HAEM5:Classic Hodgkin lymphoma: Difference between revisions
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{{DISPLAYTITLE:Classic Hodgkin lymphoma}} | {{DISPLAYTITLE:Classic Hodgkin lymphoma}} | ||
[[HAEM5:Table_of_Contents|Haematolymphoid Tumours (WHO Classification, 5th ed.)]] | [[HAEM5:Table_of_Contents|Haematolymphoid Tumours (WHO Classification, 5th ed.)]] | ||
| Line 14: | Line 15: | ||
==Primary Author(s)*== | ==Primary Author(s)*== | ||
Xiaolin Hu, Ph.D., GeneDx | |||
==WHO Classification of Disease== | ==WHO Classification of Disease== | ||
| Line 37: | Line 38: | ||
|} | |} | ||
==Related Terminology== | ==Related Terminology== | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
|Acceptable | |Acceptable | ||
| | |N/A | ||
|- | |- | ||
|Not Recommended | |Not Recommended | ||
| | |Hodgkin disease | ||
|} | |} | ||
| Line 81: | Line 68: | ||
| | | | ||
|} | |} | ||
==Individual Region Genomic Gain/Loss/LOH== | ==Individual Region Genomic Gain/Loss/LOH== | ||
Put your text here and fill in the table <span style="color:#0070C0">(''Instructions: Includes aberrations not involving gene rearrangements. Details on clinical significance such as prognosis and other important information can be provided in the notes section. Can refer to CGC workgroup tables as linked on the homepage if applicable. Please include references throughout the table. Do not delete the table.'') </span> | Put your text here and fill in the table <span style="color:#0070C0">(''Instructions: Includes aberrations not involving gene rearrangements. Details on clinical significance such as prognosis and other important information can be provided in the notes section. Can refer to CGC workgroup tables as linked on the homepage if applicable. Please include references throughout the table. Do not delete the table.'') </span> | ||
Recurrent chromosomal imbalances are characteristic of CHL and contribute to its pathogenesis. Frequent gains include 2p (''REL''), 9p24.1 (''JAK2'', ''CD274/PDL1'', ''PDCD1LG2/PDL2''), and 17q21 (''MAP3K14''), while recurrent losses include 6q23–q24 (''TNFAIP3''). These alterations support activation of NF-κB and JAK/STAT pathways, as well as immune evasion. | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|- | |- | ||
!Chr #!! | !Chr #!!Gain, Loss, Amp, LOH!!Minimal Region Cytoband and/or Genomic Coordinates [Genome Build; Size]!!Relevant Gene(s) | ||
! | !Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | ||
! | !Established Clinical Significance Per Guidelines - Yes or No (Source) | ||
!Clinical Relevance Details/Other Notes | |||
|- | |||
|2p | |||
|gain | |||
|2p13 | |||
|''REL'' | |||
|P | |||
|No | |||
|REL amplification promotes NF-κB signaling activation that promotes HRS cell survival and proliferation.<ref>{{Cite journal|last=Joos|first=Stefan|last2=Menz|first2=Christiane K.|last3=Wrobel|first3=Gunnar|last4=Siebert|first4=Reiner|last5=Gesk|first5=Stefan|last6=Ohl|first6=Sibylle|last7=Mechtersheimer|first7=Gunhild|last8=Trümper|first8=Lorenz|last9=Möller|first9=Peter|date=2002-02-15|title=Classical Hodgkin lymphoma is characterized by recurrent copy number gains of the short arm of chromosome 2|url=https://pubmed.ncbi.nlm.nih.gov/11830490|journal=Blood|volume=99|issue=4|pages=1381–1387|doi=10.1182/blood.v99.4.1381|issn=0006-4971|pmid=11830490}}</ref><ref>{{Cite journal|last=Martín-Subero|first=José I.