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Molecular Characterization of Immunoglobulin Gene Rearrangements in Diffuse Large B-Cell Lymphoma

Antigen-Driven Origin and IGHV4-34 as a Particular Subgroup of the Non-GCB Subtype
  • Elena Sebastián
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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  • Miguel Alcoceba
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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  • Ana Balanzategui
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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  • Luis Marín
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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  • Santiago Montes-Moreno
    Affiliations
    Servicio de Anatomía Patológica, University Hospital of Marqués de Valdecilla/IFIMAV, Santander, Spain
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  • Teresa Flores
    Affiliations
    Department of Pathology, University Hospital of Salamanca, Salamanca, Spain
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  • David González
    Affiliations
    Institute of Cancer Research, Royal Cancer Hospital, London, United Kingdom
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  • M. Eugenia Sarasquete
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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  • M. Carmen Chillón
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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  • Noemí Puig
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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  • Rocío Corral
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
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  • Emilia Pardal
    Affiliations
    Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group, University Hospital Marqués de Valdecilla, Santander, Spain
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  • Alejandro Martín
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain

    Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group, University Hospital Marqués de Valdecilla, Santander, Spain
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  • Eva González-Barca
    Affiliations
    Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group, University Hospital Marqués de Valdecilla, Santander, Spain
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  • M. Dolores Caballero
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Servicio de Anatomía Patológica, University Hospital of Marqués de Valdecilla/IFIMAV, Santander, Spain

    Spanish Lymphoma/Autologous Bone Marrow Transplant Study Group, University Hospital Marqués de Valdecilla, Santander, Spain
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  • Jesús F. San Miguel
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Servicio de Anatomía Patológica, University Hospital of Marqués de Valdecilla/IFIMAV, Santander, Spain

    Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain
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  • Ramón García-Sanz
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Servicio de Anatomía Patológica, University Hospital of Marqués de Valdecilla/IFIMAV, Santander, Spain

    Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain
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  • Marcos González
    Correspondence
    Address reprint requests to Marcos González, M.D., Ph.D., Servicio de Hematología, Hospital Universitario de Salamanca, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
    Affiliations
    Department of Hematology, University Hospital of Salamanca, Salamanca, Spain

    Servicio de Anatomía Patológica, University Hospital of Marqués de Valdecilla/IFIMAV, Santander, Spain

    Cancer Research Center-IBMCC (USAL-CSIC), Salamanca, Spain
    Search for articles by this author
Published:September 13, 2012DOI:https://doi.org/10.1016/j.ajpath.2012.07.028
      The pathogenesis of diffuse large B-cell lymphoma (DLBCL) remains partially unknown. The analysis of the B-cell receptor of the malignant cells could contribute to a better understanding of the DLBCL biology. We studied the molecular features of the immunoglobulin heavy chain (IGH) rearrangements in 165 patients diagnosed with DLBCL not otherwise specified. Clonal IGH rearrangements were amplified according to the BIOMED-2 protocol and PCR products were sequenced directly. We also analyzed the criteria for stereotyped patterns in all complete IGHV-IGHD-IGHJ (V-D-J) sequences. Complete V-D-J rearrangements were identified in 130 of 165 patients. Most cases (89%) were highly mutated, but 12 sequences were truly unmutated or minimally mutated. Three genes, IGHV4-34, IGHV3-23, and IGHV4-39, accounted for one third of the whole cohort, including an overrepresentation of IGHV4-34 (15.5% overall). Interestingly, all IGHV4-34 rearrangements and all unmutated sequences belonged to the nongerminal center B-cell–like (non-GCB) subtype. Overall, we found three cases following the current criteria for stereotyped heavy chain VH CDR3 sequences, two of them belonging to subsets previously described in CLL. IGHV gene repertoire is remarkably biased, implying an antigen-driven origin in DLBCL. The particular features in the sequence of the immunoglobulins suggest the existence of particular subgroups within the non-GCB subtype.
      Diffuse large B-cell lymphoma (DLBCL) is a type of aggressive lymphoma that accounts for about 40% of B-cell non-Hodgkin lymphomas in adults,
      most of them classified as DLBCL not otherwise specified (NOS) according to World Health Organization classification (2008).
      Genome-wide expression profile technologies have allowed DLBCL NOS to be separated into two biological subtypes: germinal center B-cell–like (GCB) DLBCL and activated B-cell–like (ABC) DLBCL,
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      • Papadaki T.
      • Dogan A.
      • Degano M.
      • Matutes E.
      • Piris M.A.
      • Oscier D.
      • Stamatopoulos K.
      Over 30% of patients with splenic marginal zone lymphoma express the same immunoglobulin heavy variable gene: ontogenetic implications.
      • Zibellini S.
      • Capello D.
      • Forconi F.
      • Marcatili P.
      • Rossi D.
      • Rattotti S.
      • Franceschetti S.
      • Sozzi E.
      • Cencini E.
      • Marasca R.
      • Baldini L.
      • Tucci A.
      • Bertoni F.
      • Passamonti F.
      • Orlandi E.
      • Varettoni M.
      • Merli M.
      • Rizzi S.
      • Gattei V.
      • Tramontano A.
      • Paulli M.
      • Gaidano G.
      • Arcaini L.
      Stereotyped patterns of B-cell receptor in splenic marginal zone lymphoma.
      • Dagklis A.
      • Ponzoni M.
      • Govi S.
      • Cangi M.G.
      • Pasini E.
      • Charlotte F.
      • Vino A.
      • Doglioni C.
      • Davi F.
      • Lossos I.S.
      • Ntountas I.
      • Papadaki T.
      • Dolcetti R.
      • Ferreri A.J.
      • Stamatopoulos K.
      • Ghia P.
      Immunoglobulin gene repertoire in ocular adnexal lymphomas: hints on the nature of the antigenic stimulation.
      Although DLBCL is the most prevalent aggressive lymphoma, few studies have characterized the BCR in this entity, and most are based on small series of patients or in selected populations.
      • Hsu F.J.
      • Levy R.
      Preferential use of the VH4 Ig gene family by diffuse large-cell lymphoma.
      • Hsu F.J.
      • Levy R.
      Preferential use of the VH4 Ig gene family by diffuse large-cell lymphoma.
      • Kuppers R.
      • Rajewsky K.
      • Hansmann M.L.
      Diffuse large cell lymphomas are derived from mature B cells carrying V region genes with a high load of somatic mutation and evidence of selection for antibody expression.
      • Rosenquist R.
      • Lindstrom A.
      • Holmberg D.
      • Lindh J.
      • Roos G.
      V(H) gene family utilization in different B-cell lymphoma subgroups.
      • Lossos I.S.
      • Okada C.Y.
      • Tibshirani R.
      • Warnke R.
      • Vose J.M.
      • Greiner T.C.
      • Levy R.
      Molecular analysis of immunoglobulin genes in diffuse large B-cell lymphomas.
      • Nakamura N.
      • Kuze T.
      • Hashimoto Y.
      • Hara Y.
      • Hoshi S.
      • Sasaki Y.
      • Shirakawa A.
      • Sato M.
      • Abe M.
      Analysis of the immunoglobulin heavy chain gene variable region of CD5-positive and -negative diffuse large B cell lymphoma.
      • Capello D.
      • Martini M.
      • Gloghini A.
      • Cerri M.
      • Rasi S.
      • Deambrogi C.
      • Rossi D.
      • Spina M.
      • Tirelli U.
      • Larocca L.M.
      • Carbone A.
      • Gaidano G.
      Molecular analysis of immunoglobulin variable genes in human immunodeficiency virus-related non-Hodgkin's lymphoma reveals implications for disease pathogenesis and histogenesis.
      • Ruminy P.
      • Etancelin P.
      • Couronne L.
      • Parmentier F.
      • Rainville V.
      • Mareschal S.
      • Bohers E.
      • Burgot C.
      • Cornic M.
      • Bertrand P.
      • Lenormand B.
      • Picquenot J.M.
      • Jardin F.
      • Tilly H.
      • Bastard C.
      The isotype of the BCR as a surrogate for the GCB and ABC molecular subtypes in diffuse large B-cell lymphoma.
      • Catherwood M.A.
      • Gonzalez D.
      • Patton C.
      • Dobbin E.
      • Venkatraman L.
      • Alexander H.D.
      Improved clonality assessment in germinal centre/post-germinal centre non-Hodgkin's lymphomas with high rates of somatic hypermutation.
      In addition, partial D-J rearrangements, the pattern and distribution of mutations, and the existence of stereotyped sequences in DLBCL are still not well defined.
      • Capello D.
      • Martini M.
      • Gloghini A.
      • Cerri M.
      • Rasi S.
      • Deambrogi C.
      • Rossi D.
      • Spina M.
      • Tirelli U.
      • Larocca L.M.
      • Carbone A.
      • Gaidano G.
      Molecular analysis of immunoglobulin variable genes in human immunodeficiency virus-related non-Hodgkin's lymphoma reveals implications for disease pathogenesis and histogenesis.
      Here, we report a detailed immunogenetic analysis of the complete and partial IGH rearrangements in 165 DLBCL, the largest series to date, to improve our understanding of the biology of this disease.

