1
|
Abstract
The nitrogen mustards are powerful cytotoxic and lymphoablative agents and have been used for more than 60 years. They are employed in the treatment of cancers, sarcomas, and hematologic malignancies. Cyclophosphamide, the most versatile of the nitrogen mustards, also has a place in stem cell transplantation and the therapy of autoimmune diseases. Adverse effects caused by the nitrogen mustards on the central nervous system, kidney, heart, bladder, and gonads remain important issues. Advances in analytical techniques have facilitated the investigation of the pharmacokinetics of the nitrogen mustards, especially the oxazaphosphorines, which are prodrugs requiring metabolic activation. Enzymes involved in the metabolism of cyclophosphamide and ifosfamide are very polymorphic, but a greater understanding of the pharmacogenomic influences on their activity has not yet translated into a personalized medicine approach. In addition to damaging DNA, the nitrogen mustards can act through other mechanisms, such as antiangiogenesis and immunomodulation. The immunomodulatory properties of cyclophosphamide are an area of current exploration. In particular, cyclophosphamide decreases the number and activity of regulatory T cells, and the interaction between cyclophosphamide and the intestinal microbiome is now recognized as an important factor. New derivatives of the nitrogen mustards continue to be assessed. Oxazaphosphorine analogs have been synthesized in attempts to both improve efficacy and reduce toxicity, with varying degrees of success. Combinations of the nitrogen mustards with monoclonal antibodies and small-molecule targeted agents are being evaluated. SIGNIFICANCE STATEMENT: The nitrogen mustards are important, well-established therapeutic agents that are used to treat a variety of diseases. Their role is continuing to evolve.
Collapse
Affiliation(s)
- Martin S Highley
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Bart Landuyt
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Hans Prenen
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Peter G Harper
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| | - Ernst A De Bruijn
- Plymouth Oncology Centre, Derriford Hospital, and Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom (M.S.H.); Department of Animal Physiology and Neurobiology (B.L.) and Laboratory for Experimental Oncology (E.A.D.B.), University of Leuven, Leuven, Belgium; Oncology Department, University Hospital Antwerp, Edegem, Belgium (H.P.); and London Oncology Clinic, London, United Kingdom (P.G.H.)
| |
Collapse
|
2
|
Tsiogka A, Karamaounas A, Papakonstantinou E, Petrou P. Tractional Retinal Detachment in a Patient With Waldenström's Macroglobulinemia. Cureus 2021; 13:e12430. [PMID: 33542877 PMCID: PMC7849914 DOI: 10.7759/cureus.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An 86-year-old man with Waldenström’s macroglobulinemia and a history of acute retinal necrosis (four years ago) presented with reduced visual acuity in his right eye of three days' duration. He developed epiretinal membrane and tractional retinal detachment, which were treated successfully. Epiretinal membrane and tractional retinal detachment usually occur one to two months after the onset of retinitis. In our case, this happened four years after the diagnosis of acute retinal necrosis syndrome, prophylactic vitrectomy, and successful treatment of acute retinal necrosis syndrome in a patient with Waldenström’s macroglobulinemia.
Collapse
Affiliation(s)
| | | | | | - Petros Petrou
- Ophthalmology, "G. Gennimatas" General Hospital of Athens, Athens, GRC
| |
Collapse
|
3
|
D'Acunto C, Purpura V, Scarpellini F, Liardo EV, Melandri D. Painful, plantar nodules in cutaneous macroglobulinosis: Successful treatment with rituximab and bendamustine. JAAD Case Rep 2020; 6:981-983. [PMID: 32995424 PMCID: PMC7508713 DOI: 10.1016/j.jdcr.2020.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Carmine D'Acunto
- Department of Emergency, Burn Center and Dermatology, M. Bufalini Hospital, Cesena, Italy
| | - Valeria Purpura
- Department of Emergency, Burn Center and Dermatology, M. Bufalini Hospital, Cesena, Italy
| | - Francesca Scarpellini
- Department of Clinical Pathology, Pathology Unit, M. Bufalini Hospital, Cesena, Italy
| | | | - Davide Melandri
- Department of Emergency, Burn Center and Dermatology, M. Bufalini Hospital, Cesena, Italy
| |
Collapse
|
4
|
Tedeschi A, Conticello C, Rizzi R, Benevolo G, Laurenti L, Petrucci MT, Zaja F, Varettoni M. Diagnostic framing of IgM monoclonal gammopathy: Focus on Waldenström macroglobulinemia. Hematol Oncol 2018; 37:117-128. [DOI: 10.1002/hon.2539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Alessandra Tedeschi
- Department of HematologyNiguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Concetta Conticello
- Department of Clinical and Molecular Biomedicine, Haematology SectionUniversity of Catania Catania Italy
