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Navarro SM, Matcuk GR, Patel DB, Skalski M, White EA, Tomasian A, Schein AJ. Musculoskeletal Imaging Findings of Hematologic Malignancies. Radiographics 2017; 37:881-900. [PMID: 28388273 DOI: 10.1148/rg.2017160133] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hematologic malignancies comprise a set of prevalent yet clinically diverse diseases that can affect every organ system. Because blood components originate in bone marrow, it is no surprise that bone marrow is a common location for both primary and metastatic hematologic neoplasms. Findings of hematologic malignancy can be seen with most imaging modalities including radiography, computed tomography (CT), technetium 99m (99mTc) methylene diphosphonate (MDP) bone scanning, fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, and magnetic resonance (MR) imaging. Because of the diversity of imaging appearances and clinical behavior of this spectrum of disease, diagnosis can be challenging, and profound understanding of the underlying pathophysiologic changes and current treatment modalities can be daunting. The appearance of normal bone marrow at MR imaging and FDG PET/CT is also varied due to dynamic compositional changes with normal aging and in response to hematologic demand or treatment, which can lead to false-positive interpretation of imaging studies. In this article, the authors review the normal maturation and imaging appearance of bone marrow. Focusing on lymphoma, leukemia, and multiple myeloma, they present the spectrum of imaging findings of hematologic malignancy affecting the musculoskeletal system and the current imaging tools available to the radiologist. They discuss the imaging findings of posttreatment bone marrow and review commonly used staging systems and consensus recommendations for appropriate imaging for staging, management, and assessment of clinical remission. ©RSNA, 2017.
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Affiliation(s)
- Shannon M Navarro
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - George R Matcuk
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Dakshesh B Patel
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Matthew Skalski
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Eric A White
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Anderanik Tomasian
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
| | - Aaron J Schein
- From the Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (S.M.N., G.R.M., D.B.P., M.S., E.A.W., A.T.); and Los Robles Radiology Associates, 227 Janss Rd, Ste 150, Thousand Oaks, CA 91360 (A.J.S.)
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102
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Trop-Steinberg S, Azar Y. AP-1 Expression and its Clinical Relevance in Immune Disorders and Cancer. Am J Med Sci 2017; 353:474-483. [PMID: 28502334 DOI: 10.1016/j.amjms.2017.01.019] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
The inflammatory response is known to have a significant role in certain autoimmune diseases and malignancies. We review current knowledge regarding the functions of activator protein 1 (AP-1) as an important modulator in several immune disorders and carcinomas. AP-1 is overexpressed in rheumatoid arthritis and in long-term allogeneic hematopoietic stem cell transplantation survivors; however, decreased expression of AP-1 has been observed in psoriasis, systematic lupus erythematosus and in patients who do not survive after hematopoietic stem cell transplantation. AP-1 also is implicated in the control of various cancer cells. Higher levels of AP-1 components are present in breast and endometrial carcinomas, colorectal cancer and in acute myeloid leukemia, Hodgkin׳s lymphoma and anaplastic large cell lymphoma, with downregulation in ovarian and gastric carcinomas and in patients with chronic myelogenous leukemia. AP-1 may enable the development of helpful markers to identify early-stage disease or to predict severity.
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Affiliation(s)
| | - Yehudit Azar
- Bone Marrow Transplantation Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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103
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Ramsey SD, Nademanee A, Masszi T, Holowiecki J, Abidi M, Chen A, Stiff P, Viviani S, Sweetenham JW, Radford J, Zhu Y, Bonthapally V, Thomas E, Richhariya A, Hunder NN, Walewski J, Moskowitz CH. Quality of life results from a phase 3 study of brentuximab vedotin consolidation following autologous haematopoietic stem cell transplant for persons with Hodgkin lymphoma. Br J Haematol 2016; 175:860-867. [PMID: 27649689 DOI: 10.1111/bjh.14316] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/13/2016] [Indexed: 11/27/2022]
Abstract
Brentuximab vedotin (BV) significantly improved progression-free survival in a phase 3 study in patients with relapsed or refractory Hodgkin lymphoma (RR-HL) post-autologous-haematopoietic stem cell transplant (auto-HSCT); we report the impact of BV on quality of life (QOL) from this trial. The European Quality of Life five dimensions questionnaire was administered at the beginning of each cycle, end of treatment, and every 3 months during follow-up; index value scores were calculated using the time trade-off (TTO) method for UK-weighted value sets. Questionnaire adherence during the trial was 87·5% (N = 329). In an intent-to-treat analysis, compared with placebo, TTO scores in the BV arm did not exceed the minimally important difference (MID) of 0·08 except at month 15 (-0·084; 95% confidence interval, -0·143 to -0·025). On-treatment index scores were similar between arms and did not reach the MID at any time point; mixed-effect modelling showed that BV treatment effect was not significant (P = 0·2127). BV-associated peripheral neuropathy did not meaningfully impact QOL. Utility scores for patients who progressed declined compared with those who did not; TTO scores between these patients exceeded the MID beginning at month 15. In conclusion, QOL decreased modestly with BV consolidation treatment in patients with RR-HL at high risk of relapse after auto-HSCT.