|last2=Gesk|first2=Stefan|last3=Harder|first3=Lana|last4=Sonoki|first4=Takashi|last5=Tucker|first5=Philip W.|last6=Schlegelberger|first6=Brigitte|last7=Grote|first7=Werner|last8=Novo|first8=Francisco J.|last9=Calasanz|first9=María J.|date=2002-02-15|title=Recurrent involvement of the REL and BCL11A loci in classical Hodgkin lymphoma|url=https://pubmed.ncbi.nlm.nih.gov/11830502|journal=Blood|volume=99|issue=4|pages=1474–1477|doi=10.1182/blood.v99.4.1474|issn=0006-4971|pmid=11830502}}</ref><ref name=":2">{{Cite journal|last=Steidl|first=Christian|last2=Telenius|first2=Adele|last3=Shah|first3=Sohrab P.|last4=Farinha|first4=Pedro|last5=Barclay|first5=Lorena|last6=Boyle|first6=Merrill|last7=Connors|first7=Joseph M.|last8=Horsman|first8=Douglas E.|last9=Gascoyne|first9=Randy D.|date=2010-07-22|title=Genome-wide copy number analysis of Hodgkin Reed-Sternberg cells identifies recurrent imbalances with correlations to treatment outcome|url=https://pubmed.ncbi.nlm.nih.gov/20339089|journal=Blood|volume=116|issue=3|pages=418–427|doi=10.1182/blood-2009-12-257345|issn=1528-0020|pmid=20339089}}</ref> | |||
|- | |||
|9p | |||
|Gain | |||
|9p24.1 | |||
|''CD274'' (PD-L1), ''PDCD1LG2'' (PD-L2), JAK2 | |||
|T, P | |||
|Yes <ref name=":1" /> | |||
|9p24.1 amplification drives PD-L1/PD-L2 overexpression leading to immune suppression. Relevant for immune checkpoint inhibitor therapy <ref name=":1">{{Cite journal|last=Green|first=Michael R.|last2=Monti|first2=Stefano|last3=Rodig|first3=Scott J.|last4=Juszczynski|first4=Przemyslaw|last5=Currie|first5=Treeve|last6=O'Donnell|first6=Evan|last7=Chapuy|first7=Bjoern|last8=Takeyama|first8=Kunihiko|last9=Neuberg|first9=Donna|date=2010-10-28|title=Integrative analysis reveals selective 9p24.1 amplification, increased PD-1 ligand expression, and further induction via JAK2 in nodular sclerosing Hodgkin lymphoma and primary mediastinal large B-cell lymphoma|url=https://pubmed.ncbi.nlm.nih.gov/20628145|journal=Blood|volume=116|issue=17|pages=3268–3277|doi=10.1182/blood-2010-05-282780|issn=1528-0020|pmc=2995356|pmid=20628145}}</ref><ref>{{Cite journal|last=Roemer|first=Margaretha G. M.|last2=Advani|first2=Ranjana H.|last3=Ligon|first3=Azra H.|last4=Natkunam|first4=Yasodha|last5=Redd|first5=Robert A.|last6=Homer|first6=Heather|last7=Connelly|first7=Courtney F.|last8=Sun|first8=Heather H.|last9=Daadi|first9=Sarah E.|date=2016-08-10|title=PD-L1 and PD-L2 Genetic Alterations Define Classical Hodgkin Lymphoma and Predict Outcome|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC5019753/|journal=Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology|volume=34|issue=23|pages=2690–2697|doi=10.1200/JCO.2016.66.4482|issn=1527-7755|pmc=5019753|pmid=27069084}}</ref> | |||
|- | |||
|17q | |||
|Gain | |||
|17q21 | |||
|''MAP3K14'' | |||
|P | |||
|No | |||
|MAP3K14 (NIK) gain activates alternative NF-κB signaling <ref name=":2" /> | |||
|- | |- | ||
| | |19q | ||
|Gain | |||
| | |19q13.3 | ||
| | |''RELB'' | ||
|P | |||
