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Touré SA, Niang D, Gueye SM, Keita M, Diallo AB, Bousso ES, Dieng F, Faye BF, Seck M, Diop S. Lymphocytic Lymphoma Transforming into Hodgkin Lymphoma in Sub-Saharan Africa: Case Report and Literature Review. Hematol Rep 2024; 16:523-528. [PMID: 39189246 PMCID: PMC11348024 DOI: 10.3390/hematolrep16030050] [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: 02/23/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 08/28/2024] Open
Abstract
The Hodgkin variant Richter syndrome (HvRS) is an infrequent complication occurring in 1% of lymphocytic lymphoma/chronic lymphocytic leukemia patients. We report a case of HvRS diagnosed in Sub-Saharan Africa. A 63-year-old patient was consulted for the investigation of an abdominal mass that had been evolving for 5 years prior to admission. His history revealed night sweats, 13% weight loss in 3 months and persistent pruritis. Examination revealed bilateral cervical axillary and inguinal macroadenopathies, painless abdominal distension, pruritic lesions and WHO 2 PS. The blood count showed anemia at 9.5 g/dL. Histology revealed a lymphomatous proliferation of diffuse architecture, nodular in places, with Hodgkin and Sternberg cells associated with small lymphocytes, histiocytes and eosinophilic polymorphs. Immunohistochemistry showed CD20, PAX5, BCL2, CD5, CD23 and MYC positivity; Ki67 at 10% and cyclin D1, BCL6 and CD10 negativity; CD30 positivity on Hodgkin and Sternberg cells that remained CD20 negative; difficulty interpreting CD15; EBV positivity (EBERs); and CD3 and CD5 positivity on reactive T cells. CD138 and kappa and lambda light chains were non-contributory. The extension work-up classified the patient as Ann Arbor stage III B with a Hasenclever score of 3/7. This case illustrates the difficulties in diagnosing HvRS in our countries, where the number of haematopathologists is insufficient and the technical facilities are limited.
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Affiliation(s)
| | - Dibor Niang
- Pathology Department, Gaston Berger University, Saint-Louis 234, Senegal
| | | | - Mohamed Keita
- Hematology Department, Cheikh Anta Diop University, Dakar 10700, Senegal
| | | | | | - Fatma Dieng
- Clinical Hematology Unit, National Blood Transfusion Center, Dakar 5002, Senegal
| | - Blaise Felix Faye
- Hematology Department, Cheikh Anta Diop University, Dakar 10700, Senegal
| | - Moussa Seck
- Hematology Department, Cheikh Anta Diop University, Dakar 10700, Senegal
| | - Saliou Diop
- Hematology Department, Cheikh Anta Diop University, Dakar 10700, Senegal
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2
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Jensen CE, Stephens DM. Contemporary Standard of Care Therapy for Richter's Transformation and Future Directions. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024:S2152-2650(24)00262-3. [PMID: 39122639 DOI: 10.1016/j.clml.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 08/12/2024]
Abstract
Richter's transformation (RT) is a life-threatening evolution of chronic lymphocytic leukemia (CLL) into a more aggressive lymphoma, typically diffuse large B-cell lymphoma (DLBCL), marking a challenging juncture in CLL management due to the associated poor prognosis and limited treatment options. This review delves into the current therapeutic landscape for RT. Despite the modest efficacy of traditional chemoimmunotherapy (CIT) regimens such as R-CHOP and its variations, this regimen remains the most commonly recommended standard of care. Multiple therapeutic strategies are under investigation, including targeted kinase inhibitors, checkpoint inhibitors, bispecific antibodies, and CAR T therapy. Given the complex nature of RT and the evolving therapeutic paradigms, ongoing research is imperative to refine treatment strategies and integrate novel therapeutic agents to enhance survival and quality of life for people with RT. Given the lack of a clear standard of approach in the management of RT, patients with RT should be prioritized to enroll on clinical trials where feasible.
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Affiliation(s)
- Christopher E Jensen
- Division of Hematology, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Deborah M Stephens
- Division of Hematology, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
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3
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Al-Ibraheem A, Allouzi S, Abdlkadir AS, Mikhail-Lette M, Al-Rabi K, Ma'koseh M, Knoll P, Abdelrhman Z, Shahin O, Juweid ME, Paez D, Lopci E. PET/CT in leukemia: utility and future directions. Nucl Med Commun 2024; 45:550-563. [PMID: 38646840 DOI: 10.1097/mnm.0000000000001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
2-Deoxy-2-[ 18 F]fluoro- d -glucose PET/computed tomography ([ 18 F]FDG PET/CT) has proven to be a sensitive method for the detection and evaluation of hematologic malignancies, especially lymphoma. The increasing incidence and mortality rates of leukemia have raised significant concerns. Through the utilization of whole-body imaging, [ 18 F]FDG PET/CT provides a thorough assessment of the entire bone marrow, complementing the limited insights provided by biopsy samples. In this regard, [ 18 F]FDG PET/CT has the ability to assess diverse types of leukemia The utilization of [ 18 F]FDG PET/CT has been found to be effective in evaluating leukemia spread beyond the bone marrow, tracking disease relapse, identifying Richter's transformation, and assessing the inflammatory activity associated with acute graft versus host disease. However, its role in various clinical scenarios in leukemia remains unacknowledged. Despite their less common use, some novel PET/CT radiotracers are being researched for potential use in specific scenarios in leukemia patients. Therefore, the objectives of this review are to provide a thorough assessment of the current applications of [ 18 F]FDG PET/CT in the staging and monitoring of leukemia patients, as well as the potential for an expanding role of PET/CT in leukemia patients.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC),
- Department of Radiology and Nuclear Medicine, School of Medicine, University of Jordan, Amman, Jordan,
| | - Sudqi Allouzi
- Department of Nuclear Medicine and PET/CT, King Hussein Cancer Center (KHCC),
| | | | - Miriam Mikhail-Lette
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria,
| | - Kamal Al-Rabi
- Department of Medical Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan,
| | - Mohammad Ma'koseh
- Department of Medical Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan,
| | - Peter Knoll
- Dosimetry and Medical Radiation Physics Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria,
| | - Zaid Abdelrhman
- Department of Medical Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan,
| | - Omar Shahin
- Department of Medical Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan,
| | - Malik E Juweid
- Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan and
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria,
| | - Egesta Lopci
- Department of Nuclear Medicine, IRCCS - Humanitas Clinical and Research Hospital, Rozzano (MI), Italy
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4
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Balikov DA, Brown NA, Elner VM, Wubben TJ, Rao RC, Demirci H. Posterior Uveitis in Ocular-Involving Chronic Lymphocytic Leukemia and the Utility of Negative MYD88 L265P Testing in the Diagnosis. Ocul Oncol Pathol 2024; 10:103-113. [PMID: 38882022 PMCID: PMC11178345 DOI: 10.1159/000535951] [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: 06/23/2023] [Accepted: 12/16/2023] [Indexed: 06/18/2024] Open
Abstract
Introduction The aim of this study was to investigate if a negative test result for MYD88 L265P mutation, associated with vitreoretinal lymphoma (VRL) and primary CNS lymphoma, in liquid biopsies from intraocular fluids can be a useful adjuvant test to diagnose chronic lymphocytic leukemia in clinically challenging cases. Case Presentations We selected patients with a past medical history or examinations findings suspicious for intraocular lymphoma. We evaluated both vitreous and aqueous humor-derived (AHD) MYD88 L265P mutation from patients that had suspected intraocular lymphoma that warranted a liquid biopsy procedure. Gold-standard cytopathology, flow cytometry, and gene rearrangement studies were also performed. All 4 patients had negative AHD MYD88 L265P mutation testing. Gold-standard testing (cytology) either showed paucicellular specimens (1/4) or specimens with high background inflammation (3/4). One case showed a rare B-cell clonal population (CD5+, Kappa-restricted by flow cytometry), but this was not sufficient to make any definitive diagnosis. All patients were subsequently initiated on systemic therapy and had improvement in their disease burden. Conclusions Negative AHD MYD88 L265P mutation testing can serve as an adjuvant molecular test to diagnose difficult cases of intraocular CLL.
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Affiliation(s)
- Daniel A Balikov
- Department of Ophthalmology and Visual Science, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Noah A Brown
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Victor M Elner
- Department of Ophthalmology and Visual Science, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Thomas J Wubben
- Department of Ophthalmology and Visual Science, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Rajesh C Rao
- Department of Ophthalmology and Visual Science, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Center for RNA Biomedicine, University of Michigan, Ann Arbor, MI, USA
- A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor, MI, USA
- Division of Ophthalmology, Surgical ServiceVeterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Hakan Demirci
- Department of Ophthalmology and Visual Science, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
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Heyman B, Choi M, Kipps TJ. A + AVD for Treatment of Hodgkin Lymphoma Variant of Richter's Transformation. Case Rep Hematol 2024; 2024:7612622. [PMID: 38434151 PMCID: PMC10908572 DOI: 10.1155/2024/7612622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/08/2024] [Accepted: 01/20/2024] [Indexed: 03/05/2024] Open
Abstract
Hodgkin lymphoma variant of Richter's transformation (HvRT) is a rare complication for patients with chronic lymphocytic leukemia (CLL), with an overall poor prognosis. We present the first known case series of patients with HvRT treated with the combination of brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A + AVD). In our series of 4 patients, two patients treated with A + AVD for HvRT had durable remissions of 40 and 42 months, while two patients had disease progression and ultimately died. Continued investigation into the optimal management for patients with HvRT is still needed.
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Affiliation(s)
- Benjamin Heyman
- Division of Regenerative Medicine, Department of Medicine, UC San Diego Moores Cancer Center, UC San Diego, La Jolla, California 92093, USA
| | - Michael Choi
- Division of Hematology/Oncology, Department of Medicine, UC San Diego, La Jolla, California 92093, USA
| | - Thomas J. Kipps
- Center for Novel Therapeutics, Division of Hematology/Oncology, Department of Medicine, UC San Diego, La Jolla, California 92093, USA
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6
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Miki K, Ogasawara R, Sugimura S, Sugita J, Nozu R, Kojima K, Hidaka D, Shimizu A, Okada K, Kobayashi N, Ogasawara M, Imamura M, Matsuno Y, Ota S. A case of Hodgkin lymphoma-type Richter syndrome presenting as small-intestinal perforation. Int J Hematol 2023; 118:766-771. [PMID: 37672179 DOI: 10.1007/s12185-023-03655-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
Hodgkin lymphoma type of Richter syndrome (HL-type RS) is a rare disease that arises in patients with chronic lymphocytic leukemia (CLL). HL-type RS lesions can manifest in various sites and are often accompanied by related symptoms. This is the first case report to describe diagnosis of HL-type RS after emergency surgery for gastrointestinal perforation caused by the development of a HL-type RS lesion. A 47-year-old man diagnosed with CLL three years prior began treatment with ibrutinib due to worsening anemia and splenomegaly two months prior to the emergency department presentation. Although splenomegaly improved, lymphocytopenia, anemia, and a newly arising mesenteric lymphadenopathy continued to worsen. He presented to the emergency department with abdominal pain, and subsequent surgery revealed small intestinal perforation and mesenteric lymphadenopathy with HL-type RS confirmed by histopathological examination of the resected small intestine. He subsequently received brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A + AVD), which effectively managed the HL-type RS. If CLL clinical presentation deviates from the typical course, an early tissue biopsy should be considered to evaluate for HL-type RS. Given the adoption of the A + AVD regimen as the standard treatment for Hodgkin lymphoma, further research is needed to evaluate its efficacy in HL-type RS.
