Prognosis Of Diffuse Large B-cell Lymphoma Patients Research Articles

Nomogram for predicting survival of patients with diffuse large B-cell lymphoma.

The international prognostic index (IPI) system has been widely used to predict prognosis in diffuse large B-cell lymphoma (DLBCL). However, this system categorizes DLBCL patients into four risk groups, and cannot optimize individualized prognosis. In addition, other clinicopathological factors, such as molecular aberrations, are not incorporated into the system. To partly overcome these weak points, we developed nomograms to predict individual patient survival. We also incorporated MYD88L265P and CD79BY196 mutations into the nomograms since these mutations are associated with a worse prognosis and their signaling pathways have been highlighted as a therapeutic target. We analyzed 302 DLBCL cases for which multivariate analysis by Cox proportional hazard regression was performed. Nomograms for progression-free survival (PFS) and overall survival (OS) were constructed and assessed by a concordance index (C-index). The nomograms were also evaluated using an open external dataset (n = 187). The MYD88L265P and/or CD79BY196 (MYD88/CD79B) mutation was detected in 62/302 patients. The nomograms incorporating IPI factors exhibited a C-index of 0.738 for PFS and a C-index of 0.765 for OS. The nomograms incorporating IPI factors and the MYD88/CD79B mutation showed a C-index of 0.745 for PFS and a C-index of 0.769 for OS. The nomograms we created were evaluated using an external dataset and were well validated. The present nomograms incorporating IPI factors and the MYD88/CD79B mutation have sufficient discrimination ability, and may effectively predict prognosis in DLBCL patients. The prognostic models we have presented here may help clinicians personalize prognostic assessments and clinical decisions.

The impact of MYD88 and PIM1 in mature large B-cell non-Hodgkin lymphomas: Defining element of their evolution and prognosis.

Sequence studies of the entire exome and transcriptome of lymphoma tissues have identified MYD88 and PIM1 as involved in the development and oncogenic signaling. We aimed to determine the frequency of MYD88 and PIM1 mutations, as well as their expressions in conjunction with the clinicopathological parameters identified in mature large B-cell non-Hodgkin lymphomas. The ten-year retrospective study included 50 cases of mature large B-cell lymphoma, diagnosed at the Pathology Department of the Emergency County Hospital of Constanţa and Săcele County Hospital of Brasov. They were statistically analyzed by demographic, clinicopathological, and morphogenetic characteristics. We used a real-time polymerase chain reaction technique to identify PIM1 and MYD88 mutations as well as an immunohistochemical technique to evaluate the expressions of the 2 genes. Patients with lymphoma in the small bowel, spleen, brain, and testis had a low-performance status Eastern Cooperative Oncology Group (P = .001). The Eastern Cooperative Oncology Group performance status represented an independent risk factor predicting mortality (HR = 9.372, P < .001). An increased lactate dehydrogenase value was associated with a low survival (P = .002). The international prognostic index score represents a negative risk factor in terms of patient survival (HR = 4.654, P < .001). In cases of diffuse large B-cell lymphoma (DLBCL), immunopositivity of MYD88 is associated with non-germinal center B-cell origin (P < .001). The multivariate analysis observed the association between high lactate dehydrogenase value and the immunohistochemical expression of PIM1 or with the mutant status of the PIM1 gene representing negative prognostic factors (HR = 2.066, P = .042, respectively HR = 3.100, P = .004). In conclusion, our preliminary data suggest that the oncogenic mutations of PIM1 and MYD88 in our DLBCL cohort may improve the diagnosis and prognosis of DLBCL patients in an advanced stage.

S100A8 is a prognostic signature and associated with immune response in diffuse large B-cell lymphoma.

S100A8, a calcium-binding protein belonging to the S100 family, is involved in immune responses and multiple tumor pathogens. Diffuse large B-cell lymphoma (DLBCL) is one of the most common types of B-cell lymphoma and remains incurable in 40% of patients. However, the role of S100A8 and its regulation of the immune response in DLBCL remain unclear. The differential expression of S100A8 was identified via the GEO and TCGA databases. The prognostic role of S100A8 in DLBCL was calculated using the Kaplan-Meier curve. The function enrichment of differentially expressed genes (DEGs) was explored through GO, KEGG, GSEA, and PPI analysis. In our cohort, the expression of S100A8 was verified. Meanwhile, the biological function of S100A8 was applied after the inhibition of S100A8 in an in vitro experiment. The association between S100A8 and immune cell infiltration and treatment response in DLBCL was analyzed. S100A8 was significantly overexpressed and related to a poor prognosis in DLBCL patients. Function enrichment analysis revealed that DEGs were mainly enriched in the IL-17 signaling pathway. Our cohort also verified this point. In vitro experiments suggested that inhibition of S100A8 should promote cell apoptosis and suppress tumor growth. Single-cell RNA sequence analysis indicated that S100A8 might be associated with features of the tumor microenvironment (TME), and immune infiltration analyses discovered that S100A8 expression was involved in TME. In terms of drug screening, we predicted that many drugs were associated with preferable sensitivity. Elevated S100A8 expression is associated with a poor prognosis and immune infiltration in DLBCL. Inhibition of S100A8 could promote cell apoptosis and suppress tumor growth. Meanwhile, S100A8 has the potential to be a promising immunotherapeutic target for patients with DLBCL.

