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Alsuhebany N, Pan C, Holovac E, Do B, McBride A. Zanubrutinib in Mantle Cell Lymphoma Management: A Comprehensive Review. Blood Lymphat Cancer 2023; 13:67-76. [PMID: 38034984 PMCID: PMC10683511 DOI: 10.2147/blctt.s426588] [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: 07/15/2023] [Accepted: 11/10/2023] [Indexed: 12/02/2023]
Abstract
Purpose The pharmacology, pharmacokinetics, pharmacodynamics, clinical efficacy, and safety of zanbrutinib are described. Summary Mantle cell lymphoma (MCL) is a mature B-cell lymphoma that is typically associated with unfavorable outcomes, and virtually all patients with MCL have refractory or relapsed disease despite aggressive treatment. The treatment paradigm for MCL has transformed dramatically over the past decade owing to rapid advancements in immunotherapy and molecular-targeted therapies. Zanubrutinib, a second-generation Bruton's tyrosine kinase inhibitor (BTKI) designated for mature B-cell non-Hodgkin's lymphoma (NHL), has drastically improved the survival outcomes in relapsed/refractory (R/R) MCL patients. This selective BTKI is a small molecule that functions by forming a covalent bond in the active site of BTK. The inhibition of BTK activity is essential for the signaling of B-cell antigen receptor (BCR) and cytokine receptor pathways. In a preclinical study, zanubrutinib inhibited malignant B-cell proliferation and reduced tumor growth. Zanubrutinib was granted FDA-accelerated approval based on the results of Phase I and II trials. The investigator-assessed overall response rate was 83.7%, of which 78% of patients achieved complete response. The median duration of response was 19.5 months, and the median progression-free survival was 22.1 months. The most common (≥20%) all-grade adverse events were low neutrophil count (46.5%), upper respiratory tract infection (38.4%), rash (36.0%), low white blood cell count (33.7%), and low platelet count (32.6%). Conclusion Zanubrutinib is a selective, next-generation, orally active, irreversible BTK inhibitor. The selectivity of zanubrutinib and its superior efficacy, with a well-tolerated safety profile, have proven to be attractive options for other malignancies.
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Affiliation(s)
- Nada Alsuhebany
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Congshan Pan
- Department of Oncology Pharmacy, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Eileen Holovac
- Department of Oncology Pharmacy, VA Loma Linda Healthcare System, Loma Linda, CA, USA
| | - Brian Do
- Department of Oncology Pharmacy, Southern Arizona VA Hlth Care, Tucson, AZ, USA
| | - Ali McBride
- WW HEOR Markets, Bristol-Myers Squibb, New York City, NY, USA
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2
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Decombis S, Papin A, Bellanger C, Sortais C, Dousset C, Le Bris Y, Riveron T, Blandin S, Hulin P, Tessoulin B, Rouel M, Le Gouill S, Moreau-Aubry A, Pellat-Deceunynck C, Chiron D. The IL32/BAFF axis supports prosurvival dialogs in the lymphoma ecosystem and is disrupted by NIK inhibition. Haematologica 2022; 107:2905-2917. [PMID: 35263985 PMCID: PMC9713562 DOI: 10.3324/haematol.2021.279800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/09/2022] [Indexed: 12/14/2022] Open
Abstract
Aggressive B-cell malignancies, such as mantle cell lymphoma (MCL), are microenvironment-dependent tumors and a better understanding of the dialogs occurring in lymphoma-protective ecosystems will provide new perspectives to increase treatment efficiency. To identify novel molecular regulations, we performed a transcriptomic analysis based on the comparison of circulating MCL cells (n=77) versus MCL lymph nodes (n=107) together with RNA sequencing of malignant (n=8) versus normal B-cell (n=6) samples. This integrated analysis led to the discovery of microenvironment-dependent and tumor-specific secretion of interleukin-32 beta (IL32β), whose expression was confirmed in situ within MCL lymph nodes by multiplex immunohistochemistry. Using ex vivo models of primary MCL cells (n=23), we demonstrated that, through the secretion of IL32β, the tumor was able to polarize monocytes into specific MCL-associated macrophages, which in turn favor tumor survival. We highlighted that while IL32β-stimulated macrophages secreted several protumoral factors, they supported tumor survival through a soluble dialog, mostly driven by BAFF. Finally, we demonstrated the efficacy of selective NIK/alternative-NFkB inhibition to counteract microenvironment-dependent induction of IL32β and BAFF-dependent survival of MCL cells. These data uncovered the IL32β/BAFF axis as a previously undescribed pathway involved in lymphoma-associated macrophage polarization and tumor survival, which could be counteracted through selective NIK inhibition.
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Affiliation(s)
- Salomé Decombis
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS
| | - Antonin Papin
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS
| | - Céline Bellanger
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS
| | - Clara Sortais
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS; Service d'Hématologie Clinique, Unité d'Investigation Clinique, CHU, Nantes
| | - Christelle Dousset
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS; Service d'Hématologie Clinique, Unité d'Investigation Clinique, CHU, Nantes
| | - Yannick Le Bris
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS; Service d'Hématologie Biologique, CHU, Nantes
| | - Thiphanie Riveron
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS
| | - Stéphanie Blandin
- SFR-Santé, INSERM UMS016, CNRS UMS 3556, FED 4202, UNIV Nantes, CHU, Nantes
| | - Philippe Hulin
- SFR-Santé, INSERM UMS016, CNRS UMS 3556, FED 4202, UNIV Nantes, CHU, Nantes
| | - Benoit Tessoulin
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS; Service d'Hématologie Clinique, Unité d'Investigation Clinique, CHU, Nantes
| | - Mathieu Rouel
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS
| | - Steven Le Gouill
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS; Service d'Hématologie Clinique, Unité d'Investigation Clinique, CHU, Nantes
| | - Agnès Moreau-Aubry
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS
| | - Catherine Pellat-Deceunynck
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS
| | - David Chiron
- Nantes Université, Inserm, CNRS, Université d'Angers, CRCI2NA, Nantes - France; L'Héma-NexT, i-Site NexT, Nantes, France; GDR3697 Micronit, CNRS.
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3
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Avery J, Chandhok N, Rainey C, Torres R, Huntington S, Isufi I, Seropian S, Xu ML, Foss F. Peripheral Blood Involvement at Staging in Patients With Aggressive Peripheral T-Cell Lymphoma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:680-689. [PMID: 35568635 DOI: 10.1016/j.clml.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Peripheral T-Cell Lymphomas (PTCL) are a rare subgroup of lymphomas with a poor outcome.Traditional prognostic measures rely heavily on disease stage, and with the advent of targeted treatment, further stratificationcriteria are needed to guide treatment. To date, the impact of blood involvement at diagnosis on outcomes has not been assessed. MATERIALS AND METHODS We retrospectively reviewed blood involvement by flow cytometry at diagnosis in 102 consecutivelytreated patients who had flow cytometry data available at diagnosis. Of these, 78 patients with nodal subtypes were identified andstudied in this analysis. RESULTS Of 78 patients with nodal subtypes of PTCL who had flow data available at the time ofdiagnosis, circulating populations of malignant T cells matching those in the biopsied lymph nodes were found in 21 patients bymultiparameter flow cytometry. A positive flow cytometry was highly correlated with bone marrow involvement. The patientswith a negative flow cytometry had a trend toward a longer median PFS compared to those with a positive flow but there was noimpact on overall survival. CONCLUSIONS Circulating malignant tumor cells can be found in the peripheral blood in a subset ofpatients with aggressive nodal T-cell lymphomas, including peripheral t-cell lymphoma not otherwise specified andangioimmunoblastic T-cell lymphomas, and blood involvement is correlated with bone marrow involvement.