| | - Rita Rizzi
- Department of Emergency and Organ Transplantation, Hematology SectionUniversity of Bari Medical School Bari Italy
| | - Giulia Benevolo
- Division of HematologyAOU Città della Salute e della Scienza Torino Italy
| | - Luca Laurenti
- Department of HematologyCatholic University Hospital “A. Gemelli” Rome Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Cellular Biotechnologies and Hematology“Sapienza” University Rome Italy
| | - Francesco Zaja
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari “Carlo Melzi”University of Udine Udine Italy
| | - Marzia Varettoni
- Division of HematologyFondazione IRCCS Policlinico S. Matteo Pavia Italy
| |
Collapse
|
5
|
Hellman J, Harocopos G, Lin L. Waldenstrom macroglobulinemia involving the superior rectus muscle. Am J Ophthalmol Case Rep 2018; 10:304-306. [PMID: 29780960 PMCID: PMC5956744 DOI: 10.1016/j.ajoc.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/16/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We present the first reported case of Waldenstrom macroglobulinemia in the right superior rectus causing diplopia. OBSERVATIONS A 72-year-old man with a 6-month history of untreated asymptomatic Waldenstrom macroglobulinemia presented with 2 years of diagonal binocular diplopia that was previously thought to be due to ocular myasthenia gravis. Examination showed mild right proptosis and right hypotropia, and MRI revealed a focal lesion of the right superior rectus muscle. Orbital biopsy was performed, and histopathology showed lymphoplasmacytic infiltration among the skeletal muscle fibers of the rectus muscle. Immunostaining confirmed a B-cell preponderance, along with more extensive staining for IgM than IgG, and in situ hybridization confirmed lambda restriction. These findings corresponded with those of his previous bone marrow biopsy, confirming Waldenstrom macroglobulinemia as the etiology for the extraocular muscle mass. CONCLUSIONS AND IMPORTANCE Lymphoma of an extraocular muscle is a rare manifestation of orbital lymphoma, and the tumors are usually mucosa-associated lymphoid tissue (MALT) lymphomas (i.e. extranodal marginal zone lymphomas). There are 4 previous reports of lymphoplasmacytic lymphoma of an extraocular muscle; however this is the first reported case of such a lesion in a patient with concurrent Waldenstrom macroglobulinemia at the time of diagnosis.
Collapse
Affiliation(s)
- J.B. Hellman
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA
| | - G.J. Harocopos
- Departments of Ophthalmology and Visual Sciences and of Pathology and Immunology, Washington University, St. Louis, MO, USA
| | - L.K. Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA
| |
Collapse
|
6
|
Chang CY, Yeh RH, Chen JH, Wu YY, Huang TC, Chang PY, Dai MS, Chen YC, Ho CL. Unusual presentation of Waldenstrom macroglobulinemia. JOURNAL OF CANCER RESEARCH AND PRACTICE 2018. [DOI: 10.1016/j.jcrpr.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
7
|
Abstract
PURPOSE To describe Waldenström's macroglobulinemia (WM) as a masquerade syndrome. METHODS Case report. RESULTS A 59-year-old human leukocyte antigen (HLA)-A29-negative white male presented with a 7-year history of floaters, progressive vision loss, and poor contrast sensitivity along with choroidal lesions suggestive of birdshot chorioretinopathy (BCR). Fluorescein angiography, fundus autofluorescence, and indocyanine green angiography showed multiple areas of hyperfluorescence and hypofluorescence. Electroretinography showed reduced cone and rod responses. Comprehensive workup for infectious, paraneoplastic, and other causes including sarcoidosis was negative at the time. The patient was treated with multiple immunomodulatory agents without any significant improvement. Two years after initial presentation, the patient developed normocytic anemia and high levels of inflammatory markers. Further workup yielded a diagnosis of WM. His choroidal lesions were significantly reduced after treatment with rituximab and bendamustine. CONCLUSION We report a case of WM masquerading as BCR. Other indolent diseases should be considered in the differential diagnosis for HLA-A29-negative patients presenting with birdshot-like lesions, especially if they are clinically unresponsive to multiple systemic immunosuppressive agents.
Collapse
|
8
|
BDR in newly diagnosed patients with WM: final analysis of a phase 2 study after a minimum follow-up of 6 years. Blood 2017; 129:456-459. [DOI: 10.1182/blood-2016-09-742411] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/25/2016] [Indexed: 12/18/2022] Open
Abstract
Key Points
BDR is a chemotherapy-free, non-stem-cell–toxic regimen associated with high response rates and long-term remissions. The long-term safety profile of BDR is favorable, with high probability of response to reintroduction of rituximab-based regimens at relapse.
