Witzig, Thomas E.

Abstract Abstract 2656 Background Treatment of non-Hodgkin lymphoma (NHL) can lead to development of cardiovascular disease (CVD). We sought to describe the cumulative incidence of CVD in adult NHL survivors diagnosed in the recent treatment era (since 2002) and identify clinical and treatment predictors for its development. Methods All patients were from the Mayo component of the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (SPORE). The MER offers enrollment to all consecutive patients with newly diagnosed NHL who are US residents and age >18 years. Clinical data from the time of diagnosis and treatment data are abstracted from medical records using a standard protocol. Patients are prospectively contacted via telephone or in person per protocol every 6 months for the first 3 years from diagnosis and yearly afterwards to assess disease status and development of comorbid conditions. CVD events, including heart failure (HF), myocardial infarction (MI), arrhythmia, pericarditis, and valvular heart disease, occurring after diagnosis were identified during follow-up and validated against medical records. HF was validated with the Cardiovascular Health Study Criteria and/or the Framingham Criteria. MI was validated using case definition standards of coronary heart disease, while arrhythmia, pericarditis, and valvular heart disease were validated using clinical definitions. The prevalence of CVD and associations between CVD and clinical characteristics (sex, age) and treatment (radiation, anthracyclines) were performed using Cox models with a competing risk approach. Results 1164 patients with NHL were enrolled into the MER at Mayo Clinic between 9/1/2002–2/28/2008. 646 were male (56%) and median age at diagnosis was 62 years (range 20–93). Median follow-up of all cases was 59 months (range 1–105). 131 patients reported CVD prior to the diagnosis of NHL and were excluded from analyses. An additional 76 patients did not have follow-up and were excluded. Of the 957 remaining patients, 75 (7.8%) self-reported a new diagnosis of CVD. Of these, 71 cases had available medical records. 57 of the 71 reviewed cases (80%) were validated (18 HF, 9 MI, 21 arrhythmia, 2 pericarditis, and 10 valvular heart disease). Cumulative incidence of CVD at 1, 3, 5, and 7 years was 1.3%, 3.7%, 5.2%, and 7.4%, respectively. Median time from NHL diagnosis to CVD was 26.5 months (range 1–84). Older age was associated with increased risk of overall CVD (p-value<0.001). Gender (p=0.59), radiation therapy (p=0.61), and anthracycline treatment (p=0.25) were not associated with the incidence of overall CVD. Among types of CVD, anthracycline use was associated with development of HF (HR=5.30; p-value=0.008) and arrhythmia (HR=2.68; p-value=0.04). Radiation was associated with development of arrhythmia (HR=2.73; p-value=0.03), while older age was associated with development of HF (HR=1.36 per 5 year increment; p-value=0.003) and arrhythmia (HR=1.25 per 5 year increment; p-value=0.02). Conclusions The risk of CVD in patients with NHL is approximately 1% per year after the initial diagnosis of lymphoma. The most commonly occurring CVDs in this cohort of NHL survivors were arrhythmia and HF. Treatment with anthracyclines and radiation are associated with increased risk of developing some types of CVD. 80% of self-reported CVD events in NHL survivors were validated using epidemiologic criteria. Future studies will include building models incorporating comorbid health conditions and lifestyle factors to determine risk of CVD as well as the impact of CVD on quality of life. Disclosures: No relevant conflicts of interest to declare.