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Affiliation(s)
| | | | - Chanelle Rainey
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Richard Torres
- Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Scott Huntington
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Iris Isufi
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Stuart Seropian
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mina L Xu
- Department of Hematopathology, Yale University School ofMedicine, New Haven, CT, USA
| | - Francine Foss
- Section of Hematology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
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4
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Kuhlman JJ, Moustafa MA, Jiang L, Iqbal M, Seegobin K, Wolcott Z, Ayala E, Ansell S, Rosenthal A, Paludo J, Micallef I, Johnston P, Inwards D, Habermann T, Kharfan-Dabaja M, Witzig TE, Nowakowski GS, Tun HW. Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e815-e825. [PMID: 35534379 DOI: 10.1016/j.clml.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Leukemic involvement in high grade B cell lymphoma (L-HGBL) is rare and has been sparsely described in the literature. We report our experience in a large single institution multicenter academic setting. MATERIALS AND METHODS Medical records of patients with HGBL who received care at Mayo Clinic between 2003 and 2020 were reviewed. L-HGBL was confirmed by peripheral blood smear and flow cytometry with corroboration from tissue and bone marrow biopsy findings. RESULTS Twenty patients met inclusion criteria. All patients had significant bone marrow involvement by HGBL. Leukemic involvement presented in 11 of 20 (55%) in the de novo and 9 of 20 (45%) in the relapsed setting. Seven of 20 patients had DLBCL, NOS, 6 of 20 had transformation (t-DLBCL), 3 of 20 had transformed double/triple hit lymphoma (t-DHL/THL), 2 of 20 had double hit lymphoma (DHL), and 2 of 20 had HGBL with intermediate features between DLBCL and Burkitt lymphoma. Nine of 15 patients had MYC translocation. Based on Hans criteria, 11 of 20 had germinal center B-cell (GCB) cell of origin (COO) and 9/20 had non-GCB COO. Five of 11 de novo patients experienced CNS relapse/progression. All de novo patients received anthracycline-based chemoimmunotherapy. Eighteen of 20 patients died of progressive disease. Median overall survival was significantly better in the de novo compared to relapsed group (8.9 months vs. 2.8 months, P = .01). COO, MYC status, DHL/THL status, HGBL subtype, or treatment group did not demonstrate a significant effect on overall survival. CONCLUSION L-HGBL carries a poor prognosis and is associated with MYC translocation, DHL/THL status, transformation, and high CNS risk. Novel therapeutic approaches are needed for L-HGBL.
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Affiliation(s)
| | | | - Liuyan Jiang
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, FL
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Karan Seegobin
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Zoe Wolcott
- Department of Neurology, Mayo Clinic, Jacksonville, FL
| | - Ernesto Ayala
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Steve Ansell
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Allison Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ
| | - Jonas Paludo
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Ivana Micallef
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Patrick Johnston
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - David Inwards
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Thomas Habermann
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Thomas E Witzig
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Han W Tun
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL.
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5
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Trouvain AM, Bocqué C, Müller LJ, Heinrich C, Bewarder M, Pérez Guerra N, Szurman G, Becker SL, Rickmann A. [Conjunctival mantle cell lymphoma-a therapeutic challenge]. DIE OPHTHALMOLOGIE 2022; 119:837-840. [PMID: 34319474 DOI: 10.1007/s00347-021-01462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 01/26/2023]
Affiliation(s)
- André M Trouvain
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland.
| | - Catheline Bocqué
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
| | - Lisa J Müller
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
| | - Christoph Heinrich
- Klinische, molekulare u. Zytopathologie, Institut für Pathologie Saarbrücken-Rastpfuhl, Saarbrücken, Deutschland
| | - Moritz Bewarder
- Institut für Innere Medizin, Abteilung Hämatologie und Onkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Núria Pérez Guerra
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
| | - Gesine Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
| | - Sören L Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Annekatrin Rickmann
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland
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Abstract
PURPOSE OF REVIEW Validated metrics to optimize older adult patient selection for Chimeric Antigen Receptor T-cell therapy (CART) are lacking; however, some preliminary data suggests that geriatric assessments and cumulative illness rating score may be useful tools. In addition, interventions capable of enhancing outcomes in older adults receiving CART have yet to be elucidated. The purpose of this review is to present data extrapolating from other diseases and therapeutic modalities, related to product selection, toxicity mitigation strategies, comprehensive coordinated models of care, and functional optimization of patients. RECENT FINDINGS The most robust data in older adults are among relapsed and refractory (r/r) diffuse large B-cell lymphoma (DLBCL) patients where three products are available with the longest clinical follow up and the most abundant real-world evidence (RWE). Data for the approved CART products for follicular lymphoma (FL) and mantle cell lymphoma (MCL) are relatively new and RWE is lacking in general. Data for CART products in multiple myeloma (MM) and B-cell acute lymphoblastic leukemia (B-ALL) are even more recent, but preliminary data in older adults seem to follow the trend of excellent efficacy in this age group with age-stratified toxicity data limited. Landmark trials and RWE studies indicate that the high response rates of CART for older adult patients, age 65 years and older, are maintained, while toxicity may be amplified. Clinically important toxicities include grade 3 or higher cytokine release syndrome (CRS), neurotoxicity, and infections.
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7
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Mantle cell lymphoma and the evidence of an immature lymphoid component. Leuk Res 2022; 115:106824. [DOI: 10.1016/j.leukres.2022.106824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022]
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8
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Carreras J, Nakamura N, Hamoudi R. Artificial Intelligence Analysis of Gene Expression Predicted the Overall Survival of Mantle Cell Lymphoma and a Large Pan-Cancer Series. Healthcare (Basel) 2022; 10:healthcare10010155. [PMID: 35052318 PMCID: PMC8775707 DOI: 10.3390/healthcare10010155] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 02/07/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a subtype of mature B-cell non-Hodgkin lymphoma characterized by a poor prognosis. First, we analyzed a series of 123 cases (GSE93291). An algorithm using multilayer perceptron artificial neural network, radial basis function, gene set enrichment analysis (GSEA), and conventional statistics, correlated 20,862 genes with 28 MCL prognostic genes for dimensionality reduction, to predict the patients' overall survival and highlight new markers. As a result, 58 genes predicted survival with high accuracy (area under the curve = 0.9). Further reduction identified 10 genes: KIF18A, YBX3, PEMT, GCNA, and POGLUT3 that associated with a poor survival; and SELENOP, AMOTL2, IGFBP7, KCTD12, and ADGRG2 with a favorable survival. Correlation with the proliferation index (Ki67) was also made. Interestingly, these genes, which were related to cell cycle, apoptosis, and metabolism, also predicted the survival of diffuse large B-cell lymphoma (GSE10846, n = 414), and a pan-cancer series of The Cancer Genome Atlas (TCGA, n = 7289), which included the most relevant cancers (lung, breast, colorectal, prostate, stomach, liver, etcetera). Secondly, survival was predicted using 10 oncology panels (transcriptome, cancer progression and pathways, metabolic pathways, immuno-oncology, and host response), and TYMS was highlighted. Finally, using machine learning, C5 tree and Bayesian network had the highest accuracy for prediction and correlation with the LLMPP MCL35 proliferation assay and RGS1 was made. In conclusion, artificial intelligence analysis predicted the overall survival of MCL with high accuracy, and highlighted genes that predicted the survival of a large pan-cancer series.