Collapse
|
9
|
Gavriatopoulou M, Terpos E, Kastritis E, Dimopoulos MA. Current treatment options and investigational drugs for Waldenstrom’s Macroglobulinemia. Expert Opin Investig Drugs 2017; 26:197-205. [DOI: 10.1080/13543784.2017.1275561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra General Hospital, Athens, Greece
| |
Collapse
|
10
|
Ma SK, Kim SS, Bae EH, Kim SW. Perirenal mass with nephrotic syndrome caused by Waldenström macroglobulinaemia. Nephrology (Carlton) 2016; 21:905-6. [PMID: 27619105 DOI: 10.1111/nep.12682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 11/19/2015] [Accepted: 11/22/2015] [Indexed: 10/21/2022]
Affiliation(s)
- Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Sun Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
11
|
Shiba K, Abe R, Miyauchi T, Nomura T, Kondo T, Shimizu H. Massive petechiae as an initial symptom of Waldenström's macroglobulinemia. Int J Dermatol 2016; 55:e361-2. [DOI: 10.1111/ijd.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/06/2015] [Accepted: 08/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Keiko Shiba
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Riichiro Abe
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Toshinari Miyauchi
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Toshifumi Nomura
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Takeshi Kondo
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Hiroshi Shimizu
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| |
Collapse
|
12
|
Boyle E, Manier S, Lejeune J, Fouquet G, Guidez S, Bonnet S, Debarri H, Demarquette H, Dulery R, Gay J, Hennache B, Onraed B, Faucompré JL, Schraen S, Facon T, Avet-Loiseau H, Chevret S, Leblond V, Harding S, Leleu X. IgMκ and IgMλ Measurements for the Assessment of Patients with Waldenström's Macroglobulinaemia. Clin Cancer Res 2016; 22:5152-5158. [DOI: 10.1158/1078-0432.ccr-15-2899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/05/2016] [Indexed: 11/16/2022]
|
13
|
Gaudette BT, Dwivedi B, Chitta KS, Poulain S, Powell D, Vertino P, Leleu X, Lonial S, Chanan-Khan AA, Kowalski J, Boise LH. Low expression of pro-apoptotic Bcl-2 family proteins sets the apoptotic threshold in Waldenström macroglobulinemia. Oncogene 2016; 35:479-90. [PMID: 25893290 PMCID: PMC4874246 DOI: 10.1038/onc.2015.103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/29/2015] [Accepted: 02/20/2015] [Indexed: 11/09/2022]
Abstract
Waldenström macroglobulinemia (WM) is a proliferative disorder of IgM-secreting, lymphoplasmacytoid cells that inhabit the lymph nodes and bone marrow. The disease carries a high prevalence of activating mutations in MyD88 (91%) and CXCR4 (28%). Because signaling through these pathways leads to Bcl-xL induction, we examined Bcl-2 family expression in WM patients and cell lines. Unlike other B-lymphocyte-derived malignancies, which become dependent on expression of anti-apoptotic proteins to counter expression of pro-apoptotic proteins, WM samples expressed both pro- and anti-apoptotic Bcl-2 proteins at low levels similar to their normal B-cell and plasma cell counterparts. Three WM cell lines expressed pro-apoptotic Bcl-2 family members Bim or Bax and Bak at low levels, which determined their sensitivity to inducers of intrinsic apoptosis. In two cell lines, miR-155 upregulation, which is common in WM, was responsible for the inhibition of FOXO3a and Bim expression. Both antagonizing miR-155 to induce Bim and proteasome inhibition increased the sensitivity to ABT-737 in these lines indicating a lowering of the apoptotic threshold. In this manner, treatments that increase pro-apoptotic protein expression increase the efficacy of agents treated in combination in addition to direct killing.
Collapse
Affiliation(s)
- Brian T. Gaudette
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA 30322
- Winship Cancer Institute, Emory University, Atlanta, GA 30322
- Graduate Program in Immunology and Molecular Pathogenesis, Emory University, Atlanta, GA 30322
| | - Bhakti Dwivedi
- Winship Cancer Institute, Emory University, Atlanta, GA 30322
| | | | - Stéphanie Poulain
- Service d’Hématologie Immunologie Cytogénétique, Hopital de Valenciennes, Valenciennes, France
| | - Doris Powell
- Winship Cancer Institute, Emory University, Atlanta, GA 30322
- Department of Radiation Oncology, Emory University, Atlanta, GA 30322
| | - Paula Vertino
- Winship Cancer Institute, Emory University, Atlanta, GA 30322
- Department of Radiation Oncology, Emory University, Atlanta, GA 30322
| | - Xavier Leleu
- Service des Maladies du Sang, Hopital Claude Huriez, CHRU Lille, Lille, France
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA 30322
- Winship Cancer Institute, Emory University, Atlanta, GA 30322
| | | | - Jeanne Kowalski
- Winship Cancer Institute, Emory University, Atlanta, GA 30322
| | - Lawrence H. Boise
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA 30322
- Winship Cancer Institute, Emory University, Atlanta, GA 30322
- Graduate Program in Immunology and Molecular Pathogenesis, Emory University, Atlanta, GA 30322
- Department of Cell Biology, Emory University, Atlanta, GA 30322
| |
Collapse
|
14
|
Lepretre S, Dartigeas C, Feugier P, Marty M, Salles G. Systematic review of the recent evidence for the efficacy and safety of chlorambucil in the treatment of B-cell malignancies. Leuk Lymphoma 2015; 57:852-65. [PMID: 26308278 DOI: 10.3109/10428194.2015.1085528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Emergence of new agents has deeply modified treatment options and the role of chlorambucil (CLB) in B-cell malignancies. We conducted a systematic review of prospective, randomized, controlled trials (RCTs) investigating the benefits and harms of CLB used alone or in combination with other treatment in patients suffering from chronic lymphocytic leukemia (CLL), low-grade non-Hodgkin lymphoma (NHL) or Waldenström macroglobulinemia (WM). For CLL, review of the nine RCTs showed that the main advantage of CLB is its low toxicity in comparison with purine nucleoside analogs like fludarabine in either CLL or NHL. In CLL, the major disadvantage is the very low rate of complete response, except when combining an anti-CD20 antibody. For B-cell lymphoma and WM, six RCTs were summarized. Results according to the usual criteria are presented and the role of CLB, used mostly in combination with an anti-CD20 antibody, is discussed for each indication, in particular for unfit patients.