      Materials and Methods

      Patient Characteristics and Immunohistochemistry

      A total of 165 patients with DLBCL were selected retrospectively on the basis of a diagnosis of de novo DLBCL NOS according to the 2008 World Health Organization classification.
      The median age was 59 years, with a range from 15 to 86 years. Fifty-one percent of the patients were male, and 48% of the total series had an International Prognostic Index score ≥3.
      A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma The Non-Hodgkin's Lymphoma Classification Project.
      To distinguish DLBCL biological subtypes, Hans' algorithm
      • Hans C.P.
      • Weisenburger D.D.
      • Greiner T.C.
      • Gascoyne R.D.
      • Delabie J.
      • Ott G.
      • Muller-Hermelink H.K.
      • Campo E.
      • Braziel R.M.
      • Jaffe E.S.
      • Pan Z.
      • Farinha P.
      • Smith L.M.
      • Falini B.
      • Banham A.H.
      • Rosenwald A.
      • Staudt L.M.
      • Connors J.M.
      • Armitage J.O.
      • Chan W.C.
      Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray.
      was used as a feasible surrogate of genome-wide expression profiles, since it has demonstrated a reproducibility beyond 80%.
      • Hans C.P.
      • Weisenburger D.D.
      • Greiner T.C.
      • Gascoyne R.D.
      • Delabie J.
      • Ott G.
      • Muller-Hermelink H.K.
      • Campo E.
      • Braziel R.M.
      • Jaffe E.S.
      • Pan Z.
      • Farinha P.
      • Smith L.M.
      • Falini B.
      • Banham A.H.
      • Rosenwald A.
      • Staudt L.M.
      • Connors J.M.
      • Armitage J.O.
      • Chan W.C.
      Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray.
      • Choi W.W.
      • Weisenburger D.D.
      • Greiner T.C.
      • Piris M.A.
      • Banham A.H.
      • Delabie J.
      • Braziel R.M.
      • Geng H.
      • Iqbal J.
      • Lenz G.
      • Vose J.M.
      • Hans C.P.
      • Fu K.
      • Smith L.M.
      • Li M.
      • Liu Z.
      • Gascoyne R.D.
      • Rosenwald A.
      • Ott G.
      • Rimsza L.M.
      • Campo E.
      • Jaffe E.S.
      • Jaye D.L.
      • Staudt L.M.
      • Chan W.C.
      A new immunostain algorithm classifies diffuse large B-cell lymphoma into molecular subtypes with high accuracy.
      Accordingly, immunostaining with antibodies to BCL-6, CD10, and melanoma-associated antigen (mutated) 1 (MUM1/IRF4) was performed in 121 patients, which allowed them to be separated into GCB DLBCL (38%) and non-GCB (62%). A total of 159 patients received treatment with curative intent, 125 of them (81%) with rituximab-based regimens (Table 1).
      Table 1Clinical-Biological Characteristics of DLBCL Patients at Diagnosis (n = 165)
      Variable% of Patients
      Median follow-up, months (range)27.8 (0–198)
      Age [years, median (range)]58.7 (15–86)
       ≤6054
       >6046
      Sex
       Male51
       Female49
      Performance status
       ECOG <270
       ECOG ≥230
      β2-microglobulin >3 mg/L36
      Albumin <3.5 g/dL47
      LDH elevated59
      IPI
       IPI 0–124
       228
       324
       IPI 4–524
      Immunostaining
       GCB38
       Non-GCB62
      Treatment
       Rituximab-based81
       Others19
      ECOG, Eastern Cooperative Oncology Group; GCB, germinal center B-cell–like; IPI, International Prognostic Index; LDH, lactate dehydrogenase.
      The study was approved by the local ethics review committee in accordance with Spanish legislation, and informed consent was obtained from all participants.

      DNA Extraction

      Tumor DNA was extracted from samples collected at the time of diagnosis. These involved lymph nodes (84%), bone marrow (10%), and other tumor tissues (6%). In fresh samples, high-molecular-weight DNA was isolated using the DNAzol reagent (MRC, Cincinnati, Ohio).
      • Gonzalez M.
      • Gonzalez D.
      • Lopez-Perez R.
      • Garcia-Sanz R.
      • Chillon M.C.
      • Balanzategui A.
      • Mateos M.V.
      • Alaejos I.
      • Langerak A.W.
      • Orfao A.
      • Van Dongen J.J.
      • San Miguel J.F.
      Heteroduplex analysis of VDJ amplified segments from rearranged IgH genes for clonality assessments in B-cell non-Hodgkin's lymphoma A comparison between different strategies.
      DNA was extracted from formalin-fixed paraffin-embedded (FFPE) tissue in half of the lymph nodes using RecoverAll Total Nucleic Acid Isolation Kit (Ambion/Applied Biosystems, Foster City, California) or QuickExtract FFPE DNA Extraction Kit (Epicenter Biotechnologies, Madison, Wisconsin), with no differences in terms of recovery capacity.

      Identification of Clonal Rearrangements

      All samples were tested for the amplification of IGH rearrangements according to the BIOMED-2 Concerted Action protocols, where we actively participated in the standardization.
      • Van Dongen J.J.
      • Langerak A.W.
      • Bruggemann M.
      • Evans P.A.
      • Hummel M.
      • Lavender F.L.
      • Delabesse E.
      • Davi F.
      • Schuuring E.
      • Garcia-Sanz R.
      • van Krieken J.H.
      • Droese J.
      • Gonzalez D.
      • Bastard C.
      • White H.E.
      • Spaargaren M.
      • Gonzalez M.
      • Parreira A.
      • Smith J.L.
      • Morgan G.J.
      • Kneba M.
      • Macintyre E.A.
      Design and standardization of PCR primers and protocols for detection of clonal immunoglobulin and T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936.
      In this strategy, complete V-D-J rearrangement amplification was performed by multiplex PCR with a set of family-specific primers of the framework region 1 (FR1) and one IGHJ consensus primer. In cases using the IGHV4-34 gene, a second PCR was performed with primers from the IGHV leader region. For the samples with no detectable amplification from FR1, PCR was performed from FR2. Additionally, partial D-J rearrangements were amplified in two different reactions using family-specific primers for the IGHD1-IGHD6 and IGHD7 families, respectively, together with the consensus IGHJ primer. The presence of the monoclonal rearrangement was then confirmed by GeneScan with an ABI 3130 DNA Sequencer (Applied Biosystems).

      Sequencing and Identification of IGH Gene Rearrangements

      PCR products were sequenced directly, including both forward and reverse reads, using Big-Dye terminators (Applied Biosystems).
      • Van Dongen J.J.
      • Langerak A.W.
      • Bruggemann M.
      • Evans P.A.
      • Hummel M.
      • Lavender F.L.
      • Delabesse E.
      • Davi F.
      • Schuuring E.
      • Garcia-Sanz R.
      • van Krieken J.H.
      • Droese J.
      • Gonzalez D.
      • Bastard C.
      • White H.E.
      • Spaargaren M.
      • Gonzalez M.
      • Parreira A.
      • Smith J.L.
      • Morgan G.J.
      • Kneba M.
      • Macintyre E.A.
      Design and standardization of PCR primers and protocols for detection of clonal immunoglobulin and T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936.
      Germline IGHV, IGHD, and IGHJ genes from complete V-D-J rearrangements were identified using the IMGT/V-QUEST database (http://www.imgt.org, last accessed March 21, 2012). The following information was extracted: IGHV, IGHD, and IGHJ gene usage, the percentage of IGHV identity to the closest germline gene, and the VH CDR3 length and composition. The VH CDR3 length was determined by counting the number of amino acids from the cysteine at position 104 and the tryptophan at position 118, according to the IMGT unique numbering system.
      • Lefranc M.P.
      • Pommie C.
      • Ruiz M.
      • Giudicelli V.
      • Foulquier E.
      • Truong L.
      • Thouvenin-Contet V.
      • Lefranc G.
      IMGT unique numbering for immunoglobulin and T cell receptor variable domains and Ig superfamily V-like domains.
      Partial D-J rearrangements were analyzed using BLAST database.
      Gene usage in DLBCL was compared with that previously described in normal B lymphocytes and in other B-LPDs for complete
      • Arons E.
      • Roth L.
      • Sapolsky J.
      • Suntum T.
      • Stetler-Stevenson M.
      • Kreitman R.J.
      Evidence of canonical somatic hypermutation in hairy cell leukemia.
      • Brezinschek H.P.
      • Foster S.J.
      • Brezinschek R.I.
      • Dorner T.
      • Domiati-Saad R.
      • Lipsky P.E.
      Analysis of the human VH gene repertoire Differential effects of selection and somatic hypermutation on human peripheral CD5(+)/IgM+ and CD5(−)/IgM+ B cells.
      • Gonzalez D.
      • van der Burg M.
      • Garcia-Sanz R.
      • Fenton J.A.
      • Langerak A.W.
      • Gonzalez M.
      • Van Dongen J.J.
      • San Miguel J.F.
      • Morgan G.J.
      Immunoglobulin gene rearrangements and the pathogenesis of multiple myeloma.
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      • Martin-Jimenez P.
      • Garcia-Sanz R.
      • Balanzategui A.
      • Alcoceba M.
      • Ocio E.
      • Sanchez M.L.
      • Gonzalez M.
      • San Miguel J.
      Molecular characterization of heavy chain immunoglobulin gene rearrangements in Waldenstrom's macroglobulinemia and IgM monoclonal gammopathy of undetermined significance.
      • Hadzidimitriou A.
      • Agathangelidis A.
      • Darzentas N.
      • Murray F.
      • fau-Larue M.H.
      • Bredo P.L.
      • Navarro L.A.
      • Dagklis A.
      • Rombout P.
      • Beldjord K.
      • Kolstad A.
      • Dreyling M.H.
      • Anagnostopoulos A.
      • Tsaftaris A.
      • Mavragani-Tsipidou P.
      • Rosenwald A.
      • Ponzoni M.
      • Groenen P.
      • Ghia P.
      • Sander B.
      • Papadaki T.
      • Campo E.
      • Geisler C.
      • Rosenquist R.
      • Davi F.
      • Pott C.
      • Stamatopoulos K.
      Is there a role for antigen selection in mantle cell lymphoma? Immunogenetic support from a series of 807 cases.
      • Bikos V.
      • Darzentas N.
      • Hadzidimitriou A.
      • Davis Z.
      • Hockley S.
      • Traverse-Glehen A.
      • Algara P.
      • Santoro A.
      • Gonzalez D.
      • Mollejo M.
      • Dagklis A.
      • Gangemi F.
      • Bosler D.S.
      • Bourikas G.
      • Anagnostopoulos A.
      • Tsaftaris A.
      • Iannitto E.
      • Ponzoni M.
      • Felman P.
      • Berger F.
      • Belessi C.
      • Ghia P.
      • Papadaki T.
      • Dogan A.
      • Degano M.
      • Matutes E.
      • Piris M.A.
      • Oscier D.
      • Stamatopoulos K.
      Over 30% of patients with splenic marginal zone lymphoma express the same immunoglobulin heavy variable gene: ontogenetic implications.
      and partial
      • Martin-Jimenez P.
      • Garcia-Sanz R.
      • Balanzategui A.
      • Alcoceba M.
      • Ocio E.
      • Sanchez M.L.
      • Gonzalez M.
      • San Miguel J.
      Molecular characterization of heavy chain immunoglobulin gene rearrangements in Waldenstrom's macroglobulinemia and IgM monoclonal gammopathy of undetermined significance.
      • Tsakou E.
      • Agathagelidis A.
      • Boudjoghra M.
      • Raff T.
      • Dagklis A.
      • Chatzouli M.
      • Smilevska T.
      • Bourikas G.
      • Merle-Beral H.
      • Manioudaki-Kavallieratou E.
      • Anagnostopoulos A.
      • Bruggemann M.
      • Davi F.
      • Stamatopoulos K.
      • Belessi C.
      Partial versus productive IGH locus rearrangements in chronic lymphocytic leukemia: implications for B-cell receptor stereotypy.
      • Gonzalez D.
      • Gonzalez M.
      • Balanzategui A.
      • Sarasquete M.E.
      • Lopez-Perez R.
      • Chillon M.C.
      • Garcia-Sanz R.
      • San Miguel J.F.
      Molecular characteristics and gene segment usage in IGH gene rearrangements in multiple myeloma.
      • Martin-Jimenez P.
      • Garcia-Sanz R.
      • Gonzalez D.
      • Balanzategui A.
      • Perez J.J.
      • Caballero M.D.
      • Sarasquete M.E.
      • Galende J.
      • Orfao A.
      • Lopez-Berges M.C.
      • San Miguel J.F.
      • Gonzalez M.
      Molecular characterization of complete and incomplete immunoglobulin heavy chain gene rearrangements in hairy cell leukemia.
      rearrangements.