Co-expression of regulatory B-cell markers, transforming growth factor β and interleukin-10 as a prognostic factor in diffuse large B-cell lymphoma

Regulatory B cells (Bregs) suppress antitumor immunity by producing anti-inflammatory cytokines such as transforming growth factor β (TGF-β) and interleukin-10 (IL-10) and promoting tumor growth. It is unknown whether diffuse large B-cell lymphoma (DLBCL), a common subtype of B-cell malignancy, exhibits characteristics similar to those of Bregs. This study aimed to clarify the features of DLBCLs carrying Breg markers. In 123 DLBCL cases, we evaluated TGF-β and IL-10 expression in tumor biopsy samples using immunohistochemical staining and retrospectively analyzed their clinicopathological characteristics. Fifteen cases (12.2 %) classified as Breg-type DLBCL were positive for both TGF-β and IL-10. Breg-type DLBCL is mainly classified as having activated B cell-like cells of origin. Breg-type DLBCL cases showed significantly worse progression-free survival and overall survival (OS) than other DLBCL cases (P = 0.0016 and P = 0.042, respectively). In multivariate analysis, Breg-type DLBCL significantly affected OS (hazard ratio, 3.13; 95 % confidence interval 1.15–8.55; P = 0.025). Gene expression analysis showed that the expression of follicular dendritic cell-associated genes (FCER2, PIK3CD, FOXO1) was downregulated in Breg-type DLBCLs compared to other DLBCLs. These results suggest that the double expression of Breg markers, TGF-β and IL-10, in tumor cells indicates a poor prognosis in DLBCL patients. Further studies evaluating genomic abnormalities could confirm the characteristics of Breg-type DLBCL.

Prognostic value of lactate dehydrogenase, serum albumin and the lactate dehydrogenase/albumin ratio in patients with diffuse large B-cell lymphoma

ABSTRACT Objective To investigate the prognostic value of lactate dehydrogenase (LDH), serum albumin (ALB) and the lactate dehydrogenase/albumin ratio (LAR) in diffuse large B-cell lymphoma (DLBCL) before primary treatment. Methods The clinical data of 212 primary adult DLBCL patients admitted to the First People's Hospital of Lianyungang from January 2017 to December 2022 were analyzed retrospectively. The optimal cutoff values of LDH, ALB, and LAR were determined using ROC curves. Survival curves of LDH, ALB, and LAR were plotted and analyzed using the Cox regression model and Kaplan–Meier method with the log-rank test. Results Among the 212 patients admitted, the study derived the optimal cutoff values for ALB, LDH, and LAR as 38, 301, and 6, respectively. The Kaplan–Meier method and log-rank test analysis indicated a significant association between lower ALB levels, elevated LDH levels, elevated LAR levels, and shorter overall survival (OS) and progression-free survival (PFS) (P < 0.05). Additionally, the critical values of ALB and LDH were grouped into three categories. The differences in OS and PFS among these three groups were statistically significant (P < 0.05). Cox multifactorial analysis revealed that the LAR was an independent factor influencing the prognosis of OS and PFS, with a higher prognostic value than LDH and ALB alone. Conclusion Decreased ALB levels and elevated LDH and LAR levels at the time of initial diagnosis are indicative of a poor prognosis in DLBCL patients. Furthermore, the study highlighted that the LAR has a higher prognostic value than LDH and ALB alone.

Comprehensive analysis of the prognostic implication and immune infiltration of CISD2 in diffuse large B-cell lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most common B-cell lymphoma in adults. CDGSH iron sulfur domain 2 (CISD2) is an iron-sulfur protein and plays a critical role of cell proliferation. The aberrant expression of CISD2 is associated with the progression of multiple cancers. However, its role in DLBCL remains unclear. The differential expression of CISD2 was identified via public databases, and quantitative real-time PCR (qRT-PCR) and western blot were used to identifed the expression of CISD2. We estimated the impact of CISD2 on clinical prognosis using the Kaplan-Meier plotter. Meanwhile, the drug sensitivity of CISD2 was assessed using CellMiner database. The 100 CISD2-related genes from STRING obtained and analyzed using the LASSO Cox regression. A CISD2 related signature for risk model (CISD2Risk) was established. The PPI network of CISD2Risk was performed, and functional enrichment was conducted through the DAVID database. The impacts of CISD2Risk on clinical features were analyzed. ESTIMATE, CIBERSORT, and MCP-counter algorithm were used to identify CISD2Risk associated with immune infiltration. Subsequently, Univariate and multivariate Cox regression analysis were applied, and a prognostic nomogram, accompanied by a calibration curve, was constructed to predict 1-, 3-, and 5-years survival probabilities. CISD2 was upregulated in DLBCL patients comparing with normal controls via public datasets, similarly, CISD2 was highly expressed in DLBCL cell lines. Overexpression of CISD2 was associated with poor prognosis in DLBCL patients based on the GSE31312, the GSE32918, and GSE93984 datasets (P<0.05). Nine drugs was considered as a potential therapeutic agents for CISD2. By using the LASSO cox regression, twenty seven genes were identified to construct CISD2Risk, and biological functions of these genes might be involved in apoptosis and P53 signaling pathway. The high CISD2Risk value had a worse prognosis and therapeutic effect (P<0.05). The higher stromal score, immune score, and ESTIMATE score were associated with lowe CISD2Risk value, CISD2Risk was negatively correlated with several immune infiltrating cells (macrophages M0 and M1, CD8 T cells, CD4 naïve T cells, NK cell, etc) that might be correlated with better prognosis. Additionally, The high CISD2Risk was identified as an independent prognostic factor for DLBCL patients using both univariate and multivariate Cox regression. The nomogram produced accurate predictions and the calibration curves were in good agreement. Our study demonstrates that high expression of CISD2 in DLBCL patients is associated with poor prognosis. We have successfully constructed and validated a good prognostic prediction and efficacy monitoring for CISD2Risk that included 27 genes. Meanwhile, CISD2Risk may be a promising evaluator for immune infiltration and serve as a reference for clinical decision-making in DLBCL patients.