Abstract The mammalian target of rapamycin (mTOR) exists in two complexes, mTORC1 and mTORC2. Most mTOR inhibitors used for hematologic diseases such as rapamycin, everolimus, and temsirolimus are considered mTORC1 inhibitors and do not target mTORC2. The central role of the mTOR kinase in controlling cell growth has sparked interest in discovering mTOR inhibitors that bind to the ATP active site and therefore target both mTORC2 and mTORC1. mTOR also regulates protein synthesis by phosphorylating the P70S6-Kinase and the eIF4E-binding-protein, 4EBP1. The effect of active site dual mTOR inhibitors on cap dependent translation has not been investigated in lymphomas. In this study we moved beyond the effect of the dual mTOR inhibitor CC214-1 (Celgene Pharmceuticals) on the mTORC2/AKT pathway to focus on its effects on cap dependent protein translation. Cap dependent translation is regulated by the translation initiation complex eIF4F (eIF4E-eIF4G-eIF4A). First, we assessed the formation of the active eIF4F (m7GTP-eIF4E-eIF4G) translation complex by a pull down assay using agarose-immobilized m7GTP cap analog to capture eIF4E and its binding partner in lymphoma cell lines (Jeko, Mino, Granta and JVM2, Ly3, Ly1, DHL6) and in primary cells (n=5). Our data demonstrate that the cap bound fraction from normal B cells contain very little eIF4G and eIF4A; however, lymphoma cells were enriched with eIF4G, eIF4E and eIF4A. Increased mRNA of eIF4E and eIF4G was observed in all lymphoma cell lines tested as compared to normal B-cells. 150 untreated diffuse large B cell lymphoma samples were stained for eIF4E by immunohistochemistry and 76% (135/150) were found eIF4E positive. Taken together, these data suggest that lymphoma cells exist in a translational activated state compared to normal B-cells. Next, we examined the effect of the dual mTOR inhibitor CC214-1 on the integrity of the eIF4F complex. In the CC214-1 treated cells the quantity of the eIF4E bound to 4EBP1 was increased whereas the amount of the eIF4E bound to eIF4G was decreased in the CC214-1 treated lymphoma cells but not in those treated with a selective mTORC1 agent (everolimus). We also found that the phosphorylation of 4EBP1 that controls protein synthesis is partially resistant to everolimus/rapamycin but fully suppressed with CC214-1. CC214-1 had a dose-dependent inhibitory effect on lymphoma cell survival; however, everolimus and rapamycin were only cytostatic. Moreover, CC-214 was much more potent than rapamycin and everolimus in blocking protein translation measured by the leucine incorporation assay. To elucidate the role of the eIF4E complex in the response to CC214-1, we transiently expressed WT-eIF4E plasmid in Jeko cells and then treated with CC214-1. Ectopic expression of wt-eIF4E led to a loss in the CC-214-1 dependent decrease in the eIF4E bound eIF4G as compared with the control plasmid. Moreover, overexpression of eIF4E also protected against CC214-1-induced apoptosis. To evaluate the efficiency of cap-dependent translation in the presence of CC214-1 and rapamycin, we used the bicistronic reporter assay where translation initiation of the first cistron is dependent on the 5′ cap, whereas initiation of the second cistron depends on a viral internal ribosome entry site. Transfection of this plasmid in CC214-1 treated cells caused a significant decrease in cap-dependent, but not IRES-dependent, translation. We next looked the effect of CC214-1 on the eIF4E regulated translationally active mRNA targets. We isolated eIF4E known mRNA targets (Myc, Cylin D1, Cyclin D2 and MCL-1) by immunoprecipitation assays using eIF4E antibody (mRNA-IP). CC214-1 treated RNA-IP data showed decreased expression of Myc but not the other mRNA targets. Myc is highly expressed in the DLBCL tumors and would be a good prognostic or predictive biomarker for CC214-1 therapy. Translation deregulation is an important mechanism that causes aberrant cell growth in lymphoma cells. Currently, there is a need to identify additional agents that target this pathway. These studies provide a mechanistic basis of targeting cap dependent translation in lymphoma through next generation dual mTOR inhibitors. This study also suggests eIF4E (indicative of activated eIF4F complex) as a potential biomarker for the selection of patients for next generation mTOR inhibitors clinical trials in lymphoma patients. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 2682 Background: The PI3K-Akt pathway is critical to tumor growth in lymphoid malignancies and mTOR inhibitors have shown promising activity in lymphoid malignancies. However, alternate signaling pathways allow cells to escape the effect of mTOR inhibition. Pre-clinical studies have shown that the combination of LBH589, an HDAC inhibitor, with the mTOR inhibitor RAD001 results in potent synergy. We then explored this combination in a phase I/II clinical trial. Patients and Methods: Patients with relapsed multiple myeloma (MM), non-Hodgkin lymphoma (NHL) or Hodgkin Lymphoma (HL) were enrolled into a phase I trial of escalating doses of LBH589 and RAD001. The doses are shown in the table. The study utilized a 3+ 3 design with MTD defined as the maximum dose resulting in less than 2 dose limiting toxicities (DLT) during the first cycle among 6 patients treated at that dose. DLT was defined as a grade 4 neutropenia or thrombocytopenia lasting >= 7 days, febrile neutropenia or any other grade >=3 non-hematologic toxicity considered possibly related to the drugs. Once MTD was determined, patients were enrolled into two separate phase 2 studies, one for relapsed MM and another for relapsed NHL or HL. Results: Twenty-six patients were enrolled to the phase 1 study; 23 were eligible for MTD analysis. There were 16 patients with NHL, 4 with HL and 3 with MM. Median age was 61 (range, 24–73) and 17 were male. The median number of prior therapies was 4 (range 2–11), including a prior stem cell transplant in 11 (48%). No DLT was observed at any of the doses tested in the trial (See below). Hematological toxicities were the most common AEs observed, with a grade 3 or 4 hematologic AE in 15 patients and grade 3 or 4 non-hematologic AEs in 6 patients across all cycles administered. Grade 3 and 4 hematologic AEs included 10 patients with neutropenia and 8 patients with thrombocytopenia. Grade 3 and 4 non-hematologic AEs included hyperglycemia, hypertriglyceridemia, hypophosphatemia, diarrhea, pneumonia and mucositis in one patient each. Overall, 10 responses (43%) were seen (Table). Conclusions: The combination of LBH589 and RAD0001 is tolerated at the doses tested, with hematological toxicities being the most common adverse events. The recommended phase II dose is LBH 40 mg MWF every other week along with 5 mg RAD001 every day in 4-week cycles. Clinical efficacy was seen in all diseases tested with partial responses seen in NHL and HL as well as a minor response in a patient with refractory myeloma, who had previously failed single agent RAD001. Phase 2 trials are ongoing in both disease groups. Disclosures: Kumar: Merck: Consultancy, Honoraria; Celgene: Consultancy, Research Funding; Millennium Pharmaceuticals, Inc.: Research Funding; Genzyme: Research Funding; Novartis: Research Funding. Off Label Use: Use of the investigational agent MLN9708 for the treatment of previously untreated multiple myeloma. Lacy:Celgene: Research Funding. Reeder:Celgene: Research Funding; Millennium Pharmaceuticals Inc.: Research Funding; Novartis: Research Funding.