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MESH Headings
- Humans
- Male
- Middle Aged
- Anemia/complications
- Antineoplastic Combined Chemotherapy Protocols
- Hodgkin Disease/complications
- Hodgkin Disease/diagnosis
- Hodgkin Disease/drug therapy
- Intestinal Perforation/etiology
- Intestinal Perforation/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Lymphadenopathy/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Splenomegaly/complications
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Affiliation(s)
- Kosuke Miki
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan.
| | - Reiki Ogasawara
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Shunsuke Sugimura
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Junichi Sugita
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Rintaro Nozu
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Keisuke Kojima
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Daisuke Hidaka
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Ai Shimizu
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kohei Okada
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Naoki Kobayashi
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Masahiro Ogasawara
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Masahiro Imamura
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan
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Abrisqueta P, Nadeu F, Bosch-Schips J, Iacoboni G, Serna A, Cabirta A, Yáñez L, Quintanilla-Martínez L, Bosch F. From genetics to therapy: Unraveling the complexities of Richter transformation in chronic lymphocytic leukemia. Cancer Treat Rev 2023; 120:102619. [PMID: 37660626 DOI: 10.1016/j.ctrv.2023.102619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
Richter transformation (RT) refers to the progression of chronic lymphocytic leukemia, the most prevalent leukemia among adults, into a highly aggressive lymphoproliferative disorder, primarily a diffuse large B-cell lymphoma. This is a severe complication that continues to be a therapeutic challenge and remains an unmet medical need. Over the last five years, significant advances have occurred in uncovering the biological processes leading to the RT, refining criteria for properly diagnose RT from other entities, and exploring new therapeutic options beyond the ineffective chemotherapy. This review summarizes current knowledge in RT, including recent advances in the understanding of the pathogenesis of RT, in the classification of RT, and in the development of novel therapeutic strategies for this grave complication.
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Affiliation(s)
- Pau Abrisqueta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Ferran Nadeu
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Jan Bosch-Schips
- Department of Pathology, Hospital Universitari de Bellvitge-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Angel Serna
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Alba Cabirta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Lucrecia Yáñez
- Department of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Leticia Quintanilla-Martínez
- Institute of Pathology and Neuropathology, Tübingen University Hospital and Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany
| | - Francesc Bosch
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
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8
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Innocenti I, Benintende G, Tomasso A, Fresa A, Autore F, Larocca LM, Laurenti L. Richter transformation in Chronic Lymphocytic Leukemia. Hematol Oncol 2023; 41:293-300. [PMID: 36433773 DOI: 10.1002/hon.3106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/10/2022] [Accepted: 11/19/2022] [Indexed: 11/28/2022]
Abstract
Chronic lymphocytic leukemia can evolve to an aggressive lymphoma-in most of the cases diffuse large B cells lymphoma, rarely Hodgkin lymphoma-and this complication is defined Richter syndrome (RS). Immunogenotypic features that characterize RS include unmutated IgHV status with high prevalence of IgHV4-39/D6-13/J5 sequence; deletion of chromosome 17p or 11q; activation of oncogenes as NOTCH1 and c-MYC; inactivation of onco-suppressors as TP53 and CDKN2A; high expression of CD38 in lymph-nodes. The prognosis of this condition is very poor: patients experience a rapid clinical deterioration with frequent therapeutic failure since the current options include suboptimal strategies as standard chemo-immunotherapy followed by hematopoietic stem cells transplantation or enrollment in clinical trials which investigate the efficacy of target drugs. Understanding the biology of such a heterogeneous condition is crucial to personalize the treatment and improve patient's survival.
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Affiliation(s)
- Idanna Innocenti
- Sezione di Ematologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario a. Gemelli IRCCS, Rome, Italy
| | - Giulia Benintende
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annamaria Tomasso
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Fresa
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Autore
- Sezione di Ematologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario a. Gemelli IRCCS, Rome, Italy
| | | | - Luca Laurenti
- Sezione di Ematologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario a. Gemelli IRCCS, Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Cook JR, Amador C, Czader M, Duffield A, Goodlad J, Ott G, Xiao W, Dave S, Thakkar D, Thacker E, Dogan A, Wasik M, Nejati R. Transformations of marginal zone lymphomas and lymphoplasmacytic lymphomas: Report from the 2021 SH/EAHP Workshop. Am J Clin Pathol 2023:7143713. [PMID: 37186259 DOI: 10.1093/ajcp/aqad034] [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: 12/05/2022] [Accepted: 03/10/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To summarize the conclusions of the 2021 Society for Hematopathology/European Association for Haematopathology workshop regarding transformations of marginal zone lymphoma (MZL) and lymphoplasmacytic lymphoma (LPL). METHODS Nineteen cases were submitted to this portion of the workshop. Additional studies were performed in cases with sufficient material. RESULTS Cases included splenic MZL (n = 4), splenic diffuse red pulp small B-cell lymphoma (n = 2), nodal MZL (n = 4), extranodal MZL (n = 1), and LPL (n = 8). The most common transformation was to diffuse large B-cell lymphoma (DLBCL), but others included classic Hodgkin lymphoma, high-grade B-cell lymphomas with MYC and BCL6 rearrangements, plasmablastic lymphoma, and plasma cell leukemia. Two splenic MZLs with transformation to DLBCL contained t(14;19)(q32;q13.3) IGH::BCL3 rearrangements in both samples. Paired sequencing studies in 5 MZLs with transformation to clonally related DLBCL identified a variety of mutations and gene fusions at the time of transformation, including CARD11, IGH::MYC, NOTCH2, P2RY8, TBLX1X1, and IGH::CD274. CONCLUSIONS Marginal zone lymphoma and LPL may undergo a variety of transformation events, most commonly to DLBCL, which is usually, although not always, directly clonally related to the underlying low-grade lymphoma. Multiparameter analysis including broad-based sequencing studies can assist in the diagnosis and classification of these uncommon cases.
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Affiliation(s)
- James R Cook
- Department of Laboratory Medicine, Robert J. Tomisch Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, US
| | - Catalina Amador
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, US
| | - Magdalena Czader
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, US
| | - Amy Duffield
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Medical Center, New York, NY, US
| | - John Goodlad
- Department of Pathology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - German Ott
- Department of Clinical Pathology, Robert-Borsch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology, Stuttgart, Germany
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Medical Center, New York, NY, US
| | - Sandeep Dave
- Duke University School of Medicine, Durham, NC, US
| | | | | | - Ahmet Dogan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Medical Center, New York, NY, US
| | - Mariusz Wasik
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, US
| | - Reza Nejati
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, US
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10
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Afonso C, Gomes M, Pereira MI, Faria C, Pina R, Saraiva T, Geraldes C, Carda JP. Hodgkin's variant of Richter transformation during ibrutinib therapy: A case report and review of the literature. Clin Case Rep 2022; 10:e6136. [PMID: 36225619 PMCID: PMC9529751 DOI: 10.1002/ccr3.6136] [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] [Received: 11/10/2021] [Revised: 06/22/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Abstract
Hodgkin's variant of Richter transformation is a rare complication of chronic lymphocytic leukemia and is associated with inferior outcomes compared to de novo Hodgkin lymphoma. Further data concerning prognosis and treatment of Hodgkin's variant of Richter transformation occurring in the setting of novel targeted therapies are needed.
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Affiliation(s)
- Carolina Afonso
- Department of HematologyHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Marília Gomes
- Department of HematologyHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
- Faculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Marta Isabel Pereira
- Department of HematologyHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
- Faculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Carlos Faria
- Department of PathologyHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Raquel Pina
- Department of PathologyHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Tiago Saraiva
- Department of Nuclear MedicineHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
| | - Catarina Geraldes
- Department of HematologyHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
- Faculty of MedicineUniversity of CoimbraCoimbraPortugal
- Faculdade de MedicinaCoimbra Institute for Clinical and Biomedical Research (iCBR) – Grupo de Investigação em Ambiente, Genética e Oncobiogia (CIMAGO), Universidade de Coimbra, e Centro de Inovação em Biomedicina e Biotecnologia (CIBB)CoimbraPortugal
| | - José Pedro Carda
- Department of HematologyHospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de CoimbraCoimbraPortugal
- Faculty of MedicineUniversity of CoimbraCoimbraPortugal
- Faculdade de MedicinaCoimbra Institute for Clinical and Biomedical Research (iCBR) – Grupo de Investigação em Ambiente, Genética e Oncobiogia (CIMAGO), Universidade de Coimbra, e Centro de Inovação em Biomedicina e Biotecnologia (CIBB)CoimbraPortugal
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11
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Salvetti C, Vitale C, Griggio V, Drandi D, Jones R, Bonello L, Bomben R, Bragoni A, Bagnara D, Fais F, Gattei V, Cavallo F, Zamò A, Coscia M. Case Report: Sequential Development of Three Mature Lymphoid Neoplasms in a Single Patient: Clonal Relationship and Molecular Insights. Front Oncol 2022; 12:917115. [PMID: 35734588 PMCID: PMC9207196 DOI: 10.3389/fonc.2022.917115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/09/2022] [Indexed: 12/29/2022] Open
Abstract
Two main variants of Richter syndrome (RS) are recognized, namely, the diffuse large B-cell lymphoma (DLBCL) and the Hodgkin’s lymphoma (HL) variant. Clonal relationship, defined as an identity of the immunoglobulin heavy chain variable (IGHV) region sequence between chronic lymphocytic leukemia (CLL) and RS clones, characterizes patients with a poor prognosis. Due to method sensitivity, this categorization is performed without considering the possibility of small-size ancillary clones, sharing the same phenotype with the preexisting predominant CLL clone, but with different IGHV rearrangements. Here we describe and molecularly profile the peculiar case of a patient with a CLL-like monoclonal B-cell lymphocytosis (MBL), who sequentially developed a DLBCL, which occurred concomitantly to progression of MBL to CLL, and a subsequent HL. Based on standard IGHV clonality analysis, DLBCL was considered clonally unrelated to the concomitantly expanded CLL clone and treated as a de novo lymphoma, achieving a persistent response. Three years later, the patient further developed a clonally unrelated HL, refractory to bendamustine, which was successfully treated with brentuximab vedotin and radiotherapy, and later with pembrolizumab. We retrospectively performed additional molecular testing, by applying next-generation sequencing (NGS) of immunoglobulin repertoire (Ig-rep) techniques and a more sensitive allele-specific oligonucleotide-droplet digital PCR (ASO-ddPCR) strategy, in order to quantitatively investigate the presence of the rearranged IGHV genes in tumor specimens collected during the disease course. In this highly complex case, the application of modern and sensitive molecular technologies uncovered that DLBCL, initially considered as a de novo lymphoma, was instead the result of the transformation of a preexisting ancillary B-cell clone, which was already present at the time of first MBL diagnosis. A similar approach was also applied on the HL sample, showing its clonal unrelatedness to the previous MBL and DLBCL.
