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Diffuse large B-cell lymphoma (DLBCL) is a biologically and clinically heterogeneous disease. Transcriptomic and genetic characterization of DLBCL has increased the understanding of its intrinsic pathogenesis and provided potential therapeutic targets. However, the role of the microenvironment in DLBCL biology remains less understood. Here, we performed a transcriptomic analysis of the microenvironment of 4,655 DLBCLs from multiple independent cohorts and described four major lymphoma microenvironment categories that associate with distinct biological aberrations and clinical behavior. We also found evidence of genetic and epigenetic mechanisms deployed by cancer cells to evade microenvironmental constraints of lymphoma growth, supporting the rationale for implementing DNA hypomethylating agents in selected patients with DLBCL. In addition, our work uncovered new therapeutic vulnerabilities in the biochemical composition of the extracellular matrix that were exploited to decrease DLBCL proliferation in preclinical models. This novel classification provides a road map for the biological characterization and therapeutic exploitation of the DLBCL microenvironment.Significance:In a translational relevant transcriptomic-based classification, we characterized the microenvironment as a critical component of the B-cell lymphoma biology and associated it with the DLBCL clinical behavior establishing a novel opportunity for targeting therapies.This article is highlighted in the In This Issue feature, p. 1307

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In the hemato-oncology field, remarkable scientific progress has been achieved, primarily propelled by the discovery of new technologies, improvement in genomics, and novel in vitro and in vivo models. The establishment of multiple cell line collections and the development of instrumental mouse models enhanced our ability to discover effective therapeutics. However, cancer models that faithfully mimic individual cancers are still imperfect. Patient-derived tumor xenografts (PDTXs) have emerged as a powerful tool for identifying the mechanisms which drive tumorigenesis and for testing potential therapeutic interventions. The recognition that PDTXs can maintain many of the donor samples’ properties enabled the development of new strategies for discovering and implementing therapies. Described in this article are protocols for the generation and characterization of lymphoma PDTXs that may be used as the basis of shared procedures. Universal protocols will foster the model utilization, enable the integration of public and private repositories, and aid in the development of shared platforms. © 2021 Wiley Periodicals LLC. Basic Protocol 1: Tissue handling and cryopreservation of primary and PDTX samples. Basic Protocol 2: Performing tumor implant in immunocompromised mice PDTX models. Alternate Protocol 1: Intra-medullary femoral injection. Alternate Protocol 2: Intravenous injection. Alternate Protocol 3: Intraperitoneal injection. Support Protocol 1: Phenotypical characterization of PDTXs by flow cytometry. Support Protocol 2: Biological and molecular characterization of PDTX tumors by PCR detection of IGK, IGH, and TCR rearrangements. Basic Protocol 3: Harvesting PDTX-derived tumor cells for ex vivo experiments. Basic Protocol 4: In vivo testing of multiple compounds in a PDTX mouse model.

With a rising incidence of COVID-19-associated morbidity and mortality worldwide, it is critical to elucidate the innate and adaptive immune responses that drive disease severity. We performed longitudinal immune profiling of peripheral blood mononuclear cells from 45 patients and healthy donors. We observed a dynamic immune landscape of innate and adaptive immune cells in disease progression and absolute changes of lymphocyte and myeloid cells in severe versus mild cases or healthy controls. Intubation and death were coupled with selected natural killer cell KIR receptor usage and IgM+ B cells and associated with profound CD4 and CD8 T cell exhaustion. Pseudo-temporal reconstruction of the hierarchy of disease progression revealed dynamic time changes in the global population recapitulating individual patients and the development of an eight-marker classifier of disease severity. Estimating the effect of clinical progression on the immune response and early assessment of disease progression risks may allow implementation of tailored therapies.

Enhancers are regulatory regions of DNA, which play a key role in cell-type specific differentiation and development. Most active enhancers are transcribed into enhancer RNA (eRNA) that can regulate transcription of target genes by means of in cis as well as in trans action. eRNA stabilize contacts between distal genomic regions and mediate the interaction of DNA with master transcription factors. Here, we characterized an enhancer eRNA, GECPAR (germinal center proliferative adapter RNA), which is specifically transcribed in normal and neoplastic germinal center B cells from the super-enhancer of POU2AF1, a key regulatory gene of the germinal center reaction. Using diffuse large B-cell lymphoma cell line models, we demonstrated the tumor suppressor activity of GECPAR, which is mediated via its transcriptional regulation of proliferation and differentiation genes, particularly MYC and the Wnt pathway.