The Characterization and Prognostic Value of Tumor Immune Microenvironment in Diffuse Large B-Cell Lymphoma

Introduction: Diffuse large B-cell lymphoma (DLBCL) is featured by high heterogeneity, especially in clinical outcome. Tumor microenvironment (TME) represents a complex ecosystem around tumor cells, which has been found to be associated with the prognosis of DLBCL patients. However, the overall profile of TME immune components, perception of its correlation with tumor development and molecular mechanism are still insufficient in DLBCL. Here, we aimed to investigate novel prognostic scoring system and biomarkers based on TME immune components, and explore their underlying molecular mechanism in the development of DLBCL. Methods: Microarray transcriptomic data and corresponding clinical information of DLBCL patients (n=946) from GSE23501, GSE53786, GSE10846, GSE136971, GSE57611 and GSE32918 in GEO database were analyzed. The immune composition was calculated by CIBERSORT. Immunohistochemistry (IHC) was used to assess the expression level of CD2 in DLBCL tissues. Seurat in R was employed for conducting single-cell analysis. The study was performed with the approval of the Medical Ethical Committee of Shandong Provincial Hospital, and all samples were collected with informed consents. Results: To assess the immune cell composition of TME in DLBCL patients, we conducted a comprehensive analysis of the relative proportions of 22 distinct immune cell types within DLBCL TME. Subsequently, the prognostic role of TME immune components in DLBCL patients was probed, and a novel TME immune score based on the proportion of 22 immune cells was established. Furthermore, to evaluate the association between TME immune score and clinical prognosis in DLBCL patients, we performed K-M analysis and 3,5,10-year ROC analysis, which revealed the high prognostic efficacy of TME immune score. Higher TME immune scores were demonstrated to be significantly associated with worse prognosis, which was subsequently validated in an external cohort containing 230 DLBCL patients. Survival data of quartile subgroups also unveiled the prognostic value of TME immune score in DLBCL patients ( Fig. 1A). We further explored the correlation between TME immune score and clinical pathological features in DLBCL patients. Higher TME immune scores were observed to be correlated with more advanced Ann Arbor stage, non-germinal center B-cell-like subtype, lower expression levels of immune checkpoint molecules (CTLA-4, PD-1, PD-L2), decreased ESTIMATE stromal and immune scores, as well as higher tumor purity, indicating that the TME immune score may enable the prediction of treatment response to immune checkpoint inhibitors. The potential molecular mechanism of TME modulation in DLBCL development was further explored. Results of GO and KEGG enrichment illuminated that differential expression genes (DEGs) in two groups were significantly enriched in the anti-tumor immunity related processes and pathways, especially T-cell receptor activation. Subsequently, 6 hub genes (CCL5, CD2, CD3E, MMP9, CCR5, GATA3) in protein-protein interaction network constructed by DEGs were identified, whose expression levels were found to be associated with prognosis in DLBCL patients. Moreover, IHC was used to investigate the relevance of CD2 protein expression with prognosis in DLBCL patients. The expression of CD2 protein was found to be associated with poor prognosis in DLBCL patients ( Fig. 1A). To further investigate the regulatory function of CD2 in the immune microenvironment of DLBCL, we conducted single-cell analysis based on three DLBCL patients, and revealed that CD2 was prominently expressed in T cell subpopulation and was correlated with different differentiation trajectory of T cells in DLBCL. Subsequent differential gene analysis revealed that DEGs between state 1 and state 2, 3 were significantly enriched in KEGG pathways including antigen presentation and Th cell differentiation ( Fig. 1B), suggesting the role of CD2 in T cell activation and differentiation. Conclusions: Taken together, we established a novel TME immune score which could serve as a prognostic indicator in DLBCL patients. More importantly, we identified CD2 as a prognostic biomarker in DLBCL patients and unveiled its association with different T-cell activation states. Our study might provide a novel prognostic stratification strategy and promising biomarkers, which could facilitate the individualized management in DLBCL patients.

The Construction of Novel Risk Scores in Diffuse Large B-Cell Lymphoma with Diabetes and the Identification of Glycosylation-Related Prognostic Biomarkers

Background: Glucose metabolism and glycosylation modification have been found to be associated with the development of a variety of tumors, and targeting them has become a new avenue of therapeutic intervention in tumors. Diffuse large B-cell lymphoma (DLBCL) patients accompanied with diabetes has been found to display worse prognosis. However, the role of glucose metabolism and glycosylation modification in DLBCL development has not been elucidated. Here, we aimed to establish novel risk scores in DLBCL patients with diabetes, and identify glycosylation-related prognostic biomarkers, which might significantly improve the risk stratification and individualized treatment in DLBCL patients with diabetes. Methods:We retrospectively analyzed 176 patients diagnosed with DLBCL with diabetes in Shandong Provincial Hospital from June 2011 to Feb 2022. Univariate analysis and multivariate analysis were applied to evaluate the prognostic role of clinical indicators in DLBCL patients with diabetes. This study was approved by the Medical Ethical Committee of Shandong Provincial Hospital, and all samples were collected with informed consents. RNA sequencing (RNA-seq) data and clinical data of DLBCL patients were collected from GSE23647 (n = 42), GSE32018 (n = 35), GSE181063 (n = 1037). Then, LASSO Cox regression analysis and immune infiltration estimate were applied to illuminate the role of differentially expressed glycosylation-related genes (GRGs) in prognostic prediction and immune response in DLBCL development. Results: A total of 176 eligible DLBCL patients with diabetes were included. Through univariate and multivariate analysis, three clinical variables were confirmed as independently prognostic predictors in DLBCL patients with diabetes, including sialic acid (SA) ≥ 754 mg/L (HR: 2.684, P = 0.01), lactic dehydrogenase (LDH) ≥ 250 U/L (HR: 3.730, P = 0.005) and creatinine (CREA) ≥ 135 μmol/L (HR: 12.550, P = 0.04). Subsequently, a novel prognostic model, SLC-Score (= 2.5 × SA + 3.5 × LDH + 12.5 × CREA), was constructed, and patients were stratified into 2 groups: low-score (&amp;lt; 6 score, n=31) group, and high-score (≥ 6 score, n=79) group. The prognosis of DLBCL patients in the 2 groups presented significant differences (Fig. 1A). ROC curve showed that the discriminative ability of the SLC-Score was better than NCCN-IPI score (AUC=0.818 vs 0.635, Fig. 1A). Time-dependent ROC also revealed the high predictable ability of SLC-Score in DLBCL with diabetes (1-year AUC=0.850, 3-year AUC=0.860, 5-year AUC=0.950, respectively). Decision curve analysis revealed that SLC-Score model had higher net benefit than NCCN-IPI score. To identify prognostic GRGs in DLBCL and explore the regulatory role of glycosylation modification in DLBCL development, we obtained 438 GRGs using GeneCards and KEGG. Univariate Cox regression analysis was applied to evaluate the predictive ability of these GRGs in the assessment of clinical prognosis of DLBCL patients, and five GRGs (MAN1C1, BAG2, FBP1, ST8SIA1, HSPH1) were found to be differentially expressed and display prognostic role in DLBCL patients (Fig. 1B). Through Lasso Cox analysis, we established a 5-gene signature in DLBCL patients, which displayed reliable predictive ability in the prognosis of DLBCL patients (Fig. 1B). Furthermore, immune infiltration estimate revealed the close association between GRGs and immune response in DLBCL, indicating the underlying mechanism of glycosylation modification in DLBCL development. Furthermore, we performed pan-cancer analysis in 33 kinds of tumors from TCGA database, and illuminated the prognostic role of glycosylation-related gene signature in several tumors, including DLBCL, acute myeloid leukemia, and bladder urothelial carcinoma, etc. Conclusions: For the first time, we established the novel SLC-Score and illuminated its superiority in prognostic prediction for DLBCL patients with diabetes. GRGs were found to be intimately associated with immune response and clinical prognosis in the development of DLBCL. Our findings might provide novel risk scores and glycosylation-related biomarkers to improve the risk stratification of DLBCL patients with diabetes.