Collapse
Affiliation(s)
- Stéphane Lepretre
- a Service d'hématologie, centre de lutte contre le cancer, Henri Becquerel , Rouen , France
| | - C Dartigeas
- b Service de cancérologie et d'hématologie thérapie cellulaire, CHU Bretonneau , Tours , France
| | - P Feugier
- c Service hématologie, CHU Nancy Brabois, Vandoeuvre Les Nancy , Nancy , France
| | - M Marty
- d Nukleus, département recherche clinique , Paris , France , and
| | - G Salles
- e Service d'hématologie, Hospices civils de Lyon, Centre hospitalier Lyon Sud , Lyon , France
| |
Collapse
|
15
|
Kastritis E, Kyrtsonis MC, Morel P, Gavriatopoulou M, Hatjiharissi E, Symeonidis AS, Vassou A, Repousis P, Delimpasi S, Sioni A, Michalis E, Michael M, Vervessou E, Voulgarelis M, Tsatalas C, Terpos E, Dimopoulos MA. Competing risk survival analysis in patients with symptomatic Waldenström macroglobulinemia: the impact of disease unrelated mortality and of rituximab-based primary therapy. Haematologica 2015; 100:e446-9. [PMID: 26294729 DOI: 10.3324/haematol.2015.124149] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Marie-Christine Kyrtsonis
- Hematology Section of the First Department of Propedeutic Internal Medicine, Laikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Pierre Morel
- Service D'Hématologie Clinique et Thérapie Cellulaire CHU (University Hospital), Amiens, France
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | | | | | - Amalia Vassou
- University of Ioannina, Hematology Division, Ioannina, Greece
| | - Panagiotis Repousis
- Peripheral General Anticancer Hospital-Metaxa, Department of Hematology, Piraeus, Greece
| | - Sossana Delimpasi
- Evangelismos Hospital, Hematology Department, Athens, Attica, Greece
| | - Anastasia Sioni
- St Savvas Oncology Hospital, Hematology Division, Athens, Greece
| | - Evrydiki Michalis
- G.Gennimatas General Hospital, Department of Hematology, Athens, Greece
| | - Michail Michael
- Department of Haematology, Nicosia General Hospital, Cyprus, Greece
| | | | - Michael Voulgarelis
- Department of Pathophysiology, National And Kapodistrian University of Athens, School of Medicine, Greece
| | | | - Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| |
Collapse
|
16
|
Jackson DA, Smith TD, Amarsaikhan N, Han W, Neil MS, Boi SK, Vrabel AM, Tolosa EJ, Almada LL, Fernandez-Zapico ME, Elsawa SF. Modulation of the IL-6 Receptor α Underlies GLI2-Mediated Regulation of Ig Secretion in Waldenström Macroglobulinemia Cells. THE JOURNAL OF IMMUNOLOGY 2015; 195:2908-16. [PMID: 26238488 DOI: 10.4049/jimmunol.1402974] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 07/14/2015] [Indexed: 12/15/2022]
Abstract
Ig secretion by terminally differentiated B cells is an important component of the immune response to foreign pathogens. Its overproduction is a defining characteristic of several B cell malignancies, including Waldenström macroglobulinemia (WM), where elevated IgM is associated with significant morbidity and poor prognosis. Therefore, the identification and characterization of the mechanisms controlling Ig secretion are of great importance for the development of future therapeutic approaches for this disease. In this study, we define a novel pathway involving the oncogenic transcription factor GLI2 modulating IgM secretion by WM malignant cells. Pharmacological and genetic inhibition of GLI2 in WM malignant cells resulted in a reduction in IgM secretion. Screening for a mechanism identified the IL-6Rα (gp80) subunit as a downstream target of GLI2 mediating the regulation of IgM secretion. Using a combination of expression, luciferase, and chromatin immunoprecipitation assays we demonstrate that GLI2 binds to the IL-6Rα promoter and regulates its activity as well as the expression of this receptor. Additionally, we were able to rescue the reduction in IgM secretion in the GLI2 knockdown group by overexpressing IL-6Rα, thus defining the functional significance of this receptor in GLI2-mediated regulation of IgM secretion. Interestingly, this occurred independent of Hedgehog signaling, a known regulator of GLI2, as manipulation of Hedgehog had no effect on IgM secretion. Given the poor prognosis associated with elevated IgM in WM patients, components of this new signaling axis could be important therapeutic targets.