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Affiliation(s)
- Chiara Salvetti
- Division of Hematology, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Candida Vitale
- Division of Hematology, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Valentina Griggio
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Daniela Drandi
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Rebecca Jones
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Lisa Bonello
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Molecular Pathology Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Alberto Bragoni
- Pathology Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Davide Bagnara
- Department of Experimental Medicine, University of Genova, Genova, Italy
| | - Franco Fais
- Department of Experimental Medicine, University of Genova, Genova, Italy.,U.O. Molecular Pathology, I.R.C.C.S. Policlinico San Martino, Genova, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy
| | - Federica Cavallo
- Division of Hematology, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Alberto Zamò
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Marta Coscia
- Division of Hematology, University of Torino, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
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12
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Zhu K, Jamroz A, Huang S, Villa D, Freeman CL, Scott DW, Slack G, Sehn LH, Connors JM, Toze CL, Savage KJ, Gerrie AS. Outcomes of Hodgkin variant Richter transformation in chronic lymphocytic leukaemia and small lymphocytic lymphoma in British Columbia. Br J Haematol 2022; 198:684-692. [PMID: 35567407 DOI: 10.1111/bjh.18241] [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: 02/12/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
Hodgkin variant Richter transformation (HvRT) is a rare and challenging complication of chronic lymphocytic leukaemia (CLL) for which information on prognostic factors and treatment approaches remain limited. We analysed characteristics and survival outcomes of a population-based cohort of 32 patients with HvRT identified in British Columbia over a 40-year period. Median interval from CLL diagnosis to HvRT was 5.6 years (range, 0-33.6), with five cases diagnosed concurrently. Most patients (80%) had treatment for CLL prior to HvRT. Median age at HvRT was 71 years (range, 51-86) and the majority of patients had high-risk disease, including stage 3-4 in 87% and International Prognostic Score (IPS) ≥ 4 in 65%. Two-year progression-free (PFS) and overall survival (OS) from HvRT were 47% (95% CI: 29%-64%) and 57% (95% CI: 38%-72%), respectively. OS from HvRT was significantly worse in those with anaemia (p = 0.02), elevated lactate dehydrogenase (p = 0.04), high IPS (p = 0.04), and worse performance status (p = 0.001). For those treated with curative-intent ABVD/ABVD-like therapy, 2-year PFS and OS were 70% (95% CI: 45%-85%) and 74% (95% CI: 49%-89%), respectively. In this real-world population-based cohort, HvRT was associated with poor clinical outcomes overall; however, those able to tolerate curative-intent therapy had similar survival to older patients with de novo HL.
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Affiliation(s)
- Kai Zhu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Jamroz
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steven Huang
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diego Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciara L Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Centre, Tampa, Florida, USA
| | - David W Scott
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham Slack
- Department of Pathology and Laboratory Medicine, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Aberrant Expression of Lymphoid Enhancer-Binding Factor 1 (LEF1) in Hodgkin Lymphoma. Hum Pathol 2022; 125:2-10. [PMID: 35421421 DOI: 10.1016/j.humpath.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
Abstract
Lymphoid enhancer-binding factor 1 (LEF1) is a transcription factor involved in T-cell maturation and is usually absent in mature B-cells. Previous studies have shown aberrant LEF1 expression as a sensitive and specific marker in chronic lymphocytic leukemia/small lymphocytic lymphoma. Our primary aims were i) to analyze LEF1 expression in classic Hodgkin lymphomas (CHL) including de novo and Richter syndrome (RS), and to assess if LEF1 can be a surrogate marker to assess clonal relationship in RS, and ii) to compare LEF1 expression in CHL and Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). We included 117 patients: 24 CHL-RS, 66 CHL-de novo and 27 NLPHL. There was no significant difference in LEF1 expression between CHL-RS and CHL-de novo (79.2% vs 87.9%, P = 0.299), or in type I and type II CHL-RS (75% vs 81.3%, P = 1.000). However, CHL showed a significantly higher LEF1 expression compared to NLPHL (85.6% vs 44.4%, P<0.0001). As the Wnt/β-catenin pathway directly regulates LEF1 expression in a β-catenin-dependent way, β-catenin expression was assessed in 76 cases and all were negative. Additionally, no association between EBV-positivity and LEF1-expression was detected. Overall, our findings show high LEF1 expression in CHL, regardless of RS or de novo, indicating LEF1 cannot be utilized as a surrogate marker to suggest clonal relationship in RS. Compared with CHL, LEF1 expression is significantly less common in NLPHL, further attesting that they are biologically distinct entities. The absent β-catenin expression suggests LEF1 expression is independent of Wnt/β-catenin signaling pathway in Hodgkin lymphomas.
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14
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Condoluci A, Rossi D. Biology and Treatment of Richter Transformation. Front Oncol 2022; 12:829983. [PMID: 35392219 PMCID: PMC8980468 DOI: 10.3389/fonc.2022.829983] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/25/2022] [Indexed: 12/28/2022] Open
Abstract
Richter transformation (RT), defined as the development of an aggressive lymphoma on a background of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), represents a clinical unmet need because of its dismal prognosis. An increasing body of knowledge in the field of RT is arising from the recent development of preclinical models depicting the biology underlying this aggressive disease. Consistently, new therapeutic strategies based on a genetic rationale are exploring actionable pathogenic pathways to improve the outcome of patients in this setting. In this review, we summarize the current understandings on RT biology and the available treatment options.
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Affiliation(s)
- Adalgisa Condoluci
- Division of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland.,Università della Svizzera Italiana, Lugano, Switzerland
| | - Davide Rossi
- Division of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland.,Università della Svizzera Italiana, Lugano, Switzerland
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15
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Abstract
PURPOSE OF REVIEW Richter's transformation (RT) occurs when chronic (CLL) transforms into an aggressive lymphoma. Despite improvements in the treatment of CLL, prognosis for RT remains poor. Here, we review current literature of RT, with a focus on novel treatment options. RECENT FINDINGS Efforts are underway to improve outcomes for patients with RT. While small molecule inhibitors have limited efficacy as monotherapy, recent developments combining them with chemo-immunotherapy show promise. Studies exploring the use of cellular therapies including chimeric antigen receptor T-cells and bispecific antibodies are ongoing. The current treatment paradigm for RT is to enroll these patients on a clinical trial when available, together with consultation for a consolidative allogeneic stem cell transplant. Trials investigating novel combinations and cellular therapy are ongoing. Determining predictive variables of transformation is imperative to design studies that allow for early identification and intervention for patients with RT.
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Affiliation(s)
- Audrey M Sigmund
- Division of Hematology, Department of Internal Medicine, The Ohio State University, 11th Floor Lincoln Tower and 1140D Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
| | - Adam S Kittai
- Division of Hematology, Department of Internal Medicine, The Ohio State University, 11th Floor Lincoln Tower and 1140D Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA.
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16
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King RL, Gupta A, Kurtin PJ, Ding W, Call TG, Rabe KG, Kenderian SS, Leis JF, Wang Y, Schwager SM, Slager SL, Kay NE, Koehler A, Ansell SM, Inwards DJ, Habermann TM, Shi M, Hanson CA, Howard MT, Parikh SA. Chronic lymphocytic leukemia (CLL) with Reed-Sternberg-like cells vs Classic Hodgkin lymphoma transformation of CLL: does this distinction matter? Blood Cancer J 2022; 12:18. [PMID: 35091549 PMCID: PMC8799721 DOI: 10.1038/s41408-022-00616-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
The distinction between chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) with isolated Hodgkin/Reed-Sternberg cells (CLL-HRS; background milieu with a paucity of inflammatory cells) and overt transformation to classic Hodgkin lymphoma (CLL-HL; mixed inflammatory background) is incompletely understood. This retrospective study examined the clinicopathologic features of CLL-HRS (n = 15) and CLL-HL (n = 31) patients seen over the past three decades from a single institution. The phenotypic features of Reed-Sternberg cells in both groups were similar, including expression of CD30, CD15, and PAX5, as well as EBV status. However, a spectrum of background CLL/SLL infiltration amongst the HRS cells was noted on pathologic review, and four patients had both diagnoses, either concurrently or in succession. The median overall survival (OS) of patients with CLL-HRS was 17.5 months compared to 33.5 months for patients with CLL-HL (P = 0.24). Among patients with CLL-HRS, those who received Hodgkin-directed therapy had a significantly longer median OS (57 months) compared to those who received CLL-directed therapy (8.4 months, P = 0.02). Our clinical and pathologic findings suggest a biologic continuum between CLL-HRS and CLL-HL and indicate that CLL-HRS patients may benefit from Hodgkin-directed therapy.
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Affiliation(s)
- Rebecca L. King
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Alia Gupta
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Paul J. Kurtin
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Wei Ding
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Timothy G. Call
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Kari G. Rabe
- Department of Quantitative Health Sciences, Rochester, MN USA
| | - Saad S. Kenderian
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Jose F. Leis
- grid.417468.80000 0000 8875 6339Department of Hematology/Oncology, Mayo Clinic, Scottsdale, AZ USA
| | - Yucai Wang
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Susan M. Schwager
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Susan L. Slager
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA ,Department of Quantitative Health Sciences, Rochester, MN USA
| | - Neil. E. Kay
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Amber Koehler
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Stephen M. Ansell
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - David J. Inwards
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Thomas M. Habermann
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
| | - Min Shi
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Curtis A. Hanson
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Matthew T. Howard
- grid.66875.3a0000 0004 0459 167XDivision of Hematopathology, Mayo Clinic, Rochester, MN USA
| | - Sameer A. Parikh
- grid.66875.3a0000 0004 0459 167XDivision of Hematology, Mayo Clinic, Rochester, MN USA
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17
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Stephens DM, Boucher K, Kander E, Parikh SA, Parry EM, Shadman M, Pagel JM, Cooperrider J, Rhodes J, Mato A, Winter A, Hill B, Gaballa S, Danilov A, Phillips T, Brander DM, Smith SM, Davids M, Rogers K, Glenn MJ, Byrd JC. Hodgkin lymphoma arising in patients with chronic lymphocytic leukemia: outcomes from a large multi-center collaboration. Haematologica 2021; 106:2845-2852. [PMID: 33054118 PMCID: PMC8561295 DOI: 10.3324/haematol.2020.256388] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) patients who develop Hodgkin lymphoma (HL) have limited survival. No current therapeutic standard of care exists. We conducted a multi-center retrospective study of patients with Hodgkin Transformation (HT) of CLL. Clinicobiologic characteristics, treatment type, and survival outcomes were analyzed and compared with historic case series. Ninety-four patients were identified. Median age at HT was 67 years (range, 38-85). Median time from CLL diagnosis to HT was 5.5 years (range, 0-20.2). Prior to HT, patients received a median of 2 therapies for CLL (range, 0-12). As initial therapy for HT, 61% (n=62) received ABVD-based regimens (adriamycin, bleomycin, vinblastine, and dacarbazine). Seven (7%) patients received hematopoietic cell transplantation (HCT) while in first complete remission (CR1). The median number of treatments for HT per patient was 1 (range, 0-5) with 59 (61%) patients only receiving one line of therapy. After HT, patients had a median follow-up of 1.6 years (range, 0-15.1). Two-year overall survival (OS) after HT diagnosis was 72% (95%CI 62-83%). The patients who received standard ABVD-based therapy had a median OS of 13.2 years. Although limited by small sample size, the patients who underwent HCT for HT in CR1 had a similar 2-year OS (n=7; 67%) compared to patients who did not undergo HCT for HT in CR1 (n=87; 72%; p=0.46). In this multi-center study, HT patients treated with ABVD-based regimens had prolonged survival supporting the use of these regimens as standard of care for these patients.
