cSCC staging methods are reported to have sub-optimal performances in metastasis prediction. Accurate identification of patients with tumors at high risk of metastasis would have a significant impact on management. Archival FFPE tissue from primary cSCC with perilesional normal tissue from 237 immunocompetent patients (151 non-metastasizing and 86 metastasizing) were collected retrospectively from four centers. All pathology was centrally reviewed and T-staged by consensus. TempO-seq was used to probe the whole transcriptome and machine learning algorithms were applied to derive predictive signatures, with a 75%:25% split for training and testing datasets. A 20-gene prognostic model was developed and validated, with an accuracy of 86.0%, sensitivity of 85.7%, specificity of 86.1%, and positive predictive value of 78.3% in the testing set. A linear predictor was also developed, significantly correlating with metastatic risk. This has provided biological insights into the process of metastasis and potential therapeutic targets. There are biological and genomic mechanisms common to cSCC across different tissue types and the prognostic signature may provide further insights into common differentiation and stem-like pathways underpinning cSCC. Ultimately, the 20-gene prognostic signature has the potential to be incorporated into clinical workflows for cSCC to significantly improve risk stratification, identify patients with high-risk cSCC who may benefit from adjuvant treatment and reduce overtreatment for patients with low-risk cSCC.

Macrophage activation syndrome (MAS) is a potentially life-threatening complication of rheumatic diseases. We report a unique case of a previously healthy 20-year-old female presenting with MAS as first presentation of systemic lupus erythematosus. Remission was achieved with hydroxychloroquine, intravenous methylprednisolone pulse followed by oral prednisolone and cyclosporine. However, the management of MAS is still challenging, and the mortality rate remains high.El síndrome de activación macrofágica (SAM) es una complicación potencialmente letal de algunas enfermedades reumáticas. Presentamos un caso único de una mujer de 20 años previamente sana que se presentó con SAM como primera manifestación de lupus eritematoso sistémico. Se logró una remisión completa con hidroxicloroquina, pulsos intravenosos de metilprednisolona seguido de prednisolona oral y ciclosporina. Sin embargo, el manejo del SAM sigue siendo un desafío y la tasa de mortalidad sigue siendo alta.

The biological features of IGHV-M chronic lymphocytic leukemia responsible for disease progression are still poorly understood. We undertook a longitudinal study close to diagnosis, pre-treatment and post relapse in 13 patients presenting with cMBL or Stage A disease and good-risk biomarkers ( IGHV-M genes, no del(17p) or del(11q) and low CD38 expression) who nevertheless developed progressive disease, of whom 10 have required therapy. Using cytogenetics, fluorescence in situ hybridisation, genome-wide DNA methylation and copy number analysis together with whole exome, targeted deep- and Sanger sequencing at diagnosis, we identified mutations in established chronic lymphocytic leukemia driver genes in nine patients (69%), non-coding mutations ( PAX5 enhancer region) in three patients and genomic complexity in two patients. Branching evolutionary trajectories predominated ( n =9/13), revealing intra-tumoural epi- and genetic heterogeneity and sub-clonal competition before therapy. Of the patients subsequently requiring treatment, two had sub-clonal TP53 mutations that would not be detected by standard methodologies, three qualified for the very-low-risk category defined by integrated mutational and cytogenetic analysis and yet had established or putative driver mutations and one patient developed progressive, therapy-refractory disease associated with the emergence of an IGHV-U clone. These data suggest that extended genomic and immunogenetic screening may have clinical utility in patients with apparent good-risk disease.

Histone methyltransferases (HMTs) are important epigenetic regulators of gene transcription and are disrupted at the genomic level in a spectrum of human tumours including haematological malignancies. Using high-resolution single nucleotide polymorphism (SNP) arrays, we identified recurrent deletions of the SETD2 locus in 3% (8/261) of chronic lymphocytic leukaemia (CLL) patients. Further validation in two independent cohorts showed that SETD2 deletions were associated with loss of TP53, genomic complexity and chromothripsis. With next-generation sequencing we detected mutations of SETD2 in an additional 3.8% of patients (23/602). In most cases, SETD2 deletions or mutations were often observed as a clonal event and always as a mono-allelic lesion, leading to reduced mRNA expression in SETD2-disrupted cases. Patients with SETD2 abnormalities and wild-type TP53 and ATM from five clinical trials employing chemotherapy or chemo-immunotherapy had reduced progression-free and overall survival compared with cases wild type for all three genes. Consistent with its postulated role as a tumour suppressor, our data highlight SETD2 aberration as a recurrent, early loss-of-function event in CLL pathobiology linked to aggressive disease.

In developing the manufacturing route for the cathepsin K inhibitor SB462795, the oxidation of a secondary alcohol for the final chemical stage is described. Prospective conditions were limited by several factors, particularly general safety concerns of oxidation reactions, the requirement to control impurities and transition metals isolated in the final product, and the desire to reduce the environmental impact. Two N-oxy free radical approaches (TEMPO and PIPO) and Moffatt conditions were evaluated in depth for their potential to achieve the targets. For reasons of robustness, scalability, and cost-effectiveness, the Moffatt conditions were the best manufacturing option.