Collapse
Affiliation(s)
- David A Jackson
- Department of Biological Sciences, Northern Illinois University, DeKalb, IL 60115; and
| | - Timothy D Smith
- Department of Biological Sciences, Northern Illinois University, DeKalb, IL 60115; and
| | - Nansalmaa Amarsaikhan
- Department of Biological Sciences, Northern Illinois University, DeKalb, IL 60115; and
| | - Weiguo Han
- Department of Biological Sciences, Northern Illinois University, DeKalb, IL 60115; and
| | - Matthew S Neil
- Department of Biological Sciences, Northern Illinois University, DeKalb, IL 60115; and
| | - Shannon K Boi
- Department of Biological Sciences, Northern Illinois University, DeKalb, IL 60115; and
| | - Anne M Vrabel
- Schulze Center for Novel Therapeutics, Mayo Clinic, Rochester, MN 55905
| | - Ezequiel J Tolosa
- Schulze Center for Novel Therapeutics, Mayo Clinic, Rochester, MN 55905
| | - Luciana L Almada
- Schulze Center for Novel Therapeutics, Mayo Clinic, Rochester, MN 55905
| | | | - Sherine F Elsawa
- Department of Biological Sciences, Northern Illinois University, DeKalb, IL 60115; and
| |
Collapse
|
17
|
Cao X, Ye Q, Orlowski RZ, Wang X, Loghavi S, Tu M, Thomas SK, Shan J, Li S, Qazilbash M, Yin CC, Weber D, Miranda RN, Xu-Monette ZY, Medeiros LJ, Young KH. Waldenström macroglobulinemia with extramedullary involvement at initial diagnosis portends a poorer prognosis. J Hematol Oncol 2015; 8:74. [PMID: 26104577 PMCID: PMC4487966 DOI: 10.1186/s13045-015-0172-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/11/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The prognostic importance of extramedullary involvement in patients with Waldenström macroglobulinemia (WM) at diagnosis and treatment options for these patients has not been well evaluated. In this study, we investigated the clinical manifestations, biological features, and effect of first-line therapy on the outcome of WM patients diagnosed with extramedullary involvement (EMWM) vs those with only bone marrow involvement (BMWM). METHODS We analyzed the clinical data of 312 WM patients diagnosed with EMWM (n = 106) and BMWM (n = 206) at The University of Texas MD Anderson Cancer Center from 1994 to 2014. EMWM was confirmed by biopsy, positron emission tomography-computed tomography, or magnetic resonance imaging, and clinical laboratory analyses. RESULTS Characteristics associated with EMWM were male sex (P = 0.027), age younger than 65 years (P = 0.048), presence of B symptoms (P < 0.001), high serum beta-2 macroglobulin (P < 0.001) level, low serum albumin level (P = 0.036), and cytogenetic abnormalities (P = 0.010). Kaplan-Meier survival analysis results showed that EMWM patients had a significantly shorter median overall survival (P < 0.001) and progression-free survival (PFS) (P < 0.001) than did BMWM patients. Chemotherapy combined with targeted therapy improved PFS for BMWM patients (P = 0.004) but not for EMWM patients. Additionally, initial treatment with rituximab significantly improved the PFS of BMWM patients (P = 0.012) but had no effect on EMWM patients. However, EMWM patients treated with nucleoside analogs attained a better PFS than those who did not (P = 0.021). CONCLUSIONS We show that extramedullary involvement at diagnosis is an adverse prognostic factor in WM patients and that first-line therapy with nucleoside analogs improved PFS for patients with EMWM. The study provides unique clinical and treatment observations in subtypes of WM patients.
Collapse
Affiliation(s)
- Xin Cao
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
- Department of Hematology, the Affiliated Hospital of Nantong University, Nantong, China.
| | - Qing Ye
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Xiaoxiao Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Sanam Loghavi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Meifeng Tu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Sheeba K Thomas
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Jatin Shan
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Shaoying Li
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Muzaffar Qazilbash
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - C Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Donna Weber
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Zijun Y Xu-Monette
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
- The University of Texas School of Medicine, Graduate School of Biomedical Sciences, Houston, TX, USA.
| |
Collapse
|
18
|
Van Cauwenberge MG, Depreter B, Dumoulin EN, Emmerechts J, Nollet F, Vanopdenbosch LJ. Bing-Neel syndrome: Two unexpected cases and a review of the literature. J Neurol Sci 2015; 356:19-26. [PMID: 26159625 DOI: 10.1016/j.jns.2015.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 06/01/2015] [Accepted: 06/13/2015] [Indexed: 10/23/2022]
Abstract
Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma characterized by the proliferation of small B-lymphocytes in the bone marrow that produce monoclonal immunoglobulin M (IgM). We describe two patients with WM who presented with neurological symptoms due to infiltration of lymphoplasmacytoid tumor cells in the central nervous system, a condition known as Bing-Neel syndrome. A literature review revealed that this syndrome is rare and commonly missed in clinical practice due to its variable presentation and a lack of awareness or knowledge. Brain and spinal magnetic resonance imaging may show a focal mass or diffuse infiltration. The diagnosis of Bing-Neel syndrome requires proof of IgM or lymphoplasmacytoid cells in cerebrospinal fluid or in a brain biopsy. Treatment with intravenous and/or intrathecal chemotherapy and cranial radiotherapy is described in literature with generally poor outcome, although a combination of these therapies seems to improve outcome. Nevertheless, insufficient data are currently available to make general treatment recommendations.