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Affiliation(s)
- Deborah M Stephens
- Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, Utah, USA.
| | - Ken Boucher
- Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, Utah, USA
| | - Elizabeth Kander
- Division of Hematology, Ohio State University, Columbus, Ohio, USA
| | - Sameer A Parikh
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Erin M Parry
- Division of Hematology, Dana Farber, Boston, Massachusetts, USA
| | | | - John M Pagel
- Division of Hematology and Oncology, Swedish Cancer Institute, Seattle, Washington
| | | | - Joanna Rhodes
- Division of Hematology, Northwell Health, New Hyde Park, New York, USA
| | - Anthony Mato
- Division of Hematology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allison Winter
- Division of Hematology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Hill
- Division of Hematology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sameh Gaballa
- Division of Oncology, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexey Danilov
- Division of Hematology, City of Hope, Duarte, California, USA
| | - Tycel Phillips
- Division of Hematology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sonali M Smith
- Division of Oncology, University of Chicago, Chicago, Illinois, USA
| | - Matthew Davids
- Division of Hematology, Dana Farber, Boston, Massachusetts, USA
| | - Kerry Rogers
- Division of Hematology, Ohio State University, Columbus, Ohio, USA
| | - Martha J Glenn
- Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City, Utah, USA
| | - John C Byrd
- Division of Hematology, Ohio State University, Columbus, Ohio, USA
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18
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Koshiishi M, Odate T, Nakagawa Y, Suzuki J, Kumagai T, Kawashima I, Yamamoto T, Nakajima K, Tanaka M, Oishi N, Kondo T, Kirito K. Early Transformation to Classic Hodgkin Lymphoma in a Chemotherapy-naïve Chronic Lymphocytic Leukemia Patient upon Initial Treatment with Ibrutinib. Intern Med 2021; 60:3305-3308. [PMID: 33896865 PMCID: PMC8580765 DOI: 10.2169/internalmedicine.6979-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 71-year-old woman with a four-year history of chronic lymphocytic leukemia (CLL) received ibrutinib as initial treatment due to progressive anemia and thrombocytopenia. Eleven months after the start of the treatments, although her cytopenia had ameliorated, she developed classic Hodgkin lymphoma, a rare form of Richter's transformation. She was successfully treated with two courses of adriamycin, vinblastin, bleomycin and dacarbazine followed by radiotherapy. In general, several clinical, genetic and molecular factors are associated with Richter's transformation. In addition, our present case suggested that ibrutinib could be a potential risk factor for Richter's transformation in CLL patients.
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Affiliation(s)
- Megumi Koshiishi
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Toru Odate
- Department of Pathology, University of Yamanashi, Japan
| | - Yukie Nakagawa
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Jun Suzuki
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Takuya Kumagai
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Ichiro Kawashima
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Takeo Yamamoto
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Kei Nakajima
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Masaru Tanaka
- Department of Hematology/Oncology, University of Yamanashi, Japan
| | - Naoki Oishi
- Department of Pathology, University of Yamanashi, Japan
| | - Tetuso Kondo
- Department of Pathology, University of Yamanashi, Japan
| | - Keita Kirito
- Department of Hematology/Oncology, University of Yamanashi, Japan
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19
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Eyre TA, Riches JC, Patten PEM, Walewska R, Marr H, Follows G, Hillmen P, Schuh AH. Richter transformation of chronic lymphocytic leukaemia: a British Society for Haematology Good Practice Paper. Br J Haematol 2021; 196:864-870. [PMID: 34607388 DOI: 10.1111/bjh.17882] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/12/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Toby A Eyre
- Department of Haematology, Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John C Riches
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Piers E M Patten
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.,Department of Haematology, King's College Hospital, London, UK
| | - Renata Walewska
- Department of Haematology, University Hospitals Dorset, Bournemouth, UK
| | - Helen Marr
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | | | - Peter Hillmen
- St. James's Institute of Oncology, Leeds, UK.,Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Anna H Schuh
- Department of Haematology, Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Department of Oncology, University of Oxford, John Radcliffe Hospital, Oxford, UK
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20
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Gupta N, Mittal A, Duggal R, Dadu T, Agarwal A, Handoo A. Hodgkin Variant of Richter's Transformation in Chronic Lymphocytic Leukemia (CLL): An Illustrative Case Report and Literature Review. Int J Hematol Oncol Stem Cell Res 2021; 15:249-254. [PMID: 35291669 PMCID: PMC8888358 DOI: 10.18502/ijhoscr.v15i4.7480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
Hodgkin lymphoma variant of Richter's transformation (HL-RT) is a rare event, occurring in < 1% chronic lymphocytic leukemia (CLL) cases, of which, in < 10% cases, HL is the first finding leading to a diagnosis of CLL that co-exists simultaneously. Here we report a 60 years old male patient who presented with an outside diagnosis of lymphocyte-rich classical HL. On evaluation, he had only B-symptoms in the form of low-grade fever and weight loss. Peripheral smear revealed mild leukocytosis with an absolute lymphocytosis and a few smudge cells. Bone marrow (BM) aspirate and biopsy exhibited diffuse infiltration by a small cell, low grade, Non-Hodgkin's lymphoma with no immunohistochemical evidence of HL. Flow cytometry performed on BM was consistent with classical immunoprofile of CLL. Meanwhile the lymph node received for review revealed diffuse effacement of nodal architecture by small mature lymphocytes with immunoprofile of CLL expressing CD20, CD5, and CD23. Interspersed between these cells, were a few eosinophils along with classical Reed Sternberg cells, expressing CD30, MUM-1, CD15, and dim PAX-5, with a surrounding rosette of T-Cells highlighted by CD3 and PD-1 and negative for CD45, CD20, and EBV immunohistochemistry. Fluorodeoxyglucose positron emission tomography (FDG-PET) scan revealed hepatosplenomegaly with multiple supra/infra diaphragmatic lymph nodes. So, a final diagnosis of HL-RT in CLL was considered. The patient is currently doing well after the first cycle of ABVD chemotherapy. HL-RT occurring in CLL is a rare event with heterogeneous clinical presentation, morphology, clonal origin, disease course, prognostic features, and survival.
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Affiliation(s)
- Nishit Gupta
- Department of Haematology, BLK Superspeciality Hospital, Delhi, India, 110005
| | - Aditi Mittal
- Department of Haematology, BLK Superspeciality Hospital, Delhi, India, 110005
| | - Rajan Duggal
- Department of Histopathology, BLK Superspeciality Hospital, Delhi, India, 110005
| | - Tina Dadu
- Department of Haematology, BLK Superspeciality Hospital, Delhi, India, 110005
| | - Amit Agarwal
- Department of Medical Oncology, BLK Superspeciality Hospital, Delhi, India, 110005
| | - Anil Handoo
- Department of Haematology, BLK Superspeciality Hospital, Delhi, India, 110005
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21
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Angioimmunoblastic T-Cell Lymphoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Novel Form of Composite Lymphoma Potentially Mimicking Richter Syndrome. Am J Surg Pathol 2021; 45:773-786. [PMID: 33739791 DOI: 10.1097/pas.0000000000001646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is an indolent small B-cell neoplasm that may transform into a clinically aggressive disease, namely Richter syndrome, usually as diffuse large B-cell lymphoma. Besides, CLL/SLL encompasses an increased risk of developing other secondary cancers, including a variety of T-cell lymphomas, often of the anaplastic large-cell type or with a cytotoxic phenotype. Here, we report a small series of patients with composite lymphomas consisting of CLL/SLL and angioimmunoblastic T-cell lymphoma (AITL), a hitherto unrecognized association. The 3 patients (1 male/2 females, 68 to 83 y) presented with high-grade-type symptoms. One patient was clinically suspicious for Richter syndrome, in the others CLL/SLL and AITL were concomitant de novo diagnoses. CLL/SLL and AITL were admixed in the same lymph nodes (3/3 cases) and in the bone marrow (1/2 cases). In all cases, the AITL comprised prominent clear cells with a strong T follicular helper immunophenotype and similar mutations consisting of TET2 or DNMT3A alterations, IDH2 R172K/M, and RHOA G17V. The 3 patients received chemotherapy. One died of early AITL relapse. The other 2 remained in complete remission of AITL, 1 died with recurrent CLL, and 1 of acute myeloid leukemia. These observations expand the spectrum of T-cell lymphoma entities that occur in association with CLL/SLL, adding AITL to the rare variants of aggressive neoplasms manifesting as Richter syndrome. Given that disturbances of T-cell homeostasis in CLL/SLL affect not only cytotoxic but also helper T-cell subsets, these may contribute to the emergence of neoplasms of T follicular helper derivation.