      Analysis of Somatic Hypermutation

      Percentage Identity with the Closest IGHV Germline

      The use of 98% as the percentage identity cutoff value has customarily been used for the clinical consideration of a patient's sequence as mutated or unmutated based on the exclusion of potential genomic polymorphisms. This cutoff has a prognostic value in CLL.
      • Hamblin T.J.
      • Davis Z.
      • Gardiner A.
      • Oscier D.G.
      • Stevenson F.K.
      Unmutated Ig V(H) genes are associated with a more aggressive form of chronic lymphocytic leukemia.
      However, it has been shown that most sequence differences in the 98% to 99.99% group correspond to low-level SHM,
      • Davis Z.A.
      • Orchard J.A.
      • Corcoran M.M.
      • Oscier D.G.
      Divergence from the germ-line sequence in unmutated chronic lymphocytic leukemia is due to somatic mutation rather than polymorphisms.
      as applied in recent studies.
      • Hadzidimitriou A.
      • Agathangelidis A.
      • Darzentas N.
      • Murray F.
      • fau-Larue M.H.
      • Bredo P.L.
      • Navarro L.A.
      • Dagklis A.
      • Rombout P.
      • Beldjord K.
      • Kolstad A.
      • Dreyling M.H.
      • Anagnostopoulos A.
      • Tsaftaris A.
      • Mavragani-Tsipidou P.
      • Rosenwald A.
      • Ponzoni M.
      • Groenen P.
      • Ghia P.
      • Sander B.
      • Papadaki T.
      • Campo E.
      • Geisler C.
      • Rosenquist R.
      • Davi F.
      • Pott C.
      • Stamatopoulos K.
      Is there a role for antigen selection in mantle cell lymphoma? Immunogenetic support from a series of 807 cases.
      • Hockley S.L.
      • Giannouli S.
      • Morilla A.
      • Wotherspoon A.
      • Morgan G.J.
      • Matutes E.
      • Gonzalez D.
      Insight into the molecular pathogenesis of hairy cell leukaemia, hairy cell leukaemia variant and splenic marginal zone lymphoma, provided by the analysis of their IGH rearrangements and somatic hypermutation patterns.
      We, therefore, classified the sequences as previously described
      • Hadzidimitriou A.
      • Agathangelidis A.
      • Darzentas N.
      • Murray F.
      • fau-Larue M.H.
      • Bredo P.L.
      • Navarro L.A.
      • Dagklis A.
      • Rombout P.
      • Beldjord K.
      • Kolstad A.
      • Dreyling M.H.
      • Anagnostopoulos A.
      • Tsaftaris A.
      • Mavragani-Tsipidou P.
      • Rosenwald A.
      • Ponzoni M.
      • Groenen P.
      • Ghia P.
      • Sander B.
      • Papadaki T.
      • Campo E.
      • Geisler C.
      • Rosenquist R.
      • Davi F.
      • Pott C.
      • Stamatopoulos K.
      Is there a role for antigen selection in mantle cell lymphoma? Immunogenetic support from a series of 807 cases.
      : “truly unmutated” when no deviation from the germline was observed; “minimal/borderline mutated” when there was 97.0% to 99.9% similarity with the germline; and finally, “highly mutated” when the deviation from the germinal sequence was >97%.

      SHM Characteristics

      Nucleotide characteristics of IGHV mutations in DLBCL were studied to establish whether the pattern of distribution was consistent with the canonical SHM process.
      • Messmer B.T.
      • Albesiano E.
      • Messmer D.
      • Chiorazzi N.
      The pattern and distribution of immunoglobulin VH gene mutations in chronic lymphocytic leukemia B cells are consistent with the canonical somatic hypermutation process.
      This analysis was also performed separately in both the GCB and non-GCB subtypes, as well as in DLBCL expressing particular IGHV genes.
      The defined characteristics of canonical SHM include: i) a higher ratio of replacement (R) versus silent (S) mutations in the CDRs than in the FRs; ii) base change bias for transitions; and iii) more than the expected percentage of mutations in the RGYW hotspots (R = A/G, Y = C/T, and W = A/T) relative to the total number of nucleotides located within these hotspots. In addition, to determine whether these characteristics were due to selection or to mutation machinery, the mutations at redundant wobble bases were analyzed as previously reported for CLL and HCL.
      • Messmer B.T.
      • Albesiano E.
      • Messmer D.
      • Chiorazzi N.
      The pattern and distribution of immunoglobulin VH gene mutations in chronic lymphocytic leukemia B cells are consistent with the canonical somatic hypermutation process.
      • Arons E.
      • Roth L.
      • Sapolsky J.
      • Suntum T.
      • Stetler-Stevenson M.
      • Kreitman R.J.
      Evidence of canonical somatic hypermutation in hairy cell leukemia.
      Wobble bases are the third nucleotide of redundant codons. Finally, mutations at A:T and G:C pairs were studied to determine whether the mutations were targeted with approximately the same frequency as in normal cells.
      • Di Noia J.M.
      • Neuberger M.S.
      Molecular mechanisms of antibody somatic hypermutation.
      Moreover, recurrent nucleotide and amino acid changes for the most common IGHV genes were analyzed to find evidence of driven SHM in DLBCL.