Diffuse large B-cell lymphoma (DLBCL) is a biologically and clinically heterogeneous disease. Transcriptomic and genetic characterization of DLBCL has increased the understanding of its intrinsic pathogenesis and provided potential therapeutic targets. However, the role of the microenvironment in DLBCL biology remains less understood. Here, we performed a transcriptomic analysis of the microenvironment of 4,655 DLBCLs from multiple independent cohorts and described four major lymphoma microenvironment categories that associate with distinct biological aberrations and clinical behavior. We also found evidence of genetic and epigenetic mechanisms deployed by cancer cells to evade microenvironmental constraints of lymphoma growth, supporting the rationale for implementing DNA hypomethylating agents in selected patients with DLBCL. In addition, our work uncovered new therapeutic vulnerabilities in the biochemical composition of the extracellular matrix that were exploited to decrease DLBCL proliferation in preclinical models. This novel classification provides a road map for the biological characterization and therapeutic exploitation of the DLBCL microenvironment.Significance:In a translational relevant transcriptomic-based classification, we characterized the microenvironment as a critical component of the B-cell lymphoma biology and associated it with the DLBCL clinical behavior establishing a novel opportunity for targeting therapies.This article is highlighted in the In This Issue feature, p. 1307

Introduction: Immunotherapy is a promising therapeutic intervention for cancer treatment. Activation of the immune system via checkpoint blockade has been shown to produce antitumor responses in patients with both solid and hematological tumors. However, many patients do not respond to checkpoint inhibitors, and additional therapies are needed to treat these patients. Testing immunotherapies requires a functional human immune system; thus, it is difficult to evaluate their effectiveness using conventional experimental models. For this reason, establishing in vivo models that closely reproduce not only human tumors, but also their interactions with the human immune system, has become mandatory. Methods: We developed a humanized mouse model and combined it with a patient-derived tumor xenograft (PDTX). Humanized mice (HuMice) were generated by transplantation of cord blood or mobilized peripheral blood CD34+ hematopoietic stem and progenitor cells into preconditioned immunodeficient mice. We compared human engraftment in 3 different mouse strains: NSG (NOD.Cg-Prkdc scidIl2rg tm1Wjl/SzJ), NSGS (NOD.Cg-Prkdc scidIl2rg tm1Wjl Tg(CMV-IL3,CSF2,KITLG)1Eav/MloySzJ) and NBSGW (NOD.Cg-Kit W-41J Tyr + Prkdc scid Il2rg tm1Wjl/ThomJ). Immune cell profiling and distribution was performed using flow cytometry and immunohistochemistry. The B cell receptor (BCR) repertoire was evaluated using an RNA-based NGS assay. To evaluate the maturation and functionality of T cells developing in HuMice we performed proliferation, degranulation and intracellular cytokine staining. Results: Two months after CD34+ cell transplantation, we observed high levels of human hematopoietic chimerism in all the 3 strains. NSGS mice supported high-level chimerism as early as 1 month after transplantation, with more than 25% of human CD45+ cells in the blood. In all mice the majority of human circulating leukocytes were CD19+ B cells. An early appearance of CD3+ human T cells was detected in NSGS mice as compared to the other strains. Notably, the T cell expansion correlated with a decrease in relative B cell abundance while the myeloid cell contribution to the graft remained steady. We documented the differentiation of CD4+ and CD8+ human T cells at a 2:1 ratio. The characterization of the T cell subsets revealed that the majority was represented by CD45RA-CCR7- effector memory cells in both the spleen and the blood of HuMice. Nevertheless, recipient mice did not exhibit overt signs of graft-versus-host disease. We also evaluated the cytotoxic potential of T cells isolated from the spleen of HuMice: ex vivo peptide antigen (i.e. EBV) presentation let to generation of effective and specific cytotoxic T-cells. After assessing a functional human immune system reconstitution in HuMice, we challenged them in vivo with low-passage tumor fragments from a diffuse large B cell lymphoma (DLBCL) PDTX. All tumor implants were successfully engrafted in both HuMice and non-humanized controls. Remarkably, all the 3 HuMice strains showed a significant reduction in the tumor volume and/or eradication compared to matched non-humanized controls. Flow cytometry analysis of the peripheral blood of humanized PDTX revealed that the tumor engraftment elicited a significant expansion of CD3+ T cells and cytotoxic CD8+ lymphocytes. Moreover, tumors developing in HuMice exhibited intermediate to high levels of tumor infiltrating T lymphocytes commingling with the neoplastic B cells, as determined by immunohistochemistry. Large areas of necrosis were often observed in PDTX of HuMice. Infiltrating CD3+ cells were TIGIT, PD-1 and Lag-3 positive, and did not efficiently proliferate ex vivo: all features consistent with an exhaustion phenotype. PDTX of HuMice often displayed larger areas of necrosis. Conclusions: Collectively, our data demonstrate that a robust reconstitution can be achieved in different strains of immunocompromised mice and that HuMice elicit effective anti-lymphoma responses. PDTX HuMice represent a powerful platform to study host-tumor interactions, and to test novel immune-based strategies (CAR-T, bifunctional Abs) and new pharmacological approaches to counteract T-cell exhaustion. Figure 1 Figure 1. Disclosures Scandura: Abbvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Constellation: Research Funding; MPN-RF (Foundation): Research Funding; CR&T (Foudation): Research Funding; European Leukemia net: Honoraria, Other: travel fees . Roth: Janssen: Consultancy; Merck: Consultancy.