Abstract Abstract 3642 Purpose: The reactive pathologic background in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) consists of lymphocytes and histocytes. Lymphopenia is a negative prognostic factor in NLPHL as it is also in Classical Hodgkin Lymphoma (cHL). In cHL, tumor-associated macrophages recruited from circulating monocytes are a negative prognostic factor for survival. Thus, we studied if the peripheral blood absolute lymphocyte count/absolute monocyte count ratio at diagnosis (ALC/AMC-DX), as a surrogate biomarker of the host response against the neoplastic lymphocytic and/or histiocytic (L&H) cells, affects survival in NLPHL. Patients and Methods: We performed a retrospective analysis of the association between ALC/AMC-DX and survival in 103 consecutive NLPHL patients that were followed at Mayo Clinic from 1974 to 2010. Receiver operating characteristic (ROC) and area under the curve (AUC) were used for ALC/AMC-DX cut-off value analysis and proportional-hazards models were used to compare survival based on the ALC/AMC-DX ratio. Results: The cohort included 67 (65%) males and 36 (35%) females. Eighty-three percent of patients presented with stage I/II and 17% with stage III/IV. Sixty-five (63%) patients were treated with radiation alone; 20 (20%) patients with chemotherapy alone; and 18 (17%) patients with chemotherapy and radiation. The median follow-up period was 8.9 years (range: 0.3–31 years). An ALC/AMC-DX ≥ 2.1 was the best cut-off value for survival with an empirical AUC of 0.82 (95% confidence interval [CI], 0.78 to 0.88), a sensitivity of 70% (95% CI, 61% to 76%) and specificity of 84% (95%CI, 59% to 82%). The cut-off value for ALC/AMC-DX ≥ 2.1 was validated by the k-fold cross validation method, showing a cross validation ROC with an AUC of 0.82 (95% CI, 0.72 to 0.93) for an ALC/AMC-DX ≥ 2.1. Using Kaplan-Meier analysis, we studied overall survival (OS), lymphoma-specific survival (LSS), progression-free survival (PFS), and time to progression (TTP) based on ALC/AMC-DX ≥ 2.1. Patients with an ALC/AMC-DX ≥ 2.1 experienced an superior OS, LSS, PFS, and TTP compared with patients with an ALC/AMC-DX < 2.1: [OS: median was 22.1 years vs 6.3 years, 10-years OS rates of 89% (95%CI, 80% to 98%) vs 44% (95%CI, 27% to 65%), p < 0.0001, respectively; LSS: median was not reached vs 7.3 years, 10-years LSS rates of 99% (95%CI, 90% to 100%) vs 45% (95%CI, 29% to 67%), p < 0.0001, respectively; PFS: median was 20.6 years vs 4.6 years, 10-years PFS rates of 84% (95%CI, 80% to 97%) vs 26% (95%CI, 18% to 55%), p < 0.0001, respectively; and TTP: median was not reached vs 5.5 years, 10-years TTP rates of 93% (95%CI, 85% to 99%) vs 29% (95%CI, 19% to 57%), p < 0.0001, respectively]. After adjusting for the International Prognostic Factors and the International Prognostic Score, ALC/AMC-DX remained an independent prognostic factor for OS {hazard ratio (HR), 0.42, 95%CI, 0.23 to 0.64, p< 0.004]; LSS [HR, 0.14; 95%CI, 0.04 to 0.23, p <0.0004]; PFS [HR, 0.14; 95%CI, 0.03 to 0.34, p < 0.001], and TTP [HR, 0.16, 95%CI, 0.04–0.34, p <0.002]. Conclusion: ALC/AMC-DX is an independent prognostic factor for survival and provides a single biomarker to predict clinical outcomes in NLPHL. Disclosures: No relevant conflicts of interest to declare.