      VH CDR3 Analysis and Identification of Stereotyped Rearrangements

      The criteria to define a stereotyped sequence are not yet well established.
      • Agathangelidis A.
      • Darzentas N.
      • Hadzidimitriou A.
      • Brochet X.
      • Murray F.
      • Yan X.J.
      • Davis Z.
      • van Gastel-Mol E.J.
      • Tresoldi C.
      • Chu C.C.
      • Cahill N.
      • Giudicelli V.
      • Tichy B.
      • Pedersen L.B.
      • Foroni L.
      • Bonello L.
      • Janus A.
      • Smedby K.
      • Anagnostopoulos A.
      • Merle-Beral H.
      • Laoutaris N.
      • Juliusson G.
      • di Celle P.F.
      • Pospisilova S.
      • Jurlander J.
      • Geisler C.
      • Tsaftaris A.
      • Lefranc M.P.
      • Langerak A.W.
      • Oscier D.G.
      • Chiorazzi N.
      • Belessi C.
      • Davi F.
      • Rosenquist R.
      • Ghia P.
      • Stamatopoulos K.
      Stereotyped B-cell receptors in one third of chronic lymphocytic leukemia: towards a molecular classification with implications for targeted therapeutic interventions.
      To perform this analysis, we used the previously described pattern-based method,
      • Darzentas N.
      • Hadzidimitriou A.
      • Murray F.
      • Hatzi K.
      • Josefsson P.
      • Laoutaris N.
      • Moreno C.
      • Anagnostopoulos A.
      • Jurlander J.
      • Tsaftaris A.
      • Chiorazzi N.
      • Belessi C.
      • Ghia P.
      • Rosenquist R.
      • Davi F.
      • Stamatopoulos K.
      A different ontogenesis for chronic lymphocytic leukemia cases carrying stereotyped antigen receptors: molecular and computational evidence.
      updated with the recently published, more stringent criteria,
      • Agathangelidis A.
      • Darzentas N.
      • Hadzidimitriou A.
      • Brochet X.
      • Murray F.
      • Yan X.J.
      • Davis Z.
      • van Gastel-Mol E.J.
      • Tresoldi C.
      • Chu C.C.
      • Cahill N.
      • Giudicelli V.
      • Tichy B.
      • Pedersen L.B.
      • Foroni L.
      • Bonello L.
      • Janus A.
      • Smedby K.
      • Anagnostopoulos A.
      • Merle-Beral H.
      • Laoutaris N.
      • Juliusson G.
      • di Celle P.F.
      • Pospisilova S.
      • Jurlander J.
      • Geisler C.
      • Tsaftaris A.
      • Lefranc M.P.
      • Langerak A.W.
      • Oscier D.G.
      • Chiorazzi N.
      • Belessi C.
      • Davi F.
      • Rosenquist R.
      • Ghia P.
      • Stamatopoulos K.
      Stereotyped B-cell receptors in one third of chronic lymphocytic leukemia: towards a molecular classification with implications for targeted therapeutic interventions.
      to identify possible restrictions in the VH CDR3 amino acid composition of rearrangements. Briefly, the criteria for stereotyped patterns included: i) at least 50% amino acid identity; ii) at least 70% similarity between sequences; iii) IGHV usage of the same clan; iv) identical VH CDR3 length; and v) exact location of the sequence pattern within the VH CDR3 region. Analyses were performed using the ClustalW/ClustalX 2.0 multiple sequence alignment software.
      Subsets were named as previously published,
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      those composed of only two sequences being considered “provisional.” A letter of the alphabet was assigned to the new subset. These were compared with previously published stereotyped patterns
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      • Agathangelidis A.
      • Darzentas N.
      • Hadzidimitriou A.
      • Brochet X.
      • Murray F.
      • Yan X.J.
      • Davis Z.
      • van Gastel-Mol E.J.
      • Tresoldi C.
      • Chu C.C.
      • Cahill N.
      • Giudicelli V.
      • Tichy B.
      • Pedersen L.B.
      • Foroni L.
      • Bonello L.
      • Janus A.
      • Smedby K.
      • Anagnostopoulos A.
      • Merle-Beral H.
      • Laoutaris N.
      • Juliusson G.
      • di Celle P.F.
      • Pospisilova S.
      • Jurlander J.
      • Geisler C.
      • Tsaftaris A.
      • Lefranc M.P.
      • Langerak A.W.
      • Oscier D.G.
      • Chiorazzi N.
      • Belessi C.
      • Davi F.
      • Rosenquist R.
      • Ghia P.
      • Stamatopoulos K.
      Stereotyped B-cell receptors in one third of chronic lymphocytic leukemia: towards a molecular classification with implications for targeted therapeutic interventions.
      and with DLBCL sequences from public databases (EMBL, http://www.ebi.ac.uk/embl, last accessed March 28, 2012; NCBI, http://www.ncbi.nlm.nih.gov, last accessed March 28, 2012).

      Statistical Analysis

      The groups of patients were compared by the χ2 or Fisher exact tests using Graph-Pad 4.0 (GraphPad Software, San Diego, California) and SPSS 15.0 (SPSS, Chicago, Illinois).
      Differences were considered to be statistically significant for values of P < 0.05.

      Results

      Detection of Clonal Rearrangements

      The overall detection rate of monoclonality by amplifying V-D-J and/or D-J rearrangements was 90% (149 of 165). V-D-J rearrangements were detected in 130 of 165 patients (79%), and D-J rearrangements were seen in 68 of 165 patients (41%).

      Complete IGHV-IGHD-IGHJ Rearrangements

      A total of 109 of 130 complete V-D-J rearrangements were successfully sequenced. Reasons for not having a sequence in the remaining 21 cases were as follows: high polyclonal background (n = 2); double sequences, with no possible individual reading (n = 1); unspecific amplification, which means that a sequence could be read but the result did not fit with any possible rearrangement (n = 2); low fluorescence (intensity) of the peak rendering an amplification band too weak for accurate sequencing performance (n = 11); and partial sequence, enough to be identified as a V-D-J rearrangement but insufficient to be completely identified (n = 5).
      A total of 103 were productive rearrangements, whereas 6 were nonproductive. Most sequences (82%) were obtained from FR1. Within the productive setting, IGHV gene repertoire analysis revealed that IGHV3 and IGHV4 were the predominant subgroups (Table 2). A total of 27 functional IGHV genes were identified, of which IGHV4-34 (15.5%), IGHV3-23 (9.7%), and IGHV4-39 (8.7%) were the most frequent. Regarding IGHD genes, a total of 25 were identified, with a predominance of IGHD3 (Table 2), especially IGHD3-22 and IGHD3-10. With respect to IGHJ gene usage, most cases used the IGHJ4 and IGHJ6 genes.
      Table 2Distribution of Families in Productive V-D-J and Partial D-J Rearrangements
      VariableV-D-J (n = 103) n (%)D-J (n = 64) n (%)
      IGHV
       117 (16.5)
       22 (1.9)
       345 (43.7)
       434 (33.0)
       54 (3.9)
       61 (1.0)
       70
      IGHD
       111 (10.7)6 (9.4)
       222 (21.4)19 (29.7)
       337 (35.9)9 (14.1)
      P < 0.01.
       46 (5.8)12 (18.8)
      P < 0.05.
       510 (9.7)5 (7.8)
       615 (14.6)12 (18.8)
       72 (1.9)1 (1.6)
      IGHJ
       14 (3.9)3 (4.9)
       25 (4.8)5 (8.2)
       313 (12.6)8 (13.1)
       446 (44.7)32 (52.5)
       513 (12.6)3 (4.9)
       622 (21.4)10 (16.4)
      Significant differences between productive V-D-J and incomplete D-J rearrangements in DLBCL are depicted in bold.
      low asterisk P < 0.05.
      P < 0.01.

      Partial IGHD-IGHJ Rearrangements

      Sequence analysis was possible in 64 partial D-J rearrangements. The IGHD2 subgroup genes were most frequent (Table 2). In comparison with complete rearrangements, IGHD4 was significantly overrepresented in partial rearrangements (18.8% versus 5.8%, P < 0.05), whereas IGHD3 was underrepresented (14.1% versus 35.9%, P < 0.01). Overall, 20 IGHD genes were identified, of which IGHD2-2 was the most frequent. IGHD3-22 and IGHD3-3, two of the most frequent IGHD genes in V-D-J rearrangements, were completely absent in partial rearrangements, suggesting that the use of certain IGHD genes may favor the rearrangement process to obtain a final complete functional rearrangement. Finally, the distribution pattern of the IGHJ genes was similar to the complete rearrangements (Table 2).

      Somatic Hypermutation

      Percentage Identity to the Closest IGHV Germline

      Somatic hypermutation (<98% of identity to the closest germline IGHV gene) was present in 94 of 103 (91%) patients who had productive complete V-D-J rearrangements (median: 10.8%; range: 0% to 26%). As expected, only 9% of the sequences were unmutated, similar to previously reported results.
      • Hsu F.J.
      • Levy R.
      Preferential use of the VH4 Ig gene family by diffuse large-cell lymphoma.
      • Lossos I.S.
      • Okada C.Y.
      • Tibshirani R.
      • Warnke R.
      • Vose J.M.
      • Greiner T.C.
      • Levy R.
      Molecular analysis of immunoglobulin genes in diffuse large B-cell lymphomas.
      • Ruminy P.
      • Etancelin P.
      • Couronne L.
      • Parmentier F.
      • Rainville V.
      • Mareschal S.
      • Bohers E.
      • Burgot C.
      • Cornic M.
      • Bertrand P.
      • Lenormand B.
      • Picquenot J.M.
      • Jardin F.
      • Tilly H.
      • Bastard C.
      The isotype of the BCR as a surrogate for the GCB and ABC molecular subtypes in diffuse large B-cell lymphoma.
      • Smit L.A.
      • Bende R.J.
      • Aten J.
      • Guikema J.E.
      • Aarts W.M.
      • van Noesel C.J.
      Expression of activation-induced cytidine deaminase is confined to B-cell non-Hodgkin's lymphomas of germinal-center phenotype.
      Overall, point mutations predominated, whereas only five cases had deletions (n = 3) or insertions (n = 2) in their sequences.
      According to the criteria for SHM described previously,
      • Hadzidimitriou A.
      • Agathangelidis A.
      • Darzentas N.
      • Murray F.
      • fau-Larue M.H.
      • Bredo P.L.
      • Navarro L.A.
      • Dagklis A.
      • Rombout P.
      • Beldjord K.
      • Kolstad A.
      • Dreyling M.H.
      • Anagnostopoulos A.
      • Tsaftaris A.
      • Mavragani-Tsipidou P.
      • Rosenwald A.
      • Ponzoni M.
      • Groenen P.
      • Ghia P.
      • Sander B.
      • Papadaki T.
      • Campo E.
      • Geisler C.
      • Rosenquist R.
      • Davi F.
      • Pott C.
      • Stamatopoulos K.
      Is there a role for antigen selection in mantle cell lymphoma? Immunogenetic support from a series of 807 cases.
      4, 8, and 91 cases were “truly unmutated,” “borderline mutated,” and “highly mutated,” respectively. All truly unmutated and borderline mutated sequences were obtained from FR1.
      Interestingly, all cases with the IGHV4-34 gene but one (15 of 16) were “highly mutated.” However, IGHV1-69, IGHV5-51, and IGHV3-21 were the most frequent genes used in “truly unmutated” and “borderline mutated” cases.
      As expected from the physiopathological point of view, mutations were observed in a minority of cases (12%) of partial D-J rearrangements with a low mutation frequency (median: 4.3%, range: 3.5% to 11.1%).