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Affiliation(s)
- Joaquim Carreras
- Department of Pathology, Faculty of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan;
- Correspondence: ; Tel.: +81-463-931-121; Fax: +81-463-911-370
| | - Naoya Nakamura
- Department of Pathology, Faculty of Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Japan;
| | - Rifat Hamoudi
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates;
- Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK
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9
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Cabeçadas J, Nava VE, Ascensao JL, Gomes da Silva M. How to Diagnose and Treat CD5-Positive Lymphomas Involving the Spleen. Curr Oncol 2021; 28:4611-4633. [PMID: 34898558 PMCID: PMC8628806 DOI: 10.3390/curroncol28060390] [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: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
Patients with CD5-expressing lymphomas presenting with splenomegaly are frequently diagnosed with chronic lymphocytic leukemia. The most important differential diagnosis is mantle cell lymphoma, both in its classical and leukemic, non-nodal forms, given its prognostic and therapeutic implications. Other small B-cell neoplasms that frequently involve the spleen and occasionally express CD5 include the splenic marginal zone lymphoma, hairy cell leukemia and, rarely, lymphoplasmacytic lymphoma. The frequency of CD5 positivity depends in part on the sensitivity of the detection methods employed. Usually, a combination of morphological, immunophenotypic and molecular findings allows for a precise sub-classification of CD5-positive, low-grade B-cell lymphomas of the spleen. Some of these tumors may display a mixture of small and larger B cells, raising the possibility of more aggressive lymphomas, such as diffuse large B-cell lymphomas (DLBCL). Approximately 5-10% of DLBCL are CD5-positive and some may manifest as primary splenic lesions. When available, the morphology of DLBCL in the splenic tissue is distinctive and a leukemic picture is very rare. In conclusion, the appropriate morphological and clinical context assisted by flow cytometry panels and/or immunohistochemistry allows the differential diagnosis of CD5-positive, non-Hodgkin, B-cell lymphomas involving the spleen.
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Affiliation(s)
- José Cabeçadas
- Department of Pathology, Portuguese Institute of Oncology Lisbon, 1099-023 Lisboa, Portugal;
| | - Victor E. Nava
- Department of Pathology, The George Washington University, Washington, DC 20037, USA;
- Department of Pathology, Veterans Health Administration Medical Center, Washington, DC 20422, USA
| | - Joao L. Ascensao
- School of Medicine, The George Washington University, Washington, DC 20037, USA;
| | - Maria Gomes da Silva
- Department of Hematology, Portuguese Institute of Oncology Lisbon, 1099-023 Lisboa, Portugal
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10
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Marques JAS, Ferreira F, Melo DP, Santos M, Vaz RP. Palatine Tonsils Primary Presentation of Blastoid Variant of Mantle Cell Lymphoma: Case Report. Head Neck Pathol 2020; 15:588-592. [PMID: 33091144 PMCID: PMC8134596 DOI: 10.1007/s12105-020-01238-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
Head and neck lymphomas can present with a wide range of symptoms. Timely and accurate diagnosis is often challenging. The blastoid variant of mantle cell lymphoma (MCL) accounts for less than one-third of all MCL cases. Isolated primary presentation on the palatine tonsils is rare, and prognosis and outcome are seemingly unfavorable. An 81-year-old man presented with persistent odynophagia, dysphagia, and obstructive hypertrophic palatine tonsils with purulent exudate. The signs and symptoms were non-responsive to antibiotic therapy, and the tonsils were biopsied. The cellular morphology, immunophenotype, and genotype supported a diagnosis of the blastoid variant of MCL. After staging, the patient underwent chemotherapy with Rituximab-Bendamustine (R-Benda). The patient is in clinical remission more than two years after therapy. We report an exceedingly rare case of blastoid MCL that is prone to be misdiagnosed as tonsillitis. We review the literature and discuss treatment options of this uncommon malignancy.
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Affiliation(s)
- Joana A. S. Marques
- Department of Otorhinolaryngology, Centro Hospitalar Universitário S. João, EPE, Porto, Portugal ,Unit of Otorhinolaryngology - Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fátima Ferreira
- Department of Clinical Haematology, Centro Hospitalar Universitário S. João, EPE, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Daniel P. Melo
- Department of Anatomic Pathology, Centro Hospitalar Universitário S. João, EPE, Porto, Portugal ,Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Margarida Santos
- Department of Otorhinolaryngology, Centro Hospitalar Universitário S. João, EPE, Porto, Portugal
| | - Ricardo P. Vaz
- Department of Otorhinolaryngology, Centro Hospitalar Universitário S. João, EPE, Porto, Portugal ,Unit of Anatomy - Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal ,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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11
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Matsuoka R, Sakamoto N, Sakata-Yanagimoto M, Chiba S, Noguchi M, Nakamura N. An overlapping case of in situ mantle cell neoplasia and leukemic non-nodal mantle cell lymphoma. J Clin Exp Hematop 2020; 60:169-173. [PMID: 33028761 PMCID: PMC7810252 DOI: 10.3960/jslrt.20022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In situ mantle cell neoplasia (isMCN) and leukemic non-nodal mantle cell lymphoma (nnMCL) are classified as an indolent subtype of mantle cell lymphoma (MCL). The tumor cells of isMCN are restricted to the inner layer of the lymphoid tissue mantle zone, exhibiting an in situ pattern histologically. On the other hand, nnMCL is distributed in the peripheral blood, bone marrow and sometimes the spleen, but lymphadenopathy or systemic organ involvement is rare. We report a case of isMCN in a submandibular lymph node resected from a 65-year-old Japanese male. The tumor cells were positive for cyclin D1 (CCND1) and SOX11 expression, and were restricted to the mantle zone area of the lymph node. However, tumor cells were also detected in the stomach mucosa, bone marrow tissue and peripheral blood, suggesting nnMCL. isMCN and nnMCL may have a partly overlapping disease spectrum, although the correlation between these two subtypes has not been well described. This present case demonstrated characteristics overlapping between isMCN and nnMCL.
