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Abstract
Large granular lymphocytes (LGLs) are large lymphocytes with azurophilic granules in their cytoplasm. LGLs are either natural killer (NK) cells or T lymphocytes. Expansions of the LGLs in the peripheral blood are seen in various conditions, including three clonal disorders: T-cell LGL (T-LGL) leukemia, chronic lymphoproliferative disorders of NK cells (CLPD-NK), and aggressive NK-cell leukemia (ANKL). However, the monoclonal and polyclonal expansion of LGLs has been associated with many other conditions. The present article describes these LGL disorders, with special emphasis on the clinical features, pathogenesis, and treatments of the three above-mentioned clonal disorders.
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Affiliation(s)
- Kazuo Oshimi
- Department of Medicine, Kushiro Rosai Hospital, Japan
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52
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Oral cyclophosphamide was effective for Coombs-negative autoimmune hemolytic anemia in CD16+CD56− chronic lymphoproliferative disorder of NK-cells. Int J Hematol 2016; 105:854-858. [DOI: 10.1007/s12185-016-2170-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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53
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Gamma-Glutamylcysteine Ethyl Ester Protects against Cyclophosphamide-Induced Liver Injury and Hematologic Alterations via Upregulation of PPAR γ and Attenuation of Oxidative Stress, Inflammation, and Apoptosis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:4016209. [PMID: 28074115 PMCID: PMC5198194 DOI: 10.1155/2016/4016209] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/24/2016] [Indexed: 12/23/2022]
Abstract
Gamma-glutamylcysteine ethyl ester (GCEE) is a precursor of glutathione (GSH) with promising hepatoprotective effects. This investigation aimed to evaluate the hepatoprotective effects of GCEE against cyclophosphamide- (CP-) induced toxicity, pointing to the possible role of peroxisome proliferator activated receptor gamma (PPARγ). Wistar rats were given GCEE two weeks prior to CP. Five days after CP administration, animals were sacrificed and samples were collected. Pretreatment with GCEE significantly alleviated CP-induced liver injury by reducing serum aminotransferases, increasing albumin, and preventing histopathological and hematological alterations. GCEE suppressed lipid peroxidation and nitric oxide production and restored GSH and enzymatic antioxidants in the liver, which were associated with downregulation of COX-2, iNOS, and NF-κB. In addition, CP administration significantly increased serum proinflammatory cytokines and the expression of liver caspase-3 and BAX, an effect that was reversed by GCEE. CP-induced rats showed significant downregulation of PPARγ which was markedly upregulated by GCEE treatment. These data demonstrated that pretreatment with GCEE protected against CP-induced hepatotoxicity, possibly by activating PPARγ, preventing GSH depletion, and attenuating oxidative stress, inflammation, and apoptosis. Our findings point to the role of PPARγ and suggest that GCEE might be a promising agent for the prevention of CP-induced liver injury.
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54
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Protective Effects of Essential Oils as Natural Antioxidants against Hepatotoxicity Induced by Cyclophosphamide in Mice. PLoS One 2016; 11:e0165667. [PMID: 27802299 PMCID: PMC5089748 DOI: 10.1371/journal.pone.0165667] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/14/2016] [Indexed: 12/13/2022] Open
Abstract
Clinical application of cyclophosphamide (CP) as an anticancer drug is often limited due to its toxicity. CP is metabolized mainly in the liver by cytochrome P450 system into acrolein which is the proximate toxic metabolite. Many different natural antioxidants were found to alleviate the toxic effects of various toxic agents via different mechanisms. Therefore, the present study aimed at investigating the role of essential oils extracted from fennel, cumin and clove as natural antioxidants in the alleviation of hepatotoxicity induced by CP through assessment of hepatotoxicity biomarkers (AST, ALT, ALP), histopathology of liver tissues as well as other biochemical parameters involved in