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Plasticity of Mature B Cells Between Follicular and Classic Hodgkin Lymphomas: A Series of 22 Cases Expanding the Spectrum of Transdifferentiation. Am J Surg Pathol 2021; 46:58-70. [PMID: 34265801 DOI: 10.1097/pas.0000000000001780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Follicular lymphoma and classic Hodgkin lymphoma can be associated in composite and/or sequential lymphomas. Common IGH and BCL2 rearrangements have already been identified between both contingents of these entities, but mutation profiles have not yet been investigated. The main objective of this study was to analyze the transdifferentiation process that may occur between Hodgkin and follicular contingents in sequential and composite lymphomas to better characterize these entities. From 2004 to 2020, a retrospective multicentric study was performed, including 9 composite and 13 sequential lymphomas. Clinical data were retrospectively collected. Fluorescent in situ hybridization of BCL2 and BCL6 rearrangements, polymerase chain reaction of IGH and IGK rearrangements, next-generation sequencing of IGK rearrangement, and targeted next-generation sequencing (TNGS) on a panel of genes frequently mutated in lymphomas were performed on each contingent of composite and sequential lymphomas. For TNGS, each contingent was isolated by laser capture microdissection. Clinical presentation and evolution were more aggressive in sequential than composite lymphomas. By fluorescent in situ hybridization, common rearrangements of BCL6 and BCL2 were identified between both contingents. Similarly, a common clonal relationship was established by evaluating IGH and IGK rearrangement by polymerase chain reaction or next-generation sequencing. By TNGS, the same pathogenic variants were identified in both contingents in the following genes: CREBBP, KMT2D, BCL2, EP300, SF3B1, SOCS1, ARID1A, and BCOR. Specific pathogenic variants for each contingent were also identified: XPO1 for Hodgkin lymphoma contingent and FOXO1, TNFRSF14 for follicular lymphoma contingent. This study reinforces the hypothesis of a transdifferentiation process between Hodgkin and follicular contingent of sequential/composite lymphomas.
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Petrackova A, Turcsanyi P, Papajik T, Kriegova E. Revisiting Richter transformation in the era of novel CLL agents. Blood Rev 2021; 49:100824. [PMID: 33775465 DOI: 10.1016/j.blre.2021.100824] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/14/2021] [Accepted: 02/19/2021] [Indexed: 12/18/2022]
Abstract
Richter transformation (RT) is the development of aggressive lymphoma - most frequently diffuse large B-cell lymphoma (DLBCL) and rarely Hodgkin lymphoma (HL) - arising on the background of chronic lymphocytic leukaemia (CLL). Despite recent advances in CLL treatment, RT also develops in patients on novel agents, usually occurring as an early event. RT incidence is lower in CLL patients treated with novel agents in the front line compared to relapsed/refractory cases, with a higher incidence in patients with TP53 disruption. The genetic heterogeneity and complexity are higher in RT-DLBCL than CLL; the genetics of RT-HL are largely unknown. In addition to TP53, aberrations in CDKN2A, MYC, and NOTCH1 are common in RT-DLBCL; however, no distinct RT-specific genetic aberration is recognised yet. RT-DLBCL on ibrutinib is frequently associated with BTK and PLCG2 mutations. Here, we update on genetic analysis, diagnostics and treatment options in RT in the era of novel agents.
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Affiliation(s)
- Anna Petrackova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Peter Turcsanyi
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Tomas Papajik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Eva Kriegova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic.
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Abstract
PURPOSE OF REVIEW Richter syndrome (RS) is an uncommon but aggressive evolution of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). RS is an unmet clinical need in the field of CLL. Recent advances in understanding the biology of this condition provide the rationale for testing new therapeutic concepts in order to improve the outcome of patients developing RS, which is so far poor. In this review, we summarize disease characteristics and available therapeutic options for RS. RECENT FINDINGS Current regimens with novel agents in monotherapy have shown little impact on survival. Nevertheless, the better reported outcome for RS has been achieved with the combination of chemo-immunotherapy with a novel agent, confirming the synergistic effect of the approaches. Still, the frailty of this population may impose a less toxic management leaving most patients with no reasonable therapeutic option. Treatment options for RS need to be further expanded. Preclinical models in current development may allow to explore actionable pathways and identify new drug targeted combinations.
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Affiliation(s)
- Adalgisa Condoluci
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Davide Rossi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland.
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25
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Kojima K, Burger JA. Treatment algorithm for Japanese patients with chronic lymphocytic leukemia in the era of novel targeted therapies. J Clin Exp Hematop 2020; 60:130-137. [PMID: 32404571 PMCID: PMC7810251 DOI: 10.3960/jslrt.20002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/16/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
Treatment for patients with chronic lymphocytic leukemia (CLL) is becoming more individualized due to the recent introduction of novel molecularly targeted therapies into the therapeutic armamentarium. Genomic and molecular risk factors in CLL patients determine the individual risk for disease progression and response to therapy, and can impact survival. In this review article, we discuss current treatment strategies for CLL patients in Japan, where the novel targeted agents, the BTK inhibitor ibrutinib and BCL2 antagonist venetoclax, now are available and increasingly used in clinical practice. We also discuss the importance of CLL risk factors for making therapy decisions, focusing on immunoglobulin variable region heavy chain (IGHV) mutation status, 11q deletion, and 17p deletion. Treatment approaches for CLL have rapidly changed in the past few years because of these new targeted agents. They are highly effective, well tolerated, and have been demonstrated in a series of large randomized clinical trials to improve survival when compared with conventional chemotherapy-based treatment. Therefore, for most patients, especially high-risk CLL patients, BTK inhibitor and BCL2 antagonist therapies are preferred over chemo-immunotherapy. Currently ongoing studies seek to determine the best sequence for these new agents and whether a combination therapy approach is beneficial. With these developments, a new era of chemotherapy-free treatment for CLL patients is expected.
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MESH Headings
- Algorithms
- Antineoplastic Combined Chemotherapy Protocols
- Chromosome Deletion
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 11/metabolism
- Chromosomes, Human, Pair 17
- Disease-Free Survival
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Heavy Chains/metabolism
- Immunoglobulin Variable Region/genetics
- Immunoglobulin Variable Region/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Molecular Targeted Therapy
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Smith-Magenis Syndrome
- Survival Rate
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26
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Lymphoid enhancer binding factor 1 (LEF1) expression is significantly higher in Hodgkin lymphoma associated with Richter syndrome relative to de novo classic Hodgkin lymphoma. Ann Diagn Pathol 2020; 49:151636. [PMID: 32977233 DOI: 10.1016/j.anndiagpath.2020.151636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022]
Abstract
Lymphoid enhancer binding factor 1 (LEF1) is consistently upregulated in chronic lymphocytic leukemia (CLL) and in a subset of large B cell lymphoma. Knowledge of LEF1 expression in Hodgkin lymphoma is limited. In this study, we used immunohistochemistry to survey LEF1 expression in various subsets of Hodgkin lymphoma, de novo classic Hodgkin lymphoma (CHL) (n = 43), Hodgkin lymphoma associated with Richter syndrome (HL-RS) (n = 20), and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) (n = 9). LEF1 expression was significantly higher in HL-RS compared with de novo CHL (12/20, 60% vs. 12/43, 28%; p = 0.0248). Only a single case (1/9; 11%) of NLPHL showed LEF1 expression. Epstein-Barr virus encoded RNA (EBER) was detected in 17 (40%) cases of de novo CHL and 14 (70%) HL-RS. Notably, we identified a correlation between LEF1 expression and EBER positivity (p = 0.0488). We concluded that LEF1 is commonly positive in CHL but not in NLPHL, and such a distinction may be helpful in this differential diagnosis. The higher frequency of LEF1 upregulation in HL-RS relative to de novo CHL suggests that these neoplasms might have different underlying pathogenic mechanisms and warrants further investigation.
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27
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Vidhya M. Synchronous Lymphomas: An Uncommon Affair. Turk J Haematol 2020; 37:203-204. [PMID: 31744267 PMCID: PMC7463205 DOI: 10.4274/tjh.galenos.2019.2019.0187] [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: 12/01/2022] Open
Affiliation(s)
- Manohor Vidhya
- Sri Shankara Cancer Hospital and Research Centre, Division of Histopathology, Bangalore, India
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28
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Zheng XQ, Zhu HY, Ding CY, Wang L, Fan L, Xu W, Li JY. [Clinical value of PET/CT in the diagnosis of Richter syndrome]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:689-693. [PMID: 32942827 PMCID: PMC7525174 DOI: 10.3760/cma.j.issn.0253-2727.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Indexed: 12/05/2022]
Affiliation(s)
- X Q Zheng
- Department of Hematology, Key Laboratory of Hematology of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - H Y Zhu
- Department of Hematology, Key Laboratory of Hematology of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Pukou CLL Center, Pukou Division of Jiangsu Province Hospital, Nanjing 210031, China
| | - C Y Ding
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L Wang
- Department of Hematology, Key Laboratory of Hematology of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L Fan
- Department of Hematology, Key Laboratory of Hematology of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - W Xu
- Department of Hematology, Key Laboratory of Hematology of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - J Y Li
- Department of Hematology, Key Laboratory of Hematology of Nanjing Medical University, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Pukou CLL Center, Pukou Division of Jiangsu Province Hospital, Nanjing 210031, China
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29
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da Mata S, Melo D, Barroca H. A case of classical Hodgkin lymphoma-type of Richter transformation with prolonged survival: Fine needle aspiration findings and mimickers. Cytopathology 2020; 31:607-610. [PMID: 32492252 DOI: 10.1111/cyt.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sara da Mata
- Instituto Português de Oncologia de Lisboa, Francisco Gentil, E.P.E, Lisboa, Portugal
| | - Daniel Melo
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Helena Barroca
- Centro Hospitalar Universitário de São João, Porto, Portugal
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30
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Armand P, Murawski N, Molin D, Zain J, Eichhorst B, Gulbas Z, Hawkes EA, Pagel JM, Phillips T, Ribrag V, Svoboda J, Stathis A, Chatterjee A, Orlowski R, Marinello P, Christian B. Pembrolizumab in relapsed or refractory Richter syndrome. Br J Haematol 2020; 190:e117-e120. [PMID: 32544980 PMCID: PMC7496875 DOI: 10.1111/bjh.16762] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
| | - Niels Murawski
- Universitäts-klinikum des Saarlandes Innere Medizin I, Homburg, Germany
| | - Daniel Molin
- Experimental and Clinical Oncology, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | | | | | - Eliza A Hawkes
- Olivia Newton-John Cancer Research Institute, Austin Health, Victoria, Australia
| | - John M Pagel
- Swedish Center for Blood Disorders and Stem Cell Transplants, Swedish Cancer Institute, Seattle, WA, USA
| | | | | | - Jakub Svoboda
- Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Beth Christian
- The James Cancer Hospital and Solove Research Institute, Ohio State University, Columbus, OH, USA
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31