Selinexor in Combination with Salvage Regimen for Refractory Diffuse Large B-Cell Lymphoma (DLBCL) Patients with TP53 Alterations

Background TP53 has been identified as one of the most frequently altered gene in diffuse large B-cell lymphoma (DLBCL). The prognosis of DLBCL patients with TP53 mutations ( TP53mut) was poor prognosis in R-CHOP era, even with treatments like autologous stem-cell transplantation (ASCT) or anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy. Moreover, TP53 mutations are more prevalent at relapse and are associated with therapeutic resistance. Selinexor is a selective inhibitor of nuclear export with promising anti-cancer properties and preclinical studies have shown its potential to suppress tumor cells with TP53 mutations. Several clinical studies proved selinexor in combination with R-GDP/R-ICE/R-Gemox was effective in relapsed/refractory DLBCL. Method The study enrolled relapsed/refractory DLBCL patients with TP53 alterations (including TP53 mutation and/or deletion) for treatment with selinexor in combination with salvage regimens (R-GDP/R-ICE/R-Gemox) since November 2021 in our center. The treatment was administered orally as 40 mg of selinexor on days 1, 8, and 15, combined with one of the following regimens: R-GDP (R 375mg/m2 d0, gemcitabine 1g/m2*d1, cisplatin 25mg/m2 d1-d3, dexamethasone 40mg d1-d4). R-ICE (R 375mg/m2 d0, ifosfamide 1.5g/m2*3d, carboplatin (AUC 5) and etoposide 100mg/m2*3d). R-Gemox ((R 375mg/m2 d0, gemcitabine 1g/m2*d1, oxaliplatin 100mg/m2*d1) every 3 weeks as per physician's choice. Objective response rate (ORR) was evaluated every 3 cycles based on Lugano 2014 criteria and Adverse events (AE) were rated according to the NCI CTCAE 5.0. Results 20 patients were treated with selinexor plus salvage regimen in this study and received at least two cycles of treatment, making them eligible for analysis. The median age of the 20 patients was 54 years (range 15 to 77), of this patients, 12 (60%) were male, 12 (60%) patients had disease stage III-IV at screening, and 45% with IPI&amp;gt;2. The median number of prior regimen was 1 (range, 1-4) with 2 patients (2 L) and 1 patient (3L). ALL patients were refractory to the last line of treatment. The patients received a median of three cycles (range, 2-6) of selinexor 40mg once a week combined with salvage regimen (13 patients received selinexor plus R-GDP, 6 with selinexor plus R-ICE and 1 with selinexor plus R-Gemox). The mutational profile of patients was presented in Figure A (14 patients with TP53 mutation, 5 patients with TP53 mutation and deletion, 1 with TP53 deletion). The best overall and complete response rates were 75% and 25%, respectively. Among them, 6 patients in PR and 1 patient in SD received CART treatment, and 5 achieved PR and 2 with CR after CART treatment (Figure B). One patient experienced PD after selinexor+R-GDP and died of disease progression within one month after CART transfusion. 1 SD patient transferred to CD3/CD20 bispecific antibody clinical trial and still progressed during the bispecific treatment. Taken together, selinexor-based salvage regimen had promising response rate in refractory DLBCL with TP53 alterations, and could be a potential bridging approach before CART therapy. Patients responded to selinexor-based regimen tended to have better outcome after CART or bispecific antibody treatment. Conclusions TP53 alterations are associated with poor outcomes in DLBCL. We identified an effective dosing schedule of selinexor (40mg QW) in combination with R-GDP/R-ICE/R-Gemox for TP53-altered refractory DLBCL patients. Further research is warranted to investigate the mechanism of action behind this treatment approach

High Level of IL-16 Secreted By Non-GCB DLBCL Facilitates Tumor Growth Though the Tumor-Promoting and Immunosuppressive Tumor Microenvironment