the metabolism of CP. The data of the present study showed that treatment of male mice with cyclophosphamide (2.5 mg/Kg BW) as repeated dose for 28 consecutive days was found to induce hepatotoxicity through the elevation in the activities of AST, ALT, and ALP. Combined administration of any of these oils with CP to mice partially normalized the altered hepatic biochemical markers caused by CP, whereas administration of fennel, clove or cumin essential oils alone couldn't change liver function indices. Moreover, CP caused histological changes in livers of mice including swelling and dilation in sinusoidal space, inflammation in portal tract and hepatocytes, as well as, hyperplasia in Kuppfer cells. However, co-administration of any of the essential oils with CP alleviated to some extent the changes caused by CP but not as the normal liver. CP was also found to induce free radical levels (measured as thiobarbituric acid reactive substances) and inhibited the activities of superoxide dismutase, glutathione reductase, and catalase as well as activities and protein expressions of both glutathione S-transferase (GSTπ) and glutathione peroxidase. Essential oils restored changes in activities of antioxidant enzymes (SOD, CAT, GR, GST, and GPx) caused by CP to their normal levels compared to control group. In addition, treatment of mice with CP was found to induce the protein expression of CYP 3A4, 2B1/2, 2C6, 2C23. Moreover, the present study showed that essential oils reduced the expression of CYPs 2E1, 3A4 but could not restore the expression of CYP 2C6 and 2C23 compared to CP-treated mice. Interestingly, pretreatment of mice with essential oil of clove was found to restore activities of DMN-dI, AHH, and ECOD which were induced by CP to their normal control levels. It is concluded that EOs showed a marked hepatoprotective effect against hepatotoxicity induced by CP. In addition, co-administration of CP with any of these oils might be used as a new strategy for cancer treatment to alleviate the hepatotoxicity induced by CP.
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55
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Gore PR, Prajapati CP, Mahajan UB, Goyal SN, Belemkar S, Ojha S, Patil CR. Protective Effect of Thymoquinone against Cyclophosphamide-Induced Hemorrhagic Cystitis through Inhibiting DNA Damage and Upregulation of Nrf2 Expression. Int J Biol Sci 2016; 12:944-53. [PMID: 27489498 PMCID: PMC4971733 DOI: 10.7150/ijbs.15781] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/06/2016] [Indexed: 12/17/2022] Open
Abstract
Cyclophosphamide (CYP) induced hemorrhagic cystitis is a dose-limiting side effect involving increased oxidative stress, inflammatory cytokines and suppressed activity of nuclear factor related erythroid 2-related factor (Nrf2). Thymoquinone (TQ), an active constituent of Nigella sativa seeds, is reported to increase the expression of Nrf2, exert antioxidant action, and anti-inflammatory effects in the experimental animals. The present study was designed to explore the effects of TQ on CYP-induced hemorrhagic cystitis in Balb/c mice. Cystitis was induced by a single intraperitoneal injection of CYP (200 mg/kg). TQ was administered intraperitoneally at 5, 10 and 20 mg/kg doses twice a day, for three days before and three days after the CYP administration. The efficacy of TQ was determined in terms of the protection against the CYP-induced histological perturbations in the bladder tissue, reduction in the oxidative stress, and inhibition of the DNA fragmentation. Immunohistochemistry was performed to examine the expression of Nrf2. TQ protected against CYP-induced oxidative stress was evident from significant reduction in the lipid peroxidation, restoration of the levels of reduced glutathione, catalase and superoxide dismutase activities. TQ treatment significantly reduced the DNA damage evident as reduced DNA fragmentation. A significant decrease in the cellular infiltration, edema, epithelial denudation and hemorrhage were observed in the histological observations. There was restoration and rise in the Nrf2 expression in the bladder tissues of mice treated with TQ. These results confirm that, TQ ameliorates the CYP-induced hemorrhagic cystitis in mice through reduction in the oxidative stress, inhibition of the DNA damage and through increased expression of Nrf2 in the bladder tissues.