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Affiliation(s)
- Ryota Matsuoka
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Noriaki Sakamoto
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Shigeru Chiba
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masayuki Noguchi
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Kanagawa, Japan
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12
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Hansen MH, Cédile O, Blum MK, Hansen SV, Ebbesen LH, Bentzen HHN, Thomassen M, Kruse TA, Kavan S, Kjeldsen E, Kristensen TK, Haaber J, Abildgaard N, Nyvold CG. Molecular characterization of sorted malignant B cells from patients clinically identified with mantle cell lymphoma. Exp Hematol 2020; 84:7-18.e12. [PMID: 32173361 DOI: 10.1016/j.exphem.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/06/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
Mantle cell lymphoma (MCL) is a tumor with a poor prognosis. A few studies have examined the molecular landscape by next-generation sequencing and provided valuable insights into recurrent lesions driving this heterogeneous cancer. However, none has attempted to cross-link the individual genomic and transcriptomic profiles in sorted MCL cells to perform individual molecular characterizations of the lymphomas. Such approaches are relevant as MCL is heterogenous by nature, and thorough molecular diagnostics may potentially benefit the patient with more focused treatment options. In the work described here, we used sorted lymphoma cells from four patients at diagnosis and relapse by intersecting the coding DNA and mRNA. Even though only a few patients were included, this method enabled us to pinpoint a specific set of expressed somatic mutations, to present an overall expression profile different from the normal B cell counterparts, and to track molecular aberrations from diagnosis to relapse. Changes in single-nucleotide coding variants, subtle clonal changes in large-copy-number alterations, subclonal involvement, and changes in expression levels in the clinical course provided detailed information on each of the individual malignancies. In addition to mutations in known genes (e.g., TP53, CCND1, NOTCH1, ATM), we identified others, not linked to MCL, such as a nonsense mutation in SPEN and an MYD88 missense mutation in one patient, which along with copy number alterations exhibited a molecular resemblance to splenic marginal zone lymphoma. The detailed exonic and transcriptomic portraits of the individual MCL patients obtained by the methodology presented here could help in diagnostics, surveillance, and potentially more precise usage of therapeutic drugs by efficient screening of biomarkers.
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Affiliation(s)
- Marcus Høy Hansen
- Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Oriane Cédile
- Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Mia Koldby Blum
- Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Simone Valentin Hansen
- Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | | | | | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Denmark
| | - Torben A Kruse
- Department of Clinical Genetics, Odense University Hospital, Denmark
| | - Stephanie Kavan
- Department of Clinical Genetics, Odense University Hospital, Denmark
| | - Eigil Kjeldsen
- Department of Hematology, Aarhus University Hospital, Denmark
| | - Thomas Kielsgaard Kristensen
- Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Jacob Haaber
- Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Charlotte Guldborg Nyvold
- Haematology-Pathology Research Laboratory, Research Unit for Haematology and Research Unit for Pathology, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
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Zhou X, Steinhardt MJ, Düll J, Krummenast F, Danhof S, Meckel K, Nickel K, Grathwohl D, Leicht HB, Rosenwald A, Einsele H, Rasche L, Kortüm M. Obinutuzumab and venetoclax induced complete remission in a patient with ibrutinib-resistant non-nodal leukemic mantle cell lymphoma. Eur J Haematol 2020; 104:352-355. [PMID: 31922303 DOI: 10.1111/ejh.13382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 01/08/2023]
Abstract
We herein report the case of a 73-year-old male patient who was diagnosed with leukemic non-nodal MCL. This patient had received six cycles of bendamustine, which resulted in a transient remission, and a second-line therapy with ibrutinib, which unfortunately failed to induce remission. We started a treatment with single-agent obinutuzumab at a dose of 20 mg on day 1, 50 mg on day 2-4, 330 mg on day 5, and 1000 mg on day 6. The laboratory analysis showed a rapid decrease of leukocyte count. Four weeks later, we repeated the treatment with obinutuzumab at a dose of 1000 mg q4w and started a therapy with venetoclax at a dose of 400 mg qd, which could be increased to 800 mg qd from the third cycle. This combination therapy was well tolerated. The patient achieved a complete remission (CR) after three cycles of obinutuzumab and venetoclax. To date, the patient has a progression-free survival of 17 months under ongoing obinutuzumab maintenance q4w. This is the first report about obinutuzumab and venetoclax induced CR in rituximab-intolerant patient with an ibrutinib-resistant MCL. This case suggests that obinutuzumab- and venetoclax-based combination therapy might be salvage therapy in patients with ibrutinib-resistant MCL.
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Affiliation(s)
- Xiang Zhou
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | | | - Johannes Düll
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | - Franziska Krummenast
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | - Sophia Danhof
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | - Katharina Meckel
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | - Katharina Nickel
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | - Denise Grathwohl
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | - Hans-Benno Leicht
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | - Andreas Rosenwald
- Department of Pathology, Würzburg University Hospital, Würzburg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | - Leo Rasche
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Kortüm
- Department of Internal Medicine II, Würzburg University Hospital, University of Würzburg, Würzburg, Germany
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14
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Mundt F, Merrien M, Nygren L, Sutton LA, Christensson B, Wahlin BE, Rosenquist R, Sander B, Wasik AM. Expression of GNAZ, encoding the Gα z protein, predicts survival in mantle cell lymphoma. Br J Haematol 2019; 185:708-712. [PMID: 30788840 DOI: 10.1111/bjh.15810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 12/21/2018] [Indexed: 01/26/2023]
Abstract
Mantle cell lymphoma (MCL), a malignancy of B-lymphocytes, has a poor prognosis. It is thus necessary to improve the understanding of the pathobiology of MCL and identify factors contributing to its aggressiveness. Our studies, based on Affymetrix data from 17 MCL biopsies, real-time quantitative polymerase chain reaction data from 18 sorted primary MCL cells and 108 MCL biopsies compared to non-malignant tissue, reveals that GNAZ expression predicts poor clinical outcome of MCL patients (Cox regression, P = 0·014) and lymphocytosis (Mann-Whitney, P = 0·011). We show that GNAZ translates to Gαz protein - a signalling molecule within the G-protein coupled receptor network. Our findings suggest that GNAZ/Gαz contribute to the MCL pathobiology.
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Affiliation(s)
- Filip Mundt
- Proteomics and Biomarkers, The Broad Institute of MIT and Harvard, Boston, Cambridge, MA, USA
| | - Magali Merrien
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lina Nygren
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lesley A Sutton
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Birger Christensson
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Björn E Wahlin
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Sander
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Agata M Wasik
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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15
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Cocco G, Boccatonda A, D'Ardes D, Galletti S, Schiavone C. Mantle cell lymphoma: from ultrasound examination to histological diagnosis. J Ultrasound 2018; 21:339-342. [PMID: 30132201 DOI: 10.1007/s40477-018-0318-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/09/2018] [Indexed: 01/19/2023] Open
Abstract
We report the case of a 42-year-old patient referred to our department for the examination of two large, symmetrical inguinal lumps. The ultrasound examination of the swollen lymph node demonstrated a cortical echogenicity greater than the medullary echogenicity, and the vascularization stop around the cortical zone suggested a pathological pattern of mantle cell lymphoma. In this type of lymphoma, lymphocytes are localized in a mantle zone, inducing a thickening of the lumps. Therefore, for the first time, ultrasound examination detected sonographic vascular features of mantle cell lymphoma, allowing the identification of the disease and suggesting the specific histological diagnosis.