Abstract Background IL-10 polarized macrophages promote tumor growth and survival. The T-cell transcription factor GATA binding protein-3 (GATA3) epigenetically regulates IL10 expression. Therefore, we investigated the extent to which GATA-3 regulates IL-10 production and macrophage polarization in T-cell lymphomas. Methods Monocyte-derived macrophages were generated and polarized with T-cell lymphoma conditioned media ((TCL-CM). Immunophenotypic and functional characteristics associated with IL10-polarized macrophages were examined. GATA3-dependent cytokine production was evaluated in T-cell lymphoma lines by shRNA knockdown. Alternatively polarized macrophages and GATA3 expression were examined in a cohort of patients with peripheral T cell lymphoma, not otherwise specified (PTCL, NOS) (n=76). Comparisons among groups were evaluated using a Student's t test. Progression-free and overall survival (PFS & OS) was estimated using the Kaplan-Meier method and two-tailed log-rank test based on Cox proportional hazards model. Results To investigate the ability of T-cell lymphomas to alternatively polarize macrophages, monocytes from healthy donors were cocultured with TCL-CM. Macrophages were shown to have immunophenotypic characteristics of IL10-polarized macrophages (pSTAT3+/CD16hi/CD163hi/HLA-DR-/lo) by flow cytometry, which was abrogated by IL10, but not IL6, neutralization. TCL-CM polarized macrophages produced abundant IL-10 and were impaired in their ability to stimulate T-cell proliferation. Collectively, these results demonstrate that T-cell lymphomas promote alternative macrophage polarization in an IL-10 dependent manner, and both CD163 and pSTAT3 may aid in their identification in clinical T-cell lymphoma specimens. Therefore, CD163+/pSTAT3+ macrophages were visualized by immunofluorescence in PTCL, NOS specimens. IL-10 polarized macrophages were not identified in normal tissues, but were abundant constituents of the tumor microenvironment in 68% of the PTCL, NOS specimens examined (n=31). STAT3 phosphorylation in response to IL-10 is dependent upon the Janus kinases (JAK) JAK1 and TYK2, both of which are inhibited at nanomolar (and clinically achievable) concentrations by the “JAK2” inhibitor ruxolitinib. Therefore, we sought to determine whether ruxolitinib may prevent IL-10-induced macrophage polarization. As expected, ruxolitinib inhibited IL-10-induced STAT3 phosphorylation. More importantly, macrophages polarized in the presence of ruxolitinib lost the immunophenotype characteristics of IL-10 polarized macrophages, and were CD16-/loCD163-/loHLA-DRhi. Furthermore, IL-10 production was significantly impaired in macrophages polarized in the presence of ruxolitinib, while their ability to stimulate T-cell proliferation was significantly increased. In a separate initiative, we identified GATA3 as the key regulator of IL-10 and Th2 cytokine (IL-4, IL-13 and IL-5) expression in T-cell lymphoma lines by shRNA knockdown assays. Therefore, we examined GATA3 expression by immunohistochemistry in PTCL, NOS specimens. GATA-3 expression was observed in most of the T-cell lymphoma lines and in 47% of PTCL, NOS specimens (n=76). In the cohort of the 76 PTCL, NOS patients, the median PFS and OS observed in GATA3+ PTCL, NOS was 5 months (4-8 months, 95% CI) and 8 months (5-14 months, 95% CI), respectively. In contrast, the median PFS and OS in GATA3- PTCL, NOS was 1.3 years (0.6-1.6, 95% CI) and 1.6 years (0.7-6.9 95% CI), respectively. Conclusions Alternatively polarized macrophages are abundant in T-cell lymphomas and are generated in an IL-10- and STAT3-dependent manner. GATA-3 regulates IL-10 production in these lymphomas, and its expression identified a high-risk subset of PTCL, NOS with distinct clinicopathological features. As IL-10-dependent STAT3 phosphorylation and macrophage polarization were impaired by ruxolitinib, the JAK2 inhibitors may warrant closer scrutiny as immunomodulatory agents. Disclosures: Off Label Use: Ruxolitinib, a JAK2 inhibitor, may warrant closer scrutiny as an immunomodulatory agent in TCL therapeutics.

