Comparison of Immunohistochemistry Assay Results with Gene
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r Biomar ula ke c rs Schaffer et al., J Mol Biomark Diagn 2018, 9:2 le o & M D f i DOI: 10.4172/2155-9929.1000386 a o g l Journal of Molecular Biomarkers n a o n r s i u s o J ISSN: 2155-9929 & Diagnosis Research Article Open Access Comparison of Immunohistochemistry Assay Results with Gene Expression Profiling Methods for Diffuse Large B-Cell Lymphoma Subtype Identification in Matched Patient Samples Michael Schaffer1, Shalini Chaturvedi1, JD Alvarez1, Sandy Frans2, Regina Aquino1, Brett Hall1, Mark Wildgust3 and Sriram Balasubramanian1* 1Janssen Oncology Translational Research, Spring House, PA, USA 2Janssen Research and Development, Beerse, Belgium 3Janssen Research and Development, Raritan, NJ, USA Abstract Background: The cell of origin (COO) in diffuse large B-cell lymphoma (DLBCL) has prognostic importance. While the COO was originally classified into germinal center B-cell (GCB) or activated B-cell (ABC) subtypes by microarray analysis, routine use was not practical. Immunohistochemistry (IHC)–based methods are widely used with varying results due to lack of standardization. Several classification methods have been developed recently; understanding the concordance between these and existing methods is essential to their practical application. Therefore, we evaluated concordance between 3 commercial assays: a standardized Hans-based IHC method and 2 gene expression profiling (GEP) methods and compared these to the accepted microarray classification. Methods: 137 DLBCL-confirmed tumor samples were evaluated using a standardized Hans-based IHC method for GCB or non-GCB subtype, by a published microarray-based assay, a digital gene expression-based Lymphoma Subtyping Test (LST) and a next-generation sequencing-based assay (EdgeSeq COO). Subtype calls from the 3 GEP methods were harmonized to “GCB” or “non-GCB” and assessed for concordance. Results: Concordance between the Hans-based IHC assay and the microarray-based assay, LST assay and EdgeSeq assay was 79.6% (N=137), 80.0% (N=125) and 78.2% (N=64), respectively; the positive percent agreement (PPA) in non-GCB was 88.9%, 87.0% and 78.1%, respectively. Concordance for the Hans-based IHC assay versus GEP methods was especially high for direct GCB calls (91.0%, 88.3% and 78.1% for microarray, LST and EdgeSeq COO methods, respectively). The newly developed GEP assays performed well against the microarray GEP method, against which they were calibrated (concordance 93.7% and 87.5% and PPA 94.3% and 92.9%, respectively, for LST and EdgeSeq COO). Conclusion: These results demonstrated good consistency between various platforms for stratification of DLBCL into COO subtype classifications. Application of a standardized Hans-based IHC assay offers a robust, rapid and easily accessible platform to classify DLBCL into prognostically important subtypes. Keywords: Diffuse large B-cell lymphoma; Hans-based have shown favorable responses to the Bruton’s tyrosine kinase (BTK) immunohistochemistry; Gene expression profiling inhibitor ibrutinib [11] or the immunomodulatory drug lenalidomide [12], alone or in combination with chemotherapy. This provides a Introduction rationale for the selective development of treatments for subtypes of Diffuse large B-cell lymphoma (DLBCL) is the most common DLBCL classified by COO, which further emphasizes the need for rapid type of lymphoma, accounting for 30% to 35% of non-Hodgkin and accurate identification of these subtypes. lymphoma [1,2]. DLBCL is a heterogeneous disease and has distinct Most patients with PMBL have a favorable outcome with a 3-year molecular subtypes based on the cell of origin (COO). Methods such overall survival rate of 97% [2]. In clinical practice today, PMBL is as immunohistochemistry (IHC) and gene expression profiling (GEP) easily diagnosed by other methods; thus, DLBCL COO classification are among the more common approaches used to classify subtypes efforts have focused on distinguishing the remaining subtypes. of DLBCL. GEP using DNA microarrays has been the standard The accepted standard for classification of DLBCL subtypes has experimental approach to molecularly classify DLBCL into major COO subtypes: germinal center B-cell–like (GCB), activated B-cell–like (ABC) and primary mediastinal B-cell lymphoma (PMBL) [3-6]. The small number of patients who cannot be classified clearly into these *Corresponding author: Sriram Balasubramanian, Janssen Oncology Translational Research, 1400 McKean Road, Spring House, PA 19087, USA, Tel: molecular subtypes are referred to as “unclassified” (UNC). +1 2157937757; E-mail: [email protected] Depending on the molecular subtype, the pathobiology of the Received March 03, 2018; Accepted March 21, 2018; Published March 24, 2018 disease is diverse; other than PBML, the initial clinical presentation Citation: Schaffer M, Chaturvedi S, Alvarez JD, Frans S, Aquino R, et al. (2018) of each subtype is similar but associated with very different clinical Comparison of Immunohistochemistry Assay Results with Gene Expression outcomes and large underlying molecular diversity. Of these biological Profiling Methods for Diffuse Large B-Cell Lymphoma Subtype Identification factors, the COO has proved to be the most important, and it is now in Matched Patient Samples. J Mol Biomark Diagn 9: 386. doi: 10.4172/2155- accepted that COO is a prognostic factor in DLBCL [7-9]. 