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Abrisqueta P, Delgado J, Alcoceba M, Oliveira AC, Loscertales J, Hernández‐Rivas JA, Ferrà C, Cordoba R, Yáñez L, Medina A, Motlló C, Iacoboni G, Villacampa G, González M, Bosch F. Clinical outcome and prognostic factors of patients with Richter syndrome: real‐world study of the Spanish Chronic Lymphocytic Leukemia Study Group (GELLC). Br J Haematol 2020; 190:854-863. [DOI: 10.1111/bjh.16748] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Pau Abrisqueta
- Department of Hematology Hospital Vall d'Hebron Barcelona Spain
| | - Julio Delgado
- Department of Hematology Hospital Clínic Barcelona Spain
| | - Miguel Alcoceba
- Department of Hematology University Hospital of Salamanca (HUS/IBSAL) CIBERONC and Center for Cancer Research‐IBMCC (USAL‐CSIC) Salamanca Spain
| | - Ana Carla Oliveira
- Department of Hematology Institut Català d'Oncologia, L'Hospitalet de LLobregat Hospitalet Spain
| | - Javier Loscertales
- Department of Hematology Hospital Universitario de La Princesa IIS‐IP Madrid Spain
| | | | - Christelle Ferrà
- Department of Hematology University Hospital GermansTrias y Pujol Badalona Spain
| | - Raul Cordoba
- Department of Hematology Fundación Jiménez Díaz Madrid Spain
| | - Lucrecia Yáñez
- Department of Hematology Hospital Marqués de Valdecilla Santander Spain
| | - Angeles Medina
- Department of Hematology Hospital Costa del Sol Marbella Spain
| | - Cristina Motlló
- Department of Hematology Hospital Sant Joan de Déu, Fundació Althaia Manresa Spain
| | - Gloria Iacoboni
- Department of Hematology Hospital Vall d'Hebron Barcelona Spain
| | - Guillermo Villacampa
- Oncology Data Science (OdysSey Group) Vall d’Hebron Institute of Oncology Barcelona Spain
| | - Marcos González
- Department of Hematology University Hospital of Salamanca (HUS/IBSAL) CIBERONC and Center for Cancer Research‐IBMCC (USAL‐CSIC) Salamanca Spain
| | - Francesc Bosch
- Department of Hematology Hospital Vall d'Hebron Barcelona Spain
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32
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Cannatella JJ, Vu K, Qi Z, Van Ziffle J, Wang L, Kaplan LD, Prakash S, Xie Y. Chronic lymphocytic leukemia/small lymphocytic lymphoma with Hodgkin Reed-Sternberg-like cells and subsequent transformation to EBV-positive diffuse large B-cell lymphoma – A case report and literature review. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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33
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Complexities in the diagnosis of large B-cell lymphomas, classic Hodgkin lymphomas and overlapping peripheral T-cell lymphomas simplified: An evidence-based guide. Ann Diagn Pathol 2020; 46:151534. [PMID: 32473554 DOI: 10.1016/j.anndiagpath.2020.151534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 12/27/2022]
Abstract
The diagnosis of a large B-cell lymphoma and classic Hodgkin lymphoma (CHL) is often straightforward. However, in select circumstances, these simple diagnoses can be quite complex. In part, diagnostic difficulty may be due to uncertainty in the evaluation of morphologic and immunophenotypic features along a biologic continuum, or alternatively arise from uncertainty in predicting the behavior and outcomes of patients. Here, we systematically discuss and review areas of diagnostic difficulty in the diagnosis of large B-cell lymphomas (LBCL), classic Hodgkin lymphomas (CHL) and peripheral T-cell lymphomas (PTCL). We provide careful data-driven analyses and evidence-based approaches to help guide pathologists and clinicians. We discuss: 1) marginal zone lymphomas with increased large cells versus diffuse large B-cell lymphoma (DLBCL), 2) chronic lymphocytic leukemia with expanded proliferation centers versus diffuse large B-cell lymphoma (DLBCL), 3) chronic lymphocytic leukemia with Hodgkin/Reed-Sternberg-like cells versus CHL arising from chronic lymphocytic leukemia, 4) complex cases of follicular lymphoma versus DLBCL, 5) PTCL with large B-cell proliferations versus PTCL with LBCL, 6) PTCL with Hodgkin/Reed-Sternberg-like cells versus CHL, and finally 7) blastoid/pleomorphic mantle cell lymphoma versus DLBCL. Our evidence and data driven approach may serve as a useful diagnostic guide.
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34
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Delestre F, Blanche P, Bouayed E, Bouscary D, Mouthon L, Brezin A, Le Jeunne C, Chaigne B. Ophthalmic involvement of chronic lymphocytic leukemia: A systematic review of 123 cases. Surv Ophthalmol 2020; 66:124-131. [PMID: 32407752 DOI: 10.1016/j.survophthal.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/30/2022]
Abstract
To identify clinical presentations, main causes, and prognosis of ophthalmic involvement in chronic lymphocytic leukemia (CLL), we performed a systematic review of articles describing CLL ophthalmic involvement in January 2019, using the PubMed database. We found 86 articles describing 123 cases of patients with ophthalmic involvement associated with CLL. Ophthalmic symptoms were CLL's first manifestation in 25.6% of patients and revealed Richter transformation in 11.0%. There were three main causes of ophthalmic features: CLL-infiltration (52.0%), lymphoma (26.0%), and infection (15.4%), with specific clinical and radiological characteristics. CLL-infiltration was mostly bilateral, whereas lymphoma was usually unilateral (P = 0.02). Optic neuropathy was always secondary to CLL-infiltration, and in those cases, cerebrospinal fluid immunophenotyping was a potential alternative to invasive biopsy as it confirmed the diagnosis in 4 patients (36.4%). On the contrary, lymphoma usually presented as adnexal involvement (P = 0.04), particularly as an orbital mass (P = 0.004). Infections concerned mostly patients previously treated for CLL (P < 0.0001), and main presentations included posterior uveitis (P = 0.0002) and retinal infiltrates (P < 0.0001). Overall, the prognosis was poor, as 29.3% of the patients died within 36 months of follow-up, and 26.1% had a partial or total visual loss. Eye infections were associated with the poorest prognosis as 47% of patients died, with a 6-month-median survival.
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Affiliation(s)
- Florence Delestre
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Philippe Blanche
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emna Bouayed
- Service d'ophtalmologie, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Didier Bouscary
- Service d'hématologie, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Antoine Brezin
- Service d'ophtalmologie, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Claire Le Jeunne
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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35
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Theofilou VI, Katsoulas N, Tosios KI, Sklavounou A, Nikitakis NG. Richter transformation in the oral and maxillofacial area: report of 2 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e14-e20. [PMID: 32402567 DOI: 10.1016/j.oooo.2020.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/16/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
Richter transformation (RT) is a term used to refer to the development of an aggressive lymphoma, usually of diffuse large B-cell lymphoma type, in a patient with a history of chronic lymphocytic leukemia. It may present with heterogeneous manifestations, including the occurrence of tumors at extranodal sites. To date, only 6 cases of RT involving the oral and maxillofacial region have been reported. Here, we present 2 rare cases of lymphoma initially affecting the maxilla and the lower gingiva, respectively, of female patients with chronic lymphocytic leukemia and review the English language literature about RT manifesting in the oral and maxillofacial tissues.
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Affiliation(s)
- Vasileios Ionas Theofilou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Katsoulas
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- Associate Professor, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- Professor, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G Nikitakis
- Professor and Chair, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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36
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Parikh SA, Achenbach SJ, Call TG, Rabe KG, Ding W, Leis JF, Kenderian SS, Chanan‐Khan AA, Koehler AB, Schwager SM, Muchtar E, Fonder AL, McCullough KB, Nedved AN, Smith MD, Slager SL, Kay NE, Finnes HD, Shanafelt TD. The impact of dose modification and temporary interruption of ibrutinib on outcomes of chronic lymphocytic leukemia patients in routine clinical practice. Cancer Med 2020; 9:3390-3399. [PMID: 32187452 PMCID: PMC7221301 DOI: 10.1002/cam4.2998] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 12/18/2022] Open
Abstract
To study the impact of dose modification and temporary interruption of ibrutinib in routine clinical practice, we conducted a retrospective study of consecutive CLL patients treated with ibrutinib outside the context of a clinical trial at Mayo Clinic, (Rochester, MN) from 11/2013 to 12/2017. Of 209 patients, 131 (74%) had unmutated IGHV, 38 (20%) had TP53 disruption, and 47 (22%) were previously untreated. A total of 87/209 (42%) patients started reduced dose ibrutinib (<420 mg daily; n = 43, physician preference; n = 33, concomitant medications; and n = 11, other). During 281 person-years of treatment, 91/209 patients had temporary dose interruption (54%, nonhematologic toxicity; 29%, surgical procedures; 10%, hematologic toxicity; and 7%, other). After a median follow-up of 24 months, the estimated median event-free survival (EFS) was 36 months, and median overall survival (OS) was not reached. On multivariable analyses, temporary ibrutinib interruption (hazard ratio [HR]: 2.37, P = .006) and TP53 disruption at ibrutinib initiation (HR: 1.81, P = .048) were associated with shorter EFS, whereas only TP53 disruption (HR: 2.38, P = .015) was associated with shorter OS. Initial ibrutinib dose and dose modification during therapy did not appear to impact EFS or OS. These findings illustrate the challenges associated with continuous oral therapy with ibrutinib in patients with CLL.
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Affiliation(s)
- Sameer A. Parikh
- Division of HematologyDepartment of MedicineMayo ClinicRochesterMNUSA
| | - Sara J. Achenbach
- Division of Biomedical Statistics & InformaticsMayo ClinicRochesterMNUSA
| | - Timothy G. Call
- Division of HematologyDepartment of MedicineMayo ClinicRochesterMNUSA
| | - Kari G. Rabe
- Division of Biomedical Statistics & InformaticsMayo ClinicRochesterMNUSA
| | - Wei Ding
- Division of HematologyDepartment of MedicineMayo ClinicRochesterMNUSA
| | - Jose F. Leis
- Department of Hematology and OncologyMayo ClinicPhoenixAZUSA
| | - Saad S. Kenderian
- Division of HematologyDepartment of MedicineMayo ClinicRochesterMNUSA
| | | | - Amber B. Koehler
- Division of HematologyDepartment of MedicineMayo ClinicRochesterMNUSA
| | - Susan M. Schwager
- Division of HematologyDepartment of MedicineMayo ClinicRochesterMNUSA
| | - Eli Muchtar
- Division of HematologyDepartment of MedicineMayo ClinicRochesterMNUSA
| | - Amie L. Fonder
- Division of HematologyDepartment of MedicineMayo ClinicRochesterMNUSA
| | | | | | | | - Susan L. Slager
- Division of Biomedical Statistics & InformaticsMayo ClinicRochesterMNUSA
| | - Neil E. Kay
- Division of HematologyDepartment of MedicineMayo ClinicRochesterMNUSA
| | | | - Tait D. Shanafelt
- Division of HematologyStanford University School of MedicinePalo AltoCAUSA
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37
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Meacham PJ, Williams AM, Strawderman M, Baran AM, Archibald WJ, Wallace DS, Tschernia NP, Burack WR, Barr PM, Zent CS. Additional B-cell malignancies in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL). Leuk Lymphoma 2020; 61:1636-1644. [PMID: 32175786 DOI: 10.1080/10428194.2020.1737690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Family and migration studies suggest a genetic risk of developing chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL). We hypothesized that CLL patients have an increased risk of additional clonally unrelated B-cell malignancies. To test this, we studied 467 CLL patients (2743 person-years (PYs)) at a single institution over 17 years. The incidence rate (IR) of any additional B-cell lymphoid malignancy was 10.9 per 1000 PYs (n = 30, 6.4%). Eighteen (4%) patients had a clonally unrelated B-cell malignancy (IR = 6.6 per 1000 PYs). Standardized incidence ratios (SIRs) were used to compare the incidence of additional clonally unrelated B-cell malignancies in CLL patients to the age- and sex-matched expected rates in the USA generated from the Surveillance, Epidemiology, and End Results (SEER) database. For the subset of 13 patients having data for comparison in the SEER database, the SIR was 5.41 (95% CI = 2.9, 9.3) which is supportive of our hypothesis.