Abstract Background Relatively few studies have evaluated the role of host (germline) genetics in predicting outcome in diffuse large B-cell lymphoma (DLBCL), and of these, most were small candidate gene studies without replication and/or from the pre-R-CHOP era. We report the first genome-wide association study (GWAS) of outcome in DLBCL patients treated with rituximab and anthracycline-based chemotherapy. We used two independent studies for discovery, and validated the results in two additional independent studies. Methods In the discovery phase, we conducted a meta-analysis of two GWAS studies of DLBCL patients treated with rituximab and anthracycline-based chemotherapy, the first study as part of the prospective clinical trials of the LNH2003B program (N=540) of the Lymphoma Study Association (LYSA) and the second as part of the Molecular Epidemiology Resource (N=316), a prospective observational study from the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (SPORE). Genotyping for the GWAS was performed using the Illumina 610 (LYSA) and 660 Quad (SPORE) BeadArrays (Illumina, San Diego, USA). HapMap2 was used to impute additional SNPs. Association testing was conducted assuming a log-additive genetic model and using Cox regression analyses. We calculated the hazard ratios (HRs) and 95% CIs for event-free survival (EFS), with adjustment for age, sex and age-adjusted IPI. The two studies were then combined using the fixed effects inverse variance method based on the beta estimates and standard errors from each study. From the meta-analysis, 89 SNPs were selected for validation, based on a minor allele frequency (MAF) >0.05 and LD pattern for multiple SNPs from the same region. Validation cohorts were an independent set of DLBCL patients from the SPORE (SPORE-2, N=366) and DLBCL patients from the prospective GOELAMS 075 phase III study (N=294), and validation genotyping was conducted using the Illumina VeraCode platform. We then conducted a meta-analysis of the 4 studies. We report SNPs with both a statistical significance of p<5x10-6 and effect sizes in the same direction across the 4 studies in the meta-analysis. For the latter SNPs, we also report the results for overall survival (OS), adjusted for age, sex and age-adjusted IPI. Results In the final meta-analysis of all four studies for the prediction of EFS, the top SNP was rs7765004 (MAF=0.30; HR=1.45; p=9.7 x 10-8) in the 6q21 region, which is near the MARCKS (myristoylated alanine-rich protein kinase C substrate) and HDAC2 genes. MARCKS encodes for a protein involved in cell mobility, while HDAC2 belongs to the histone deacetylase family. Additional SNPs from this region included rs6918103 (MAF=0.25; HR=1.38; p=7.6 x 10-6), which marks an EZH2 histone binding site, and rs11969684 (MAF=0.12; HR=1.43; p=3.3 x 10-5). The next hit was rs7712513 (MAF=0.31; HR=1.40; p=3.2 x 10-7), which is near arginine-fifty homeobox pseudogene 1 (ARGFXP1) on chromosome 5q23.2. This was followed by a region on chromosome 8q13.3, with the SNP rs9298183 (MAF=0.29; HR=1.41; p=1.4 x 10-6) from LOC100132891 showing the strongest association, along with 3 other SNPs from this region (rs2035376, rs6472637, and rs1600797; all p<5 x 10-6). These SNPs are near the musculin gene (MSC) a transcriptional repressor of E2A frequently silenced by promoter methylation in DLBCL. Finally, rs2253986 (MAF=0.27; HR=1.39; p=3.4 x 10-6) at chromosome 16q12.2, along with rs2253971 and rs6499810, were associated with EFS. These SNPs are located in CES5A (carboxylesterase 5A), which encodes a member of the carboxylesterase family. The family members are responsible for the hydrolysis or transesterification of various xenobiotics. The top SNPs associated with EFS also predicted OS, including rs7765004 (HR=1.41; p=1.2 x 10-5), rs7712513 (HR=1.39; p=8.4 x 10-6), rs9298183 (HR=1.36; p=3.5 x 10-5), and rs2253986 (HR=1.35; p=5.2 x 10-5). Conclusions Although our top SNPs on did not reach genome-wide significance (p<5x10-8), they showed clear consistency across the four large prospective studies and predicted both EFS and OS independently of IPI. The strongest findings were from loci on 6q21, 8q13.3, 5q23.2, and 16q12.2, and several genes from these regions are involved in methylation and xenobiotic metabolism, supporting a role for host genetic variation in these pathways in DLBCL prognosis. Disclosures: No relevant conflicts of interest to declare.