| | |No | ||
|Overexpression of RELB leads to enhanced NF-kB signaling and HRS cell survival. <ref>{{Cite journal|last=Slovak|first=Marilyn L.|last2=Bedell|first2=Victoria|last3=Hsu|first3=Ya-Hsuan|last4=Estrine|first4=Dolores B.|last5=Nowak|first5=Norma J.|last6=Delioukina|first6=Maria L.|last7=Weiss|first7=Lawrence M.|last8=Smith|first8=David D.|last9=Forman|first9=Stephen J.|date=2011-05-15|title=Molecular karyotypes of Hodgkin and Reed-Sternberg cells at disease onset reveal distinct copy number alterations in chemosensitive versus refractory Hodgkin lymphoma|url=https://pubmed.ncbi.nlm.nih.gov/21385932|journal=Clinical Cancer Research: An Official Journal of the American Association for Cancer Research|volume=17|issue=10|pages=3443–3454|doi=10.1158/1078-0432.CCR-10-1071|issn=1557-3265|pmc=3096736|pmid=21385932}}</ref> | |||
| | |||
| | |||
| | |||
|- | |- | ||
| | |20q | ||
|Gain | |||
| | |20q13 | ||
| | |''CD40'' | ||
|P | |||
| | |No | ||
|Over expression of CD40 activates NF-kB signaling, promotes proliferation and immune evasion.<ref>{{Cite journal|last=Alibrahim|first=Mohamed N.|last2=Gloghini|first2=Annunziata|last3=Carbone|first3=Antonino|date=2024-12-05|title=Pathobiological Features and Therapeutic Opportunities Linked to TNF Family Member Expression in Classic Hodgkin Lymphoma|url=https://pubmed.ncbi.nlm.nih.gov/39682256|journal=Cancers|volume=16|issue=23|pages=4070|doi=10.3390/cancers16234070|issn=2072-6694|pmc=11640334|pmid=39682256}}</ref><ref>{{Cite journal|last=De Re|first=Valli|last2=Caggiari|first2=Laura|last3=Repetto|first3=Ombretta|last4=Mussolin|first4=Lara|last5=Mascarin|first5=Maurizio|date=2019-10-02|title=Classical Hodgkin's Lymphoma in the Era of Immune Checkpoint Inhibition|url=https://pubmed.ncbi.nlm.nih.gov/31581738|journal=Journal of Clinical Medicine|volume=8|issue=10|pages=1596|doi=10.3390/jcm8101596|issn=2077-0383|pmc=6832444|pmid=31581738}}</ref> | |||
| | |||
| | |||
| | |||
|- | |- | ||
| | |6q | ||
|Loss | |||
| | |6q23-24 | ||
| | |''TNFAIP3'' | ||
|P | |||
| | |No | ||
'' | |Loss of TNFAIP3 (A20), a negative regulator of NF‑κB, enhance NF-kB signling <ref name=":0">{{Cite journal|last=Schmitz|first=Roland|last2=Hansmann|first2=Martin-Leo|last3=Bohle|first3=Verena|last4=Martin-Subero|first4=Jose Ignacio|last5=Hartmann|first5=Sylvia|last6=Mechtersheimer|first6=Gunhild|last7=Klapper|first7=Wolfram|last8=Vater|first8=Inga|last9=Giefing|first9=Maciej|date=2009-05-11|title=TNFAIP3 (A20) is a tumor suppressor gene in Hodgkin lymphoma and primary mediastinal B cell lymphoma|url=https://pubmed.ncbi.nlm.nih.gov/19380639|journal=The Journal of Experimental Medicine|volume=206|issue=5|pages=981–989|doi=10.1084/jem.20090528|issn=1540-9538|pmc=2715030|pmid=19380639}}</ref> | ||
| | |||
| | |||
|< | |||
|- | |- | ||
| | |13q | ||
| | |Loss | ||
| | |13q14 | ||
| | |''RB1'' | ||
| | |P | ||
| | |No | ||
| | |loss of tumor suppressors and contribute to HRS cell survival | ||
|} | |} | ||
The table below seems duplicated, can be deleted? | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
| Line 218: | Line 217: | ||
!Chromosomal Pattern | !Chromosomal Pattern | ||
!Molecular Pathogenesis | !Molecular Pathogenesis | ||