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Affiliation(s)
| | | | | | | | | | | | | | - Walter Richard Burack
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
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38
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Zanwar S, Abeykoon JP, Durot E, King R, Perez Burbano GE, Kumar S, Gertz MA, Quinquenel A, Delmer A, Gonsalves W, Cornillet‐Lefebvre P, He R, Warsame R, Buadi FK, Novak AJ, Greipp PT, Inwards D, Habermann TM, Micallef I, Go R, Muchtar E, Kourelis T, Dispenzieri A, Lacy MQ, Dingli D, Nowakowski G, Thompson CA, Johnston P, Thanarajasingam G, Bennani NN, Witzig TE, Villasboas J, Leung N, Lin Y, Kyle RA, Rajkumar SV, Ansell SM, Le‐Rademacher JG, Kapoor P. Impact of MYD88 L265P mutation status on histological transformation of Waldenström Macroglobulinemia. Am J Hematol 2020; 95:274-281. [PMID: 31814157 DOI: 10.1002/ajh.25697] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 12/28/2022]
Abstract
Histological transformation in Waldenström macroglobulinemia (WM) is an uncommon complication, with limited data, particularly regarding the impact of MYD88 L265P mutation on transformation. We examined risk factors and outcomes associated with transformation in WM, highlighting the role of MYD88 L265P mutation. Patients with WM seen at Mayo Clinic, Rochester, USA and University Hospital of Reims, France, between 01/01/1996 and December 31, 2017 were included; 50 (4.3%) of 1147 patients transformed to a high-grade lymphoma, with median time-to-transformation of 4.5 (range 0-21) years in the transformed cohort. The MYD88 L265P mutation status was known in 435/1147 (38%) patients (406 with non-transformed WM and 29 patients in transformed cohort). On multivariate analysis, MYD88 WT status alone was an independent predictor of transformation (odds ratio, 7[95%CI: 2.1-23]; P = .003). Additionally, the MYD88 WT status was independently associated with shorter time-to-transformation (HR 7.9 [95%CI: 2.3-27; P = .001]), with a 5-year transformation rate of 16% for MYD88 WT vs 2.8% with MYD88 L265P mutated patients. Patients with transformation demonstrated a significant increase in risk of death compared to patients who did not transform (HR 5.075; 95%CI: 3.8-6.8; P < .001). In conclusion, the MYD88 WT status is an independent predictor of transformation and associated with a shorter time-to-transformation. Additionally, transformation conferred an inferior overall survival in patients with WM.
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Affiliation(s)
- Saurabh Zanwar
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Jithma P. Abeykoon
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Eric Durot
- Department of HematologyUniversity Hospital of Reims and UFR Médecine Reims France
| | - Rebecca King
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Minnesota
| | - Gabriela E. Perez Burbano
- Division of Biomedical Statistics and Informatics, Department of Health Sciences ResearchMayo Clinic Rochester Minnesota
| | - Shaji Kumar
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Morie A. Gertz
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Anne Quinquenel
- Department of HematologyUniversity Hospital of Reims and UFR Médecine Reims France
| | - Alain Delmer
- Department of HematologyUniversity Hospital of Reims and UFR Médecine Reims France
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Rong He
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Minnesota
| | - Rahma Warsame
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Francis K. Buadi
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Anne J. Novak
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - David Inwards
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Thomas M. Habermann
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Ivana Micallef
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Ronald Go
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Eli Muchtar
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Martha Q. Lacy
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - David Dingli
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Grzegorz Nowakowski
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Carrie A. Thompson
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Patrick Johnston
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Gita Thanarajasingam
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - N. Nora Bennani
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Thomas E. Witzig
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Jose Villasboas
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Nelson Leung
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Yi Lin
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Robert A. Kyle
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - S. Vincent Rajkumar
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Stephen M. Ansell
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Jennifer G. Le‐Rademacher
- Division of Biomedical Statistics and Informatics, Department of Health Sciences ResearchMayo Clinic Rochester Minnesota
| | - Prashant Kapoor
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
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39
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Ben-Dali Y, Hleuhel MH, da Cunha-Bang C, Brieghel C, Poulsen CB, Clasen-Linde E, Bentzen HHN, Frederiksen H, Christiansen I, Nielsen LH, Enggaard L, Helleberg M, Clausen M, Frederiksen M, Pedersen RS, Niemann CU, Andersen MA. Richter's transformation in patients with chronic lymphocytic leukaemia: a Nationwide Epidemiological Study. Leuk Lymphoma 2020; 61:1435-1444. [PMID: 32031030 DOI: 10.1080/10428194.2020.1719092] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Richter's transformation (RT) refers to the development of an aggressive lymphoma in patients with chronic lymphocytic leukemia (CLL). Approximately, 2-10% of patients with CLL develop RT, most often as diffuse large B-cell lymphoma. To assess the incidence of RT, we examined risk factors for RT and death among patients with RT in a nationwide CLL cohort (from 2008 to 2016). Among 3772 patients, 113 had biopsy-proven RT. With a median follow-up of 4.3 years, the 5-year cumulative incidence of RT was 2.8%. Advanced Binet stage (B/C) (p<.001), unmutated IGHV (p<.001), and del(17p) (p<.001) were independently associated with risk of developing RT. Half of the patients with RT (49%) were treatment-naïve prior to transformation and demonstrated longer survival after RT compared to patients previously treated for CLL (6.1 vs. 2.8 years, p=.03). Whether this finding could be explained by a higher proportion of clonally unrelated RT among treatment-naïve patients, remain to be addressed.
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Affiliation(s)
- Yasmin Ben-Dali
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mariam H Hleuhel
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Caspar da Cunha-Bang
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Haematology, Roskilde University, Roskilde, Denmark
| | - Christian Brieghel
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Erik Clasen-Linde
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans H N Bentzen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ilse Christiansen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Linda H Nielsen
- Department of Haematology, Sydvestjysk Sygehus, Esbjerg, Denmark
| | - Lisbeth Enggaard
- Department of Haematology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Clausen
- Department of Haematology, Sygehus Lillebaelt, Vejle, Denmark
| | | | | | - Carsten U Niemann
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael A Andersen
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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40
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Parikh SA, Meacham PJ, Zent CS, Evans AG. Multiple B cell malignancies in patients with chronic lymphocytic leukemia: epidemiology, pathology, and clinical implications. Leuk Lymphoma 2020; 61:1037-1051. [PMID: 31928278 DOI: 10.1080/10428194.2019.1709830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is associated with increased risk for certain cancers, but relatively little is known about the risk for these patients to develop additional B cell malignancies. Here, we review the available epidemiological data on multiple B cell malignancies in CLL, discuss diagnostic methods and proper pathologic evaluation to distinguish CLL from other B cell malignancies, and address clinical challenges and unmet needs in caring for CLL patients with unrelated B cell malignancies and disease transformation. Considerations include CLL patients with unrelated monoclonal B cell lymphocytosis, biclonal CLL, secondary B cell non-Hodgkin lymphomas, and Richter syndrome - both clonally related transformation and de novo large B cell lymphoma. We address the challenges that remain in order to better understand the underlying risk factors and biology that may put CLL patients at increased risk of developing multiple B cell neoplasia.
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Affiliation(s)
- Sameer A Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Andrew G Evans
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
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41
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Skala SL, Ye JC, Stumph J, Macon WR, Quinones FR, Khachaturov V, Ketterling RP, Dewar R. Combined Tumors in Hematolymphoid Neoplasms: Case Series of Histiocytic and Langerhans Cell Sarcomas Arising From Low-Grade B-Cell Lymphoma. CLINICAL PATHOLOGY 2019; 12:2632010X19878410. [PMID: 31633108 PMCID: PMC6769199 DOI: 10.1177/2632010x19878410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/04/2019] [Indexed: 12/11/2022]
Abstract
We report an index case of histiocytic sarcoma arising in a 70-year-old patient with long-standing chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The patient presented in 2017 with painful, enlarging swelling of the left neck. He had remote history of cutaneous squamous cell carcinoma with no sign of recurrence, and his CLL/SLL was thought to be in remission. Computed tomography showed mild splenomegaly and multifocal lymphadenopathy including a 3-cm left neck mass. Biopsy of the left neck mass showed CLL/SLL with associated histiocytic sarcoma. Flow cytometry demonstrated a B cell neoplasm with CLL/SLL phenotype. Despite radiation therapy, he expired 3 months after presentation. Two similar cases (CLL/SLL and histiocytic sarcoma, follicular lymphoma and Langerhans cell sarcoma) from another institution are also illustrated. The pathological features of combined tumors in lymphoid neoplasms, a general framework to the work-up to determine interrelatedness of tumor components, and the clinical relevance are discussed.