Abstract Long noncoding RNAs (lncRNAs) are defined as RNA-like transcripts that are over 200 nucleotides and lack significant open reading frames. Some lncRNAs such as HOTAIR, MALAT1 and H19 have been found to be associated with clinical prognosis and are potential drivers of cancer progression in cancers of the breast, lung, and liver respectively. The role of lncRNAs in lymphoma is unknown. Dysregulation of eIF4E (a key component of the translation initiation complex eIF4F) influences global protein translation, especially the translation of “weak” mRNAs that can be malignancy-related. We and others have found that eIF4E is dysregulated in B-cell lymphoma. The aim of this study is to identify eIF4E-associated lncRNAs through next generation RNA-Sequencing (NGS RNA-Seq) and delineate their role in protein translation in lymphoma. RNA-immunoprecipitation (RNA-IP) was used to pull down eIF4E-bound lncRNA in lymphoma cells. eIF4E-bound lncRNAs were immunoprecipitated with eIF4E antibody or IgG control in Jeko, a mantle cell lymphoma (MCL) cell line and sent for microarray analysis and NGS-RNA-Seq for identification of lncRNAs. The microarray analysis showed that several lncRNAs were enriched with eIF4E antibody compared to IgG control. These included SNHG4 (13.6 fold), SNHG12 (4.8 fold), NCRNA00171 (4.8 fold) and IPW (4.6 fold), GNASAS (3.5 fold), SNHG7 (3.3 fold), NCRNA00182 (2.7 fold), NCRNA00094 (2.6 fold), NCRNA00188 (2.4 fold) and NCRNA00201 (2.1 fold). The binding of these lncRNAs to eIF4E was further confirmed by RT-PCR in Jeko, Mino and Granta MCL cell lines. Next, we looked the expression of these lncRNAs by qRT- PCR in the MCL cell lines and normal controls. We found SNHG4 and IPW to be overexpressed in all the MCL cell lines, while SNHG12 and NCRNA00201 were overexpressed in the selected cell lines. No significant difference was found for the expression of NCRNA00171 and NCRNA00182 in any of the MCL cell lines compared to controls. Overall, these data suggest that several lncRNA have altered expression in malignant B-cells. Considering that the microarray assay only covered a limited number of lncRNAs, we further confirmed eIF4E bound lncRNA by NGS RNA-Seq in Jeko MCL and normal control. The binding of 10/13 lncRNA mentioned above with eIF4E were found upregulated by NGS-RNA-Seq. In addition several novel lncRNAs such as SNHG1 (161.6), AC091814.2 (98.8) and RP11-304L19.5 (64.2) showed up in NGS-RNA-Seq data. These data suggest that lncRNAs, such as SNHG12, SNHG4, and SNHG1 bind to eIF4E with high affinity in malignant B-cells and might play a role in protein translation. We knocked down the expression of SNHG4 through siRNA and demonstrated that cell proliferation and global protein translation was inhibited in lymphoma cells. To further confirm the role of SNHG4 in translation regulation, a plasmid, which contains a renilla luciferase driven by SV40 promoter, was co-transfected with SNHG4 siRNA into Mino cells. The luciferase signal, decreased compared with the cells transfected with nontargeting siRNA. These data suggest that SNHG4 is involved in the regulation of protein translation. In order to clarify the mechanism of lncRNAs bound to eIF4E we searched for RNA binding sites or motifs in eIF4E protein using the web-based tools, BindN and PPRInt. Interestingly two RNA binding motifs, KNKRGGRWLITLNKQQRRS and SHADTATKSGSTTKNR, were found in eIF4E based on the prediction. To examine whether lncRNAs bind with eIF4E through these RNA binding motifs, an eIF4E mutant plasmid with both RNA binding motifs deleted (eIF4EDel), was constructed and transfected transiently into HEK-293T cells along with eIF4EWT plasmid. RNA-IP data showed that the lncRNAs SNHG12, SNHG4 and SNHG1 were not able to bind with eIF4E in eIF4EDel-transfected cells compared with that of eIF4EWT, suggesting that these lncRNAs complex with eIF4E through RNA-binding motifs within the eIF4E. Overall, our results show that the lncRNAs, SNHG1 and SNHG4 are able to bind with eIF4E and regulate protein translation. Since lncRNAs had been found to play roles in the regulation of gene expression, including transcription, splicing and mRNA stability, our results may broaden the view of the functional role of lncRNAs in translation in lymphoma cells and in other cancers. Furthermore, our results also suggested that SNHG4 lncRNAs might be served as potential biomarkers for MCL and other B cell lymphomas for translation therapy. