The detection of specific gene rearrangements in non-Hodgkin's lymphoma using the polymerase chain reaction.

Characteristic gene rearrangements are present in most non-Hodgkin's lymphomas (NHL). These are usually detected by Southern blotting techniques. In this study, the ability of the polymerase chain reaction (PCR) to detect the t(14;18) chromosomal translocation and immunoglobulin heavy chain (IgH) gene rearrangement was evaluated. DNA from 14 follicular and 42 diffuse B-cell lymphomas was examined using oligonucleotide primers specific for opposing sides of the IgH gene rearrangement on chromosome 14 (towards conserved VH and JH sequences) and opposing sides of the t(14;18) chromosomal translocation (towards the major breakpoint region of the bcl-2 gene on chromosome 18 and conserved JH sequence on chromosome 14). The t(14;18) translocation was detected in 57% of follicular lymphomas and 21% of diffuse B-cell lymphomas. Clonal IgH gene rearrangements using PCR were detected in 50% follicular and 52% of the diffuse lymphomas. Either or both of these rearrangements were detected in 93% follicular and in 59% of diffuse lymphomas. PCR is a rapid and easy technique that can detect the abnormal rearrangement of the bcl-2 gene and clonal IgH rearrangement, indicating the presence of lymphoma. This may be of benefit in monitoring response to therapy and in predicting prognosis in this disease.     

Bcl-2 Gene and Prognosis of B-cell Lymphoma

Both the polymerase chain reaction (PCR) and Southern blot analysis were used to detect bcl-2 gene rearrangement in B-cell lymphoma. Recent molecular studies have shown that the translocation of karyotypic abnormalities t(14;18) results in the juxtaposition of the candidate proto-oncogene bcl-2 on chromosome 18 with the immunoglobulin heavy-chain locus on chromosome 14. We detected the bcl-2 rearrangement in three of six follicular lymphomas (50%), two of five follicular and diffuse lymphomas (40%), one of 13 diffuse medium-sized cell lymphomas (7.7%) and two of 33 diffuse large cell lymphomas (6.0%) through Southern blot analysis. With PCR, the rearrangement was demonstrated in five of eight follicular (63%), three of five follicular and diffuse (60%), seven of 36 diffuse large cell lymphomas (19%) and two of 13 diffuse medium-sized lymphomas (15%). Diffuse large cell lymphomas with bcl-2 rearrangement detected by PCR have a good prognosis as do cases of follicular lymphoma The bcl-2 gene is closely related to follicular lymphoma as described in previous reports and has general prognostic importance in diffuse large cell lymphoma of B cell type.     

Alterations of the Immunoglobulin Heavy Chain Locus in Progressive B-cell Lymphomas

Twenty-two patients with relapsed or progressive B-cell lymphomas (BCL) were analysed for alterations in the rearrangement status in the immunoglobulin heavy (IgH) chain gene in samples obtained on different occasions during the course of the disease. The analysis was performed using Southern blot hybridization of the IgH gene and polymerase chain reaction (PCR) amplification of the V_H gene families combined with single-strand conformation polymorphism (SSCP) analysis. Using Southern blot analysis, we found that all 22 lymphomas displayed clonal IgH rearrangements, and changes during tumour progression occurred in 8 cases. These alterations were mainly observed in cases with follicular or transformed lymphomas. More than one malignant (sub)clone, indicated by more than two rearranged bands, was detected in one case at diagnosis and in three cases at relapse. Outgrowth of subclones with divergent rearrangement patterns in different compartments was also observed in 2 out of 8 cases. PCR-SSCP analysis indicated that all 15 cases studied displayed clonal rearrangements and in 6 cases altered rearrangement patterns were detected in later samples. Southern blotting and PCR-SCCP analysis gave equivalent results. No association was found between time to relapse or survival time and alterations in rearrangement pattern. The present study illustrates that the neoplastic cell clones in BCL often display alterations in their IgH locus, but the significance of this feature remains to be clarified.     