Introduction: Diffuse Large B-Cell Lymphoma (DLBCL) is a highly heterogeneous non-Hodgkin's lymphoma. Based on cell origin, DLBCL is classified into two main molecular subtypes: the germinal center B-cell-like (GCB) subtype and the activated B-cell-like (ABC) subtype. ABC subtype is more aggressive and associated with a worse prognosis than GCB subtype. Previous studies have shown that cytokines play an important role in the growth of ABC subtypes, and IL-16 was supposed to be highly expressed in ABC-DLBCL, however it has not been explored in depth in DLBCL. In this study, we broadly assessed the expression and role of IL-16 on DLBCL. Method: Serum and tissues samples from patients with DLBCL and whole blood from healthy donors were collected. The characterization of protein expression, mRNA expression, and levels of cytokines in cells and tissues was detected by Western blotting, IHC/IHF, PCR, ELISA, RNA-seq, and Flow cytometry. Cells experiments such as cell proliferation, cell apoptosis, cell cycle, cell migration, and ADPC were detected by CCK-8, Flow cytometry, and Transwells. Gene knockdown or overexpression was conducted by lentiviruses and then verified by Western blotting and ELISA. We established subcutaneous tumors (human DLBCL cells and murine DLBCL cells) in BALB/c mice, BALC/c nude mice, and NOD SCID mice for the tumor size or the therapeutic evaluation. Results: First, we found that IL-16, secreted by the cleavage of active caspase-3 from the lymphoma cells under tumor burden, was highly expressed in ABC-DLBCL compared to GCB-DLBCL. The serum IL-16 levels were positively correlated with unfavorable prognosis in DLBCL patients. The dynamic change of serum IL-16 levels accurately predicted the treatment response in patients with DLBCL who received R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) or anti-CD19 Chimeric Antigen Receptor (CAR) T cells. Interestingly, bioactive IL-16 showed rare effect on DLBCL cells in vitro, but significantly promoted their growth in vivo. Mechanically, tumor-derived bioactive IL-16 promoted the migration of monocytes via CD4+ receptor, thereby inducing the enrichment of monocytes-derived tumor-associated macrophages in the tumor microenvironment (TME) of DLBCL, which accelerated the tumor growth primarily by expressing cytokines such as IL-6, inducing angiogenesis, and exerting immunosuppressive effects through the expression of cytokines like IL-10; thus, conferring growth advantage to the ABC- DLBCL. To translate the findings into clinical application, we design a novel treatment strategy to overcome the poor outcomes in ABC-DLBCL patients with high IL-16 expression by combination of high-dose cyclophosphamide (CTX) and the bispecific antibody targeting CD20 and CD47 (IMM0306). IMM0306 effectively reversed the tumor-promoting effects of macrophages in subsets of ABC-DLBCL, while CTX induced IL-16 and increased the infiltration of macrophages in the TME. The increasing effector cells/tumor cells ratio further improved the antitumor effect of IMM0306. The combination of high-dose CTX and IMM0306 was confirmed to significantly inhibit the growth of ABC-DLBCL with high IL-16 expression. A clinical trial is being designed to evaluate the potential for clinical applications. Conclusion: In conclusion, this study provides insight into the expression and role of IL-16 in DLBCL. IL-16 is proposed to be highly expressed in ABC-DLBCL, and serum IL-16 indicate the tumor burden, treatment response, and clinical prognosis of DLBCL patients. IL-16 may be a key driver of the TME of DLBCL, which can confer growth advantage to the ABC-DLBCL. Our data provides a theoretical basis for future clinical treatment. A novel treatment regimen (IMM0306 and CTX) could attenuate the pro-oncogenic roles of IL-16 to prevent ABC-DLBCL progression.

Predictive value of Dmax and %ΔSUVmax of 18F-FDG PET/CT for the prognosis of patients with diffuse large B-cell lymphoma

PurposeTo investigate the prognosis value of a combined model based on 18F-fluoro-deoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) baseline and interim parameters in patients with diffuse large B-cell lymphoma (DLBCL).MethodsWe retrospectively analyzed the PET metabolic parameters and clinical data of 154 DLBCL patients between December 2015 and October 2020. All of these patients underwent 18F-FDG PET/CT scan before treatment and after three or four courses of chemotherapy. The optimal cut-off values for quantitative variables were determined by the receiver operating characteristic (ROC) curve. The baseline and interim PET/CT parameters, which respectively included maximum standardized uptake value (SUVmax0), total metabolic tumor volume (TMTV0), standardized total metabolic tumor volume (STMTV0), and the distance between the two furthest lesions (Dmax) and total tumor lesion glycolysis (TTLG1), SUVmax1, TMTV1, and the rate of change of SUVmax (%ΔSUVmax), and clinical characteristics were analyzed by chi-squared test, Kaplan-Meier survival curve, and Cox regression analysis.ResultsOf 154 patients, 35 exhibited disease progression or recurrence. ROC analysis revealed that baseline 18F-FDG PET/CT metabolic parameters, including maximum standardized uptake value (SUVmax0), total metabolic tumor volume (TMTV0), standardized total metabolic tumor volume (STMTV0), and the distance between the two furthest lesions (Dmax), along with interim 18F-FDG PET/CT metabolic parameters such as total tumor lesion glycolysis (TTLG1), SUVmax1, TMTV1, and the rate of change of SUVmax (%ΔSUVmax), were predictive of relapse or progression in DLBCL patients (P < 0.05). The chi-squared test showed that TMTV0, STMTV0, Dmax, SUVmax1, TMTV1, TTLG1, %ΔSUVmax, Deauville score, IPI, Ann Arbor stage, and LDH were associated with patient prognosis (P < 0.05). Multivariate Cox regression analysis showed that Dmax (P = 0.021) and %ΔSUVmax (P = 0.030) were independent predictors of prognosis in DLBCL patients. There were statistically significant differences in PFS among the three groups with high, intermediate, and low risk according to the combination model (P < 0.001). The combination model presented higher predictive efficacy than single indicators.ConclusionThe combined model of baseline parameter Dmax and intermediate parameter %ΔSUVmax of 18F-FDG PET/CT improved the predictive efficacy of PFS and contributed to the risk stratification of patients, providing a reference for clinical individualization and precision treatment.

Prognostic value of geriatric nutritional risk index in patients with diffuse large B-cell lymphoma: a meta-analysis.