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Affiliation(s)
- G Cocco
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, G. D'Annunzio University, Cesi-Met, via Luigi Polacchi, 66100, Chieti, CH, Italy
| | - A Boccatonda
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, G. D'Annunzio University, Cesi-Met, via Luigi Polacchi, 66100, Chieti, CH, Italy.
| | - D D'Ardes
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, G. D'Annunzio University, Cesi-Met, via Luigi Polacchi, 66100, Chieti, CH, Italy
| | - S Galletti
- Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy
| | - C Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, G. D'Annunzio University, Cesi-Met, via Luigi Polacchi, 66100, Chieti, CH, Italy
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16
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Clot G, Jares P, Giné E, Navarro A, Royo C, Pinyol M, Martín-Garcia D, Demajo S, Espinet B, Salar A, Ferrer A, Muntañola A, Aymerich M, Rauert-Wunderlich H, Jaffe ES, Connors JM, Gascoyne RD, Delabie J, López-Guillermo A, Ott G, Wright GW, Staudt LM, Rosenwald A, Scott DW, Rimsza LM, Beà S, Campo E. A gene signature that distinguishes conventional and leukemic nonnodal mantle cell lymphoma helps predict outcome. Blood 2018; 132:413-422. [PMID: 29769262 PMCID: PMC6071558 DOI: 10.1182/blood-2018-03-838136] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/10/2018] [Indexed: 12/21/2022] Open
Abstract
Mantle cell lymphoma (MCL) is an aggressive B-cell malignancy, but some patients have a very indolent evolution. This heterogeneous course is related, in part, to the different biological characteristics of conventional MCL (cMCL) and the distinct subgroup of leukemic nonnodal MCL (nnMCL). Robust criteria to distinguish these MCL subtypes and additional biological parameters that influence their evolution are not well defined. We describe a novel molecular assay that reliably distinguishes cMCL and nnMCL using blood samples. We trained a 16-gene assay (L-MCL16 assay) on the NanoString platform using 19 purified leukemic samples. The locked assay was applied to an independent cohort of 70 MCL patients with leukemic presentation. The assay assigned 37% of cases to nnMCL and 56% to cMCL. nnMCL and cMCL differed in nodal presentation, lactate dehydrogenase, immunoglobulin heavy chain gene mutational status, management options, genomic complexity, and CDKN2A/ATM deletions, but the proportion with 17p/TP53 aberrations was similar in both subgroups. Sequential samples showed that assay prediction was stable over time. nnMCL had a better overall survival (OS) than cMCL (3-year OS 92% vs 69%; P = .006) from the time of diagnosis and longer time to first treatment. Genomic complexity and TP53/CDKN2A aberrations predicted for shorter OS in the entire series and cMCL, whereas only genomic complexity was associated with shorter time to first treatment and OS in nnMCL. In conclusion, the newly developed assay robustly recognizes the 2 molecular subtypes of MCL in leukemic samples. Its combination with genetic alterations improves the prognostic evaluation and may provide useful biological information for management decisions.
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Affiliation(s)
- Guillem Clot
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Pedro Jares
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Hematopathology Unit-Laboratory of Pathology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Eva Giné
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Hematology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alba Navarro
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Cristina Royo
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Magda Pinyol
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - David Martín-Garcia
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Santiago Demajo
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
| | | | - Antonio Salar
- Hematology Department, IMIM-Hospital del Mar, Barcelona, Spain
| | - Ana Ferrer
- Hematology Department, IMIM-Hospital del Mar, Barcelona, Spain
| | - Ana Muntañola
- Servei d'Hematologia, Hospital Mútua de Terrassa, Terrassa, Spain
| | - Marta Aymerich
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Hematopathology Unit-Laboratory of Pathology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Hilka Rauert-Wunderlich
- Institute of Pathology, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Elaine S Jaffe
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joseph M Connors
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Jan Delabie
- Department of Pathology, Toronto General Hospital, Toronto, ON, Canada
| | - Armando López-Guillermo
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Hematology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; and
| | | | - Louis M Staudt
- Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | - David W Scott
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Lisa M Rimsza
- Department of Pathology, Mayo Clinic, Scottsdale, AZ
| | - Sílvia Beà
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
| | - Elías Campo
- Institute for Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Spain
- Hematopathology Unit-Laboratory of Pathology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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Pease DF, Morrison VA. Treatment of mantle cell lymphoma in older adults. J Geriatr Oncol 2018; 9:308-314. [DOI: 10.1016/j.jgo.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/27/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
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18
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Zhang X, Gordon KB, Zaldivar RA, Rajjoub LZ. Mantle cell lymphoma: conjunctival mass in a female patient. Can J Ophthalmol 2017; 53:e109-e111. [PMID: 29784172 DOI: 10.1016/j.jcjo.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Xinxin Zhang
- University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Kathleen B Gordon
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC
| | - Renzo A Zaldivar
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC
| | - Lamise Z Rajjoub
- Department of Ophthalmology, University of North Carolina, Chapel Hill, NC
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19
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Vose JM. Mantle cell lymphoma: 2017 update on diagnosis, risk-stratification, and clinical management. Am J Hematol 2017; 92:806-813. [PMID: 28699667 DOI: 10.1002/ajh.24797] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma characterized by involvement of the lymph nodes, spleen, blood and bone marrow with a short remission duration to standard therapies and a median overall survival (OS) of 4-5 years. DIAGNOSIS Diagnosis is based on lymph node, bone marrow, or tissue morphology of centrocytic lymphocytes, small cell type, or blastoid variant cells. A chromosomal translocation t (11:14) is the molecular hallmark of MCL, resulting in the overexpression of cyclin D1. Cyclin D1 is detected by immunohistochemistry in 98% of cases. The absence of SOX-11 or a low Ki-67 may correlate with a more indolent form of MCL. The differential diagnosis of MCL includes small lymphocytic lymphoma, marginal zone lymphoma, and follicular lymphoma. RISK STRATIFICATION The MCL International Prognostic Index (MIPI) is the prognostic model most often used and incorporates ECOG performance status, age, leukocyte count, and lactic dehydrogenase. A modification of the MIPI also adds the Ki-67 proliferative index if available. The median OS for the low-risk group was not reached (5-year OS of 60%). The median OS for the intermediate risk group was 51 months and 29 months for the high risk group. RISK-ADAPTED THERAPY For selected indolent, low MIPI MCL patients, initial observation may be appropriate therapy. For younger patients with intermediate or high risk MIPI MCL, aggressive therapy with a cytotoxic Regimen followed by autologous stem cell transplantation should be considered. Rituximab maintenance after autologous stem cell transplantation has also improved the progression-free and overall survival. For older symptomatic MCL patients with intermediate or high risk MIPI, combination chemotherapy with R-CHOP, R-Bendamustine, or a clinical trial should be considered. In addition, rituximab maintenance therapy may prolong the progression-free survival. At the time of relapse, agents directed at activated pathways in MCL cells such as bortezomib (NFkB inhibitor), lenalidamide (anti-angiogenesis) and Ibruitinib (Bruton's Tyrosine Kinase [BTK] inhibitor) have demonstrated excellent clinical activity in MCL patients. Autologous or allogeneic stem cell transplantation can also be considered in young patients. Clinical trials with novel agents are always a consideration for MCL patients.
