The impact of MYC and BCL2 structural variants in tumors of DLBCL morphology and mechanisms of false-negative MYC IHC

• Published in: Blood 2021-04, Vol.137 (16), p.2196-2208
• Main Authors: Collinge, Brett, Ben-Neriah, Susana, Chong, Lauren, Boyle, Merrill, Jiang, Aixiang, Miyata-Takata, Tomoko, Farinha, Pedro, Craig, Jeffrey W., Slack, Graham W., Ennishi, Daisuke, Mottok, Anja, Meissner, Barbara, Chavez, Elizabeth A., Gerrie, Alina S., Villa, Diego, Freeman, Ciara, Savage, Kerry J., Sehn, Laurie H., Morin, Ryan D., Mungall, Andrew J., Gascoyne, Randy D., Marra, Marco A., Connors, Joseph M., Steidl, Christian, Scott, David W.
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.2020007193

When the World Health Organization defined high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (HGBL-DH/TH) as a clinical category, rearrangements were the only structural variant (SV) incorporated. An “atypical double-hit” category has been proposed, encompassing tumors with concurrent MYC and BCL2 SVs other than cooccurring translocations (ie, copy number variations [CNVs]). Although the identification of a gene expression signature (DHITsig) shared among tumors harboring MYC and BCL2 rearrangements (HGBL-DH/TH-BCL2) has confirmed a common underlying biology, the biological implication of MYC and BCL2 CNVs requires further elucidation. We performed a comprehensive analysis of MYC and BCL2 SVs, as determined by fluorescent in situ hybridization (FISH), in a cohort of 802 de novo tumors with diffuse large B-cell lymphoma morphology. Although BCL2 CNVs were associated with increased expression, MYC CNVs were not. Furthermore, MYC and BCL2 CNVs, in the context of atypical double-hit, did not confer a similar gene expression profile as HGBL-DH/TH-BCL2. Finally, although MYC immunohistochemistry (IHC) has been proposed as a screening tool for FISH testing, 2 mechanisms were observed that uncoupled MYC rearrangement from IHC positivity: (1) low MYC messenger RNA expression; and (2) false-negative IHC staining mediated by a single-nucleotide polymorphism resulting in an asparagine-to-serine substitution at the 11th amino acid residue of MYC (MYC-N11S). Taken together, these results support the current exclusion of MYC and BCL2 CNVs from HGBL-DH/TH and highlight the ability of a molecular-based classification system to identify tumors with shared biology that FISH and IHC fail to fully capture. •Although BCL2 CNVs produce aberrant expression, MYC CNVs do not, and neither MYC nor BCL2 CNVs confer a similar biology as HGBL-DH/TH-BCL2.•MYC-N11S polymorphism is associated with false-negative IHC staining, a mechanism of IHC negativity in MYC rearranged tumors. [Display omitted]