Rearrangement of immunoglobulin, T-cell receptor, and bcl-2 genes in malignant lymphomas in Hong Kong

The pattern of malignant lymphomas in the Hong Kong Chinese population is characterized by a low incidence of Hodgkin's disease and follicular lymphomas. The authors studied the immunoglobulin (Ig), T-cell receptor (TCR), and bcl-2 gene rearrangement in 62 cases of malignant lymphoma in this population by Southern blot hybridization. Two cases of Hodgkin's disease showed no rearrangement of the Ig and TCR genes. All 42 cases of B-cell lymphoma had Ig heavy chain (JH) rearrangement with or without additional rearrangement of the light chains (C kappa and C lambda). One case of diffuse B-cell lymphoma had additional T-cell receptor beta-chain (C beta) rearrangement. Sixteen of 18 cases of T-cell lymphoma had C beta rearrangement, and one case of T-lymphoblastic lymphoma had additional JH rearrangement. Two of eight (25%) cases of follicular lymphoma but only one of the 34 (2.9%) cases of diffuse B-cell lymphoma had bcl-2 rearrangement that was detected by pFL-1 probe. None of the 62 cases showed bcl-2 rearrangement using the pFL-2 probe. In conclusion, the Ig and TCR gene rearrangement pattern of the lymphomas found in Hong Kong correlates well with the T-cell and B-cell lineage, which is similar to reports in the white population. However, the incidence of bcl-2 gene rearrangement in follicular B-cell lymphoma is lower than that reported in the US but comparable with that in Japan.     

非霍奇金淋巴瘤患者外周血bcl-2/IgH基因的研究

目的 检测非霍奇金淋巴瘤患者t(14；18)异位bcl-2／IgH基因突变3种类型，探讨外周血bcl．2／IgH基因突变在非霍奇金淋巴瘤诊断和治疗过程中的变化。方法 采集非霍奇金淋巴瘤患者和正常人外周血，PCR方法检测bcl-2／IgH基因3种不同重排方式的发生率。结果 正常人bcl-2／IgH3种基因异位的概率分别为mbr3．8％，mcr1．9％，mdr1．9％。同时发生3种异位的概率为0，发生2种异位的概率为0。非霍奇金淋巴瘤患者化疗前mbr、mcr和mdl的发生率分别为71．2％、50．0％和25．0％，化疗后的发生率分别为6713％、44．2％和17．3％。化疗前后同时有发生两种异位的概率分别为7．7％和11．5％，同时发生3种异位的发生率为分别为5．8％和3．8％。结论 同时检测3种bcl-2／IgH基因重排在非霍奇金淋巴瘤患者化疗前后发生率和重排率有差异，对临床诊断和个体化化疗方案的选择以及疾病预后的监测有重要意义。     

Incidence and clinical significance of bcl-2/IgH rearrangements in follicular lymphoma

Bcl-2/IgH rearrangement is the molecular hallmark of follicular lymphoma (FL) which is present in 70-90% of the cases at diagnosis. The clinical significance of this feature is controversial. The aim of this study was to analyze the bcl-2/IgH rearrangement by means of a PCR technique, and to correlate molecular findings with clinical characteristics and outcome. Sixty-nine patients (median age, 53 years; male/female ratio: 35/34) diagnosed with FL in a single institution were included in the study. A total of 77 DNA samples were analyzed, 54 were obtained from lymph node biopsy and 23 from peripheral blood or bone marrow. Bcl-2/IgH rearrangement was assessed for both the major breakpoint region (MBR) and the minor cluster region (mcr) breakpoints by a PCR technique. Thirty-nine out of sixty patients (65%) with assessable samples were found to have a bcl-2/IgH rearrangement in the MBR breakpoint, whereas bcl-2/IgH rearrangement in mcr was observed in one patient (2%) and no rearrangement at MBR or mcr in the remaining 20 patients (33%). Regarding the initial characteristics, patients with bcl-2/IgH rearrangements at MBR or mcr were younger (<65 years) than those with no rearrangement at these sites (p = 0.0001). No differences were found according to bcl-2/IgH rearrangement in terms of complete response rate, time to treatment failure and overall survival. In our series bcl-2/IgH rearrangement at MBR or mcr, which was found in 67% of the patients, was not correlated with response to treatment, survival nor time-to-treatment-failure.     