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 3678 The JAK/STAT pathway is becoming a relevant target for lymphoma therapy and inhibitors of the pathway are now in clinical trial. It would be ideal to identify patients for trial by assessment of pathway activation. We analyzed the primary tumors from 50 patients with diffuse large B cell lymphoma (DLBCL) using antibody against phosphorylated tyrosine signal transducer and activator of transcription 3 (STAT3) revealed that 52% (21/40) of DLBCL tumors express tyrosine phosphorylated STAT3 (pSTAT3). There are several potential mechanisms of activation of the JAK/STAT pathway. Protein tyrosine phosphatases such as SHP1 are key negative regulators of this pathway. SHP-1 is also considered a tumor suppressor gene because of its ability to antagonize the action of tyrosine kinases. Persistent activation of STAT3 seems to play a critical role in the pathogenesis of several malignancies. In an attempt to determine mechanism of STAT3 phosphorylation, we analyzed SHP1 expression and its correlation to STAT3 phosphorylation in DLBCL tumors. We analyzed SHP1 expression by immunohistochemistry (IHC) in a tissue microarray composed of 27 DLBCL tumor samples. SHP1 was found silenced in 33% (7/27) of DLBCL cases. To confirm our IHC data SHP1 mRNA expression was also analyzed in DLBCL patients (n=7) and CD19+ normal B cells (n=3) using reverse transcriptase polymerase chain reaction (RT-PCR). SHP1 expression was found silenced in 57% (4/7) of cases, however normal B cells expressed a significant amount of SHP1 mRNA transcripts. We next sought to determine the mechanism of SHP1 silencing in these patients. DNA methylation is the most common mechanism of gene silencing and gene inactivation in human cancers and methylation of a cluster of CPG sites near the proximal SHP1 promoter 2 has been shown in myeloma and T cell lymphoma cells. We analyzed the frequency of SHP1 DNA methylation in 40 DLBCL patients and in DLBCL cell lines by analyzing the proximal promoter regions for SHP1 with methylation specific (MSP) and unmethylation specific (UMSP) PCR primers. We found SHP1 methylation in 2.5% (1/40) DLBCL tumors and none of the DLBCL cell lines tested (OCILy3, OCILy10, SUDHL2, SUDHL6, OCILy19 and OCILy1) were positive for methylation. Furthermore, bisulphite sequencing of the MSP product confirmed methylated cytosines in the one MSP-positive DLBCL patient sample and in the positive control (methylated DNA). We next confirmed our MSP methylation results in the 40 DLBCL tumors DNA with a high resolution melting (HRM) methylation array for accurate detection of changes in the CpG methylation. The primers were designed to flank CpG islands, not to specifically amplify (converted) methylated or unmethylated DNA (as in MSP PCR). Data were normalized to an unmethylated control. Based on the melting profile, there was no methylation in the controls but detectable methylation (>5%) in the SHP1 promoter region was found in 10% (4/40) of DLBCL samples. The one sample that was positive with MSP PCR was also >50% methylated by HRM. Next we analyzed whether there is any correlation between SHP1 expression and tyrosine phoshorylated STAT3 (pSTAT3). In the 27 cases of DLBCL studied, 16 were pSTAT3 negative and 11 were pSTAT3 positive by IHC. 50% (8/16) of the pSTAT3 negative cases had very high expression of SHP1. Similarly, 45 % (5/11) of pSTAT3 positive cases were SHP1 negative consistent with loss of SHP1 gene expression. These data suggest that loss of SHP1 expression is one of several potential mechanisms that can contribute to increased tyrosine STAT3 activation in DLBCL. In addition, these data suggest that CPG island promoter hypermethylation in the SHP1 promoter is not associated with SHP1 gene silencing in DLBCL tumors. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 996 Background: Treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) has improved survival in diffuse large B-cell lymphoma (DLBCL) lymphoma, although a significant percentage of patients do not achieve a remission or they relapse. One potential explanation for this observation is that host pharmacogenetic background may impact metabolism, detoxification and transport of R-CHOP. However, there are few prospectively collected data that address pharmacogenetics in DLBCL, particularly for event-free and overall survival in the rituximab era. We therefore tested the hypothesis that functional candidate single nucleotide polymorphisms (SNPs) from genes involved in the metabolism of CHOP (CYP2C19, CYP3A5, ABCB1, ABCC2, ABCG2, RAC2, CYBA, NR3C1, GSTA1, GSTP1, TP53) and rituximab (FCGR2A, FCGR3A) influence prognosis in DLBCL. Methods: We genotyped 19 SNPs from 13 genes in a prospective cohort of newly diagnosed DLBCL patients with germline DNA enrolled at the Mayo Clinic and University of Iowa from 2002–2008 as part of the Molecular Epidemiology Resource of the Iowa/Mayo Lymphoma SPORE. All patients were systematically followed through 2009 for overall survival (OS) and event-free survival (EFS), defined as disease progression, retreatment or death due to any cause. All SNPs were genotyped on the Illumina Golden-Gate platform. Cox regression was used to estimate Hazard Ratios (HRs) and 95% confidence intervals (CI) for individual SNPs with OS and EFS. Each SNP was modeled with the most prevalent homozygous genotype used as the reference group. An ordinal test was used to assess the trend across genotypes, and a p<0.05 was considered statistically significant. All Cox models adjusted for International Prognostic Index (IPI) and treatment. Results: The median age at diagnosis of the 439 DLBCL patients was 62 years (range 18–92). The IPI was distributed