MBL in Blood Donors: An Extended Immunophenotypic Analysis of CLL-like, CD5+ MBL.

Transcription

1 1 th Canadian CLL Meeting Winnipeg, Manitoba Inn at the Forks September 18-19, 214 MBL in Blood Donors: An Extended Immunophenotypic Analysis of CLL-like, CD5+ MBL. Fatima Abbasi 1, Justin Meskas 2, Ryan Brinkman 2 and GE Marti 3 CBER FDA, Silver Spring, MD University of British Columbia, Vancouver, British Columbia, Canada and Potomac, MD. Gerald Marti, MD PhD CDRH FDA, NHLBI, NCI, NIH Bethesda and Silver Spring, MD (No Conflict of Interest Declared)

2 Monoclonal B Cell Lymphocytosis (MBL) in Healthy Blood Donors: an unexpectedly Common finding Youn Shim, Jane Rachel, Paolo Ghia, Jeff Boren, Fatima Abbasi, Antonis Dagklis, Geri Venable, Jiyeon Kang, Heba Degheidy, Fred Plapp, Robert Vogt, Jay Menitove and Gerald Marti ATSDR and CDC Atlanta, GA; SLH and Community Blood Center, Kansas City, MO; Scientific Institute and Universita' Vita Salute San Raffaele Milan, Italy CBER, CDRH, FDA

3 Abstract. MBL in 149 (7.1%) of 298 unique donors Ages >45 years Midwestern U.S. regional blood center Low-count MBL, 99 CLL-like (66.4%), 22 atypical (14.8%) 9 CD5 (12.8%) 4-biclonal (2.7%) Five donors (3.4%) B-cell clonal counts above 5 cells/µl, including three with cells/µl Of 51 MBL samples IGHV-D-J genotypes 71% and 29% used IGHV3- and IGHV4-family gene 82% with somatic hypermutation,18% had germ-line identity MBL prevalence is much higher in blood donors than previously reported and, although uncommon, the presence of high-count MBL warrants further investigations to define the biological fate of the transfused cells in recipients.

4 a systematic study of MBL prevalence in blood donors Six color screening panel: (CD19, CD2, CD5, CD45 and κ/λ immunoglobulin light chains). Eight color confirmation panel (separate slide) 5, events BD Biosciences FACSCanto II flow cytometer. Gating Strategy sub classification of MBL PCR amplification, and IGHV IGHD IGHJ gene rearrangements were sequenced when possible.

5 Results. Median age donors 57 years (range years) and 54 % were men. Median WBC, ALC, BALC: 57/µl (range 245/µl 1692/µl), 176/µl (range 49/µl 521/µl) 171/µl (range 14/µl 2925/µl) History of cancer was reported in 114 (5.4%) of the 298 donors. (11.4% of 114) than donors who did not have (6.8% of 1983), HCV was positive in four individuals (No MBL) None tested positive for HBV or HIV.

6 Table 1: Age- and gender-specific prevalence of MBL among 298 blood donors ages 45 years or older in a Midwestern U.S. regional blood center between 21 and 211 Age Women N PE (95% CI) Men N PE (95% CI) All* N PE (95% CI) years 7/ (.7 3.5) 24/ ( ) 31/ ( ) years 27/ (5. 1.8) 38/ ( ) 65/ ( ) 65 years or older 18/ ( ) 35/ ( ) 53/ ( ) All ages 52/ (4. 7.) 97/ (7. 1.4) 149/ (6. 8.3) *The denominators in this column include a total of 4 donors whose gender was unreported. Number of donors with MBL / number of all donors in the category Prevalence estimate per 1 persons

7 The clonal count was much higher (median 333/µl, 1 th 9 th percentiles ) in the subset of MBL donors in whom more than 8% of the B cells were clonal.

8 Table 2: Adjusted prevalence ratios (PR) of MBL 95% CI P-value Adjusted PR Gender Men 1.5* Women 1 (ref) Age >64 years < years years 1 (ref) *Adjusted for age. Adjusted for gender.