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Affiliation(s)
- Prashant R Gore
- 1. Department of Pharmacology, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, District-Dhule, Maharashtra, 425405, India
| | - Chaitali P Prajapati
- 1. Department of Pharmacology, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, District-Dhule, Maharashtra, 425405, India
| | - Umesh B Mahajan
- 1. Department of Pharmacology, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, District-Dhule, Maharashtra, 425405, India
| | - Sameer N Goyal
- 1. Department of Pharmacology, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, District-Dhule, Maharashtra, 425405, India
| | - Sateesh Belemkar
- 2. School of Pharmacy and Technology Management, SVKM's NMIMS, MPTP, Shirpur, District- Dhule, Maharashtra, 425405, India
| | - Shreesh Ojha
- 3. Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates, University, Al Ain, Abu Dhabi 17666, United Arab Emirates
| | - Chandragouda R Patil
- 1. Department of Pharmacology, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, District-Dhule, Maharashtra, 425405, India
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56
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Peng G, Yang W, Zhang L, Zhou K, Li Y, Li Y, Ye L, Li J, Fan H, Song L, Zhao X, Wu Z, Zhang F, Jing L. Moderate-dose cyclophosphamide in the treatment of relapsed/refractory T-cell large granular lymphocytic leukemia-associated pure red cell aplasia. Hematology 2016; 21:138-43. [PMID: 27077768 DOI: 10.1080/10245332.2015.1101977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Guangxin Peng
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Wenrui Yang
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Li Zhang
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Kang Zhou
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Yang Li
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Yuan Li
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Lei Ye
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Jianping Li
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Huihui Fan
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Lin Song
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Xin Zhao
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Zhijie Wu
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Fengkui Zhang
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Liping Jing
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
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57
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Ginseng alleviates cyclophosphamide-induced hepatotoxicity via reversing disordered homeostasis of glutathione and bile acid. Sci Rep 2015; 5:17536. [PMID: 26625948 PMCID: PMC4667192 DOI: 10.1038/srep17536] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/02/2015] [Indexed: 12/19/2022] Open
Abstract
Cyclophosphamide (CP), a chemotherapeutic agent, is restricted due to its side effects, especially hepatotoxicity. Ginseng has often been clinically used with CP in China, but whether and how ginseng reduces the hepatotoxicity is unknown. In this study, the hepatoprotective effects and mechanisms under the combined usage were investigated. It was found that ginseng could ameliorate CP-induced elevations of ALP, ALT, ALS, MDA and hepatic deterioration, enhance antioxidant enzymes’ activities and GSH’s level. Metabolomics study revealed that 33 endogenous metabolites were changed by CP, 19 of which were reversed when ginseng was co-administrated via two main pathways, i.e., GSH metabolism and primary bile acids synthesis. Furthermore, ginseng could induce expression of GCLC, GCLM, GS and GST, which associate with the disposition of GSH, and expression of FXR, CYP7A1, NTCP and MRP 3, which play important roles in the synthesis and transport of bile acids. In addition, NRF 2, one of regulatory elements on the expression of GCLC, GCLM, GS, GST, NTCP and MRP3, was up-regulated when ginseng was co-administrated. In conclusion, ginseng could alleviate CP-induced hepatotoxicity via modulating the disordered homeostasis of GSH and bile acid, which might be mediated by inducing the expression of NRF 2 in liver.
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58
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Abstract
Mature T-cell leukemias are a group of uncommon lymphoid neoplasms. These disorders have widely variable clinical features, ranging from indolent, slowly progressive processes to diseases with rapidly progressive courses, leading to death. Cytogenetic aberrations have long been identified in some of these diseases, and recent studies have found recurrent genetic mutations that contribute to their pathogenesis. Conventional multiagent chemotherapy lacks significant efficacy in this group of diseases and therapies vary from immunosuppression to treatment with monoclonal antibodies, antiviral agents, and hematopoietic stem cell transplantation. The recent expansion of knowledge regarding the underlying genetic basis of these disorders raises hope that new, more targeted therapeutic approaches will be available to patients in the near future.
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Affiliation(s)
- Nathanael G Bailey
- Department of Pathology, University of Michigan, M5242 Medical Science 1 1301 Catherine St, Ann Arbor, MI, 48109, USA.
| | - Kojo S J Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, 422 Curie Boulevard, Philadelphia, PA, 19104, USA.