as follows: 0–1 (34%), 2 (26%), 3 (24%) and 4–5 (16%). All patients were treated with chemotherapy, and 91% received R-CHOP. Through 2009, there were 171 events (39%) and 122 (28%) deaths, with a median follow-up for living patients of 49 months (range 1–98). The SNP rs1045642 in the ATP-binding cassette (ABC) protein gene ABCB1 was associated with OS (p=0.012). The variant T allele for ABCB1 rs1045642 (minor allele frequency (MAF)=0.47) is associated with a silent I→I substitution, and the T allele predicts low enzyme expression. Compared to CC homozygotes, patients with CT (HR=0.66, 95% CI 0.44–0.99) or TT (HR=0.53, 95% CI 0.31–0.90) genotypes had superior OS. We also observed an association of the GSTP1 SNP rs1695 with OS (p-trend=0.018). The variant G allele (MAF of 0.31) is associated with an A→V substitution, and this change predicts low enzyme expression. Compared to AA homozygotes, patients with the AG (HR=0.78, 95% CI 0.54–1.14) or GG (HR=0.39, 95% CI 0.17–0.90) genotypes had superior OS. Nearly identical associations for these two SNPS were observed with EFS. There were no significant associations with any of the other SNPs that we evaluated. Conclusions: In a large series of newly diagnosed DLBCL patients treated in the rituximab era, we found evidence that genetic variation in ABCB1 and GSTP1 is associated with improved OS and EFS after adjusting for IPI and treatment. The variant allele for ABCB1 is associated with slower enzyme activity, favorably impacting doxorubicin and vincristine pharmacodynamics, and the variant allele for GSTP1 is associated with slower detoxification of doxorubicin and vincristine, increasing bioavailability of these drugs. A comprehensive evaluation of the role of pharmacogenetics in DLBCL is warranted. Support: P50 CA97274, R01 CA129539. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 970 The mammalian target of rapamycin, mTOR, is a highly conserved serine/threonine kinase known to play a role in regulating mRNA translation, cell cycle progression, cell proliferation and apoptosis. As a downstream effector of the phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway, mTOR is a component of two distinct complexes, TORC1 and TORC2. While TORC1 facilitates cell cycle progression from G1 into S phase by phosphorylating p70S6 kinase and eukaryotic initiation factor 4E binding protein 1 (4E-BP1), TORC2 catalyzes the activating phosphorylation of Akt on Ser473, providing a feedback loop for further activation of mTOR. Phase II trials have shown activity of the TORC1-selective inhibitor rapamycin and its analogs in a wide range of lymphoma subtypes. The purpose of this study was to evaluate the anti-proliferative and pro-apoptotic effects of the dual TORC1/TORC2 inhibitor OSI-027 in human neoplastic lymphoid cells in vitro. MTS assays demonstrated that OSI-027 inhibited proliferation in a wide range of lymphoid lines, including SeAx (Sezary syndrome), DoHH2 (large cell lymphoma), RL (follicular lymphoma) and Jurkat (T cell ALL), as well as clinical lymphoma and T cell ALL samples, with IC50 values ranging from 0.078 to 10 μM. Propidium iodide staining followed by flow cytometry for subdiploid cells revealed induction of apoptosis within 48 h of treatment with OSI-027 (but not rapamycin) in SeAx, DoHH2, and Jurkat cells. Examination of Jurkat variants with alterations in key proteins involved in the death receptor versus mitochondrial pathway revealed diminished apoptotic responses to OSI-027 when Bcl-2 was overexpressed or caspase 9 was silenced, indicating involvement of the mitochondrial pathway. Immunoblotting for Bcl-2 family members revealed upregulation of Bim and Puma after a 48-hour exposure to OSI-027 but not rapamycin. This upregulation was also seen at the mRNA level, with a 12- to 20-fold increase in Puma mRNA and 4- to 12-fold induction of Bim mRNA. Small interfering RNA (siRNA)-mediated knockdown of Bim and Puma significantly diminished the apoptotic response to OSI-027. Because the Foxo3a transcription factor has been implicated in Bim and Puma expression and is known to be activated when Akt is inhibited, we next examined whether Bim and Puma induction was Foxo3a-dependent. Luciferase reporter assays showed that OSI-027 activated the full-length Puma and Bim promoters and that this activation was diminished when the Foxo3a binding sites were deleted or mutated. In addition, OSI-027 induced nuclear translocation of Foxo3a, while Foxo3a siRNA diminished OSI-027-induced apoptosis in Jurkat cells. Collectively, these results indicate that OSI-027 inhibits proliferation and induces apoptosis in a wide range of neoplastic lymphoid cells through a process that involves Foxo3a-mediated upregulation of Bim and Puma. These results also suggest that dual inhibition of TORC1 and TORC2 may be an effective treatment strategy in lymphoid malignancy. Disclosures: Barr: OSI Pharmaceuticals: Employment. Witzig:Novartis and Celgene: Patents & Royalties, Research Funding, Served on advisory boards with Novartis and Celgene – both uncompensated with compensation to Mayo Clinic.