9 Table 3: Germline and somatic hypermutation status of IGHV gene in 5 MBL cases MBL subtype Mutated N (%) Unmutated* N (%) Total N (%) CLL-like 25 (8.6) 6 (19.4) 31 (1) Atypical 7 (87.5) 1 (12.5) 8 (1) CD5 9 (81.8) 2 (18.2) 11 (1) Total 41 (82.) 9 (18.) 5 (1) *Having a greater than or equal to the 98% germline identity. Includes 5 cases with 1% homology to the corresponding germ-line sequence: 4 CLL-like (2 IGHV3-74, 1 IGHV3-48, and 1 IGHV4-59) and 1 atypical MBL (IGHV3-23). There is not a statistically significant relationship between MBL subtype and somatic hypermutation status (Fisher s exact test, p=1).

10 Table 4. IGHV-D-J rearrangements and IGHV mutational status in 13 MBL cases who had a clonal B-cell count above 165/µl I D MBL subtyp e Ag e Histor y Cance r* WBC ALC BAL C Clon al B- cell kapp a/ lam bda IGHV IGHD IGHJ IGH D RF HCDR 3 length Mutation (%) 1 CLLlike 57 No n/a n/a n/a n/a n/a n/a 4 CLLlike 8 Atypica l 9 Atypica l No No Yes Yes No No No Yes CD5 71 No CD5 53 No CD5 58 No CD5 67 No IGHV3-33 IGHV CLLlike IGHD3-22*1 3 CLLlike IGHD6-19*1 IGHJ3* 2 IGHJ4* mutated (97.6) 1 13 mutated (93.7) n/a n/a n/a n/a n/a n/a IGHV3-74 IGHV4-34 IGHV3-48 IGHV3-64 IGHV3-23 IGHV3-15 IGHV CLLlike IGHD6-19*1 6 CLLlike IGHD3-1*1 7 CLLlike IGHD4-23*1 IGHD2-21*2 IGHD6-13*1 IGHD3-1*1 IGHD2-21*2 IGHJ6* 2 IGHJ5* 1 IGHJ5* 1 IGHJ6* 3 IGHJ4* 1 IGHJ6* 2 IGHJ4* unmutated (1) 2 23 mutated (91.3) 2 18 unmutated (1) 2 16 mutated (88.3) 1 14 mutated (97.) 3 17 unmutated (98.2) 3 16 mutated (93.2) n/a n/a n/a n/a n/a n/a IGHV3-49 IGHD5-12*1 IGHJ4* 1 n/a: data not available. IGHD RF: IGHD reading frame. *History of any cancer Absolute cell count / µl Somatic hypermutation status of IGHV gene (percent homology to the corresponding germ-line sequences) 2 14 mutated (95.3)

11 Figure 2. Clonal B-cell counts among 11 CLL-like MBL cases

12 Figure 3. Clonal B-cell counts among 23 atypical and 21 CD5 MBL cases

13 Figure 4. IGHV gene repertoires in 51 MBL cases

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15 Evolved Panel 2 FITC PE PerCP APC PE Cy7 APC Cy7 Pacific Blue V5 1 stained cells efluer 2 CD45 3 CD45 4 CD2 PerCP 5 CD19PerCP CD45 6 Cy5.5 CD5 7 CD19 8 CD3 CD2 9 CD45 1 Unstained 2 Kappa Lambda CD2 CD22 CD5 CD19 CD19 CD45 PerCP 3 CD27 CD38 CD69 CD23 CD5 CD19 CD2 CD45 PerCP 4 IgM IgD CD2 CD5 CD1 CD19 CD11c CD45 PerCP 5 CD79b Lambda CD19 Kappa CD5 CD3 CD2 CD45 onal PerCPCy55 6 CD3 CD56+16 CD45 CD19 CD4 CD8

16 Gating Strategy for MBL Detection 25K 25K 2K 2K SSC-A 15K 1K FSC-H 15K 1K K 5K 5K 1K 15K 2K 25K FSC-A 5K 1K 15K 2K 25K FSC-A

17 Gating Strategy for MBL Detection <PE-A>: Lambda <APC-A>: CD <PE-A>: Lambda <FITC-A>: Kappa <PerCP-Cy5-5-A>: CD2 PerCP <FITC-A>: Kappa <PE-A>: Lambda <PE-A>: Lambda <FITC-A>: Kappa <FITC-A>: Kappa

18 Original Three CDC Cases

19 CD5+CLL-Like MBL Atypical MBL CD5-MBL

20 Cluster Analysis: Data Set 99 CLL-like, 22 atypical, 9 CD5 negative 4-biclonal, 2 normal immune-phenotypes. Unsupervised clustering was unsuccessful. Gating Strategy not optimal: scatter vs CD2/CD19 Small populations overshadowed by other cell populations Manual Analysis CD5+ CLL-Like ranked ordered by clone size Light chain restriction (mono-typic expression) was separated from polyclonal B cells. This step served as a positive internal control..

