Diffuse large B-cell lymphoma: 2019 update on diagnosis, risk stratification, and treatment.

DISEASE OVERVIEW: Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma originating from the germinal center, and it represents a heterogeneous group of diseases with variable outcomes that are differentially characterized by clinical features, cell of origin (COO), molecular features, and most recently, frequently recurring mutations. DIAGNOSIS: DLBCL is ideally diagnosed from an excisional biopsy of a suspicious lymph node, which shows sheets of large cells that disrupt the underlying structural integrity of the follicle center and stain positive for pan-B-cell antigens, such as CD20 and CD79a. COO is determined by immunohistochemical stains, while molecular features such as double-hit or triple-hit disease are determined by fluorescent in situ hybridization analysis. Commercial tests for frequently recurring mutations are currently not routinely used to inform treatment. RISK STRATIFICATION: Clinical prognostic systems for DLBCL, including the rituximab International Prognostic Index, age-adjusted IPI, and NCCN-IPI, use clinical factors for the risk stratification of patients, although this does not affect the treatment approach. Furthermore, DLBCL patients with non-germinal center B-cell (GCB)-like DLBCL (activated B-cell like and unclassifiable) have a poorer response to up-front chemoimmunotherapy (CI) compared to patients with GCB-like DLBCL. Those with c-MYC-altered disease alone and in combination with translocations in BCL2 and/or BCL6 (particularly when the MYC translocation partner is immunoglobulin) respond poorly to up-front CI and salvage autologous stem cell transplant at relapse. RISK-ADAPTED THERAPY: This review will focus on differential treatment of DLBCL up-front and at the time of relapse by COO and molecular features.

Diagnosis of CLL revisited: increased specificity by a modified five-marker scoring system including CD200.

The modified Matutes score has been the basis for the diagnosis of chronic lymphocytic leukaemia (CLL) by flow cytometry for the past 15 years. To increase the specificity of the current score we systematically evaluated the diagnostic value of established as well as novel markers, such as CD200, in a large cohort of patients with untreated B-cell malignancies (n = 370). Double positivity for CD5 and CD23 was of very high value to differentiate between CLL and non-CLL cases. In addition, lack of FMC7 expression as well as CD79b expression intensity showed high sensitivity (90·4% and 92·3%) with acceptable specificity (74·4% and 76·9%). For surface IgM, low or absent expression displayed poor specificity in distinguishing CLL from non-CLL cases (51,3%; sensitivity 83,7%). Finally, CD200 positivity showed high sensitivity and specificity. Therefore, CD5/CD23, FMC7, CD79b and CD200 were included in our new CLLflow score, which retained high sensitivity (97·1% vs. 98·6% for the Matutes score, P = 0·38), but showed markedly increased specificity (87·2% vs. 53·8%, P < 0·001). These results were confirmed in our validation cohort (sensitivity 97·0% vs. 100%, P = not applicable; specificity 86·4% vs. 59·1%, P = 0·03). Our data support the use of our new CLLflow score for the diagnosis of CLL with significantly higher specificity.

Effect of sow vaccination against porcine circovirus type 2 (PCV2) on virological profiles in herds with or without PCV2 systemic disease.

We investigated porcine circovirus type 2 (PCV2) virological profiles in herds affected (PCVAD-AH, n = 5) or non-affected (PCVAD-NAH, n = 4) by PCV2-associated diseases (PCVAD), before and after 1 y of PCV2 gilt and sow vaccination. Fresh feces from the floor (5 pens/age/farm) and 5 blood samples (1/pen) were collected at 3, 9, 15, 21 wk. Individual feces and blood samples were collected from 5 gilts and 15 sows. Sampling was repeated 1 y after vaccination. Quantitative PCR on feces, PCV2 antibodies in blood serum and cell-mediated immunity were investigated. Before vaccination, pigs of PCVAD-AH had higher viral load in feces (9 and 15 wk), lower IgG and higher IgM (3 wk) and lower lymphocyte counts (9 and 15 wk) suggesting immunosuppression. Vaccination reduced viral load in growers, increased IgG (3 wk) suggesting improved maternal immunity, reduced IgM (3 wk), increased total antibody titers in sows and increased CD79a cells in the pigs.

Effet de la vaccination des truies contre le circovirus porcin de type 2 (PCV2) sur les profils virologiques des troupeaux atteints ou non de la maladie systémique PCV2. Nous avons fait une enquête sur les profils virologiques du circovirus porcin de type 2 (PCV2) dans les troupeaux affectés (PCVAD-AH, n = 5) ou non affectés (PCVAD-NAH, n = 4) par les maladies associées au PCV2 (MAPCV), 1 an avant et 1 an après la vaccination des cochettes et des truies contre le PCV2. Des fèces fraîches sur le plancher (5 enclos/âge/ferme) et 5 échantillons de sang (1/enclos) ont été prélevés à 3, 9, 15 et 21 semaines. Des fèces individuelles et des échantillons sanguins ont été préIevés auprès de 5 cochettes et de 15 truies. L'échantillonnage a été répété 1 an après la vaccination. La RCP quantitative sur les fèces, les anticorps de PCV2 dans le sérum sanguin et l'immunité à médiation cellulaire ont fait l'objet d'une enquête. Avant la vaccination, les porcs de PCVAD-AH présentaient une charge virale supérieure dans les fèces (à 9 et à 15 semaines), une IgG inférieure et une IgM supérieure (à 3 semaines) ainsi qu'une numération inférieure des lymphocytes (à 9 et à 15 semaines) suggérant l'immunosuppression. La vaccination a réduit la charge virale chez les porcs en croissance, a augmenté les IgG (à 3 semaines) suggérant une immunité maternelle améliorée, a réduit les IgM (à 3 semaines), a augmenté le total des titres d'anticorps chez les truies et a augmenté les cellules CD79a chez les porcs.(Traduit par Isabelle Vallières).