9929.1000386 DLBCL subtypes respond to therapy in very different ways [10]. For Copyright: © 2018 Schaffer M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits example, patients with ABC DLBCL who failed R-CHOP (rituximab, unrestricted use, distribution, and reproduction in any medium, provided the cyclophosphamide, doxorubicin, vincristine and prednisone) therapy original author and source are credited. J Mol Biomark Diagn, an open access journal Volume 9 • Issue 2 • 1000386 ISSN:2155-9929 Citation: Schaffer M, Chaturvedi S, Alvarez JD, Frans S, Aquino R, et al. (2018) Comparison of Immunohistochemistry Assay Results with Gene Expression Profiling Methods for Diffuse Large B-Cell Lymphoma Subtype Identification in Matched Patient Samples. J Mol Biomark Diagn 9: 386. doi: 10.4172/2155-9929.1000386 Page 2 of 8 been using microarray GEP [13]. However, a reproducible, easy-to-use samples and allows more subtle evaluation of the sample and staining and validated microarray-based GEP assay for DLBCL subtyping has characteristics by a pathologist. not been accessible to all medical communities and any microarray Each methodology described has its own limitations; however, GEP-based approach generally has a turnaround time of 2 to 3 weeks, optimized assays using some of these methodologies are becoming which makes it difficult to implement as a prospective selection marker. commercially available, and thus multiple assays may be used to identify Therefore, routine clinical practice in DLBCL has used standard IHC- DLBCL patients and select the optimum therapy in the clinic. Therefore, based methods, which are widely available in most clinical settings, it becomes important to compare multiple platforms and evaluate to classify patients for therapy. Much effort has been dedicated to the concordance between these IHC and GEP assays, as well as the developing robust IHC assays using various combinations of CD10, concordance across the different GEP assays. To this end, we compared BCL6, BCL2, MUM1/IRF4, FOXP1, GCET1 and LMO2 proteins, all the Hans-based IHC assay with the traditional microarray GEP-based of which have been identified as having differential expression in the method and the novel gene expression-based assays described above DLBCL subtypes. These markers have been used to develop at least 9 under standard conditions, using the same set of clinical specimens. different IHC tests [14]. The Hans method was developed in 2004, based on 3 markers: CD10, BCL6 and MUM1/IRF4 [15], and has remained Materials and Methods the most popular due to its simplicity with only 3 widely used markers, Tissue samples a consistent 30% cutoff for all 3 markers and demonstrated prognostic value. This binary algorithm segregates patients into 2 groups – GCB All clinical samples used in this study were from FFPE blocks (in 42% of patients) and non-GCB (in 58% of patients) – instead of the purchased from Molecular Response (San Diego, CA, USA) or continuum from which discrete classes are derived from population- Conversant Bio (Huntsville, AL, USA), and obtained with informed based numeric cutoffs [15]. The non-GCB group incorporates the ABC consent. All samples were reviewed by a certified pathologist to subtype along with the unclassified group, and as with ABC DLBCL, confirm the disease diagnosis and verify tumor content before IHC or these non-GCB patients have a less favorable outcome with standard GEP analysis. A total of 194 samples were first evaluated for disease immunochemotherapy [16]. Algorithms for IHC have 80% to 87% diagnosis confirmation and then tested. concordance with GEP and have gained the most clinical acceptance Sample preparation, RNA extraction and GEP [17-19]. However, there can be limitations to using IHC algorithms, including reproducibility concerns and variability between laboratories; 6 sections of 10 μm each were cut from the tissue block per sample also, the various IHC methods have not been uniformly reported to have and de-paraffinized using xylene as described in the AllPrep DNA/ the same prognostic utility as GEP [20,21]. A standardized Hans-based