21 CLL Like MBL

22 84_99421

23 154

24 45 1

25 45 2

26 <PE-A>: Lambda <APC-A>: CD <PE-A>: CD <PE-Cy7-A>: CD <PerCP-Cy5-5-A>: CD <FITC-A>: Kappa <PerCP-Cy5-5-A>: CD <PerCP-Cy5-5-A>: CD <APC-Cy7-A>: CD <APC-A>: CD11c <PE-A>: CD <PE-A>: IgD

27 25 1

28 25_ <PE-A>: Lambda <FITC-A>: Kappa <PE-A>: Lambda <FITC-A>: CD <PE-A>: CD <APC-Cy7-A>: CD27 H <FITC-A>: Kappa <PerCP-Cy5-5-A>: CD <PerCP-Cy5-5-A>: CD <PerCP-Cy5-5-A>: CD <PE-Cy7-A>: CD <FITC-A>: CD <APC-A>: CD <PerCPC 55A> CD

29 29

30 23 1

31 23 2

32 12

33 93

34 26_57697

35 96 1

36 96 2

37 <APC-Cy7-A>: CD <PE-A>: Lambda <PE-Cy7-A>: CD <PE-A>: Lambda <PE-A>: Lambda <PerCP-Cy5-5-A>: CD2 PerCP FSC-A, SSC-A subset CDC_12758_ _Tube_2.fcs Event Count: <FITC-A>: Kappa <<PerCP-Cy5-5-A>, <<APC-Cy7-A> subset CDC_12758_ _Tube_2.fcs Event Count: <PerCP-Cy5-5-A>: CD2 PerCP <<PerCP-Cy5-5-A>, <<APC-Cy7-A> subset CDC_12758_ _Tube_2.fcs Event Count: <FITC-A>: Kappa clone CDC_12758_ _Tube_2.fcs Event Count: <FITC-A>: Kappa NRB CDC_12758_ _Tube_2.fcs Event Count: <PE-A>: Lambda <PE-A>: Lambda <PE-A>: Lambda <APC-A>: CD <PE-A>: CD <FITC-A>: Kappa CD5 brt CD2brt CDC_12758_ _Tube_2.fcs Event Count: <FITC-A>: Kappa IntermedCD5 CDC_12758_ _Tube_2.fcs Event Count: <FITC-A>: Kappa CD5-CD2brt CDC_12758_ _Tube_2.fcs Event Count: <Pacific Blue-A>: CD2 All B cells CDC_12758_ _Tube_3.fcs Event Count: <Pacific Blue-A>: CD2 All B cells CDC_12758_ _Tube_3.fcs Event Count: <FITC-A>: CD <PerCP-Cy5-5-A>: CD69 PerCP <PE-Cy7-A>: CD <PE-A>: IgD <FITC-A>: IgM <Pacific Blue-A>: CD2 All B cells CDC_12758_ _Tube_3.fcs Event Count: <Pacific Blue-A>: CD2 All B cells CDC_12758_ _Tube_3.fcs Event Count: <PerCP-Cy5-5-A>: CD19 CD19 B cells CDC_12758_ _Tube_4.fcs Event Count: <PerCP-Cy5-5-A>: CD19 CD19 B cells CDC_12758_ _Tube_4.fcs Event Count: <PerCP-Cy5-5-A>: CD19 CD19 B cells CDC_12758_ _Tube_4.fcs Event Count: 28557