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59
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Marchand T, Lamy T, Finel H, Arcese W, Choquet S, Finke J, Huynh A, Irrera G, Karakasis D, Konopacki J, Lambert J, Michieli M, Schouten HC, Schroyens W, Sucak G, Tischer J, Vandenberghe E, Dreger P. Hematopoietic stem cell transplantation for T-cell large granular lymphocyte leukemia: a retrospective study of the European Society for Blood and Marrow Transplantation. Leukemia 2015; 30:1201-4. [DOI: 10.1038/leu.2015.256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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60
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LeBlanc FR, Loughran TP. Large granular lymphocyte leukemia: clinical background, molecular pathogenesis and treatment. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1062362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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61
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Lazaro E, Morel J. Management of neutropenia in patients with rheumatoid arthritis. Joint Bone Spine 2015; 82:235-9. [PMID: 25819216 DOI: 10.1016/j.jbspin.2015.01.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 12/20/2022]
Abstract
Neutropenia is defined as a neutrophil count lower than 1.5g/L, with categorization as mild, moderate, or severe when the count is 1.5-1g/L, 1-0.5g/L, or<0.5g/L, respectively. The main complication is infection, whose risk increases with the depth and duration of the neutropenia. Comprehensive etiological investigations are mandatory to determine the best treatment strategy. Constitutional neutropenia is rarely seen in everyday rheumatology practice. It predominantly affects patients of African descent and is usually moderate and well tolerated. Congenital neutropenia due to genetic abnormalities is severe and chiefly seen in the pediatric population. Most cases of neutropenia in patients with rheumatoid arthritis (RA) are acquired. Medications are the most common causes, making detailed history-taking crucial. Many medications used to treat RA can induce neutropenia. Folic acid deficiency should be sought routinely in patients taking methotrexate. A less common cause of neutropenia is an RA-related autoimmune reaction. Splenomegaly suggests Felty's syndrome, which is accompanied with large granular lymphocytic (LGL) leukemia in 40% of cases. The treatment depends on the depth of the neutropenia and findings from the etiological workup. A neutrophil count below 0.5g/L, a fever, and the presence of clinical signs indicate a life-threatening condition requiring emergent treatment. In other patients, the first step is immediate discontinuation of any possibly involved drugs, simultaneously with the etiological workup.
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Affiliation(s)
- Estibaliz Lazaro
- Service de médecine interne, hôpital du Haut-Lévêque, université de Bordeaux, 33604 Pessac, France.
| | - Jacques Morel
- Service de médecine interne, hôpital du Haut-Lévêque, université de Bordeaux, 33604 Pessac, France; Département de rhumatologie, hôpital Lapeyronie, université de Montpellier 1, 34295 Montpellier cedex 5, France
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62
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Acquired inhibitors to factor VIII and fibrinogen in the setting of T-cell large granular lymphocyte leukemia. Blood Coagul Fibrinolysis 2015; 26:211-3. [DOI: 10.1097/mbc.0000000000000209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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63
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Tees MT, Whitehurst MT, Sokol L. Treating rare lymphoproliferative malignancies: a focus on indolent large granular lymphocytic leukemia. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Large granular lymphocyte leukemia is a heterogeneous group of lymphoproliferative disorders that arises from mature T cells or NK cells. These disorders are relatively uncommon and usually present with cytopenias and/or autoimmune disorders. As patients often do not have symptoms warranting therapy upfront, surveillance is often employed. Common frontline therapies include cyclosphosphamide, methotrexate or cyclosporine A, however, no controlled trials or retrospective analyses have demonstrated one superior therapeutic strategy. Mechanisms of pathogenesis and survival have been identified that include abnormalities in the cell surface receptors halting apoptotic signals, dysregulation of prosurvival and apoptotic signaling pathways, and somatic mutations of the STAT3 and STAT5b genes, among others. Investigating novel therapies that target pathways shared by other neoplastic processes, as well as the identification of new agents directed toward the aberrant cellular mechanisms of large granular lymphocyte leukemia, are fundamental to moving from empiric chemotherapy to targeted therapies in the future.
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Affiliation(s)
- Michael T Tees
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Matthew T Whitehurst
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Lubomir Sokol
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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64
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Rajala HLM, Olson T, Clemente MJ, Lagström S, Ellonen P, Lundan T, Hamm DE, Zaman SAU, Lopez Marti JM, Andersson EI, Jerez A, Porkka K, Maciejewski JP, Loughran TP, Mustjoki S. The analysis of clonal diversity and therapy responses using STAT3 mutations as a molecular marker in large granular lymphocytic leukemia. Haematologica 2014; 100:91-9. [PMID: 25281507 DOI: 10.3324/haematol.2014.113142] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
T-cell large granular lymphocytic leukemia and chronic lymphoproliferative disorder of natural killer cells are intriguing entities between benign and malignant lymphoproliferation. The molecular pathogenesis has partly been uncovered by the recent discovery of somatic activating STAT3 and STAT5b mutations. Here we show that 43% (75/174) of patients with T-cell large granular lymphocytic leukemia and 18% (7/39) with chronic lymphoproliferative disorder of natural killer cells harbor STAT3 mutations when analyzed by quantitative deep amplicon sequencing. Surprisingly, 17% of the STAT3-mutated patients carried multiple STAT3 mutations, which were located in different lymphocyte clones. The size of the mutated clone correlated well with the degree of clonal expansion of the T-cell repertoire analyzed by T-cell receptor beta chain deep sequencing. The analysis of sequential samples suggested that current immunosuppressive therapy is not able to reduce the level of the mutated clone in most cases, thus warranting the search for novel targeted therapies. Our findings imply that the clonal landscape of large granular lymphocytic leukemia is more complex than considered before, and a substantial number of patients have multiple lymphocyte subclones harboring different STAT3 mutations, thus mimicking the situation in acute leukemia.