BCL-2 gene in lymphocytic malignancy

In t(14;18) (q32;q21) lymphomas, bcl-2 gene is activated by the juxtaposition of immunoglobulin (Ig) gene. The fused bcl-2-Ig gene generates chimeric mRNAs which consist of bcl-2 at 5' portion and Ig at 3' portion. Chimeric mRNA does not disrupt the bcl-2 coding frame of 239 amino acid polypeptide. Bcl-2-Ig transgenic mice demonstrated the extended B cell survival and the follicular lymphoproliferation, but they did not develop a malignancy until 25 weeks. Ten percent of them, however, developed malignant diffuse large-cell lymphomas after a long latency. Forty percent of these malignancies demonstrated the c-myc rearrangement, indicating that multiple step changes are required for malignant transformation in bcl-2 activated cells. Study on the bcl-2 gene rearrangement in Japanese B cell lymphoma and B-CLL revealed that 10 out of 32 cases of follicular lymphoma (31%), 5 out of 56 cases of diffuse lymphoma (9%) and 2 out of 30 cases of B-CLL (7%) were rearranged. Less frequency of B cell lymphoma, particularly follicular lymphoma in Japan might be partly due to the less bcl-2 involvement than in American cases. The ratio of bcl-2 involvement in B-CLL is not significantly different between Japan and U.S.A.. bcl-2 rearrangement at 5' promoter region is noted for Japanese B-CLL which was demonstrated for American cases. The clinical application of polymerase chain reaction for bcl-2 translocation was also discussed.     

PCR和FISH技术在子宫颈淋巴瘤与淋巴瘤样病变诊断和鉴别诊断中的作用

 目的　探讨PCR和FISH检测技术在原发性子宫颈淋巴瘤与淋巴瘤样病变的诊断与鉴别诊断中的作用。方法　收集3例原发性子宫颈弥漫性大B细胞淋巴瘤（DLBCL）与2例子宫颈淋巴瘤样病变,进行PCR-IgH重排及FISH检测。结果　PCR检测显示3例DLBCL和1例淋巴瘤样病变中出现单克隆性IgH基因重排。间期FISH检测显示3例DLBCL均发生了IgH和bcl-6基因断裂,而2例淋巴瘤样病变均未检测到特定的染色体断裂。结论　PCR-IgH重排并非仅见于子宫颈细胞淋巴瘤。间期FISH检测IgH和bcl-6基因的断裂对于子宫颈B细胞淋巴瘤和淋巴瘤样病变的诊断和鉴别诊断有帮助。     

Juxtaposition of human bcl-2 and immunoglobulin lambda light chain gene in chronic lymphocytic leukemia is the result of a reciprocal chromosome translocation between chromosome 18 and 22

The human bcl-2 gene is a oncogene candidate which is involved in the t(14;18) translocation specifically associated with follicular and diffuse B cell lymphomas. This translocation deregulates bcl-2 gene expression by placing it into immunoglobulin heavy chain locus (IgH). We have recently reported a case of chronic lymphocytic leukemia (CLL 1446) carrying a unique bcl-2 gene rearrangement with the immunoglobulin lambda light chain (Ig lambda) gene. This juxtaposition of the bcl-2 and Ig lambda genes resembles a variant chromosome translocation in Burkitt's lymphoma, although karyotype data of CLL 1446 is not available. In this paper, we completed the structural analysis of the bcl-2/Ig lambda gene rearrangement in CLL 1446 by cloning the corresponding partner of the rearrangement. This revealed that the juxtaposition of the bcl-2 and Ig lambda genes is a result of a reciprocal chromosome translocation between chromosomes 18 and 22 with deletions of 2 and 15 bp, respectively. Although a conserved immunoglobulin recombination signal (7mer-9mer) was absent around the breakpoint on chromosome 18, nonamer-like sequence was recognized within the deleted region at the breakpoint on chromosome 22. No extranucleotide was associated with both joining sites of the t(18;22) translocation. This is in sharp contrast to the t(14;18) translocation involving IgH locus in which the presence of extranucleotides is common and correlates well with the presence and absence of extranucleotides on V-(D)-J joining of IgH and light chain (L) genes, respectively. The data together suggest that the mechanism responsible for the physiological rearrangement of immunoglobulin genes is involved in this translocation.     