38 <Pacific Blue-A>: CD <PE-A>: Lambda <APC-A>: CD <PE-A>: Lambda <PE-A>: Lambda <PerCP-Cy5-5-A>: CD2 FSC-A, SSC-A subset CDC_47521_#2_K,2f,LBD.fcs Event Count: <FITC-A>: Kappa <<PerCP-Cy5-5-A>, <<Pacific Blue-A> subset CDC_47521_#2_K,2f,LBD.fcs Event Count: <PerCP-Cy5-5-A>: CD2 <<PerCP-Cy5-5-A>, <<Pacific Blue-A> subset CDC_47521_#2_K,2f,LBD.fcs Event Count: <FITC-A>: Kappa Clone CDC_47521_#2_K,2f,LBD.fcs Event Count: <FITC-A>: Kappa NRB CDC_47521_#2_K,2f,LBD.fcs Event Count: <PE-A>: Lambda <PE-A>: Lambda <PE-A>: Lambda <APC-A>: CD <PE-A>: CD <FITC-A>: Kappa CD5brt CDC_47521_#2_K,2f,LBD.fcs Event Count: <FITC-A>: Kappa CD5 Intermediate CDC_47521_#2_K,2f,LBD.fcs Event Count: <FITC-A>: Kappa Cd5dim CDC_47521_#2_K,2f,LBD.fcs Event Count: <PerCP-Cy5-5-A>: CD2 All B cells CDC_47521_#3-CD2Cd79b.fcs Event Count: <PerCP-Cy5-5-A>: CD2 All B cells CDC_47521_#3-CD2Cd79b.fcs Event Count: <FITC-A>: CD <APC-A>: CD <PE-Cy7-A>: CD <PE-A>: IgD <FITC-A>: IgM <PerCP-Cy5-5-A>: CD2 <<PerCP-Cy5-5-A>, <<APC-Cy7-A> subset CDC_47521_#5_CD27,2f,CD22,2f,CD11c.fcs Event Count: <Pacific Blue-A>: CD2 B CDC_47521_#4-IgM,2f,IgD.fcs Event Count: <PerCP-Cy5-5-A>: CD2 All B cells CDC_47521_#3-CD2Cd79b.fcs Event Count: <Pacific Blue-A>: CD2 B CDC_47521_#4-IgM,2f,IgD.fcs Event Count: <Pacific Blue-A>: CD2 B CDC_47521_#4-IgM,2f,IgD.fcs Event Count: 1675

39

40 Table 1 CD 22 CD 25 CD ID K/L CD CD CD CD Ig Ig CD CD 1 clone 79b C M D K + + +** dim dim K dim + bimodamodamodal bi bi B + + comb? 25 K + + dim dim K + + dim dim L* + Neg Neg K + Neg Neg Neg L + bimodal + dim dim K K [ ] 154 Monoty pic [ ] + bimodal Neg dim dim Neg Neg Neg + +

41 Immunophenotype: Findings and Interpretation CD45+/CD19+/CD2dim/CD5+/CD23+/CD27+/CD69+. CD1 and CD79b were negative CD38 was variable with IgM and IgD varying from dim to negative. Memory B cell or perhaps a Naïve B cell Neither immature nor a plasma blast. Suggests the potential for subsets in this main group.

42 Conclusions MBL prevalence higher in blood donors than previously reported high-count MBL warrants further investigations to define the biological fate of the transfused cells in recipients. Further analysis of B cell subsets also seems warranted. Blood InSight Editorial: look-back study at donors of CLL or MBL recipients formation of a blood donor clinical MBL cohort for longitudinal study would be equally valuable InFinicyte Cluster Anaysis

43 Past and Present Model CLL Evolution Increased understanding of multiple pathways to final CLL clone

44 Present Model CLL Evolution Increased understanding of multiple pathways to final CLL clone

45 Natural History of MBL and CLL G e n e t i c E v e n t s Pre- MBL CD5+ MBL +/- d13q14 Early CLL Rai Binet A Symptomatic Refractory CLL Richters/PL Rai III/IV Transformation Binet C Interaction with antigen and microenvironment

46 Natural History of MBL G e n e t i c E v e n t s Lo Count MBL mutated Intermediate Count MBL Mutated 13q14 del High Count MBL Complex Karyotype Interaction with antigen and microenvironment

47 Mulligan et al Leukemia & Lymphoma, Early Online, 1 6, MBL: 322 MBL [cll] and 92 MBL[nhl]

48