! | !Prevalence - | ||
Common >20%, Recurrent 5-20% or Rare <5% (Disease) | |||
! | !Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | ||
! | !Established Clinical Significance Per Guidelines - Yes or No (Source) | ||
! | !Clinical Relevance Details/Other Notes | ||
|- | |- | ||
| | |Aneuploidy | ||
|Chromosomal instability | |||
| | |Common | ||
| | |P | ||
| | |No | ||
| | |Common in HRS cells; associated with genomic instability and disease progression (PMID: 7632954) | ||
| | |||
|- | |- | ||
| | |Hypertetraploidy | ||
|Chromosomal duplication leading to genome-wide imbalance | |||
| | |Recurrent (5–20%) | ||
|P | |||
| | |No | ||
| | |Frequently observed in CHL; reflects chromosomal instability (PMID: 7632954) | ||
| | |||
|- | |- | ||
| | |Recurrent chromosomal imbalances (e.g., 2p, 9p, 17q gains; 6q loss) | ||
| | |Deregulated NF-κB and JAK/STAT signaling; immune evasion | ||
| | |Common (>20%) | ||
| | |P,T | ||
| | |Yes (PMID: 19380639, 20628145) | ||
| | |Involves REL, JAK2, PD-L1, PD-L2, TNFAIP3; contributes to pathogenesis and guides immunotherapy potential | ||
|} | |} | ||
The below table can be deleted? | |||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
| Line 258: | Line 255: | ||
!Notes | !Notes | ||
|- | |- | ||
| | |Aneuploidy, hypertetraploidy | ||
|No | |No | ||
| | |unkonwn | ||
|unknown | |||
|Common in HRS cells; contributes to genomic instability (PMID: 7632954) | |||
|} | |} | ||
| Line 273: | Line 266: | ||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|- | |- | ||
!Gene!! | !Gene!!Genetic Alteration!!Tumor Suppressor Gene, Oncogene, Other!!Prevalence - | ||
Common >20%, Recurrent 5-20% or Rare <5% (Disease) | |||
! | !Diagnostic, Prognostic, and Therapeutic Significance - D, P, T | ||
! | !Established Clinical Significance Per Guidelines - Yes or No (Source) | ||
! | !Clinical Relevance Details/Other Notes | ||
|- | |- | ||
| | |TNFAIP3 | ||
|Inactivating mutation | |||
|Tumor Suppressor Gene | |||
| | |Recurrent (5-20%) | ||
| | |P | ||
| | |No | ||
| | |Loss of function mutations disrupt NF-κB regulation (PMID: 19380639) | ||
| | |- | ||
| | |SOCS1 | ||
|Frameshift and nonsense mutations | |||
|Tumor Suppressor Gene | |||
|Recurrent (5-20%) | |||
|P | |||
|No | |||
|SOCS1 mutations activate JAK/STAT signaling (PMID: 24531327) | |||
|- | |||
|STAT6 | |||
|Missense mutations | |||
|Oncogene | |||
|Recurrent (5-20%) | |||
|P | |||
|No | |||
|STAT6 mutations drive cytokine signaling alterations (PMID: 24531327, 29650799) | |||
|- | |- | ||
| | |B2M | ||
|Inactivating mutations | |||
| | |Tumor Suppressor Gene | ||
| | |Rare (<5%) | ||
|< | |P | ||
| | |No | ||
| | |Loss of MHC class I expression aids immune evasion (PMID: 21368758) | ||
| | |||
|- | |- | ||
| | |CIITA | ||
| | |Inactivating mutations | ||
| | |Tumor Suppressor Gene | ||
|< | |Rare (<5%) | ||
| | |P | ||
| | |No | ||
| | |Loss of MHC class II expression aids immune evasion (PMID: 21368758) | ||
|- | |- | ||
| | |XPO1 | ||
| | |Missense mutations | ||
| | |Oncogene | ||
| | |Rare (<5%) | ||
| | |Unknown | ||
| | |No | ||
| | |Emerging evidence of role in CHL pathogenesis (PMID: 33686198) | ||