Clonal immunoglobulin gene rearrangements and normal T-cell receptor, bcl-2, and c-myc genes in primary cutaneous B-cell lymphomas

Fourteen cases of primary cutaneous B-cell lymphomas were investigated at the immunohistochemical and molecular level to further characterize this newly defined entity. Neoplastic cells from all cases, phenotyped with a panel of monoclonal antibodies, were positive for HLA-DR, for the B-cell markers CD19, CD22, but not CD23 (except one case), and negative for the T-cell marker CD2. Monoclonal immunoglobulin light chains were demonstrated in six cases. The reactivity with the Ki-67 monoclonal antibody indicated that the neoplastic cells are proliferating. In five biopsies the presence of dendritic cells infiltrating the neoplastic areas was revealed using the monoclonal antibody Kim4b. By Southern blot analysis, clonal rearrangement of the immunoglobulin heavy chain gene (involving one or both alleles) was shown in 12 of 14 cases and of the light chain genes in 13 cases. The bcl-2 oncogene, normally involved in nodal follicular lymphomas, was in germ-line configuration. The c-myc and the beta and gamma chain genes of the T-cell receptor were also in the germ-line configuration. None of the cases presented Epstein-Barr virus sequences. These data indicate that primary cutaneous lymphomas of B-cell origin share morphological and phenotypic similarities with the nodal B-cell lymphomas of follicular histotype, are proliferating, and express in 45% of cases clear monoclonal immunoglobulin light chain; the molecular analysis confirms the B-cell derivation and the monoclonal nature of this neoplasia; it also shows that neither bcl-2 nor c-myc oncogenes are involved and that no inappropriate rearrangements of the T-cell receptor genes are found in this lymphoma.     

High-dose therapy with autologous bone marrow support as consolidation of remission in follicular lymphoma: long-term clinical and molecular follow-up.

PURPOSE: To evaluate the long-term results of high-dose therapy (HDT) in follicular lymphoma, with specific emphasis on the prognostic significance of polymerase chain reaction (PCR)-detectable Bcl-2/IgH rearrangements. PATIENTS AND METHODS: Between June 1985 and October 1995, 99 patients with follicular lymphoma received HDT as consolidation of second or subsequent remission. Bone marrow was treated in vitro with anti-B-cell antibodies and complement. RESULTS: Sixty-five patients remained alive, 49 treatment-failure free, with a median follow-up of 5.5 years (range, 1.5 to 12.5 years). Four "early" and 10 "late" deaths occurred from treatment-related causes; seven of the latter were due to secondary myelodysplasia (s-MDS) or secondary acute myeloblastic leukemia. Overall, 12 (12%) of the 99 patients developed s-MDS or acute myeloblastic leukemia. Kaplan-Meier estimates of freedom from recurrence (FFR) and survival rates at 5 years were 63% (95% confidence interval [CI], 52% to 72%) and 69% (95% CI, 58% to 78%), respectively. For all 99 patients, in multivariate analysis, absence of the Bcl-2/IgH rearrangement at the time of diagnosis (hazards ratio [HR], 0.39; P =.04) and three or fewer treatment episodes before HDT (HR, 0.03; P =.001) were significant prognostic factors for improved survival. For patients bearing Bcl-2/IgH rearrangements, in univariate and multivariate analyses, absence of a PCR-detectable Bcl-2/IgH rearrangement during follow-up was associated with a significantly lower risk of recurrence (adjusted HR, 0.13; P <.001) and death (HR, 0.25; P =.02), whereas the PCR status of the reinfused bone marrow did not correlate with outcome. CONCLUSION: Prolonged FFR can be achieved in patients with follicular lymphoma after HDT, but as yet there is no survival advantage compared with conventional treatment. These results confirm that elimination of cells bearing the Bcl-2/IgH rearrangement is highly desirable and should be attempted. The incidence of s-MDS is of increasing concern in this setting.     