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Affiliation(s)
- Stephanie L Skala
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jing C Ye
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Stumph
- Michigan Pathology Specialists, Spectrum Health, Grand Rapids, MI, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Vadim Khachaturov
- Michigan Pathology Specialists, Spectrum Health, Grand Rapids, MI, USA
| | - Rhett P Ketterling
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rajan Dewar
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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42
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Drozd‐Sokołowska J, Zaucha JM, Żółtak T, Jamroziak K, Grzybowska‐Izydorczyk O, Witkowska M, Waszczuk‐Gajda A, Kaźmierczak M, Szczepaniak A, Subocz E, Knopińska‐Posłuszny W, Hołojda J, Kopińska A, Hus I, Rybka J, Wołowiec D, Kwiatkowski J, Hałaburda K, Smolewski P, Giebel S, Wiktor‐Jędrzejczak W. Hodgkin lymphoma transformation of chronic lymphocytic leukemia—A real life data from the Polish Lymphoma Research Group. Hematol Oncol 2019; 37:383-391. [DOI: 10.1002/hon.2624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Joanna Drozd‐Sokołowska
- Department of Hematology, Oncology and Internal Diseases Medical University of Warsaw Warsaw Poland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology Medical University of Gdańsk Gdańsk Poland
| | | | - Krzysztof Jamroziak
- Department of Hematology Institute of Hematology and Transfusion Medicine Warsaw Poland
| | | | - Magdalena Witkowska
- Department of Experimental Hematology Medical University of Lodz Lodz Poland
| | - Anna Waszczuk‐Gajda
- Department of Hematology, Oncology and Internal Diseases Medical University of Warsaw Warsaw Poland
| | - Maciej Kaźmierczak
- Department of Hematology and Bone Marrow Transplantation Poznan University of Medical Sciences Poznan Poland
| | - Andrzej Szczepaniak
- Department of Hematology and Bone Marrow Transplantation Poznan University of Medical Sciences Poznan Poland
| | - Edyta Subocz
- Department of Hematology Military Institute of Medicine Warsaw Poland
| | - Wanda Knopińska‐Posłuszny
- Department of Hematology Independent Public Health Care Ministry of the Interior of Warmia and Mazury Oncology Center Olsztyn Poland
| | - Jadwiga Hołojda
- Department of Hematology Specialist District Hospital Legnica Poland
| | - Anna Kopińska
- Department of Hematology and Bone Marrow Transplantation Medical University of Silesia Katowice Poland
| | - Iwona Hus
- Independent Clinical Transplantology Unit Medical University of Lublin Lublin Poland
| | - Justyna Rybka
- Department of Hematology Wroclaw Medical University Wroclaw Poland
| | - Dariusz Wołowiec
- Department of Hematology Wroclaw Medical University Wroclaw Poland
| | | | - Kazimierz Hałaburda
- Department of Hematopoietic Stem Cell Transplantation Institute of Hematology and Transfusion Medicine Warsaw Poland
| | - Piotr Smolewski
- Department of Experimental Hematology Medical University of Lodz Lodz Poland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Hematology‐Oncology Maria Sklodowska‐Curie Institute‐Cancer Center Gliwice Poland
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43
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Vanidassane I, Gogia A, Sharma V, Mallick S. Hodgkin Variant of Richter’s Transformation: Is Transplant Always an Answer? Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_71_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ilavarasi Vanidassane
- Departments of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Departments of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinod Sharma
- Departments of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Mallick
- Departments of Pathology, All India Institute of Medical Sciences, New Delhi, India
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44
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Puła B, Salomon-Perzyński A, Prochorec-Sobieszek M, Jamroziak K. Immunochemotherapy for Richter syndrome: current insights. Immunotargets Ther 2019; 8:1-14. [PMID: 30788335 PMCID: PMC6368420 DOI: 10.2147/itt.s167456] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Richter syndrome (RS) is recognized as the development of a secondary and aggressive lymphoma during the clinical course of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Most of such histological transformations are from RS to diffuse large B-cell lymphoma (DLBCL-RS, 90%) and Hodgkin’s lymphoma (HL-RS, 10%). Histopathological examination is a prerequisite for diagnosis. It is crucial to assess the relationship between the RS clone and the underlying CLL/SLL because clonally related DLBCL-RS has a poor outcome, while clonally unrelated cases have a prognosis similar to de novo DLBCL. An anti-CD20 antibody-based immunochemotherapy is hitherto the frontline treatment of choice for DLBCL-RS; nonetheless, the results are unsatisfactory. Allogeneic stem cell transplantation should be offered to younger and fit patients as a consolidative treatment; however, the majority of the patients may not be qualified for this procedure. The HL-RS transformation has better outcomes than those of DLBCL-RS and can effectively be treated by the adriamycin, bleomycin, vinblastine, and dacarbazine regimen. Although novel agents are currently being investigated for RS, immunochemotherapy nevertheless remains a standard treatment for DLBCL-RS.
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Affiliation(s)
- Bartosz Puła
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland,
| | | | - Monika Prochorec-Sobieszek
- Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland.,Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Krzysztof Jamroziak
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland,
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45
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Allan JN, Furman RR. Current trends in the management of Richter's syndrome. Int J Hematol Oncol 2019; 7:IJH09. [PMID: 30651968 PMCID: PMC6331753 DOI: 10.2217/ijh-2018-0010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/21/2018] [Indexed: 12/16/2022] Open
Abstract
Richter's syndrome (RS) is a life-threatening complication of chronic lymphocytic leukemia (CLL). While previous research has increased our knowledge on the distinct evolutionary patterns of RS and provided a deeper understanding of the risk factors and molecular events predisposing to transformation, there remain few targetable aberrations and treatment is largely ineffective. The ability to obtain deeper remissions, without selecting for deletion 17p, by using novel B-cell receptor (BCR) antagonists and bcl2 inhibition might lead to a decrease in the incidence of RS, but these agents have done little to significantly change outcomes when incorporated into treatment regimens for RS. In this review we highlight the current landscape of molecular lesions specific to RS, review the data on historical treatment options, and look to the horizon for potential opportunities in the future.
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Affiliation(s)
- John N Allan
- Department of Medicine, Division of Hematology & Medical Oncology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Richard R Furman
- Department of Medicine, Division of Hematology & Medical Oncology, New York-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
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Ding W. Richter transformation in the era of novel agents. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:256-263. [PMID: 30504319 PMCID: PMC6245983 DOI: 10.1182/asheducation-2018.1.256] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Recent approvals of several oral targeted agents have revolutionized chronic lymphocytic leukemia (CLL) therapy. However, CLL patients continue to progress; particularly, 4% to 20% of previously treated CLL patients undergo transformation into high-grade lymphoma. Richter transformation is defined as a transformation of CLL into aggressive lymphoma, most commonly diffuse large B-cell lymphoma. These patients typically have poor response to traditional chemotherapy used to treat de novo diffuse large B-cell lymphoma and similar or shorter overall survival (median 3-11 months) in the era of novel agents. Here, I review the contemporary literature on Richter transformation, particularly in the context of novel agents used in CLL, and discuss the management approach for these patients.
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MESH Headings
- Antineoplastic Agents/therapeutic use
- Disease-Free Survival
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Survival Rate
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Affiliation(s)
- Wei Ding
- Chronic Lymphocytic Leukemia Group, Division of Hematology, Mayo Clinic, Rochester, MN
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Hu B, Jacobs R, Ghosh N. Checkpoint Inhibitors Hodgkin Lymphoma and Non-Hodgkin Lymphoma. Curr Hematol Malig Rep 2018; 13:543-554. [DOI: 10.1007/s11899-018-0484-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Thebo U, Millett RL, Elkon J, Haroun F. Two distinct histological Richter's transformations 23 years apart in a patient with chronic lymphocytic leukaemia. BMJ Case Rep 2018; 2018:bcr-2018-225893. [PMID: 30301728 DOI: 10.1136/bcr-2018-225893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A 53-year-old man with a 1-year history of chronic lymphocytic leukaemia (CLL) presented with a left bicep mass. Biopsy and staging workup revealed Richter's transformation (RT) Ann Arbor stage 1E diffuse large B-cell lymphoma in the bicep. The patient was treated with combination chemotherapy with cyclophosphamide, doxorubicin, Vincristine and prednisone followed by site radiation and did well thereafter. His CLL progressed and required treatment on two more occasions 11 and 18 years after his initial diagnosis with fludarabine, Cytoxan and Rituxan and then with bendamustine and rituximab. 23 years after initial presentation, he developed diffuse lymphadenopathy and B-symptoms. A biopsy of an enlarged cervical lymph node demonstrated only CLL for which he was started on ibrutinib. Treatment was shortly discontinued thereafter due to intolerance and worsening symptoms. A second biopsy was performed which revealed concurrent CLL and Hodgkin's lymphoma representing a second and histologically distinct RT.
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Affiliation(s)
- Umera Thebo
- Hematology and Oncology, George Washington University, Washington, DC, USA
| | - Ralph Linwood Millett
- Department of Hematology and Oncology, George Washington University, Washington, DC, USA
| | - Jacob Elkon
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Faysal Haroun
- Hematology and Oncology, George Washington University, Washington, DC, USA
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Parikh SA. Chronic lymphocytic leukemia treatment algorithm 2018. Blood Cancer J 2018; 8:93. [PMID: 30283014 PMCID: PMC6170426 DOI: 10.1038/s41408-018-0131-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/22/2018] [Accepted: 09/17/2018] [Indexed: 11/08/2022] Open
Abstract
The treatment landscape for patients with chronic lymphocytic leukemia (CLL) has changed considerably with the introduction of very effective oral targeted therapies (such as ibrutinib, idelalisib, and venetoclax), and next-generation anti-CD20 monoclonal antibodies (such as obinutuzumab). These agents lead to improved outcomes in CLL, even among patients with high-risk features, such as del17p13 or TP53 mutation and unmutated immunoglobulin heavy chain (IGHV) genes. Each of these treatments is associated with a unique toxicity profile; in the absence of randomized data, the choice of one type of treatment over another depends on the co-morbidities of the patient. Chemoimmunotherapy still plays an important role in the management of previously untreated CLL patients, particularly among young fit patients who have standard risk FISH profile and mutated IGHV genes. Richter's transformation of CLL remains a difficult complication to treat, although therapy with programmed death 1 inhibitors such as pembrolizumab and nivolumab has shown impressive responses in a subset of patients. Our ability to risk stratify CLL patients continues to evolve; the CLL-International Prognostic Index (CLL-IPI) is the best validated tool in predicting time to first therapy among previously untreated patients. This review summarizes the current approach to risk stratification and management of CLL patients.
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MESH Headings
- Algorithms
- Biomarkers, Tumor
- Combined Modality Therapy
- Disease Management
- Disease Progression
- Disease Susceptibility
- Drug Resistance, Neoplasm
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Practice Guidelines as Topic
- Prognosis
- Recurrence
- Treatment Outcome
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Godfrey J, Leukam MJ, Smith SM. An update in treating transformed lymphoma. Best Pract Res Clin Haematol 2018; 31:251-261. [PMID: 30213394 DOI: 10.1016/j.beha.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
Indolent lymphomas typically have a prolonged course and favorable prognosis. Recent data support survival times that can reach several decades, even if periodic treatment is needed to manage symptoms or stabilize disease. However, all indolent lymphomas have the potential to undergo transformation to an aggressive phenotype, clinically characterized by a rapid progression of adenopathy, new-onset constitutional symptoms, or laboratory abnormalities, and the immediate need for therapeutic intervention. The most common scenario is transformation of follicular lymphoma to either diffuse large B-cell lymphoma or high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 translocations; however, other indolent subtypes such as marginal zone lymphoma, lymphoplasmacytic lymphoma, small lymphocytic lymphoma/chronic lymphocytic leukemia, or even nodular lymphocyte predominant Hodgkin lymphoma, can undergo similar histologic transformation. The prognosis of transformed lymphomas has historically been quite poor, but there is ample evidence this is changing in the rituximab era. This article will provide a review of transformed lymphomas with an emphasis on treatment and the nuances of diagnosis and clinical management. Unless otherwise specified, all discussion in this review pertains to transformed follicular lymphoma which is the more common scenario and the subtype with the most robust data. In many cases, this information can be extrapolated and applied to other indolent histologies (i.e. transformed marginal zone lymphoma); however, several other clinical scenarios, such as Richter's transformation and "double hit" transformations, warrant a distinct discussion and will be reviewed separately.
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Affiliation(s)
- James Godfrey
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, USA
| | - Michael J Leukam
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, USA.
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