Geriatric nutritional risk index (GNRI) on the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) remains unclear. The purpose of this meta-analysis was to discuss the value of the GNRI in evaluating long-term outcomes in DLBCL. We systematically and roundly retrieved PubMed, Cochrane Library, Embase, Scopus and Web of Science electronic databases from inception of the databases to March 20, 2023. At the same time, we calculated the pool hazard ratios (HRs) with their 95% confidence interval (CI) for overall survival and progression-free survival to assess the effect of GNRI on the prognosis of DLBCL patients. In our primary meta-analysis, 7 trials with a total of 2448 patients were enrolled. Results showed that lower level of GNRI was related to poorer overall survival (HR = 1.78, 95% CI 1.27, 2.50, p < 0.01) and worse progression-free survival (HR = 2.31, 95% CI 1.71, 3.13, p < 0.01) in DLBCL patients. The results of our meta-analysis indicate that a lower GNRI significantly associated with poorer prognosis for DLBCL. It is believed that GNRI was a promisingly predictive indicator of survival outcomes in DLBCL patients. However, large multicenter prospective studies are necessary to verify the results.

EXPLORING THE POTENTIAL CORRELATION BETWEEN NEUTROPHIL EXTRACELLULAR TRAPS AND PROGNOSIS IN PATIENTS WITH DIFFUSE LARGE B‐CELL LYMPHOMA AND HODGKIN’S LYMPHOMA

Introduction: Neutrophil extracellular traps (NETs) are web-like structures of decondensed chromatin and granule proteins that are released from neutrophils in response to infection. NET-release also occurs and contributes to inflammation, organ dysfunction and thrombosis in patients with non-infectious inflammatory conditions, such as cancer. In several solid cancer types, NETs have been associated with poorer prognosis by facilitating tumour growth and metastasis. One study has associated NETs with tumour progression and poorer prognosis in diffuse large B-cell lymphoma (DLBCL), however the knowledge of the role of NETs in lymphoma is sparse. Here, NETs were measured in plasma from patients with DLBCL and Hodgkin’s lymphoma (HL), and correlated to blood counts and clinical outcome of the patients. Methods: Plasma samples from patients with DLBCL (n = 72) and HL (n = 54), diagnosed between 2010 and 2015, were obtained from the Swedish Uppsala Umeå Comprehensive Cancer Consortium (U-CAN) biobank. The lymphoma samples, as well as healthy controls (n = 11), were analysed using a commercial enzyme-linked immunosorbent assay (ELISA) targeting citrullinated histone 3 in complex with externalized DNA, a biomarker considered specific for NETs. Data collected from patient records, including routine blood counts at diagnosis, clinical background and disease outcome, was correlated to the obtained plasma concentrations of NETs. Results: DLBCL and HL patients showed significantly elevated concentrations of NETs in plasma compared to healthy controls (median concentrations 60.07, 65.24 and 5.366 ng/mL, p < 0.0001). In both DLBCL and HL, trends towards better overall survival (p = 0.3308 and 0.0534 respectively) and better progression free survival (p = 0.2777 and 0.1056) were seen for patients with concentrations of NETs above median. While there was no correlation between sex or age and NET levels in DLBCL patients, HL patients under the age of 50 years showed a significant correlation with higher levels of NETs (p = 0.0021). In both DLBCL and HL patients, plasma NET-levels showed a positive correlation with the neutrophil count in blood at diagnosis (p = 0.0087 and 0.0001 respectively). A neutrophil-lymphocyte ratio above 3.0, a known predictor of worse outcome in cancer patients, showed a trend towards being correlated with worse prognosis in DLBCL patients, but this was less evident for HL patients. Keywords: aggressive B-cell non-Hodgkin lymphoma, diagnostic and prognostic biomarkers, Hodgkin lymphoma No conflicts of interests pertinent to the abstract.

Alpha‐ketoglutarate Suppresses Tumor Growth of Diffuse Large B‐cell Lymphoma by Inducing Ferroptosis

Background: Metabolic reprogramming is one of the vital characteristics of cancers. Glutamine metabolism is an essential metabolic pathway in tumorigenesis, which provides a ready carbon and nitrogen source to support tumor biosynthesis, energy metabolism, and intracellular homeostasis. As a type of lymphoma with heterogeneity, diffuse large B-cell lymphoma (DLBCL) is characterized by severe metabolic vulnerability represents. Given the importance of glutamine metabolism in human cancer, revealing the characteristics of glutamine metabolism in DLBCL is expected to provide new pathogenesis and effective treatment strategies for patients. Methods: Peripheral blood serum of 120 DLBCL patients and 60 healthy donors were collected for untargeted metabolomics sequencing, followed by metabolic characteristics analysis. Subsequently, the biological functions and mechanisms of α-ketoglutarate (α-KG) were explored by RNA sequencing. Finally, ROS detection, ATP detection, and lipid peroxidation were used to verify the mechanism of α-KG-induced ferroptosis. Results: Untargeted metabolomics profiling revealed that the metabolic characteristics of DLBCL patients were significantly different from healthy controls. Among the differentially expressed metabolic pathways, glutamine metabolism accounted for the highest weight, suggesting the importance of glutamine metabolism in the tumorigenesis of DLBCL (Figure 1A). Notably, glutamate, glutamine, and α-KG were the critical metabolites in glutamine metabolism. Clinical data analysis identified that high glutamine concentrations and low decreased α-KG were associated with poor prognosis in DLBCL patients. Subsequently, dimethyl α-ketoglutarate (DM-αKG) was used to reverse glutamine metabolism and increase α-KG concentration. In vitro studies showed that DM-αKG treatment significantly inhibited cell proliferation of DLBCL cells both in vitro and in vivo (Figure 1B). In addition, DM-αKG induced non-apoptotic cell death phenotypes, represented by cell membrane swelling and LDH release. To further explore the functional mechanisms of α-KG in DLBCL, we performed RNA-sequencing in DM-αKG-treated DLBCL cells. As shown in enrichment analysis, DM-αKG treatment showed apparent dysfunction in the hypoxia-inducible factor pathway, oxidative stress response, and ferroptosis (Figure 1C). In particular, DM-αKG treatment promoted ROS release and lipid peroxidation, followed by impaired ATP production and decreased mitochondrial pathway expression. Moreover, differentially expressed genes analysis identified an increased expression of TP53 in the ferroptosis pathway, indicating the importance of TP53 in α-KG-induced ferroptosis (Figure 1D). Keywords: Aggressive B-cell non-Hodgkin lymphoma, Metabolism No conflicts of interests pertinent to the abstract.

