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      Genome-wide discovery of somatic regulatory variants in diffuse large B-cell lymphoma

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      1 , 2 , 1 , 2 , 3 , 1 , 1 , 1 , 1 , 2 , 1 , 1 , 2 , 2 , 2 , 1 , 2 , 1 , 1 , 2 , 2 , 1 , 1 , 4 , 2 , 2 , 3 , 5 , 4 , 1 , 1 , 3 , 4 , 3 , 2 , 1 , 1 , 3 , 4 , 2 , 2 , 2 , 1 , 3 ,
      Nature Communications
      Nature Publishing Group UK

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          Abstract

          Diffuse large B-cell lymphoma (DLBCL) is an aggressive cancer originating from mature B-cells. Prognosis is strongly associated with molecular subgroup, although the driver mutations that distinguish the two main subgroups remain poorly defined. Through an integrative analysis of whole genomes, exomes, and transcriptomes, we have uncovered genes and non-coding loci that are commonly mutated in DLBCL. Our analysis has identified novel cis-regulatory sites, and implicates recurrent mutations in the 3′ UTR of NFKBIZ as a novel mechanism of oncogene deregulation and NF- κB pathway activation in the activated B-cell (ABC) subgroup. Small amplifications associated with over-expression of FCGR2B (the Fc γ receptor protein IIB), primarily in the germinal centre B-cell (GCB) subgroup, correlate with poor patient outcomes suggestive of a novel oncogene. These results expand the list of subgroup driver mutations that may facilitate implementation of improved diagnostic assays and could offer new avenues for the development of targeted therapeutics.

          Abstract

          The driver mutations for the two main molecular subgroups of diffuse large B-cell lymphoma (DLBCL) are poorly defined. Here, an integrative genomics analysis identifies 3′ UTR NFKBIZ mutations within the activated B-cell DLBCL subgroup and small FCGR2B amplifications in the germinal centre B-cell DLBCL subgroup.

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          Concurrent expression of MYC and BCL2 in diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone.

          Diffuse large B-cell lymphoma (DLBCL) is curable in 60% of patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). MYC translocations, with or without BCL2 translocations, have been associated with inferior survival in DLBCL. We investigated whether expression of MYC protein, with or without BCL2 protein expression, could risk-stratify patients at diagnosis. We determined the correlation between presence of MYC and BCL2 proteins by immunohistochemistry (IHC) with survival in two independent cohorts of patients with DLBCL treated with R-CHOP. We further determined if MYC protein expression correlated with high MYC mRNA and/or presence of MYC translocation. In the training cohort (n = 167), MYC and BCL2 proteins were detected in 29% and 44% of patients, respectively. Concurrent expression (MYC positive/BCL2 positive) was present in 21% of patients. MYC protein correlated with presence of high MYC mRNA and MYC translocation (both P < .001), but the latter was less frequent (both 11%). MYC protein expression was only associated with inferior overall and progression-free survival when BCL2 protein was coexpressed (P < .001). Importantly, the poor prognostic effect of MYC positive/BCL2 positive was validated in an independent cohort of 140 patients with DLBCL and remained significant (P < .05) after adjusting for presence of high-risk features in a multivariable model that included elevated international prognostic index score, activated B-cell molecular subtype, and presence of concurrent MYC and BCL2 translocations. Assessment of MYC and BCL2 expression by IHC represents a robust, rapid, and inexpensive approach to risk-stratify patients with DLBCL at diagnosis.
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            A gene expression-based method to diagnose clinically distinct subgroups of diffuse large B cell lymphoma.

            To classify cancer specimens by their gene expression profiles, we created a statistical method based on Bayes' rule that estimates the probability of membership in one of two cancer subgroups. We used this method to classify diffuse large B cell lymphoma (DLBCL) biopsy samples into two gene expression subgroups based on data obtained from spotted cDNA microarrays. The germinal center B cell-like (GCB) DLBCL subgroup expressed genes characteristic of normal germinal center B cells whereas the activated B cell-like (ABC) DLBCL subgroup expressed a subset of the genes that are characteristic of plasma cells, particularly those encoding endoplasmic reticulum and golgi proteins involved in secretion. We next used this predictor to discover these subgroups within a second set of DLBCL biopsies that had been profiled by using oligonucleotide microarrays [Shipp, M. A., et al. (2002) Nat. Med. 8, 68-74]. The GCB and ABC DLBCL subgroups identified in this data set had significantly different 5-yr survival rates after multiagent chemotherapy (62% vs. 26%; P < or = 0.0051), in accord with analyses of other DLBCL cohorts. These results demonstrate the ability of this gene expression-based predictor to classify DLBCLs into biologically and clinically distinct subgroups irrespective of the method used to measure gene expression.
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              Selective inhibition of EZH2 by EPZ-6438 leads to potent antitumor activity in EZH2-mutant non-Hodgkin lymphoma.