Bcl-1 gene rearrangements in B cell lymphoma

We analyzed 50 B cell lymphoma samples by Southern blot analysis, using the bcl-1 and heavy chain immunoglobulin (JH) probes with two or more restriction endonucleases. All samples showed JH rearrangement, and three samples (two diffuse small lymphocytic lymphomas and one diffuse large cell lymphoma probably transformed from a diffuse small lymphocytic lymphoma) demonstrated rearranged bcl-1 sequences. The three samples showed the t(11;14)(q13;q32) chromosome translocation, and all three contained rearranged JH fragments that comigrated with the rearranged bcl-1 fragment. The breakpoint of the translocation occurred within a 1.6-kb region on chromosome 11 in the three cases. Two of the three patients had primary refractory disease. Two of the three patients had gastrointestinal involvement. Bcl-1 rearrangement may identify an unusual subset of patients with primary refractory disease with gastrointestinal involvement. It may also describe a unique subset of large cell lymphoma patients transformed from diffuse small cell histology.     

Frequency of bcl-2 Gene Rearrangement in B-Cell Non Hodgkin’s Lymphoma

Objective: The objective of the study was to determine the frequency of bcl-2 gene rearrangement in B-cellNon-Hodgkin’s lymphoma (NHL) and identify different breakpoints of bcl-2 gene. Methods: Thirty cases of Bcelllymphoma (including 8 cases of follicular lymphoma, 19 cases of diffuse large B-cell lymphoma and 3 casesof T-cell rich B-cell lymphoma) were included in the study. Good quality of DNA was extracted in 4 cases fromformalin fixed paraffin embedded tissue and in 26 cases from fine needle aspirate. The polymerase chain reactionwas done for major break point region (mbr), minor cluster region (mcr) and intermediate cluster region (icr) ofbcl-2 gene. Results: The bcl-2 gene rearrangement was identified in 23.3% of B-cell lymphoma, 50% of follicularlymphoma, 15% of diffuse large B-cell lymphoma and no bcl-2 rearrangement was identified in any of the T-cellrich B-cell lymphomas. Further analysis showed, icr breakpoint in 16.7% of B-cell lymphoma, 37.5% of follicularlymphoma and 10.5% of diffuse large B-cell lymphoma. Involvement of mbr breakpoint was found in 6.7% ofB-cell lymphoma, 12.5% of follicular lymphoma, 5.3% of diffuse large B-cell lymphoma. Involvement of mcrbreakpoint was not seen in any of the case. Conclusion: The bcl-2 gene rearrangement is quite frequent infollicular lymphoma, followed by diffuse large B-cell lymphoma. The commonest breakpoint in present series isicr followed by mbr. This indicates that primers for bcl-2 gene must include icr primer, whenever bcl-2 gene isbeing evaluated for B-cell NHL in this part of the world and this might reduce the variability of frequency ofbcl-2 gene rearrangement within and between different regions.     

High molecular response rate and clinical correlation in patients with follicular lymphoma treated with cyclophosphamide-vincristine-prednisone plus interferon alpha 2b.

PURPOSE: The role of molecular monitoring of minimal residual disease (MRD) in low-grade non-Hodgkin's lymphoma is controversial. We have performed a prospective study of the molecular behavior of 35 patients with follicular non-Hodgkin's lymphoma who received cyclophosphamide-vincristine-prednisone chemotherapy in conjunction with IFN-alpha 2b. Experimental Design: Bcl-2 and clonal immunoglobulin heavy chain (IgH) gene rearrangements were assayed at diagnosis by PCR in lymph node and bone marrow (BM) and sequentially after treatment. RESULTS: Molecular markers were detected in BM of 29 (83%) patients at diagnosis: Bcl-2 rearrangement in 20 patients (90% major breakpoint and 10% minor cluster) and clonal IgH rearrangement in 9 of 15 patients negative for Bcl-2. Molecular and clinical response was noted in 25 (86%) patients after induction treatment. Progression-free survival at 5 years was 78.1 +/- 8%. A correlation between clinical and molecular response was found in 24 patients with molecular markers in BM at diagnosis and >2 years of follow-up: 94% of patients with undetectable MRD showed continuous clinical remission, whereas 50% of patients who reverted back to positive molecular markers relapsed (P < 0.05). CONCLUSIONS: The rate of molecular response is high in patients treated with cyclophosphamide-vincristine-prednisone and IFN and MRD sequential analysis is useful for disease surveillance.     