      Nucleotide Characteristics of Somatic Hypermutation

      S mutations occurred randomly, with a relatively even distribution, whereas R mutations were mainly localized in the CDR1 and CDR2 regions, at the 5′ and 3′ ends of FR2 and the 3′ end of FR3 (see Supplemental Figure S1 at http://ajp.amjpathol.org).
      Analysis of canonical SHM was possible in 96 DLBCL sequences with <100% identity with the germline. For the 2485 mutations analyzed, the R/S mutation ratio was 1.72, being greater in the CDR (2.56) than in the FR (1.42) regions (P < 0.01) (Table 3). The transition-to-transversion ratio was 1.16, significantly higher than the expected ratio of 0.5 if the frequencies of the types of mutation were random (P < 0.01), and there was no significant difference between the CDR and FR regions. Finally, 24.9% of the DLBCL mutations were located in RGYW hotspots, a value significantly greater than the expected percentage (14.0%, P < 0.01). Thus, SHM in DLBCL displayed all of the established characteristics of canonical SHM. These canonical characteristics persisted in the most common IGHV genes, except for IGHV1 (mainly IGHV1-69), which met these three criteria to a lesser extent (Table 3).
      Table 3Characteristics of SHM in DLBCL (Global Series) and with Respect to Immunohistochemistry and the Most Common IGHV Families and Genes
      Number of sequencesNumber of mutationsR/S ratioTransition/transversion ratio% nucleotides in RGYW% of mutations in RGYW
      TotalCDRFRTotalCDRFR
      DLBCL9624851.692.561.421.1611.131.1814.024.9
      GCB319311.712.771.421.1550.971.2513.322.9
      Non-GCB4610371.562.051.391.2161.301.1814.225.2
      IGHV1156311.421.451.421.2461.291.2417.926.7
      IGHV34211271.812.711.491.1591.161.1612.019.3
      IGHV4326621.702.981.271.1151.071.1415.931.6
      IGHV1-694460.920.880.941.3001.501.2119.832.6
      IGHV3-23102431.602.241.311.5051.471.5313.126.3
      IGHV4-34153041.341.911.221.3381.391.3214.830.6
      Figures in bold indicate different R/S ratios from that expected.
      CDR, complementarity-determining regions; FR, framework region; R, replacement mutation; S, silent mutation; RGYW, hotspots.
      The bias for transitions over transversions was also reflected by the wobble base mutations (1.20, P < 0.01) (Figure 1), implying that this bias in DLBCL is due to the same mechanism of SHM.
      Figure thumbnail gr1
      Figure 1Nucleotides mutated in DLBCL. Relative frequency with which each nucleotide mutates to form each of the other three. The number of mutations occurring in each nucleotide is shown in parentheses. A: Total mutations in DLBCL. B: Mutations in redundant wobble bases.
      Finally, G:C pairs were preferentially targeted for SHM relative to A:T (ratio: 1.86) (Figure 1). This observation was especially evident in the IGHV4-34 gene (ratio: 2.23).

      Recurrent Amino Acid Changes

      Recurrent amino acid changes were mainly found among IGHV4-34, IGHV4-39, and IGHV1-18 rearrangements. For example, a substitution at the FR3 codon 92 occurred in 13 of 16 (81%) cases of IGHV4-34; the substitution of S to T (6 of 16, 38%) and S to N (4 of 16, 25%) were the most frequent changes observed. This recurrent amino acid change contrasts with the adjacent codon, 93, which did not undergo any substitution in any of the 16 sequences. Although the IGHV4-34 genes were highly mutated, all 10 available IGHV4-34 sequences conserved the specific AVY motif at the end of FR1 codons 24 to 26, and the W at position 7 was intact in the 5 IGHV4-34 cases that could be analyzed from the leader region. By contrast, the N-glycosylation site in CDR2 of IGHV4-34 was lost in 7 of 16 (44%), and only one of the sequences that lost its natural site generated two novel sites in FR3. A summary list of recurrent amino acid substitutions for the predominant IGHV genes is given in Supplemental Table S1 (available at http://ajp.amjpathol.org). Some of these changes may indicate specific driven SHM in DLBCL.

      VH CDR3 Composition and Stereotyped VH CDR3 Sequences

      The median VH CDR3 length was 15 amino acids (range: 7 to 26). VH CDR3 was longer in the IGHV4 family than in the other families (16.8 versus 14.8, P = 0.01), and in “truly unmutated” and borderline cases as compared with “highly mutated” cases (18.2 versus 15.1, P = 0.01). This was particularly pronounced among the “truly unmutated” cases (21.5 versus 15.1, P < 0.01).
      Three sequences among the 103 patients in our series met the criteria for stereotyped rearrangements and could be included into different subsets. Two sequences clustered within previously described CLL subsets (subsets 5 and 7D);
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      • Agathangelidis A.
      • Darzentas N.
      • Hadzidimitriou A.
      • Brochet X.
      • Murray F.
      • Yan X.J.
      • Davis Z.
      • van Gastel-Mol E.J.
      • Tresoldi C.
      • Chu C.C.
      • Cahill N.
      • Giudicelli V.
      • Tichy B.
      • Pedersen L.B.
      • Foroni L.
      • Bonello L.
      • Janus A.
      • Smedby K.
      • Anagnostopoulos A.
      • Merle-Beral H.
      • Laoutaris N.
      • Juliusson G.
      • di Celle P.F.
      • Pospisilova S.
      • Jurlander J.
      • Geisler C.
      • Tsaftaris A.
      • Lefranc M.P.
      • Langerak A.W.
      • Oscier D.G.
      • Chiorazzi N.
      • Belessi C.
      • Davi F.
      • Rosenquist R.
      • Ghia P.
      • Stamatopoulos K.
      Stereotyped B-cell receptors in one third of chronic lymphocytic leukemia: towards a molecular classification with implications for targeted therapeutic interventions.
      both contained the IGHV1-69 gene and were “truly unmutated.” The other case formed a probably realistic novel provisional subset (Table 4): subset A, sharing the V-D-J IGHV4-34-IGHD3-22-IGHJ2 conformation and with 79% identity of the amino acid sequence with a public DLBCL sequence.
      • Ruminy P.
      • Etancelin P.
      • Couronne L.
      • Parmentier F.
      • Rainville V.
      • Mareschal S.
      • Bohers E.
      • Burgot C.
      • Cornic M.
      • Bertrand P.
      • Lenormand B.
      • Picquenot J.M.
      • Jardin F.
      • Tilly H.
      • Bastard C.
      The isotype of the BCR as a surrogate for the GCB and ABC molecular subtypes in diffuse large B-cell lymphoma.
      A complete list of the sequences published in the literature from subsets 5 and 7D is shown in Supplemental Table S2 (available at http://ajp.amjpathol.org).
      Table 4Stereotyped VH CDR3 Amino Acid Sequences
      SubsetIGHVIGHDIGHJMutational statusVH CDR3 amino acid sequences
      Subset 5Published
      11–3436 IGHV1-69*13IGHD3-10*01IGHJ6*03100ARTMVRGVINIDYYYYYMDV
       SE-01-0444-H1 IGHV1-69*01IGHD3-10*01IGHJ6*0399.6ARGMVRGVINIDYYYYYMDV
       UK-01-0345-H1 IGHV1-69*01IGHD3-10*01IGHJ6*03100ARTMVRGVIRVMYYYYYMDV
       FR-01-0286-H1 IGHV1-69*01IGHD3-10*01IGHJ6*03100ARVMVRGVISLDYYYYYMDV
       GR-02-0510-H1 IGHV1-69*01IGHD3-10*01IGHJ6*03100ARSMVQGVINAYYYYYYMDV
       NL-01-0294-H1 IGHV1-69*01IGHD3-10*01IGHJ6*03100ARTMVQGVIRVYYYYYYMDV
      Subset 7DPublished
      11–1949 IGHV1-69*01IGHD3-3*01IGHJ6*02100AS PVGEGDDFWSGYYPNYYDYGMDV
       CZ-01-0372-H1 IGHV1-69*01IGHD3-3*01IGHJ6*02100AS SLGENYDFWSGYYPNYYYYGMDV
       FR-01-0143-H1 IGHV1-69*01IGHD3-3*01IGHJ6*02100AR PVQAKYDFWSGYYPNYYYYGMDV
       SE-01-1016-H1 IGHV1-69*01IGHD3-3*01IGHJ6*0299.6AR PGGLYYDFWSGYYPNYYYYGMDV
       CZ-01-0484-H1 IGHV1-69*01IGHD3-3*01IGHJ6*02100AR QGTLGYDFWSGYYPNYYYYGMDV
       UK-01-0427-H1 IGHV1-69*13IGHD3-3*01IGHJ6*02100AR SGREDYDFWSGYYPNYYYYGMDV
      Subset ANovel
      11–1967 IGHV4-34*01IGHD3-22*01IGHJ2*0193.8AR ALDYYDNSGRLPGYFDL
       HQ392881.1 IGHV4-34*01IGHD3-22*01IGHJ2*0195.7AR ALDYYDSSGRVLAYFDL
      Stereotyped rearrangements are compared with representative sequences from each subset. A complete list of sequences from subsets 5 and 7D is provided in Supplemental Table S2 at http://ajp.amjpathol.org. Sequences derived from the present study are remarked in bold.