|}Note: A more extensive list of mutations can be found in [https://www.cbioportal.org/ <u>cBioportal</u>], [https://cancer.sanger.ac.uk/cosmic <u>COSMIC</u>], and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content. | |}Note: A more extensive list of mutations can be found in [https://www.cbioportal.org/ <u>cBioportal</u>], [https://cancer.sanger.ac.uk/cosmic <u>COSMIC</u>], and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content. | ||
| Line 319: | Line 325: | ||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|- | |- | ||
!Gene; Genetic Alteration!! | !Gene; Genetic Alteration!!Presumed Mechanism (Tumor Suppressor Gene [TSG] / Oncogene / Other)!!Prevalence (COSMIC / TCGA / Other)!!Concomitant Mutations!!Mutually Exclusive Mutations | ||
! | !Diagnostic Significance (Yes, No or Unknown) | ||
!Prognostic Significance (Yes, No or Unknown) | !Prognostic Significance (Yes, No or Unknown) | ||
!Therapeutic Significance (Yes, No or Unknown) | !Therapeutic Significance (Yes, No or Unknown) | ||
| Line 348: | Line 354: | ||
==Epigenomic Alterations== | ==Epigenomic Alterations== | ||
Global downregulation of B-cell transcription factors (OCT2, BOB1, PU.1) and epigenetic silencing of B-cell program genes (PMID: 19465900, 14694522) | |||
==Genes and Main Pathways Involved== | ==Genes and Main Pathways Involved== | ||
{| class="wikitable sortable" | {| class="wikitable sortable" | ||
|- | |- | ||
!Gene; Genetic Alteration!!Pathway!!Pathophysiologic Outcome | !Gene; Genetic Alteration!!Pathway!!Pathophysiologic Outcome | ||
|- | |- | ||
| | |REL, TNFAIP3, NFKBIA, MAP3K14 | ||
| | |NF-κB signaling | ||
| | |Constitutive activation of classical and alternative NF-κB pathways promotes HRS cell survival (PMID: 19380639, 33686198) | ||
|- | |- | ||
| | |JAK2, STAT6, SOCS1 | ||
| | |JAK/STAT signaling | ||
| | |Dysregulation leads to proliferation and survival of HRS cells (PMID: 24531327, 29650799) | ||
|- | |- | ||
| | |CD274 (PD-L1), PDCD1LG2 (PD-L2), B2M | ||
| | |Immune evasion | ||
| | |Upregulation of PD-L1/PD-L2 and loss of MHC I/II expression enables immune escape (PMID: 20628145, 21368758) | ||
|- | |||
|EBV LMP1, LMP2A | |||
|Viral oncogenesis | |||
|LMP1 mimics CD40 signaling, LMP2A mimics BCR signaling to promote HRS cell survival in EBV+ CHL (PMID: 9501091, 17682125) | |||
|- | |- | ||
| | | | ||
| | | | ||
| | | | ||
|} | |} | ||
==Genetic Diagnostic Testing Methods== | ==Genetic Diagnostic Testing Methods== | ||
*Immunohistochemistry for CD30, CD15, PAX5, and EBV (EBER in situ hybridization) (PMID: 2477085, 6946981) | |||
*9p24.1 copy number assessment (FISH or NGS) may be used in refractory/relapsed cases to evaluate PD-L1/PD-L2 amplification for potential immunotherapy (PMID: 29394125). | |||
*TR clonality assays can help exclude T-cell lymphomas in challenging differential diagnoses (PMID: 24128129). | |||
*Targeted NGS panels for NF-κB and JAK/STAT pathway mutations (PMID: 33686198) | |||
==Familial Forms== | ==Familial Forms== | ||
Familial aggregation and monozygotic twin concordance suggest genetic predisposition (PMID: 26311361, 34208754) | |||
==Additional Information== | ==Additional Information== | ||