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Affiliation(s)
- Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Tamas Masszi
- Haematology & Stem Cell Department, Szent Istvan & Szent Laszlo Corporate Hospital, Budapest, Hungary
| | - Jerzy Holowiecki
- Department of Bone Marrow Transplantation & Oncohaematology, Maria Sklodowska-Curie Institute of Oncology, Gliwice, Poland
| | - Muneer Abidi
- Spectrum Health Cancer Center, Michigan State University, Grand Rapids, MI, USA
| | - Andy Chen
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - John W Sweetenham
- Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, UT, USA
| | - John Radford
- University of Manchester and Christie NHS Foundation Trust, Manchester, UK
| | - Yanyan Zhu
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Vijayveer Bonthapally
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | | | | | | | - Jan Walewski
- Maria Sklodowska-Curie Institute and Institute of Oncology, Warsaw, Poland
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104
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Kusminsky G, Abriata G, Forman D, Sierra MS. Hodgkin lymphoma burden in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S158-S167. [PMID: 27678318 DOI: 10.1016/j.canep.2016.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVE Hodgkin lymphoma (HL) is largely curable owing to improvements in treatment since the 1960s; nevertheless, high mortality rates have been reported in Central and South America. We describe the current burden of HL in the Central and South American region. METHODS We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries, and national-level mortality data from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence rates (ASRs) and age-standardized mortality rates (ASMRs) per 100,000 person-years for 2003-2007 and present distributions by histological subtype. RESULTS HL incidence rates varied 7-fold in males and 11-fold in females (male-to-female ratio 1:1-2.5:1). The highest ASRs were seen Argentina, Brazil, Costa Rica (males), Cuba (males) and Uruguay (females), whereas the lowest were in Bolivia and El Salvador. ASMRs varied by 4-fold in males and 6-fold in females (male-to-female ratio 1:1-4.3:1), with ASMRs <0.7 for most countries, except Cuba (≥1.0). In most countries, age-specific incidence rates of HL showed a bimodal pattern. Trends in HL in Argentina, Brazil, Chile, and Costa Rica remained stable in 1997-2008. Of all HL cases, 48% were unspecified as to histological subtype. Nodular sclerosis and mixed cellularity were the most frequent histologies. CONCLUSION The geographic variation in HL across the region may in part reflect differences in data quality and coverage, and differences in the adoption of modern therapies and healthcare access. Our results highlight the need for high-quality data and increased coverage in order to provide vital guidance for future cancer control activities.
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Affiliation(s)
| | | | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
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105
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Sultan S, Irfan SM, Parveen S, Haider SA, Masood M. Frequency and Pattern of Bone Marrow Infiltration in Classical Hodgkin's Lymphoma: Experience from Southern Pakistan. Asian Pac J Cancer Prev 2016; 17:1857-9. [PMID: 27221865 DOI: 10.7314/apjcp.2016.17.4.1857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hodgkin's lymphoma (formerly, Hodgkins disease) is a potentially curable malignancy with distinctive biological behavior and specific clinical characteristics. Limited information is available from developing countries for patients with classical Hodgkin's lymphoma (cHL). Therefore we reviewed the demographical and clinico-hematological profiles along with bone marrow infiltration patterns in adult patients presenting at Liaquat National Hospital and Medical College. MATERIALS AND METHODS In this cross sectional study, 62 adult (≥15 years) patients with cHL were enrolled from January 2010 to December 2014. RESULTS The mean age was 29.7±13.8 years with a median of 30 years. The male to female ratio was 2:1. B symptoms were present in 72.5% of patients and lymph node enlargement in 85.4%. The frequency of bone marrow infiltration in our cHL patients was found to be 27.4%, the pattern being predominantly focal followed by diffuse. The mean hemoglobin was 9.4±1.9g/dl with a mean MCV of 78.1±7.9 fl, a mean total leukocyte count of 10.9±20.6x109/l and a mean platelet count of 241.6±150.1x109/l. CONCLUSIONS Our analysis shows that clinico-pathological features of cHL in Pakistan are comparable to published data. Peripheral lymphodenopathy associated with B symptoms is the commonest presentation. Bone marrow involvement is more common in our setup as patients usually presented at an advanced stage of disease.
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Affiliation(s)
- Sadia Sultan
- Department of Hematology and Blood Bank, Liaquat National Hospital and Medical College, Pakistan, Karachi E-mail :
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