      Molecular and Immunohistochemical Correlations

      IGHV usage differed between the immunohistochemical subtypes. IGHV1 (10 of 14) and IGHV4 (15 of 21) were more frequent in the non-GCB subtype, especially for IGHV1-69 (3 of 4) and IGHV4-34 (12 of 12). A higher percentage of SHM was observed in GCB (13.8%, range: 2.9% to 26.0%) than in non-GCB (10.1%, range: 0.4% to 23.6%, P < 0.01) cases. Moreover, 6 of 7 borderline or unmutated cases with available immunostaining were non-GCB, which could explain this difference. By contrast, all IGHV4-34 cases, despite being highly mutated, belonged to the non-GCB subtype. With respect to other molecular features, VH CDR3 length and the canonical characteristics for SHM showed no differences between the GCB and non-GCB subtypes (Table 3).

      Comparative Analysis of IGH Rearrangements in DLBCLs with Other Normal B Cells and B-LPDs

      To highlight the singular characteristics of DLBCLs, we compared our results with those reported for normal B cells and other B-LPDs. As shown in Table 5, the IGHV4-34 gene was significantly overrepresented in DLBCL relative to CD5/IgM+ normal B cells (3% to 9%, P < 0.01) and to other B-LPDs, such as CLL (8.7%, P < 0.05), HCL (6.9%, P = 0.07), and especially with multiple myeloma and Waldeström macroglobulinemia (2.7% and 0%, respectively, P < 0.01). However, it was found in a similar proportion of patients with splenic marginal zone lymphoma and mantle cell lymphoma.
      • Arons E.
      • Roth L.
      • Sapolsky J.
      • Suntum T.
      • Stetler-Stevenson M.
      • Kreitman R.J.
      Evidence of canonical somatic hypermutation in hairy cell leukemia.
      • Berkowska M.A.
      • Driessen G.J.
      • Bikos V.
      • Grosserichter-Wagener C.
      • Stamatopoulos K.
      • Cerutti A.
      • He B.
      • Biermann K.
      • Lange J.F.
      • van der Burg M.
      • Van Dongen J.J.
      • van Zelm M.C.
      Human memory B cells originate from three distinct germinal center-dependent and -independent maturation pathways.
      • Brezinschek H.P.
      • Foster S.J.
      • Brezinschek R.I.
      • Dorner T.
      • Domiati-Saad R.
      • Lipsky P.E.
      Analysis of the human VH gene repertoire Differential effects of selection and somatic hypermutation on human peripheral CD5(+)/IgM+ and CD5(−)/IgM+ B cells.
      • Wu Y.C.
      • Kipling D.
      • Leong H.S.
      • Martin V.
      • Ademokun A.A.
      • Dunn-Walters D.K.
      High-throughput immunoglobulin repertoire analysis distinguishes between human IgM memory and switched memory B-cell populations.
      • Gonzalez D.
      • van der Burg M.
      • Garcia-Sanz R.
      • Fenton J.A.
      • Langerak A.W.
      • Gonzalez M.
      • Van Dongen J.J.
      • San Miguel J.F.
      • Morgan G.J.
      Immunoglobulin gene rearrangements and the pathogenesis of multiple myeloma.
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      • Martin-Jimenez P.
      • Garcia-Sanz R.
      • Balanzategui A.
      • Alcoceba M.
      • Ocio E.
      • Sanchez M.L.
      • Gonzalez M.
      • San Miguel J.
      Molecular characterization of heavy chain immunoglobulin gene rearrangements in Waldenstrom's macroglobulinemia and IgM monoclonal gammopathy of undetermined significance.
      • Klein U.
      • Rajewsky K.
      • Kuppers R.
      Human immunoglobulin (Ig)M+IgD+ peripheral blood B cells expressing the CD27 cell surface antigen carry somatically mutated variable region genes: cD27 as a general marker for somatically mutated (memory) B cells.
      By contrast, some genes frequently used in the rearrangements of normal B cells and other B-LPDs,
      • Arons E.
      • Roth L.
      • Sapolsky J.
      • Suntum T.
      • Stetler-Stevenson M.
      • Kreitman R.J.
      Evidence of canonical somatic hypermutation in hairy cell leukemia.
      • Gonzalez D.
      • van der Burg M.
      • Garcia-Sanz R.
      • Fenton J.A.
      • Langerak A.W.
      • Gonzalez M.
      • Van Dongen J.J.
      • San Miguel J.F.
      • Morgan G.J.
      Immunoglobulin gene rearrangements and the pathogenesis of multiple myeloma.
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      • Martin-Jimenez P.
      • Garcia-Sanz R.
      • Balanzategui A.
      • Alcoceba M.
      • Ocio E.
      • Sanchez M.L.
      • Gonzalez M.
      • San Miguel J.
      Molecular characterization of heavy chain immunoglobulin gene rearrangements in Waldenstrom's macroglobulinemia and IgM monoclonal gammopathy of undetermined significance.
      • Hadzidimitriou A.
      • Agathangelidis A.
      • Darzentas N.
      • Murray F.
      • fau-Larue M.H.
      • Bredo P.L.
      • Navarro L.A.
      • Dagklis A.
      • Rombout P.
      • Beldjord K.
      • Kolstad A.
      • Dreyling M.H.
      • Anagnostopoulos A.
      • Tsaftaris A.
      • Mavragani-Tsipidou P.
      • Rosenwald A.
      • Ponzoni M.
      • Groenen P.
      • Ghia P.
      • Sander B.
      • Papadaki T.
      • Campo E.
      • Geisler C.
      • Rosenquist R.
      • Davi F.
      • Pott C.
      • Stamatopoulos K.
      Is there a role for antigen selection in mantle cell lymphoma? Immunogenetic support from a series of 807 cases.
      • Bikos V.
      • Darzentas N.
      • Hadzidimitriou A.
      • Davis Z.
      • Hockley S.
      • Traverse-Glehen A.
      • Algara P.
      • Santoro A.
      • Gonzalez D.
      • Mollejo M.
      • Dagklis A.
      • Gangemi F.
      • Bosler D.S.
      • Bourikas G.
      • Anagnostopoulos A.
      • Tsaftaris A.
      • Iannitto E.
      • Ponzoni M.
      • Felman P.
      • Berger F.
      • Belessi C.
      • Ghia P.
      • Papadaki T.
      • Dogan A.
      • Degano M.
      • Matutes E.
      • Piris M.A.
      • Oscier D.
      • Stamatopoulos K.
      Over 30% of patients with splenic marginal zone lymphoma express the same immunoglobulin heavy variable gene: ontogenetic implications.
      such as IGHV3-30, were completely absent from the present series (P < 0.01). Most complete V-D-J rearrangements were mutated, with a similar percentage of SHM (11.8%) to those previously reported in multiple myeloma (9%), but higher values than in CLL and Waldeström macroglobulinemia (2.4% to 6.6%).
      • Gonzalez D.
      • van der Burg M.
      • Garcia-Sanz R.
      • Fenton J.A.
      • Langerak A.W.
      • Gonzalez M.
      • Van Dongen J.J.
      • San Miguel J.F.
      • Morgan G.J.
      Immunoglobulin gene rearrangements and the pathogenesis of multiple myeloma.
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      • Martin-Jimenez P.
      • Garcia-Sanz R.
      • Balanzategui A.
      • Alcoceba M.
      • Ocio E.
      • Sanchez M.L.
      • Gonzalez M.
      • San Miguel J.
      Molecular characterization of heavy chain immunoglobulin gene rearrangements in Waldenstrom's macroglobulinemia and IgM monoclonal gammopathy of undetermined significance.
      Regarding SHM, G:C pairs were more often targeted for SHM than A:T pairs (ratio: 1.86) (Figure 1). This differs significantly from the distribution observed in CLL (ratio: 1.56, P < 0.01), HCL (ratio 0.96, P < 0.01), and in normal B cells (ratio: 1.00, P < 0.01).
      • Messmer B.T.
      • Albesiano E.
      • Messmer D.
      • Chiorazzi N.
      The pattern and distribution of immunoglobulin VH gene mutations in chronic lymphocytic leukemia B cells are consistent with the canonical somatic hypermutation process.
      • Arons E.
      • Roth L.
      • Sapolsky J.
      • Suntum T.
      • Stetler-Stevenson M.
      • Kreitman R.J.
      Evidence of canonical somatic hypermutation in hairy cell leukemia.
      • Di Noia J.M.
      • Neuberger M.S.
      Molecular mechanisms of antibody somatic hypermutation.
      Table 5Comparison of the IGHV, IGHD, and IGHJ Families and Significantly Different IGHV Genes in Our Series of DLBCL with Those Reported for B-LPDs and Normal B Cells in the Complete V-D-J Setting
      VariableDLBCLMCLB-CLLSMZLHCLMMWMCD5/IgM+
      (n = 103)(n = 807)(n = 7596)(n = 133)(n = 102)(n = 270)(n = 58)(n = 206)
      IGHV
       116.515.523.830.114.715.66.913.1
       21.91.53.40.82.96.301.9
       343.751.648.249.653.948.975.953.9
       433.025.820.617.323.520.413.824.8
       53.95.12.52.31.07.81.72.9
       61.00.61.202.91.11.72.4
       7000.401.0001.0
      4–3415.514.68.9
      P < 0.05.
      7.57.40.9
      P < 0.01.
      0
      P < 0.01.
      3.9
      P < 0.01.
      3–3003.55.5
      P < 0.05.
      6.0
      P < 0.05.
      8.5
      P < 0.01.
      10.0
      P < 0.01.
      8.6
      P < 0.01.
      5.8
      P < 0.01.
      IGHD
       110.710.68.25.212.77.627.36.4
       221.417.419.615.512.724.24.521.2
       335.934.240.346.641.225.818.237.2
       45.88.56.37.86.910.613.610.9
       59.78.38.89.56.913.69.110.3
       614.620.315.915.518.612.127.310.3
       71.90.60.701.06.103.8
      IGHJ
       13.90.61.81.52.91.44.41.0
       24.83.52.303.91.48.92.0
       312.67.69.914.39.817.813.38.0
       444.743.743.337.646.153.435.655.0
       512.615.010.519.512.78.213.310.0
       621.429.632.327.124.517.824.424.0
      Frequencies expressed in percentages. References for comparisons are as follows: MCL,
      • Hadzidimitriou A.
      • Agathangelidis A.
      • Darzentas N.
      • Murray F.
      • fau-Larue M.H.
      • Bredo P.L.
      • Navarro L.A.
      • Dagklis A.
      • Rombout P.
      • Beldjord K.
      • Kolstad A.
      • Dreyling M.H.
      • Anagnostopoulos A.
      • Tsaftaris A.
      • Mavragani-Tsipidou P.
      • Rosenwald A.
      • Ponzoni M.
      • Groenen P.
      • Ghia P.
      • Sander B.
      • Papadaki T.
      • Campo E.
      • Geisler C.
      • Rosenquist R.
      • Davi F.
      • Pott C.
      • Stamatopoulos K.
      Is there a role for antigen selection in mantle cell lymphoma? Immunogenetic support from a series of 807 cases.
      CLL,
      • Darzentas N.
      • Hadzidimitriou A.
      • Murray F.
      • Hatzi K.
      • Josefsson P.
      • Laoutaris N.
      • Moreno C.
      • Anagnostopoulos A.
      • Jurlander J.
      • Tsaftaris A.
      • Chiorazzi N.
      • Belessi C.
      • Ghia P.
      • Rosenquist R.
      • Davi F.
      • Stamatopoulos K.
      A different ontogenesis for chronic lymphocytic leukemia cases carrying stereotyped antigen receptors: molecular and computational evidence.
      SMZL,
      • Zibellini S.
      • Capello D.
      • Forconi F.
      • Marcatili P.
      • Rossi D.
      • Rattotti S.
      • Franceschetti S.
      • Sozzi E.
      • Cencini E.
      • Marasca R.
      • Baldini L.
      • Tucci A.
      • Bertoni F.
      • Passamonti F.
      • Orlandi E.
      • Varettoni M.
      • Merli M.
      • Rizzi S.
      • Gattei V.
      • Tramontano A.
      • Paulli M.
      • Gaidano G.
      • Arcaini L.
      Stereotyped patterns of B-cell receptor in splenic marginal zone lymphoma.
      HCL,
      • Arons E.
      • Roth L.
      • Sapolsky J.
      • Suntum T.
      • Stetler-Stevenson M.
      • Kreitman R.J.
      Evidence of canonical somatic hypermutation in hairy cell leukemia.
      MM,
      • Gonzalez D.
      • van der Burg M.
      • Garcia-Sanz R.
      • Fenton J.A.
      • Langerak A.W.
      • Gonzalez M.
      • Van Dongen J.J.
      • San Miguel J.F.
      • Morgan G.J.
      Immunoglobulin gene rearrangements and the pathogenesis of multiple myeloma.
      WM,
      • Martin-Jimenez P.
      • Garcia-Sanz R.
      • Balanzategui A.
      • Alcoceba M.
      • Ocio E.
      • Sanchez M.L.
      • Gonzalez M.
      • San Miguel J.
      Molecular characterization of heavy chain immunoglobulin gene rearrangements in Waldenstrom's macroglobulinemia and IgM monoclonal gammopathy of undetermined significance.
      and normal B cells.
      • Brezinschek H.P.
      • Foster S.J.
      • Brezinschek R.I.
      • Dorner T.
      • Domiati-Saad R.
      • Lipsky P.E.
      Analysis of the human VH gene repertoire Differential effects of selection and somatic hypermutation on human peripheral CD5(+)/IgM+ and CD5(−)/IgM+ B cells.
      Significant differences between DLBCL and other B-LPDs are depicted in bold.
      MM, multiple myeloma; SMZL, splenic marginal zone lymphoma; WM, Waldeström macroglobulinemia.
      low asterisk P < 0.05.
      P < 0.01.
      Partial D-J rearrangements were present in 41% of the cases in our series (Table 2), with a similar IGHD usage to that of other B-LPDs (data not shown).