              Mutations within the catalytic domain of the histone methyltransferase EZH2 have been identified in subsets of patients with non-Hodgkin lymphoma (NHL). These genetic alterations are hypothesized to confer an oncogenic dependency on EZH2 enzymatic activity in these cancers. We have previously reported the discovery of EPZ005678 and EPZ-6438, potent and selective S-adenosyl-methionine-competitive small molecule inhibitors of EZH2. Although both compounds are similar with respect to their mechanism of action and selectivity, EPZ-6438 possesses superior potency and drug-like properties, including good oral bioavailability in animals. Here, we characterize the activity of EPZ-6438 in preclinical models of NHL. EPZ-6438 selectively inhibits intracellular lysine 27 of histone H3 (H3K27) methylation in a concentration- and time-dependent manner in both EZH2 wild-type and mutant lymphoma cells. Inhibition of H3K27 trimethylation (H3K27Me3) leads to selective cell killing of human lymphoma cell lines bearing EZH2 catalytic domain point mutations. Treatment of EZH2-mutant NHL xenograft-bearing mice with EPZ-6438 causes dose-dependent tumor growth inhibition, including complete and sustained tumor regressions with correlative diminution of H3K27Me3 levels in tumors and selected normal tissues. Mice dosed orally with EPZ-6438 for 28 days remained tumor free for up to 63 days after stopping compound treatment in two EZH2-mutant xenograft models. These data confirm the dependency of EZH2-mutant NHL on EZH2 activity and portend the utility of EPZ-6438 as a potential treatment for these genetically defined cancers.
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                Author and article information

                Contributors
                rdmorin@sfu.ca
                Journal
                Nat Commun
                Nat Commun
                Nature Communications
                Nature Publishing Group UK (London )
                2041-1723
                1 October 2018
                1 October 2018
                2018
                : 9
                : 4001
                Affiliations
                [1 ]ISNI 0000 0004 1936 7494, GRID grid.61971.38, Department of Molecular Biology and Biochemistry, , Simon Fraser University, ; Burnaby, BC V5A 1S6 Canada
                [2 ]ISNI 0000 0001 0702 3000, GRID grid.248762.d, Lymphoid Cancer Research, , British Columbia Cancer Research Centre, ; Vancouver, BC V5Z 1L3 Canada
                [3 ]ISNI 0000 0001 0702 3000, GRID grid.248762.d, Canada’s Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, ; Vancouver, BC V5Z 1L3 Canada
                [4 ]ISNI 0000 0001 0702 3000, GRID grid.248762.d, Molecular Oncology, , British Columbia Cancer Research Centre, ; Vancouver, BC V5Z 1L3 Canada
                [5 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, Department of Medical Genetics, , University of British Columbia, ; Vancouver, BC Canada
                Author information
                http://orcid.org/0000-0002-5341-7868
                http://orcid.org/0000-0002-4621-1589
                http://orcid.org/0000-0002-7804-4981
                http://orcid.org/0000-0002-6413-6586
                http://orcid.org/0000-0003-1277-6335
                http://orcid.org/0000-0003-3945-3552
                http://orcid.org/0000-0001-9203-6323
                http://orcid.org/0000-0001-9364-9391
                http://orcid.org/0000-0001-8949-4374
                http://orcid.org/0000-0001-6402-523X
                http://orcid.org/0000-0002-0905-2742
                http://orcid.org/0000-0003-2932-7800
                Article
                6354
                10.1038/s41467-018-06354-3
                6167379
                30275490
                b21ca24d-ce25-4e28-a01f-94a9ae8c7128
                © The Author(s) 2018

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 15 June 2018
                : 31 August 2018
                Funding
                Funded by: FundRef https://doi.org/10.13039/501100004376, Terry Fox Research Institute (Institut de Recherche Terry Fox);
                Award ID: 1021
                Award Recipient :
                Funded by: FundRef https://doi.org/10.13039/501100000024, Gouvernement du Canada | Canadian Institutes of Health Research (Instituts de Recherche en Santé du Canada);
                Award ID: 300738
                Award Recipient :
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