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Affiliation(s)
- Julie M Vose
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, 68198-7680
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20
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Fakhri B, Kahl B. Current and emerging treatment options for mantle cell lymphoma. Ther Adv Hematol 2017; 8:223-234. [PMID: 28811872 DOI: 10.1177/2040620717719616] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/08/2017] [Indexed: 11/17/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma with typically aggressive behavior. The genetic signature is the chromosomal translocation t(11;14)(q13;q32) resulting in overexpression of cyclin D1. Asymptomatic newly diagnosed MCL patients with low tumor burden can be closely observed, deferring therapy to the time of disease progression. Although MCL classically responds to upfront chemotherapy, it remains incurable with standard approaches. For patients in need of frontline therapy, the initial decision is whether to proceed with an intensive treatment strategy or a non-intensive treatment strategy. In general, given the unfavorable risk-benefit profile, older MCL patients should be spared intensive strategies, while younger and fit patients can be considered for intensive strategies. The bendamustine and rituximab (BR) regimen is becoming an increasingly popular treatment option among the elderly population, with improved progression-free survival (PFS) and acceptable side-effect profile. Although rituximab maintenance after R-CHOP improves survival outcomes in elderly patients, no clinical trial to date has shown statistical significance to support the use of rituximab maintenance after BR induction in older patients. In young and fit patients with MCL, an intensive strategy to maximize the length of first remission has emerged as a worldwide standard of care. With current high-dose cytarabine-containing immunochemotherapy regimens followed by autologous stem cell transplantation, the median PFS has exceeded 7 years. In the relapsed or refractory (R/R) setting, reduced intensity conditioning allogeneic hematopoietic stem cell transplantation may offer the highest likelihood of long-term survival in young R/R MCL patients, at the cost of increased risk of non-relapse mortality and chronic graft versus host disease. Novel agents targeting activated pathways in MCL cells, such as bortezomib, lenalidamide, ibrutinib and temsirolimus are now available for the management of R/R disease.
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Affiliation(s)
- Bita Fakhri
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Brad Kahl
- 660 South Euclid Ave, Campus Box 8056, Saint Louis, MO 63110, USA
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Abstract
Mantle cell lymphoma is a relatively rare subtype of lymphoma with a great deal of heterogeneity, both clinically and biologically. Since its recognition as a separate entity in the early 1990s though, consistent efforts have led to a significant improvement of overall survival, from a median overall survival of 2.5 years initially to 5-7 years currently. This decades-long and stepwise progress, summarized in the article, definitely accelerated recently, shedding light on a changing paradigm.
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Affiliation(s)
- Andre Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA.
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22
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Yang P, Lin J, Liu H, Shen H, Yang HL. Primary bone mantle cell lymphomas with multiple vertebral compression fractures: A case report. Oncol Lett 2017; 13:1288-1292. [PMID: 28454248 DOI: 10.3892/ol.2017.5553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/11/2016] [Indexed: 01/03/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a mature B-cell non-Hodgkin lymphoma. Patients with MCL generally present with extensive lymphadenopathy and extranodal involvement. To the best of our knowledge, no cases of primary bone MCL with multiple vertebral compression fractures have been reported in the literature thus far. The current study reports the case of a 75-year-old Chinese male patient presenting with lower back pain for 1 year. B symptoms were not observed in the patient's medical history. X-ray revealed osteoporosis, and mixed osteolytic and osteosclerotic lesions in the T10 and L1 vertebrae with decreased height. Computed tomography of the spine showed multiple vertebral compression fractures, particularly at T10 and L1. Furthermore, magnetic resonance imaging demonstrated a diffuse homogeneous abnormal signal with multiple vertebral compression fractures. The patient underwent vertebral biopsy and percutaneous balloon kyphoplasty. Histopathological examination of the biopsy revealed abnormal, diffuse, atypical, small-sized, slightly irregular lymphocytes with condensed chromatin. Immunohistochemical staining showed CD5+, CD20+ and cyclin D1+. Thus, the patient was diagnosed with primary bone MCLs and chemotherapy was administered. During the 2-month follow-up, the patient remained in a good clinical condition. The present study reports a rare case of primary osseous MCL and a review of the literature.
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Affiliation(s)
- Peng Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jun Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Hao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Hao Shen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Hui-Lin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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23
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Zhang XY, Xu J, Zhu HY, Wang Y, Wang L, Fan L, Wu YJ, Li JY, Xu W. Negative prognostic impact of low absolute CD4 + T cell counts in peripheral blood in mantle cell lymphoma. Cancer Sci 2016; 107:1471-1476. [PMID: 27465799 PMCID: PMC5084668 DOI: 10.1111/cas.13020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/15/2016] [Accepted: 07/25/2016] [Indexed: 02/06/2023] Open
Abstract
Tumor microenvironment and host immunity are closely related to outcome in patients with mantle cell lymphoma (MCL). However, few researchers have focused on the prognostic value of peripheral blood lymphocyte subsets counts. The purpose of this study was to investigate the prognostic value of lymphocyte subsets and absolute monocyte counts. Sixty-eight patients were analyzed retrospectively. Absolute CD4+ T cell counts (ACD4C), CD8+ T cell counts, nature killer cell counts, and CD4/CD8 ratios were assessed by peripheral blood flow cytometry and correlated with clinical parameters and long-term outcomes. The median follow-up for all patients was 21 months and the median survival time was 44 months. The overall survival (OS) rate at 1, 3, and 5 years was 80%, 51%, and 41%, respectively. In our cohort, high absolute monocyte count, and low ACD4C and CD4/CD8 ratio were associated with unfavorable OS (P = 0.029, P = 0.027, and P = 0.045, respectively) by univariate analysis. Multivariate analysis indicated that low ACD4C was a significant predictor of unfavorable OS (P = 0.004) independent of the simplified MCL International Prognostic Index (P = 0.048) in patients treated with or without rituximab (P = 0.011). Low CD4+ T cell counts proved to be a significant predictor of unfavorable OS in patients with MCL.
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Affiliation(s)
- Xin-Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Ji Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Hua-Yuan Zhu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Yan Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Yu-Jie Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China. .,Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
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24
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Abstract
The non-Hodgkin lymphomas (NHLs) are a heterogeneous family of lymphoid malignancies that are among the most common neoplasms of both dogs and humans. Owing to shared molecular, signaling, incidence, and pathologic features, there is a strong framework supporting the utilization of canine lymphoma as a comparative, large animal model of human NHL. In alignment with the biologic similarities, the current approach towards the diagnosis and classification of canine lymphoma is based upon the human World Health Organization guidelines. While this approach has contributed to an increasing appreciation of the potential biological scope of canine lymphoma, it has also become apparent that the most appropriate diagnostic philosophy must be multimodal, namely by requiring knowledge of microscopic, immunophenotypic, and clinical features before establishing a final disease diagnosis. This review seeks to illustrate the comparative similarities and differences in the diagnosis of canine lymphoma through the presentation of the microscopic and immunophenotypic features of its most common forms.