      Discussion

      Although DLBCL is the most frequent variant of non-Hodgkin lymphoma, its ontogeny is still not well understood. In this study, we analyzed complete V-D-J rearrangements in 165 untreated DLBCL, which is the largest series reported to date. Additionally, we also characterized the partial D-J rearrangements. Our results, based on the characterization of the BCR in DLBCLs, with a biased use of certain IGHV genes, evidence of canonical SHM, and the findings of shared amino acid changes and stereotyped sequences, provide new information about the ontogeny of DLBCL. Our data suggest that certain particular antigens must be involved in the development of DLBCL by stimulating the proliferation of B cells that express surface IG encoded by certain IGHV genes. Moreover, DLBCLs show clear differences from other B-LPDs with respect to IGHV usage (Table 5) and SHM.
      A strong bias at the level of IGHV gene usage was observed, with the IGHV4-34, IGHV3-23, and IGHV4-39 genes accounting for one third of the cohort. In addition, recurrent amino acid changes were found in certain IGHV genes, which may indicate specific driven SHM in DLBCL. These findings suggest that DLBCL could derive from certain B-cell populations specifically stimulated during the antigenic response. This hypothesis is even more plausible if the presence of some stereotyped sequences is taken into account. We identified three VH CDR3 stereotyped sequences in our series, which is a lower frequency than in CLL.
      • Agathangelidis A.
      • Darzentas N.
      • Hadzidimitriou A.
      • Brochet X.
      • Murray F.
      • Yan X.J.
      • Davis Z.
      • van Gastel-Mol E.J.
      • Tresoldi C.
      • Chu C.C.
      • Cahill N.
      • Giudicelli V.
      • Tichy B.
      • Pedersen L.B.
      • Foroni L.
      • Bonello L.
      • Janus A.
      • Smedby K.
      • Anagnostopoulos A.
      • Merle-Beral H.
      • Laoutaris N.
      • Juliusson G.
      • di Celle P.F.
      • Pospisilova S.
      • Jurlander J.
      • Geisler C.
      • Tsaftaris A.
      • Lefranc M.P.
      • Langerak A.W.
      • Oscier D.G.
      • Chiorazzi N.
      • Belessi C.
      • Davi F.
      • Rosenquist R.
      • Ghia P.
      • Stamatopoulos K.
      Stereotyped B-cell receptors in one third of chronic lymphocytic leukemia: towards a molecular classification with implications for targeted therapeutic interventions.
      The stereotyped sequences had a rearrangement involving the IGHV1-69 or IGHV4-34 genes. Moreover, two of them shared their IGHV1-69 rearrangement with subgroups previously described in CLL.
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      • Agathangelidis A.
      • Darzentas N.
      • Hadzidimitriou A.
      • Brochet X.
      • Murray F.
      • Yan X.J.
      • Davis Z.
      • van Gastel-Mol E.J.
      • Tresoldi C.
      • Chu C.C.
      • Cahill N.
      • Giudicelli V.
      • Tichy B.
      • Pedersen L.B.
      • Foroni L.
      • Bonello L.
      • Janus A.
      • Smedby K.
      • Anagnostopoulos A.
      • Merle-Beral H.
      • Laoutaris N.
      • Juliusson G.
      • di Celle P.F.
      • Pospisilova S.
      • Jurlander J.
      • Geisler C.
      • Tsaftaris A.
      • Lefranc M.P.
      • Langerak A.W.
      • Oscier D.G.
      • Chiorazzi N.
      • Belessi C.
      • Davi F.
      • Rosenquist R.
      • Ghia P.
      • Stamatopoulos K.
      Stereotyped B-cell receptors in one third of chronic lymphocytic leukemia: towards a molecular classification with implications for targeted therapeutic interventions.
      It is well known that there is a relationship between CLL and DLBCL, since some cases of DLBCL occur on a CLL background (Richter transformation). However, the cases reported here are de novo DLBCL, indicating “common” stereotypes between DLBCL and CLL, in contrast to other B-cell malignancies.
      • Agathangelidis A.
      • Darzentas N.
      • Hadzidimitriou A.
      • Brochet X.
      • Murray F.
      • Yan X.J.
      • Davis Z.
      • van Gastel-Mol E.J.
      • Tresoldi C.
      • Chu C.C.
      • Cahill N.
      • Giudicelli V.
      • Tichy B.
      • Pedersen L.B.
      • Foroni L.
      • Bonello L.
      • Janus A.
      • Smedby K.
      • Anagnostopoulos A.
      • Merle-Beral H.
      • Laoutaris N.
      • Juliusson G.
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      • Jurlander J.
      • Geisler C.
      • Tsaftaris A.
      • Lefranc M.P.
      • Langerak A.W.
      • Oscier D.G.
      • Chiorazzi N.
      • Belessi C.
      • Davi F.
      • Rosenquist R.
      • Ghia P.
      • Stamatopoulos K.
      Stereotyped B-cell receptors in one third of chronic lymphocytic leukemia: towards a molecular classification with implications for targeted therapeutic interventions.
      This highly restricted immunoglobulin gene repertoire with stereotyped VH CDR3 and common SHM targeting in DLBCL suggests a role for antigen selection in this entity, at least for some subsets of cases. Some of the antigens could be common to different B-LPDs but could ultimately lead to a different entity, depending on which population they stimulate. Although the results reported here support the notion that stereotyped BCRs in DLBCL do not seem to have as relevant implications as in CLL or other B-LPDs, the frequency of these stereotyped sequences and their possible biological and clinical significance in DLBCL need further analysis in larger and independent series.
      The IGHV4-34 gene was overrepresented in our series (15.5% overall), appearing at a higher frequency than in normal B cells,
      • Berkowska M.A.
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      Human memory B cells originate from three distinct germinal center-dependent and -independent maturation pathways.
      • Brezinschek H.P.
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      • Dorner T.
      • Domiati-Saad R.
      • Lipsky P.E.
      Analysis of the human VH gene repertoire Differential effects of selection and somatic hypermutation on human peripheral CD5(+)/IgM+ and CD5(−)/IgM+ B cells.
      in agreement with previous reports.
      • Hsu F.J.
      • Levy R.
      Preferential use of the VH4 Ig gene family by diffuse large-cell lymphoma.
      • Capello D.
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      Molecular analysis of immunoglobulin variable genes in human immunodeficiency virus-related non-Hodgkin's lymphoma reveals implications for disease pathogenesis and histogenesis.
      • Ruminy P.
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      • Rainville V.
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      • Cornic M.
      • Bertrand P.
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      • Jardin F.
      • Tilly H.
      • Bastard C.
      The isotype of the BCR as a surrogate for the GCB and ABC molecular subtypes in diffuse large B-cell lymphoma.
      However, there are other series in which this percentage was slightly smaller, although this discrepancy could be accounted for in terms of differences in the sample size or the CGB/non-GCB distribution.
      • Kuppers R.
      • Rajewsky K.
      • Hansmann M.L.
      Diffuse large cell lymphomas are derived from mature B cells carrying V region genes with a high load of somatic mutation and evidence of selection for antibody expression.
      • Lossos I.S.
      • Okada C.Y.
      • Tibshirani R.
      • Warnke R.
      • Vose J.M.
      • Greiner T.C.
      • Levy R.
      Molecular analysis of immunoglobulin genes in diffuse large B-cell lymphomas.
      • Daley M.D.
      • Berinstein N.L.
      • Siminovitch K.A.
      Immunoglobulin heavy chain variable gene utilization in human large cell and Burkitt's lymphoma cell lines.
