title: Identification of CD20 C-terminal deletion mutations associated with loss of CD20 expression in non-Hodgkin's lymphoma.
abstract: OBJECTIVE
  Rituximab is commonly incorporated into CD20-positive B-cell lymphoma therapy to improve response and prognosis. With increasing use, resistance to rituximab is a continuing concern, but CD20 mutation as a cause of resistance has not previously been reported.
  
  
  METHODS
  Freshly collected lymphoma cells from 50 patients with previously untreated or relapsed/resistant non-Hodgkin's B-cell lymphomas (diffuse large B cell, n = 22; follicular, n = 7; mucosa associated lymphoid tissue, n = 16; chronic lymphocytic leukemia, n = 2; small lymphocytic lymphoma, n = 1; lymphoplasmacytic, n = 1; mantle cell lymphoma, n = 1) were assessed for CD20 expression by flow cytometry, and CD20 gene sequencing was done on extracted DNA.
  
  
  RESULTS
  CD20 mutations were found in 11 (22.0%) of 50 patients and could be grouped as C-terminal deletion (8.0%), early termination (10.0%), and extracellular domain (2.0%) or transmembrane domain (2.0%) mutations. The mean fluorescence intensity of CD20 on fresh lymphoma cells was significantly lower for the C-terminal deletion mutation [3.26; 95% confidence interval (95% CI), 0.09-6.89] compared with wild type (30.8; 95% CI, 22.4-39.2; P < 0.05). In contrast, early termination mutations did not show significant differences in CD20 expression compared with wild type (19.5; 95% CI, 10.7-28.4; P > 0.05).
  
  
  CONCLUSIONS
  It is possible that C-terminal deletion mutations of CD20 may be related to relapse/resistance after rituximab therapy. These mutations should be examined in patients showing progression of disease after partial remission.
authors.affiliation: Departments of Medical Oncology and Hematology, Division of Clinical Chemotherapy, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Terui
authors.forename: Yuji
authors.initials: Y
authors.lastname: Mishima
authors.forename: Natsuhiko
authors.initials: N
authors.lastname: Sugimura
authors.forename: Kiyotsugu
authors.initials: K
authors.lastname: Kojima
authors.forename: Takuma
authors.initials: T
authors.lastname: Sakurai
authors.forename: Yuko
authors.initials: Y
authors.lastname: Mishima
authors.forename: Ryoko
authors.initials: R
authors.lastname: Kuniyoshi
authors.forename: Akiko
authors.initials: A
authors.lastname: Taniyama
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Sakura
authors.initials: S
authors.lastname: Sakajiri
authors.forename: Kengo
authors.initials: K
authors.lastname: Takeuchi
authors.forename: Chie
authors.initials: C
authors.lastname: Watanabe
authors.forename: Shunji
authors.initials: S
authors.lastname: Takahashi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Hatake
mesh_terms: D000595:Amino Acid Sequence; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000737:chemistry / Q000235:genetics* / Q000378:metabolism; D000970:Antineoplastic Agents / Q000627:therapeutic use; D019008:Drug Resistance, Neoplasm / Q000235:genetics*; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000235:genetics* / Q000378:metabolism; D008969:Molecular Sequence Data; D000069283:Rituximab; D017384:Sequence Deletion
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000069283:Rituximab