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Affiliation(s)
- Davis M. Seelig
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55455, USA
- Correspondence: ; Tel.: +1-612-626-0471
| | - Anne C. Avery
- Department of Microbiology, Immunology, and Pathology and the Flint Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA; (A.C.A.); (E.J.E.)
| | - E. J. Ehrhart
- Department of Microbiology, Immunology, and Pathology and the Flint Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA; (A.C.A.); (E.J.E.)
| | - Michael A. Linden
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455, USA;
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25
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Tucker DL, Naylor G, Kruger A, Hamilton MS, Follows G, Rule SA. Ibrutinib is a safe and effective therapy for systemic mantle cell lymphoma with central nervous system involvement - a multi-centre case series from the United Kingdom. Br J Haematol 2016; 178:327-329. [PMID: 27197509 DOI: 10.1111/bjh.14122] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- David L Tucker
- Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, Devon, UK
| | - Georgina Naylor
- Department of Haematology, Royal Cornwall Hospital, Truro, UK
| | - Anton Kruger
- Department of Haematology, Royal Cornwall Hospital, Truro, UK
| | | | | | - Simon A Rule
- Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, Devon, UK
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26
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Panero J, Alves-Paiva RM, Roisman A, Santana-Lemos BA, Falcão RP, Oliveira G, Martins D, Stanganelli C, Slavutsky I, Calado RT. Acquired TERT promoter mutations stimulate TERT transcription in mantle cell lymphoma. Am J Hematol 2016; 91:481-5. [PMID: 26852175 DOI: 10.1002/ajh.24324] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/25/2016] [Accepted: 02/01/2016] [Indexed: 01/07/2023]
Abstract
Mantle cell lymphoma (MCL) is an aggressive lymphoid neoplasm with poor prognosis. Acquired telomerase reverse transcriptase gene promoter (TERTp) mutations are among the most frequent somatic non-coding mutations in cancers. In this study, the prevalence of TERTp mutations in 24 MCL and 21 other lymphoid neoplasias (oLN) was investigated. Eight MCL samples (33%) carried TERTp mutations, two homozygous and six heterozygous (seven C228T and one C250T), which directly correlated with higher TERT transcription, mitochondrial DNA copy number, and IGHV mutational status in MCL neoplastic cells. TERTp mutations were not found in oLN. TERTp mutations correlated with more lymphoma proliferation and tumor burden, as suggested by the higher number of lymphoma cells circulating in peripheral blood, and tended to associate with longer MCL telomeres, especially in homozygous mutants, although not statistically significant. Telomere-biology genes were overexpressed in MCL cells in comparison to healthy lymphocytes, but were not influenced by mutation status. The findings described for the first time that acquired TERTp mutations are common in MCL but not in other lymphoid neoplasms. It was also demonstrated that TERTp mutations are associated with higher TERT mRNA expression in MCL cells in vivo and higher tumor burden, suggesting these mutations as a driver event in MCL development and progression.
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Affiliation(s)
- Julieta Panero
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental; CONICET-Academia Nacional de Medicina; Buenos Aires C1425AUM Argentina
| | - Raquel M. Alves-Paiva
- Divisão De Hematologia, Departamento de Clínica Médica; Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo; Ribeirão Preto SP 14048-900 Brazil
- Centro de Terapia Celular; Fundação de Amparo À Pesquisa do Estado de São Paulo (FAPESP); Ribeirão Preto SP 14048-900 Brazil
| | - Alejandro Roisman
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental; CONICET-Academia Nacional de Medicina; Buenos Aires C1425AUM Argentina
| | - Barbara A. Santana-Lemos
- Divisão De Hematologia, Departamento de Clínica Médica; Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo; Ribeirão Preto SP 14048-900 Brazil
- Centro de Terapia Celular; Fundação de Amparo À Pesquisa do Estado de São Paulo (FAPESP); Ribeirão Preto SP 14048-900 Brazil
| | - Roberto P. Falcão
- Divisão De Hematologia, Departamento de Clínica Médica; Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo; Ribeirão Preto SP 14048-900 Brazil
- Centro de Terapia Celular; Fundação de Amparo À Pesquisa do Estado de São Paulo (FAPESP); Ribeirão Preto SP 14048-900 Brazil
| | - Gustavo Oliveira
- Divisão De Hematologia, Departamento de Clínica Médica; Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo; Ribeirão Preto SP 14048-900 Brazil
| | - Diego Martins
- Divisão De Hematologia, Departamento de Clínica Médica; Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo; Ribeirão Preto SP 14048-900 Brazil
| | - Carmen Stanganelli
- División Patología Molecular, Instituto de Investigaciones Hematológicas; Academia Nacional de Medicina; Buenos Aires C1425AUM Argentina
| | - Irma Slavutsky
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental; CONICET-Academia Nacional de Medicina; Buenos Aires C1425AUM Argentina
| | - Rodrigo T. Calado
- Divisão De Hematologia, Departamento de Clínica Médica; Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo; Ribeirão Preto SP 14048-900 Brazil
- Centro de Terapia Celular; Fundação de Amparo À Pesquisa do Estado de São Paulo (FAPESP); Ribeirão Preto SP 14048-900 Brazil
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27
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Al-Nabulsi M, Basnet A, Salerno V, Cholankeril M. A case of mantle cell lymphoma presenting with ascites. Clin Case Rep 2016; 4:399-403. [PMID: 27099737 PMCID: PMC4831393 DOI: 10.1002/ccr3.533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/30/2016] [Accepted: 02/08/2016] [Indexed: 02/01/2023] Open
Abstract
Ascites with the finding of peritoneal carcinomatosis is considered an unusual presentation for mantle cell lymphoma (MCL) and has been rarely described in literature. This case reflects the importance of cytological analysis of peritoneal fluid in a patient with intractable ascites not contributing from other comorbidities. In the event a bone marrow (BM) analysis cannot be made, this may serve as an alternative method for diagnosing MCL taking into consideration the good concordance between peritoneal fluid and BM cytological markers.
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Affiliation(s)
- Majdi Al-Nabulsi
- Department of internal medicine Trinitas Regional Medical Center, Seton Hall University school of health and medical sciences Elizabeth New Jersey
| | - Alina Basnet
- Department of internal medicine Trinitas Regional Medical Center, Seton Hall University school of health and medical sciences Elizabeth New Jersey
| | - Vincent Salerno
- Department of hematology and oncology Trinitas Regional Medical Center, Seton Hall University school of health and medical sciences Elizabeth New Jersey
| | - Michelle Cholankeril
- Department of hematology and oncology Trinitas Regional Medical Center, Seton Hall University school of health and medical sciences Elizabeth New Jersey
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28
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Abstract
Mantle cell lymphoma (MCL) is a rare and aggressive form of non-Hodgkin lymphoma. Ibrutinib is a first-in-class, oral inhibitor of Bruton's tyrosine kinase which acts by downstream inhibition of the B-cell receptor. Early clinical trials have demonstrated excellent tolerability and a modest side-effect profile in relapsed/refractory MCL. Although the majority of disease responses are partial, efficacy data are impressive with more than two-thirds of patients demonstrating a durable response. This article focuses on all aspects of ibrutinib in the context of MCL, including a summary of the basic pharmacology and pharmacokinetics; a review of the safety and efficacy data published to date and a discussion of the future implications in MCL.