Detecting clonal rearrangement in non-Hodgkin's lymphomas in Taiwan by polymerase chain reaction

The detection of monoclonal expansions of the immunoglobulin heavy chain (IgH) or the T-cell receptor-gamma (TCRgamma) chain genes is an important supplement for the diagnosis of the non-Hodgkin's lymphomas (NHLs). Detection of monoclonality by polymerase chain reaction (PCR) method has offered an efficient approach for rapid diagnosis and monitoring of the therapeutic effects. Here we conducted a retrospective PCR clonality study on 49 cases of NHLs including 23 B-cell lymphomas (BCLs), 20 peripheral T-cell lymphomas (PTCLs), 6 natural killer (NK)/T-cell lymphomas and 3 reactive lymphoid tissues from southern Taiwan. Genomic DNAs from paraffin sections were extracted and analyzed by the IgH- and TCR-specific PCR reactions. The results showed that 20 of 23 (87.5%) BCLs exhibited IgH gene rearrangements and were all germline for TCRgamma. 15 of 20 (75.0%) PTCLs exhibited TCRgamma gene rearrangements while 1 case (5%) was positive for IgH gene rearrangement. The 6 NK/T-cell lymphomas and 3 reactive lymphoid tissues were all germline for either IgH or TCRgamma genes. Our results were similar to other Western reports in terms of sensitivity and cell-lineage specificity. This is the first large series of PCR clonality study of IgH and TCRgamma gene rearrangements on NHLs from Taiwan. We have confirmed that this rapid method is a sensitive diagnostic tool for NHLs.     

B-cell marker negative (CD7+, CD19-) Epstein-Barr virus-related pyothorax-associated lymphoma with rearrangement in the JH gene

Pyothorax-associated lymphoma (PAL) develops decades after receiving artificial pneumothorax for pulmonary tuberculosis. The lymphomas, develop in tissue affected by long-standing severe inflammatory process. Most cases demonstrate diffuse large B-cell lymphoma. We present a patient with T-cell phenotype-positive and B-cell phenotype-negative (CD7+, CD43+, CD19-, and CD20-) PAL. Southern blot hybridization using immunglobulin heavy chain J region (IgH) gene probe revealed a monoclonal rearrangement, and hybridization using T-cell receptor beta chain (TCR) gene probe revealed a germline configuration. This indicates that the tumor origin was of B-lymphocytes. Chromosomal abnormality of the lymphoma was complicated. It suggested that many transformations occurred. In the transformation process, probably B-cell antigens were lost, and T-cell antigens were aberrantly expressed.     

bcl-2 translocation in Japanese B cell lymphoma: novel bcl-2 translocation with immunoglobulin heavy chain diversity segment

Breakpoints of a lymphoma case with bcl-2 gene rearrangement that did not show comigration of immunoglobulin (Ig) heavy chain joining (JH) fragment were cloned. Sequence analysis revealed that the translocation broke the 3' side of the Ig heavy chain diversity (DH) segment at the heptamer recombination signal and each end was ligated to the bcl-2 locus. Since Southern blot demonstrated that both alleles of JH were rearranged, this translocation was suggested to have occurred at the step of VH-DH, or DH-DHJH recombination, one step later than that of DH-JH recombination where the common pattern of bcl-2 rearrangement generally occurs. Cases that showed comigration with JH fragment were also studied by polymerase chain reaction with 5' bcl-2 oligomer and 3' JH consensus anti-sense oligomer since it has been demonstrated that bcl-2 translocation at the major breakpoint clustering region (mbr) in American cases clusters within an about 150 bp region in the mbr. The results demonstrated that four out of five cases studied were amplified, indicating that the same clustering mechanism exists for Japanese cases. The present study, together with our previous report on Ig kappa-bcl-2, indicated that bcl-2 translocation in Japanese B cell lymphomas might occur at a later stage of B cell development, as compared with that in American cases. Less involvement of bcl-2 in Japanese B cell lymphoma may also be in part explainable by low susceptibility to bcl-2 rearrangement at the step of DH-JH recombination.