Collapse
Affiliation(s)
- M G Van Cauwenberge
- Department of Neurology, University Clinic RWTH Aachen, Germany; Department of Neurology, AZ Sint Jan Brugge Oostende, Belgium.
| | - B Depreter
- Department of Laboratory Hematology, University Hospital Ghent, Belgium
| | - E N Dumoulin
- Department of Laboratory Hematology, University Hospital Ghent, Belgium
| | - J Emmerechts
- Department of Laboratory Hematology, AZ Sint Jan Brugge Oostende, Belgium
| | - F Nollet
- Department of Laboratory Hematology, AZ Sint Jan Brugge Oostende, Belgium
| | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Monoclonal gammopathies are common in the general population and occur in 10% of patients with peripheral neuropathy. It is important for the clinician to be able to determine whether an association exists between the paraprotein and the neuropathy. The clinical phenotype of the neuropathy, as well as the type of monoclonal protein, provides clues for the diagnosis. Optimal management of paraproteinemic neuropathies requires appropriate evaluation of the monoclonal protein for an underlying hematologic disorder. RECENT FINDINGS Clinical studies in paraproteinemic neuropathies have provided a better understanding of these disorders, but much is still unknown regarding the pathophysiologic mechanisms. Recent clinical trials in immunoglobulin M (IgM) neuropathy have shown that better outcome measures and treatment approaches are needed. Peripheral blood stem cell transplantation has shown promising improvements in the treatment of polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes (POEMS) syndrome and immunoglobulin light chain (AL) amyloidosis. SUMMARY Recognizing the frequent association of neuropathy with monoclonal proteins and evaluating for a hematologic malignancy should enable physicians to find better treatments and ultimately improve neuropathy outcome.
Collapse
|
20
|
Bassarova A, Trøen G, Spetalen S, Micci F, Tierens A, Delabie J. Lymphoplasmacytic lymphoma and marginal zone lymphoma in the bone marrow: paratrabecular involvement as an important distinguishing feature. Am J Clin Pathol 2015; 143:797-806. [PMID: 25972321 DOI: 10.1309/ajcp6zodwv1cidme] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The differential diagnosis between bone marrow involvement by lymphoplasmacytic lymphoma (LPL) and marginal zone lymphoma (MZL) is challenging because histology and immunophenotype of both diseases overlap. We revisited the diagnostic pathology features of both diseases in the bone marrow. METHODS We studied a series of bone marrow trephine biopsy specimens from 59 patients with Waldenström macroglobulinemia without extramedullary involvement and bone marrow biopsy specimens from 23 patients with well-characterized MZL who also had bone marrow involvement. H&E- and immunoperoxidase-stained sections of bone marrow trephine biopsy specimens as well as flow cytometry and classic cytogenetics performed on aspirations were reviewed. The study was complemented with MYD88 L265P mutation analysis of all samples. RESULTS The most distinguishing features of LPL with respect to MZL were focal paratrabecular involvement (P < .001), the presence of lymphoplasmacytoid cells (P < .001) and Dutcher bodies (P < .001), increased numbers of mast cells (P < .001), and the MYD88 L265P mutation (P < .001). CONCLUSIONS LPL can be reliably distinguished from MZL in the bone marrow by using a combination of pathology characteristics. Our findings stress the diagnostic importance of using the combination of the following parameters for a correct LPL diagnosis: paratrabecular infiltration, the presence of lymphoplasmacytoid cells and cells with Dutcher bodies, and an increased number of mast cells in addition to the presence of MYD88 mutation.
Collapse
Affiliation(s)
- Assia Bassarova
- Department of Pathology, Akershus University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Gunhild Trøen
- University of Oslo, Oslo, Norway
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Signe Spetalen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Centre for Cancer Biomedicine, University of Oslo, Oslo, Norway
| | - Anne Tierens
- Department of Pathology, University Health Network, Toronto, Canada
| | - Jan Delabie
- University of Oslo, Oslo, Norway
- Department of Pathology, University Health Network, Toronto, Canada
| |
Collapse
|
21
|
Krem MM, Gopal AK. New targeted therapies for indolent B-cell malignancies in older patients. Am Soc Clin Oncol Educ Book 2015:e365-74. [PMID: 25993198 DOI: 10.14694/edbook_am.2015.35.e365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Molecularly targeted agents have become an established component of the treatment of indolent B-cell malignancies (iNHL). iNHL disproportionately affects older adults, so treatments that have excellent tolerability and efficacy across multiple lines of therapy are in demand. The numbers and classes of targeted therapies for iNHL have proliferated rapidly in recent years; classes of agents that show promise for older patients with iNHL include anti-CD20 antibodies, phosphatidyl-3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) signaling pathway inhibitors, immunomodulators, proteasome inhibitors, epigenetic modulators, and immunotherapies. Here, we review the proposed mechanisms of action, efficacy, and tolerability of novel agents for iNHL, with an emphasis on their applicability to older patients.