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Affiliation(s)
- Hanna L M Rajala
- Hematology Research Unit, Department of Hematology, University of Helsinki and Helsinki University Central Hospital Cancer Center, Helsinki, Finland
| | - Thomas Olson
- University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Michael J Clemente
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sonja Lagström
- Institute for Molecular Medicine (FIMM), University of Helsinki, Finland
| | - Pekka Ellonen
- Institute for Molecular Medicine (FIMM), University of Helsinki, Finland
| | - Tuija Lundan
- Department of Clinical Chemistry and TYKSLAB, University of Turku and Turku University Central Hospital, Finland
| | | | | | | | - Emma I Andersson
- Hematology Research Unit, Department of Hematology, University of Helsinki and Helsinki University Central Hospital Cancer Center, Helsinki, Finland
| | - Andres Jerez
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Kimmo Porkka
- Hematology Research Unit, Department of Hematology, University of Helsinki and Helsinki University Central Hospital Cancer Center, Helsinki, Finland
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Satu Mustjoki
- Hematology Research Unit, Department of Hematology, University of Helsinki and Helsinki University Central Hospital Cancer Center, Helsinki, Finland
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65
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Immunosuppressive therapy of LGL leukemia: prospective multicenter phase II study by the Eastern Cooperative Oncology Group (E5998). Leukemia 2014; 29:886-94. [PMID: 25306898 DOI: 10.1038/leu.2014.298] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/07/2014] [Accepted: 09/25/2014] [Indexed: 01/20/2023]
Abstract
Failure to undergo activation-induced cell death due to global dysregulation of apoptosis is the pathogenic hallmark of large granular lymphocyte (LGL) leukemia. Consequently, immunosuppressive agents are rational choices for treatment. This first prospective trial in LGL leukemia was a multicenter, phase 2 clinical trial evaluating methotrexate (MTX) at 10 mg/m(2) orally weekly as initial therapy (step 1). Patients failing MTX were eligible for treatment with cyclophosphamide at 100 mg orally daily (step 2). The overall response in step 1 was 38% with 95% confidence interval (CI): 26 and 53%. The overall response in step 2 was 64% with 95% CI: 35 and 87%. The median overall survival for patients with anemia was 69 months with a 95% CI lower bound of 46 months and an upper bound not yet reached. The median overall survival for patients with neutropenia has not been reached 13 years from study activation. Serum biomarker studies confirmed the inflammatory milieu of LGL but were not a priori predictive of response. We identify a gene expression signature that correlates with response and may be STAT3 mutation driven. Immunosuppressive therapies have efficacy in LGL leukemia. Gene signature and mutational profiling may be an effective tool in determining whether MTX is an appropriate therapy.