Research in DLBCL pathogenesis has largely focused on the lymphoma cells that defined molecular subtypes. To elucidate the role of the lymphoma microenvironment (LME) in this process, we developed and deconvoluted transcriptomics signatures of LME cells and pathways from 3,026 DLBCLs from 13 datasets including our new cohort of 127 pts. Mutations were available for 562 pts of the datasets and for 22 pts from our cohort (WES with matched normal). Applying density-based clustering we identified 4 LME signatures, independent of reported transcriptional and genetic classifications based on lymphoma cells: LME-1 DLBCLs (n=726, 24% - GCB/ABC: 35%/36%) were characterized by an "immunosuppressive" ME enriched for Tregs, myeloid-derived suppressor cells, CD8PD1high, natural killer and macrophages type 2 and prevalence of genetic mechanisms of immune escape in malignant cells such as mutations in B2M (33%) and CD70 (10%). Malignant cells in LME-1 DLBCL presented high activity of NF-kB and JAK/STAT signaling pathways, likely due to high frequency of co-occurring MYD88L265and CD79B mutations (40%) and the presence of a cytokine rich milieu including high expression of IL10, IL6 and TNFS13B. Good outcome genetic groups BN2 and EZB constituted 46% of pts LME-2 DLBCLs (n=484, 16% - GCB/ABC: 55%/30%) were characterized by an "anti-tumor immunity" ME enriched for T cells, follicular TH and follicular dendritic cells (FDC). Lymphoma cells presented the highest number of BCL2 translocations and EZH2 mutations (40%, p=0.001 vs. other LME groups) and activation of cell motility and chemotaxis pathways that likely account for the advance stage at presentation (70% were stages III/IV p=0.02 vs. 40-50% in the other LME groups). Lymphoma cells expressed higher levels of CCL20, CCR6 and CXCR5. Good outcome genetic groups BN2 and EZB constituted 74% of pts. Notably, ABC LME-2 DLBCLs had better prognosis that any other ABC DLBCL (p LME-3 DLBCLs (n=847, 28% - GCB/ABC: 56%/25%) were characterized by a "mesenchymal" ME enriched for cancer-associated fibroblasts (CAFs), reticular DC, FDC and endothelial cells. Lymphoma cells showed higher mutations in BCR/Pi3K signaling intermediates SGK1 and GNA13 (20 and 13%) and activation of the TGFB signaling and matrix remodeling pathways. LME-3 DLBCLs expressed higher levels of MMP9, MMP2, TIMP1 and TIMP2. Good outcome genetic groups BN2 and EZB constituted 75% of pts, and were no patients harboring NOTCH1 mutations. LME-3 DLBCL also had the higher proportion of non-cellular LME component represented by the extracellular matrix (ECM). Patients with DLBCL with higher ECM proportion had better progression free survival (p=0.0004). We specifically tested the ECM effect in a murine DLBCL model by analyzing changes in ECM proteins associated with disease progression by serial proteomics. DLBCL progression was accompanied by increase in lymphoma cells in detriment of CAFs and ECM proteins. Among them, we identified the small proteoglycan decorin (DCN). Accordingly, parental