Collapse
Affiliation(s)
- Maxwell M Krem
- From the University of Louisville Brown Cancer Center, Louisville, KY; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ajay K Gopal
- From the University of Louisville Brown Cancer Center, Louisville, KY; Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
22
|
Chakraborty R, Ansell SA, Kapoor P, Gertz MA. Phase II clinical trials for Waldenstrom’s macroglobulinemia. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1025749] [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]
|
23
|
Oza A, Rajkumar SV. Waldenstrom macroglobulinemia: prognosis and management. Blood Cancer J 2015; 5:e394. [PMID: 25815903 PMCID: PMC4382666 DOI: 10.1038/bcj.2015.28] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 12/12/2022] Open
Abstract
Waldenstrom macroglobulinemia (WM) is a B-cell lymphoplasmacytic lymphoma characterized by monoclonal immunoglobulin M protein in the serum and infiltration of bone marrow with lymphoplasmacytic cells. Asymptomatic patients can be observed without therapy. First-line therapy should consist of the monoclonal anti-CD20 antibody, rituximab, given typically in combination with other agents. We prefer dexamethasone, rituximab, cyclophosphamide (DRC) as initial therapy for most patients with symptomatic WM. Other reasonable options are bortezomib, rituximab, dexamethasone (BoRD) or bendamustine plus rituximab (BR). All of these regimens are associated with excellent response and tolerability. Initial therapy is usually administered for 6 months, followed by observation. Response to therapy is assessed using the standard response criteria developed by the International Working Group on Waldenstrom macroglobulinemia. Relapse is almost inevitable in WM but may occur years after initial therapy. In symptomatic patients relapsing more than 1–2 years after initial therapy, the original treatment can be repeated. For relapse occurring sooner, an alternative regimen is used. In select patients, high-dose chemotherapy followed by autologous hematopoietic cell transplantation may be an option at relapse. Options for therapy of relapsed WM besides regimens used in the front-line setting include ibrutinib, purine nucleoside analogs (cladribine, fludarabine), carfilzomib and immunomodulatory agents (thalidomide, lenalidomide).
Collapse
Affiliation(s)
- A Oza
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S V Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
24
|
Autoimmune Manifestations in Patients With Waldenström Macroglobulinemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:456-9. [DOI: 10.1016/j.clml.2014.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 12/31/2013] [Accepted: 04/30/2014] [Indexed: 12/25/2022]
|
25
|
Raheja D, Specht C, Simmons Z. Paraproteinemic neuropathies. Muscle Nerve 2014; 51:1-13. [DOI: 10.1002/mus.24471] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Divisha Raheja
- Department of Neurology; Penn State Hershey Medical Center; EC 037, 30 Hope Drive Hershey Pennsylvania 17033 USA
| | - Charles Specht
- Department of Neurology; Penn State Hershey Medical Center; EC 037, 30 Hope Drive Hershey Pennsylvania 17033 USA
- Department of Pathology; Penn State Hershey Medical Center; Hershey Pennsylvania USA
- Department of Ophthalmology; Penn State Hershey Medical Center; Hershey Pennsylvania USA
- Department of Neurosurgery; Penn State Hershey Medical Center; Hershey Pennsylvania USA
| | - Zachary Simmons
- Department of Neurology; Penn State Hershey Medical Center; EC 037, 30 Hope Drive Hershey Pennsylvania 17033 USA
| |
Collapse
|
26
|
D'Acunto C, Nigrisoli E, Liardo EV, Melandri D. Painful plantar nodules: a specific manifestation of cutaneous macroglobulinosis. J Am Acad Dermatol 2014; 71:e251-2. [PMID: 25454049 DOI: 10.1016/j.jaad.2014.08.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/24/2014] [Accepted: 08/26/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Carmine D'Acunto
- Department of Emergency, Burns Center and Dermatology, M Bufalini Hospital, Cesena, Italy.