Mucosa-associated lymphoid tissue lymphoma of the appendix vermiformis.

A 60-year-old woman with right lower abdominal pain was admitted to our hospital. Computed tomography demonstrated right hydronephrosis and an irregular mass of 4 x 3 cm adjacent to the ileocecal region and iliopsoas muscle. Preoperative serum soluble anti-interleukin-2 receptor antibody was elevated (689 U/ml). Laparotomy showed an appendiceal tumor invading the cecum, mesocolon, right ureter, and duodenum. Right hemicolectomy with partial resection of the right ureter was performed. Histologic examination revealed diffuse infiltration of centrocyte-like cells, scattered plasma cells, and immunoblasts. The centrocyte-like cells were immunohistochemically positive for CD20 and CD79a, and were negative for BCL2, CD3, CD5, and CD10; this was compatible with primary mucosa-associated lymphoid tissue (MALT) lymphoma. The patient has shown a favorable course without recurrence for 2 years postoperatively. This is the sixth documented case of primary MALT lymphoma of the appendix. The spectrum of sites in which gastrointestinal MALT lymphomas occur should be expanded to include the appendix.

Detection of intracellular antigens in porcine PBMC by flow cytometry: A comparison of fixation and permeabilisation reagents.

The staining of intracellular antigens is a standard method in flow cytometry but still only occasionally used for immunologic studies in veterinary species. In order to improve information about suitable fixation/permeabilisation protocols in porcine lymphocytes we tested six fixation/permeabilisation variants for the staining of different intracellular antigens: CD79alpha, perforin, interferon-gamma and the cell cycle associated protein Ki-67. For the fixation/permeabilisation procedure, four commercial kits from BD Biosciences, ADG Bio Research, Dako and AbD Serotec were tested in comparison to non-commercial fixation solutions of formaldehyde together with either saponin or Tween-20 for permeabilisation. Perforin and Ki-67 expressing cells were optimally stained only with permeabilisation reagents containing saponin, which includes the BD kit. In contrast, labelling of CD79alpha and IFN-gamma was possible with all investigated fixation/permeabilisation variants; however, here saponin and Tween protocols induced a higher degree of unspecific binding. Also, scatter properties of cells treated with saponin were worse compared to samples prepared with the kits from ADG, Dako and Serotec. Simultaneous staining of cell surface antigens was not negatively affected by any of the fixation/permeabilisation variants. A universal recommendation for a single fixation/permeabilisation strategy could not be deduced from our data but our work provides a useful guideline for optimal staining of common intracellular antigens analyzed in swine lymphocytes.

Cancer-associated carbohydrate identification in Hodgkin's lymphoma by carbohydrate array profiling.

Tumor-associated carbohydrates have potential not only as diagnostic tools but also as specific therapeutic targets. Their identification, however, has been hampered by the lack of suitable technologies. We used carbohydrate array technology to compare serum antibody (IgG and IgM) levels against 37 different carbohydrates between classical Hodgkin's lymphoma (cHL) patients and age/sex-matched healthy controls. Serum IgM levels measured by ELISA against 2 of the 5 carbohydrates identified using this technique, L-alpha-arabinose (L-Araf) and alpha-N-acetylgalactosamine (GalNAc(alpha)), were higher (F values of 11.30 and 18.27, respectively) in a cohort of cHL patients (n = 16) than either diffuse large B-cell lymphoma patients (n = 18) or control sera (n = 12). Higher anti-L-Araf IgM levels in cHL patients were associated with cytosine arabinoside treatment (p < 0.05). The GalNAc(alpha) glycotope, Tn, was found to be heterogeneously expressed in the Reed-Sternberg cells of 9/20 (45%) cHL cases, but not in malignant cells of 25 cases of lymphocyte-predominant HL or another 21 hematological disorders (291 cases) examined immunohistochemically. Tn was expressed in 41/238 (17%) classical HL cases present on a tissue microarray. Expression was associated with CD79a and LMP1 expression and negatively with p27(KIP1) expression (p < 0.05). Kaplan-Meier survival analysis revealed a trend towards improved relapse-free survival with Tn expression although this was not statistically significant (p = 0.271). We suggest that this technique could provide a powerful tool for identifying novel carbohydrates in other cancers.