PGD2 displays distinct effects in diffuse large B-cell lymphoma depending on different concentrations

Prostaglandin D2 (PGD2), an arachidonic acid metabolite, has been implicated in allergic responses, parasitic infection and tumor development. The biological functions and molecular mechanisms of PGD2 in diffuse large B-cell lymphoma (DLBCL) are still undefined. In this study, we firstly found the high concentration of serum PGD2 and low expression of PGD2 receptor CRTH2 in DLBCL, which were associated with clinical features and prognosis of DLBCL patients. Interestingly, different concentration of PGD2 displayed divergent effects on DLBCL progression. Low-concentration PGD2 promoted cell growth through binding to CRTH2 while high-concentration PGD2 inhibited it via regulating cell proliferation, apoptosis, cell cycle, and invasion. Besides, high-concentration PGD2 could induce ROS-mediated DNA damage and enhance the cytotoxicity of adriamycin, bendamustine and venetoclax. Furthermore, HDAC inhibitors, vorinostat (SAHA) and panobinostat (LBH589) regulated CRTH2 expression and PGD2 production, and CRTH2 inhibitor AZD1981 and high-concentration PGD2 enhanced their anti-tumor effects in DLBCL. Altogether, our findings demonstrated PGD2 and CRTH2 as novel prognostic biomarkers and therapeutic targets in DLBCL, and highlighted the potency of high-concentration PGD2 as a promising therapeutic strategy for DLBCL patients.

Activation of STING by SAMHD1 Deficiency Promotes PANoptosis and Enhances Efficacy of PD-L1 Blockade in Diffuse Large B-cell Lymphoma.

Genomic instability is a significant driver of cancer. As the sensor of cytosolic DNA, the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway plays a critical role in regulating anti-tumor immunity and cell death. However, the role and regulatory mechanisms of STING in diffuse large B-cell lymphoma (DLBCL) are still undefined. In this study, we reported that sterile alpha motif and HD domain-containing protein 1 (SAMHD1) deficiency induced STING expression and inhibited tumor growth in DLBCL. High level of SAMHD1 was associated with poor prognosis in DLBCL patients. Down-regulation of SAMHD1 inhibited DLBCL cell proliferation both in vitro and in vivo. Moreover, we found that SAMHD1 deficiency induced DNA damage and promoted the expression of DNA damage adaptor STING. STING overexpression promoted the formation of Caspase 8/RIPK3/ASC, further leading to MLKL phosphorylation, Caspase 3 cleavage, and GSDME cleavage. Up-regulation of necroptotic, apoptotic, and pyroptotic effectors indicated STING-mediated PANoptosis. Finally, we demonstrated that the STING agonist, DMXAA, enhanced the efficacy of a PD-L1 inhibitor in DLBCL. Our findings highlight the important role of STING-mediated PANoptosis in restricting DLBCL progression and provide a potential strategy for enhancing the efficacy of immune checkpoint inhibitor agents in DLBCL.

Exploring the molecular mechanisms and shared gene signatures between rheumatoid arthritis and diffuse large B cell lymphoma.

The relationship between rheumatoid arthritis (RA) and diffuse large B-cell lymphoma (DLBCL) is well characterized, but the molecular mechanisms underlying this association have not been clearly investigated. Our study aimed to identify shared gene signatures and molecular mechanisms between RA and DLBCL. We selected multiple Gene Expression Omnibus (GEO) datasets (GSE93272, GSE83632, GSE12453, GSE1919) to obtain gene expression levels and clinical information about patients with RA and DLBCL. Weighted gene co-expression network analysis (WGCNA) was used to research co-expression networks associated with RA and DLBCL. Subsequently, we performed enrichment analysis of shared genes and screened the most significant core genes. We observed expression of the screened target gene, galectin 2 (LGALS2), in DLBCL patients and its impact on patient prognosis. Finally, we analyzed the molecular functional mechanism of LGALS2 and observed its relationship with the immune response in DLBCL using single-sample Gene Set Enrichment Analysis (ssGSEA). WGCNA recognized two major modules for RA and DLBCL, respectively. Shared genes (551) were identified for RA and DLBCL by observing the intersection. In addition, a critical shared gene,LGALS2,was acquired in the validation tests. Next, we found that the expression level of LGALS2 gradually decreased with tumor progression in DLBCL and that increased expression of LGALS2 predicted a better prognosis for DLBCL patients.ssGSEA revealed that LGALS2 is involved in immune-related pathways and has a significant regulatory effect on human immune responses. Additionally, we observed that LGALS2 is closely related to the sensitivity of multiple chemotherapeutic drugs. There is extremely little research on the molecular mechanism of correlation between RA and DLBCL. Our study identified that LGALS2 is a potential therapeutic target and an immune-related biomarker for patients with RA and DLBCL.

Effects of hsa-miR-28-5p on Adriamycin Sensitivity in Diffuse Large B-Cell Lymphoma.