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66
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Poullot E, Zambello R, Leblanc F, Bareau B, De March E, Roussel M, Boulland ML, Houot R, Renault A, Fest T, Semenzato G, Loughran T, Lamy T. Chronic natural killer lymphoproliferative disorders: characteristics of an international cohort of 70 patients. Ann Oncol 2014; 25:2030-2035. [PMID: 25096606 DOI: 10.1093/annonc/mdu369] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The 2008 World Health Organization (WHO) classification distinguishes three entities among the large granular lymphocytic leukemia (LGL leukemia): T-cell LGL leukemia (T-LGL leukemia), aggressive natural killer (NK) cell leukemia, and chronic NK lymphoproliferative disorders (LPD), the later considered as a provisional entity. Only a few and small cohorts of chronic NK LPD have been published. PATIENTS AND METHODS We report here clinicobiological features collected retrospectively from 70 cases of chronic NK LPD, and compared with those of T-LGL leukemia. RESULTS There were no statistical differences between chronic NK LPD and T-LGL leukemia concerning median age [61 years (range 23-82 years)], organomegaly (26%), associated autoimmune diseases (24%), and associated hematological malignancies (11%). Patients with chronic NK LPD were significantly less symptomatic (49% versus 18%, P < 0.001) and the association with rheumatoid arthritis was more rarely observed (7% versus 17%, P = 0.03). The neutropenia (<0.5 × 10(9)/l) was less severe in chronic NK LPD (33% versus 61%, P < 0.001) without difference in the rate of recurrent infections. STAT3 mutation was detected in 12% of the cohort, which is lower than the frequency observed in T-LGL leukemia. Thirty-seven percent of the patients required specific therapy. Good results were obtained with cyclophosphamide. Overall and complete response rates were, respectively, 69% and 56%. Overall survival was 94% at 5 years. CONCLUSION This study suggests very high similarities between chronic NK LPD and T-LGL leukemias. Since chronic NK LPD is still a provisional entity, our findings should be helpful when considering further revisions of the WHO classification.
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Affiliation(s)
- E Poullot
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France; Department of Pathology, Rennes University Hospital, Rennes, France
| | - R Zambello
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy
| | - F Leblanc
- University of Virginia Cancer Center, University of Virginia School of Medicine, Charlottesville, USA
| | - B Bareau
- Department of Clinical Hematology, Clinique Cesson-Sévigné, Cesson-Sévigné
| | - E De March
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy
| | - M Roussel
- Department of Hematology-Immunology and Cell Therapy, Rennes University Hospital, Rennes; INSERM UMR 917 Faculté de médecine Université Rennes 1, Rennes
| | - M L Boulland
- Department of Hematology-Immunology and Cell Therapy, Rennes University Hospital, Rennes
| | - R Houot
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France; INSERM UMR 917 Faculté de médecine Université Rennes 1, Rennes
| | - A Renault
- Department of Clinical Investigation, Rennes University Hospital, Rennes, France
| | - T Fest
- Department of Clinical Hematology, Clinique Cesson-Sévigné, Cesson-Sévigné; INSERM UMR 917 Faculté de médecine Université Rennes 1, Rennes
| | - G Semenzato
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padua, Italy
| | - T Loughran
- University of Virginia Cancer Center, University of Virginia School of Medicine, Charlottesville, USA
| | - T Lamy
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France; INSERM UMR 917 Faculté de médecine Université Rennes 1, Rennes; Department of Clinical Investigation, Rennes University Hospital, Rennes, France.
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Abstract
Isolated neutropenia is a common clinical problem seen by primary care physicians and hematologists. The evaluation of neutropenia is dictated by the acuity of the clinical presentation and the duration, age, and clinical status of the patient. In this review, we provide a practical approach to the evaluation of the adult patient with neutropenia, with the major focus on the evaluation of neutropenia in the outpatient setting.
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Autrel-Moignet A, Lamy T. Autoimmune neutropenia. Presse Med 2014; 43:e105-18. [PMID: 24680423 DOI: 10.1016/j.lpm.2014.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/13/2014] [Accepted: 02/18/2014] [Indexed: 02/08/2023] Open
Abstract
Autoimmune neutropenia (AIN) is a rare entity caused by antibodies directed against neutrophil-specific antigens. It includes primary and secondary autoimmune neutropenia. Acute autoimmune neutropenia can be related to drug-induced mechanism or viral infections. Chronic autoimmune neutropenias occur in the context of autoimmune diseases, hematological malignancies, such as large granular lymphocyte leukemia, primary immune deficiency syndromes or solid tumors. The therapeutic management depends on the etiology. Granulocyte growth factor is the main therapeutic option, raising the question of their long-term utilization safety. Corticosteroids or immunosuppressive therapy are indicated in infection-related AIN or in case of symptomatic autoimmune disease or LGL leukemia.
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Affiliation(s)
| | - Thierry Lamy
- CHU de Rennes, service d'hématologie clinique, Rennes 35043, France; Université Rennes 1, Rennes 35043, France.
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