlation with the diagnosis, clinical characteristics and prognosis of the patients. RESULT AND CONCLUSIONS: None of these genes displayed a clear relationship with the different stages of disease pathogenesis, although ZHX2 gene was slightly more expressed in the indolent forms of the proliferative disorders (MGUS and SMM). Within symptomatic MM patients, several interesting associations were observed. Thus, in hyperdiploid MM cases, CHC1L expressions observed were fewer than in those with a normal DNA index, confirming the participation of the gene product in chromosomal condensation during the mitosis. No other important associations were observed for this gene, although patients with the lowest expression displayed a very good prognosis, but without reaching statistically significant differences. As expected, RAN expression was related to S-Phase PC, since patients with high S phase values (〉1.8 %) displayed higher levels of RAN transcripts. This, however, only resulted in a marginal impact on survival. ZHX2 provided the most interesting results, whereby decreased levels of ZHX2 were related to unfavorable prognostic indicators such as B2 microglobulin 〉4 mg/L and Hemoglobin levels

Description: Patients with mantle cell lymphoma (MCL) may present with either nodal or leukemic disease. The molecular determinants underlying this different biologic behavior are not known. This study compared the pattern of genetic abnormalities in patients with nodal and leukemic phases of MCL using comparative genomic hybridization (CGH) and fluorescence in situ hybridization (FISH) for specific gene loci. Although both leukemic and nodal MCL showed similar genomic patterns of losses (involving 6q, 11q22-q23, 13q14, and 17p13) and gains (affecting 3q and 8q), genomic loss of chromosome 8p occurred more frequently in patients with leukemic disease (79% versus 11%,P