| | - Evandro Nigrisoli
- Department of Clinical Pathology-Pathology Unit, M Bufalini Hospital, Cesena, Italy
| | | | - Davide Melandri
- Department of Emergency, Burns Center and Dermatology, M Bufalini Hospital, Cesena, Italy
| |
Collapse
|
27
|
Hultcrantz M, Pfeiffer RM, Björkholm M, Goldin LR, Turesson I, Schulman S, Landgren O, Kristinsson SY. Elevated risk of venous but not arterial thrombosis in Waldenström macroglobulinemia/lymphoplasmacytic lymphoma. J Thromb Haemost 2014; 12:1816-21. [PMID: 25196979 DOI: 10.1111/jth.12724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/01/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many malignancies, including multiple myeloma and its precursor, monoclonal gammopathy of unknown significant, are associated with an elevated risk of thromboembolism. There is limited information on the risk of thrombosis in patients with Waldenström macroglobulinemia (WM) and lymphoplasmacytic lymphoma (LPL). OBJECTIVES To assess the risk of venous and arterial thrombosis in WM/LPL patients in a large population-based cohort study in Sweden. PATIENTS/METHODS A total of 2190 patients with WM/LPL and 8086 matched controls were identified through Swedish registers between 1987 and 2005. Information on occurrence of venous and arterial thrombosis after the diagnosis of WM/LPL was obtained through the centralized Swedish Patient Register, with follow-up to 2006. Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Patients with WM/LPL had a significantly increased risk of venous thrombosis and the highest risk was observed during the first year following diagnosis (HR = 4.0, 95% CI 2.5-6.4). The risk was significantly elevated 5 (HR = 2.3, 95% CI 1.7-3.0) and 10 years after diagnosis (HR = 2.0, 95% CI 1.6-2.5). There was no increased risk of arterial thrombosis during any period of follow-up time (10-year HR = 1.0, 95% CI 0.9-1.1). CONCLUSIONS Venous thrombosis is a significant cause of morbidity in patients with WM/LPL. The potential role of thromboprophylaxis in WM/LPL, especially during the first year after diagnosis and in patients treated with thrombogenic agents, needs to be assessed to further improve outcome in WM/LPL patients.
Collapse
Affiliation(s)
- M Hultcrantz
- Department of Medicine, Division of Hematology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Atienza J, Bockorny B, Dadla A, Codreanu I, Dasanu CA. Inflammatory and immune-related conditions associated with Waldenström macroglobulinemia: a single center experience. Leuk Lymphoma 2014; 56:1179-80. [DOI: 10.3109/10428194.2014.944520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
29
|
Huang RSP, Dasgupta A, Nguyen AND, Wahed A. Inability to Measure M-Protein With Capillary Zone Electrophoresis (CAPPILLARYS 2) in Tracings With NonDiscernable Peaks. J Clin Lab Anal 2014; 29:343-6. [PMID: 25130914 DOI: 10.1002/jcla.21776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/29/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND We performed a retrospective study to illustrate the challenges with quantifying monoclonal (M)-protein in the cases of serum protein capillary zone electrophoresis (SPCZE) where no discernable peak is apparent. MATERIALS AND METHODS We retrospectively reviewed 160 serum immunofixation electrophoresis (SIFE) that were performed at Memorial Hermann Hospital-Texas Medical Center between October 2013 and November 2013 and we identified the positive SIFE results. The corresponding SPCZE of the positive SIFE were retrieved and evaluated for the ability to quantify M-proteins in them. We define the ability to quantify M-protein as the ability for the operator of the SPCZE to identify a discernable peak and to be able to manually gate the area under the peak. RESULTS Twenty-two cases of SIFE detected a monoclonal immunoglobulin. Of the corresponding 22 SPCZE, we could not quantify the M-protein in 6 (27.3%) of the cases. CONCLUSION We have shown several cases where we were not able to quantify the M-protein with SPCZE. This poses a challenge in the diagnosis and management of these patients.
Collapse
Affiliation(s)
- Richard S P Huang
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas
| | - Andy N D Nguyen
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas
| | - Amer Wahed
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, Texas
| |
Collapse
|
30
|
Clinical factors associated with response or survival after chemotherapy in patients with Waldenström macroglobulinemia in Korea. BIOMED RESEARCH INTERNATIONAL 2014; 2014:253243. [PMID: 24995279 PMCID: PMC4065725 DOI: 10.1155/2014/253243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 11/21/2022]
Abstract
Waldenström's macroglobulinemia (WM) is a B-cell proliferative malignancy characterized by immunoglobulin M monoclonal gammopathy and bone marrow infiltration by lymphoplasmacytic cells. Clinical features and cytogenetics of WM in Asia including Republic of Korea remain unclear. Moreover, no study has reported treatment outcomes in patients with WM treated with novel agent combined with conventional chemotherapy. This study investigated clinical features and assessed treatment outcomes with novel agent and conventional chemotherapy in Republic of Korea. Data from all (n = 71) patients with newly diagnosed WM at 17 hospitals who received chemotherapy between January 2005 and December 2012 were collected retrospectively. The median age of patients was 66 years (range: 37–92 years) and male to female ratio was 5 : 1. Patients treated with novel agent combined chemotherapy displayed higher overall response rate (ORR) compared to conventional chemotherapy alone (92.9% versus 52.6%, P = 0.006). The 5-year overall survival rate was 62.6% (95% confidence interval: 34.73–111.07). Use of novel agents produced higher ORR but survival benefit was not apparent due to the small number of patients and short follow-up duration. Further studies are needed to confirm the efficacy of novel agents in patients with WM.
Collapse
|