administration of recombinant DCN to DLBCL mice (n=10 vs vehicle n=10) decreased tumor volume (p LME-4 DLBCLs (n=969, 32% - GCB/ABC: 46%/38%) were characterized by a "depleted" ME with increased proportion of lymphoma cells with mutations in MYD88, PIM1 and HLA-C (36, 38 and 13%), higher genomic instability and epigenetic heterogeneity (by DNA methylation). Good outcome genetic groups BN2 and EZB constituted 68% of pts. Lymphoma cells showed activation of Pi3K signaling and hypermethylation and low expression of the TGFB mediator SMAD1 (p In sum, ME signatures in DLBCL associate with clinical outcomes independently of existing molecular subtypes, contribute to explain DLBCL biology and provide potential novel therapies Disclosures Rutherford: Karyopharm: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Honoraria; Verastem: Consultancy, Honoraria; AstraZeneca: Consultancy, Honoraria; Celgene: Consultancy, Honoraria; Heron: Consultancy, Honoraria; Janssen Scientific Affairs: Consultancy, Honoraria; Juno Therapeutics Inc: Consultancy, Honoraria. Martin:Celgene: Consultancy; Teneobio: Consultancy; Sandoz: Consultancy; I-MAB: Consultancy; Karyopharm: Consultancy; Janssen: Consultancy. Leonard:Nordic Nanovector: Consultancy; Nordic Nanovector: Consultancy; Miltenyi: Consultancy; MorphoSys: Consultancy; Merck: Consultancy; Miltenyi: Consultancy; Sandoz: Consultancy; Epizyme, Inc: Consultancy; AstraZeneca: Consultancy; AstraZeneca: Consultancy; Bayer Corporation: Consultancy; Bayer Corporation: Consultancy; ADC Therapeutics: Consultancy; Gilead: Consultancy; Karyopharm Therapeutics: Consultancy; Genentech, Inc./F. Hoffmann-La Roche Ltd: Consultancy; Sutro Biopharma: Consultancy; Celgene: Consultancy; Gilead: Consultancy; BeiGene: Consultancy; Akcea Therapeutics: Consultancy; Sandoz: Consultancy; Akcea Therapeutics: Consultancy; BeiGene: Consultancy; MorphoSys: Consultancy; Sutro Biopharma: Consultancy; Genentech, Inc./F. Hoffmann-La Roche Ltd: Consultancy; ADC Therapeutics: Consultancy; Celgene: Consultancy; Epizyme, Inc: Consultancy; Karyopharm Therapeutics: Consultancy; Merck: Consultancy.

Results During this time period, 153 (27%) of patients with breast cancer were 60 years or older. Approximately, one third (49 patients) required or elected mastectomy as primary treatment. Of the 49 women evaluated, 17 (28%) elected delayed implant-based breast reconstruction. No patients experienced major complications at the longest follow up. Conclusion Elderly women undergoing with mastectomy should be offered breast reconstruction as part of their treatment. Physicians and patients need to be educated regarding surgical options, the minimal associated morbidity and mortality, and excellent functional and cosmetic outcomes. With extended life expectancy, breast reconstruction enhances these aspects of quality of life. Future management guidelines should include breast reconstruction in the algorithm. from XXI Annual Meeting of The Italian Society of Geriatric Surgery Terni, Italy. 4–6 December 2008