Genomics, Signaling, and Treatment of Waldenstrom Macroglobulinemia

被引:72
作者
Hunter, Zachary R. [1 ,2 ]
Yang, Guang [1 ,2 ]
Xu, Lian [1 ,2 ]
Liu, Xia [1 ,2 ]
Castillo, Jorge J. [1 ,2 ]
Treon, Steven P. [1 ,2 ]
机构
[1] Dana Farber Canc Inst, Bing Ctr Waldenstroms Macroglobulinemia, M547,450 Brookline Ave, Boston, MA 02215 USA
[2] Harvard Med Sch, Boston, MA USA
关键词
MYD88 L265P MUTATION; CHRONIC LYMPHOCYTIC-LEUKEMIA; NON-HODGKIN-LYMPHOMA; B-CELL LYMPHOMA; MULTIPLE-MYELOMA; SOMATIC MUTATION; CXCR4; MUTATIONS; LYMPHOPROLIFERATIVE DISORDERS; LYMPHOPLASMACYTIC LYMPHOMA; INTERNATIONAL WORKSHOP;
D O I
10.1200/JCO.2016.71.0814
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Next-generation sequencing has revealed recurring somatic mutations in Waldenstrom macro-globulinemia (WM). Commonly recurring mutations include MYD88 (95% to 97%), CXCR4 (30% to 40%), ARID1A (17%), and CD79B (8% to 15%). Diagnostic discrimination of WM from overlapping B-cell malignancies is aided by MYD88 mutation status. Transcription is affected by MYD88 and CXCR4 mutations and includes overexpression of genes involved in VDJ recombination, CXCR4 pathway signaling, and BCL2 family members. Among patients with MYD88 mutations, those with CXCR4 mutations show transcriptional silencing of tumor suppressors associated with acquisition of mutated MYD88. Deletions involving chromosome 6q are common and include genes that modulate nuclear factor-kappa B, BCL2, BTK, apoptosis, differentiation, and ARID1B. Non-chromosome 6q genes are also frequently deleted and include LYN, a regulator of B-cell receptor signaling. MYD88 and CXCR4 mutations affect WM disease presentation and treatment outcome. Patients with wild-type MYD88 show lower bone marrow disease burden and serum immunoglobulin M levels but show an increased risk of death. Patients with CXCR4 mutations have higher bone marrow disease burden, and those with nonsense CXCR4 mutations have higher serum immunoglobulin M levels and incidence of symptomatic hyperviscosity. Mutated MYD88 triggers BTK, IRAK1/IRAK4, and HCK growth and survival signaling, whereas CXCR4 mutations promote AKT and extracellular regulated kinase-1/2 signaling and drug resistance in the presence of its ligand CXCL12. Ibrutinib is active in patients with WM and is affected by MYD88 and CXCR4 mutation status. Patients with mutated MYD88 and wild-type CXCR4 mutation status exhibit best responses to ibrutinib. Lower response rates and delayed responses to ibrutinib are associated with mutated CXCR4 in patients with WM. MYD88 and CXCR4 mutation status may be helpful in treatment selection for symptomatic patients. Novel therapeutic approaches under investigation include therapeutics targeting MYD88, CXCR4, and BCL2 signaling. (C) 2017 by American Society of Clinical Oncology
引用
收藏
页码:994 / 1001
页数:8
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