Background Adriamycin (doxorubicin) is an important traditional drug that exhibits cytotoxicity in Diffuse Large B-cell Lymphoma (DLBCL). Doxorubicin affects the DLBCL cells at all stages of their cell cycle. Combined with our previous results, this study discovered that the overexpression of hsa-miR-28-5p inhibited the proliferation, promoted apoptosis, and triggered cell cycle arrest at the S-phase in DLBCL cells. However, the effect of (Homo sapiens, hsa)-microRNA (miR)-28-5p on doxorubicin sensitivity in DLBCL has not been investigated. This study aims to reveal the effects of hsa-miR-28-5p on doxorubicin sensitivity at the level of DLBCL cells. Methods To determine the optimal concentration of doxorubicin, different concentrations of doxorubicin were used to treat DLBCL cells. CCK-8 assay was used to detect the proliferation of DLBCL cells. The hsa-miR-28-5p-mimic NC and hsa-miR-28-5p mimic were transfected to doxorubicin-mediated DLBCL cells. Simultaneously, blank control groups were set up. The cells were cultured and transfected for 24 h. Next, each group was administered with different concentrations of doxorubicin and cultured again for 24 h to observe the effects of hsa-miR-28-5p on doxorubicin sensitivity at different times. The proliferation, early apoptosis, and late apoptosis in DLBCL cells were determined using soft agar colony-forming assay, mitochondrial membrane potential assay, and caspase-3 activity assay, respectively. The apoptosis and cell cycle were explored using Annexin V-PE/7-AAD and PI/RNase staining buffer, respectively. We speculated that PD-L1 might be involved in the effect of hsa-miR-28-5p on the sensitivity of adriamycin (doxorubicin) in the DLBCL cells. Hence, we performed immunohistochemistry (IHC) to determine PD-L1 expression within formalin-fixed paraffin-embedded (FFPE) samples from 52 DLBCL cases. Results The optimal concentration of doxorubicin targeting DLBCL cells was found to be 3.028 μmol/l. The effect of doxorubicin on DLBCL cells was time- and concentration-dependent. hsa-miR-28-5p mimic + doxorubicin remarkably decreased proliferation of DLBCL. DLBCL cell apoptosis rate was the highest in hsa-miR-28-5p mimic + doxorubicin group. Apart from that, hsa-miR-28-5p mimic plus doxorubicin had the best effect in promoting DLBCL cell apoptosis. After the intervention of hsa-miR-28-5p mimic + doxorubicin on DLBCL cells, the cell cycle was arrested in the S-phase and DNA synthesis was blocked. hsa-miR-28-5p mimic + doxorubicin could regulate the cycle of DLBCL cells. As a result, overexpression of hsa-miR-28-5p combined with doxorubicin is possibly involved in the development of DLBCL by affecting the proliferation, apoptosis, and cycle of DLBCL cells. PD-L1 showed an association with the prognosis of DLBCL patients. Combining with the literature, this suggested hsa-miR-28-5p may influence DLBCL occurrence and therapeutic effect by regulating the PD-L1 level. Conclusion The combination of hsa-miR-28-5p mimic and doxorubicin may be considered more effective in inhibiting growth, arresting the cell cycle, and promoting cell apoptosis of DLBCL cells compared to using doxorubicin alone. The effects of doxorubicin on DLBCL cells were found to be time- and concentration-dependent. The overexpression of hsa-miR-28-5p enhanced the effect of doxorubicin on DLBCL cells, which may be attributed to the regulation of PD-L1 levels.

CAR T-Cell Therapy Predictive Response Markers in Diffuse Large B-Cell Lymphoma and Therapeutic Options After CART19 Failure.

Immunotherapy with T cells genetically modified with chimeric antigen receptors (CARs) has shown significant clinical efficacy in patients with relapsed/refractory B-cell lymphoma. Nevertheless, more than 50% of treated patients do not benefit from such therapy due to either absence of response or further relapse. Elucidation of clinical and biological features that would predict clinical response to CART19 therapy is of paramount importance and eventually may allow for selection of those patients with greater chances of response. In the last 5 years, significant clinical experience has been obtained in the treatment of diffuse large B-cell lymphoma (DLBCL) patients with CAR19 T cells, and major advances have been made on the understanding of CART19 efficacy mechanisms. In this review, we discuss clinical and tumor features associated with response to CART19 in DLBCL patients as well as the impact of biological features of the infusion CART19 product on the clinical response. Prognosis of DLBCL patients that fail CART19 is poor and therapeutic approaches with new drugs are also discussed.

Long non-coding RNA TRIM52-AS1 sponges microRNA-577 to facilitate diffuse large B cell lymphoma progression via increasing TRIM52 expression.

Diffuse large B cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma (NHL) globally, featuring heterogeneous clinical phenotypes and altered molecular manifestations. The long non-coding ribose nucleic acids (lncRNAs) play crucial roles in the diagnosis, treatment, and prognosis of DLBCL, requiring the exploration of complex functions and mechanisms. In this study, the expression of lncRNA TRIM52-AS1 in DLBCL tissues from the Cancer Genome Atlas (TCGA) database was initially analyzed and correlated to the data from collected clinical samples. Then, the significance of TRIM52-AS1 on the diagnosis and prognosis of DLBCL patients was predicted with the receiver-operating characteristic (ROC) curve and Kaplan-Meier (KM) analysis. Further, cell counting kit (CCK)-8, EdU staining, and flow cytometry analyses were performed to assess the effect of TRIM52-AS1 on DLBCL cell proliferation, apoptosis, and cell cycle. Then, the mechanism of TRIM52-AS1 sponging miR-577 to increase TRIM52 expression was explored using a starBase prediction approach, dual-luciferase reporter, RNA immunoprecipitation assay (RIPA), quantitative reverse transcription-polymerase chain reaction (RT-qPCR), and Western blot analyses. The experimental results confirmed the overexpression of TRIM52-AS1 in the DLBCL cell lines. Further, the high expression of TRIM52-AS1 predicted the poor Ann Arbor stage and were correlated with the presence of B symptoms, high international prognostic index, and poor disease prognosis. TRIM52-AS1 knockdown inhibited the DLBCL cell proliferation, and induced apoptosis and G0/G1 cycle arrest. Interestingly, the overexpression of TRIM52-AS1 increased the mRNA stability of TRIM52 through binding IGFBP3 protein and upregulated the TRIM52 protein expression by sponging miR-577. Together, the overexpressed TRIM52-AS1 could promote the DLBCL progression through IGFBP3/miR-218-5p/TRIM52 axis, highlighting the clinical significance of TRIM52-AS1 in the DLBCL diagnosis.