      Interestingly, the patients showing IGHV4-34 rearrangements in our series shared several common features: i) all but one were highly mutated (15 of 16 > 2%, median: 9.5%, range: 1.7% to 23.6%); ii) all of them (12 of 12) belonged to the non-GCB subtype; and iii) all (10 of 10) conserved the AVY motif. Moreover, the critical W at position 7 was intact in the five cases that could be analyzed. This specific FR1 motif is thought to be responsible for binding the N-acetyllactosamine antigenic determinant, implying that these cells may retain the ability to bind to and be activated by superantigens, despite intense SHM activity.
      • Li Y.
      • Spellerberg M.B.
      • Stevenson F.K.
      • Capra J.D.
      • Potter K.N.
      The I binding specificity of human VH 4–34 (VH 4–21) encoded antibodies is determined by both VH framework region 1 and complementarity determining region 3.
      In light of these results, our findings are consistent with those from previous studies,
      • Ruminy P.
      • Etancelin P.
      • Couronne L.
      • Parmentier F.
      • Rainville V.
      • Mareschal S.
      • Bohers E.
      • Burgot C.
      • Cornic M.
      • Bertrand P.
      • Lenormand B.
      • Picquenot J.M.
      • Jardin F.
      • Tilly H.
      • Bastard C.
      The isotype of the BCR as a surrogate for the GCB and ABC molecular subtypes in diffuse large B-cell lymphoma.
      • Jardin F.
      • Sahota S.S.
      • Ruminy P.
      • Parmentier F.
      • Picquenot J.M.
      • Rainville V.
      • Buchonnet G.
      • Lepretre S.
      • Tilly H.
      • Bastard C.
      Novel Ig V gene features of t(14;18) and t(3;14) de novo diffuse large B-cell lymphoma displaying germinal center-B cell like and non-germinal center-B cell like markers.
      and we confirm, in a larger series, the strong association between DLBCL expressing the IGHV4-34 and non-GCB subtype. However, these results require future confirmation using genome-wide expression profiles as a tool for distinguishing between the various biological subtypes of DLBCL. In addition, we describe a new stereotyped VH CDR3 pattern in DLBCL using IGHV4-34. The molecular features of this subgroup differ from other B-LPDs using this gene. For example, in HCL IGHV4-34 is mutated in only 1 of 17 cases (6%)
      • Arons E.
      • Roth L.
      • Sapolsky J.
      • Suntum T.
      • Stetler-Stevenson M.
      • Kreitman R.J.
      Evidence of canonical somatic hypermutation in hairy cell leukemia.
      ; in the small proportion of CLLs with the IgG isotype,
      • Potter K.N.
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      • Wheatley I.
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      • Orchard J.
      • Duncombe A.S.
      • Packham G.
      • Stevenson F.K.
      Structural and functional features of the B-cell receptor in IgG-positive chronic lymphocytic leukemia.
      the IGHV4-34 is the predominant gene,
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      whereas all of our IGHV4-34 DLBCL cases belonged to the non-GCB subtype, which is assumed to be IgM+.
      • Ruminy P.
      • Etancelin P.
      • Couronne L.
      • Parmentier F.
      • Rainville V.
      • Mareschal S.
      • Bohers E.
      • Burgot C.
      • Cornic M.
      • Bertrand P.
      • Lenormand B.
      • Picquenot J.M.
      • Jardin F.
      • Tilly H.
      • Bastard C.
      The isotype of the BCR as a surrogate for the GCB and ABC molecular subtypes in diffuse large B-cell lymphoma.
      Finally, mutations in codons 64 and 80 are found in IGHV4-34 sequences from DLBCL and from ocular adnexal extranodal marginal zone lymphoma, which is more frequent than in normal B cells or other B-LPDs.
      • Brezinschek H.P.
      • Foster S.J.
      • Brezinschek R.I.
      • Dorner T.
      • Domiati-Saad R.
      • Lipsky P.E.
      Analysis of the human VH gene repertoire Differential effects of selection and somatic hypermutation on human peripheral CD5(+)/IgM+ and CD5(−)/IgM+ B cells.
      • Stamatopoulos K.
      • Belessi C.
      • Moreno C.
      • Boudjograh M.
      • Guida G.
      • Smilevska T.
      • Belhoul L.
      • Stella S.
      • Stavroyianni N.
      • Crespo M.
      • Hadzidimitriou A.
      • Sutton L.
      • Bosch F.
      • Laoutaris N.
      • Anagnostopoulos A.
      • Montserrat E.
      • Fassas A.
      • Dighiero G.
      • Caligaris-Cappio F.
      • Merle-Beral H.
      • Ghia P.
      • Davi F.
      Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations.
      • Hadzidimitriou A.
      • Agathangelidis A.
      • Darzentas N.
      • Murray F.
      • fau-Larue M.H.
      • Bredo P.L.
      • Navarro L.A.
      • Dagklis A.
      • Rombout P.
      • Beldjord K.
      • Kolstad A.
      • Dreyling M.H.
      • Anagnostopoulos A.
      • Tsaftaris A.
      • Mavragani-Tsipidou P.
      • Rosenwald A.
      • Ponzoni M.
      • Groenen P.
      • Ghia P.
      • Sander B.
      • Papadaki T.
      • Campo E.
      • Geisler C.
      • Rosenquist R.
      • Davi F.
      • Pott C.
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      Is there a role for antigen selection in mantle cell lymphoma? Immunogenetic support from a series of 807 cases.
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      Biased use of the IGHV4 family and evidence for antigen selection in Chlamydophila psittaci-negative ocular adnexal extranodal marginal zone lymphomas.
      Taken together, our results suggest that DLBCL expressing IGHV4-34 may constitute a separate subgroup within the non-GCB DLBCL subtype.
      Several hypotheses have been proposed to explain the origin and frequency of clonal cells from non-GCB DLBCL. Lossos et al
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      reported that non-GCB DLBCL must derive from B cells that have passed through the GC with no possibility of additional SHM. However, Jardin et al
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      Novel Ig V gene features of t(14;18) and t(3;14) de novo diffuse large B-cell lymphoma displaying germinal center-B cell like and non-germinal center-B cell like markers.
      observed ongoing mutations in non-GCB DLBCL, including IGHV4-34 cases, which would suggest an independent GC mechanism of SHM. Regardless of the GC dependence of these mutations, we observed that SHM of the non-GCB subtype met the canonical criteria (IGHV4-34 included), which do not support the need to invoke a mutational machinery different from the normal process for IGHV mutations.
      In conclusion, on the basis of particular features in the sequence of the immunoglobulin genes, we found that different subgroups exist within the non-GCB subtype. Our data support the idea that DLBCL is characterized by a highly distinctive IG gene repertoire and, to the best of our knowledge, for the first time, we describe stereotyped sequences in DLBCL and “common” stereotypes between CLL and other B-LPD. These results indicate a role for antigen selection in DLBCL development and also open possibilities for future investigations into the biology of DLBCL.

      Acknowledgments

      We thank Alicia Antón, Felicitación García, Montserrat Hernández-Ruano (Hospital Universitario de Salamanca, Spain), and Mar López-Colomer (Centro Nacional de Investigaciones Oncológicas, Madrid, Spain) for their technical support. In addition, we thank all of the members of GELTAMO and the patients who participated in this study.

      Supplementary data

      • Supplemental Figure S1

        Distribution of replacement (A) and silent (B) mutations along the IGHV sequence. *Mutations that by themselves would have truncated the sequence. CDR, complementarity-determining region; FR, framework region.

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