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Affiliation(s)
- David L Tucker
- Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Simon A Rule
- Department of Haematology, Plymouth Hospitals NHS Trust, Plymouth, UK
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29
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Huskova H, Korecka K, Karban J, Vargova J, Vargova K, Dusilkova N, Trneny M, Stopka T. Oncogenic microRNA-155 and its target PU.1: an integrative gene expression study in six of the most prevalent lymphomas. Int J Hematol 2015; 102:441-50. [PMID: 26261072 DOI: 10.1007/s12185-015-1847-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 02/06/2023]
Abstract
The transcription factor PU.1 and its inhibitory microRNA-155 (miR-155) are important regulators of B-cell differentiation. PU.1 downregulation coupled with oncogenic miR-155 upregulation has been reported in lymphoid malignancies; however, these data have not been studied across different subtypes in relation to clinical outcomes. We studied expression of miR-155 and PU.1 in the six most prevalent human B-cell lymphomas (n = 131) including aggressive (DLBCL, HL, MCL) and indolent (B-CLL/SLL, MZL, FL) types. Levels of miR-155 and PU.1 inversely correlated in DLBCL, B-CLL/SLL, and FL tumor tissues. In HL tissues, an exceptionally high level of miR-155 was found in patients with unfavorable responses to first-line therapy and those who had shorter survival times. PU.1 downregulation was noted in B-CLL/SLL samples positive for the adverse prognostic markers CD38 and ZAP-70. Upregulation of miR-155 and downregulation of PU.1 expression are integral aspects of lymphoma biology that could mark aggressive behavior of some, but not all, lymphoma types.
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Affiliation(s)
- Hana Huskova
- Institute of Pathological Physiology, 1st Medical Faculty, Charles University in Prague, U Nemocnice 5, 128 53, Prague, Czech Republic
| | - Katarina Korecka
- 1st Medical Department - Hematology, General Faculty Hospital, U Nemocnice 2, 128 08, Prague, Czech Republic
| | - Josef Karban
- 1st Medical Department - Hematology, General Faculty Hospital, U Nemocnice 2, 128 08, Prague, Czech Republic
| | - Jarmila Vargova
- Institute of Pathological Physiology, 1st Medical Faculty, Charles University in Prague, U Nemocnice 5, 128 53, Prague, Czech Republic
| | - Karina Vargova
- Institute of Pathological Physiology, 1st Medical Faculty, Charles University in Prague, U Nemocnice 5, 128 53, Prague, Czech Republic
| | - Nina Dusilkova
- Institute of Pathological Physiology, 1st Medical Faculty, Charles University in Prague, U Nemocnice 5, 128 53, Prague, Czech Republic
| | - Marek Trneny
- 1st Medical Department - Hematology, General Faculty Hospital, U Nemocnice 2, 128 08, Prague, Czech Republic
| | - Tomas Stopka
- Institute of Pathological Physiology, 1st Medical Faculty, Charles University in Prague, U Nemocnice 5, 128 53, Prague, Czech Republic. .,1st Medical Department - Hematology, General Faculty Hospital, U Nemocnice 2, 128 08, Prague, Czech Republic.
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30
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Vose JM. Mantle cell lymphoma: 2015 update on diagnosis, risk-stratification, and clinical management. Am J Hematol 2015; 90:739-45. [PMID: 26103436 DOI: 10.1002/ajh.24094] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 01/16/2023]
Abstract
DISEASE OVERVIEW Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma characterized by involvement of the lymph nodes, spleen, blood and bone marrow with a short remission duration to standard therapies and a median overall survival (OS) of 4-5 years. DIAGNOSIS Diagnosis is based on lymph node, bone marrow, or tissue morphology of centrocytic lymphocytes, small cell type, or blastoid variant cells. A chromosomal translocation t (11:14) is the molecular hallmark of MCL, resulting in the overexpression of cyclin D1. Cyclin D1 is detected by immunohistochemistry in 98% of cases. The absence of SOX-11 or a low Ki-67 may correlate with a more indolent form of MCL. The differential diagnosis of MCL includes small lymphocytic lymphoma, marginal zone lymphoma, and follicular lymphoma. RISK STRATIFICATION The MCL International Prognostic Index (MIPI) is the prognostic model most often used and incorporates ECOG performance status, age, leukocyte count, and lactic dehydrogenase. A modification of the MIPI also adds the Ki-67 proliferative index if available. The median OS for the low-risk group was not reached (5-year OS of 60%). The median OS for the intermediate risk group was 51 months and 29 months for the high risk group. RISK-ADAPTED THERAPY For selected indolent, low MIPI MCL patients, initial observation may be appropriate therapy. For younger patients with intermediate or high risk MIPI MCL, aggressive therapy with a cytotoxic regimen ± autologous stem cell transplantation should be considered. For older MCL patients with intermediate or high risk MIPI, combination chemotherapy with R-CHOP, R-Bendamustine, or a clinical trial should be considered. In addition, rituximab maintenance therapy may prolong the progression-free survival. At the time of relapse, agents directed at activated pathways in MCL cells such as bortezomib (NFkB inhibitor), lenalidamide (anti-angiogenesis) and Ibruitinib (Bruton's Tyrosine Kinase [BTK] inhibitor) have demonstrated excellent clinical activity in MCL patients. Autologous or allogeneic stem cell transplantation can also be considered in young patients. Clinical trials with novel agents are always a consideration for MCL patients.
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Affiliation(s)
- Julie M. Vose
- Division of Hematology/Oncology; University of Nebraska Medical Center; Omaha Nebraska
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31
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Keklik M, Yildirim A, Keklik E, Ertan S, Deniz K, Ozturk F, Ileri I, Cerci I, Camlica D, Cetin M, Eser B. Pericardial, pleural and peritoneal involvement in a patient with primary gastric mantle cell lymphoma. Scott Med J 2015; 60:e21-4. [PMID: 25636307 DOI: 10.1177/0036933015570528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Primary gastric mantle cell lymphoma is a rare form of gastointestinal tumour. Although peritoneal carcinomatosis accompanied by malignant ascites is relatively common, mantle cell lymphoma presenting with ascites is rare. Also, effusions involving pericardial and pleural cavities are uncommon during the course of lymphomas. We report the first case in which pericardial, pleural and peritoneal effusion of a primary gastric mantle cell lymphoma.
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Affiliation(s)
- Muzaffer Keklik
- Medical Doctor, Department of Hematology, Faculty of Medicine, Erciyes University, Turkey
| | - Afra Yildirim
- Medical Doctor, Department of Radiology, Faculty of Medicine, Erciyes University, Turkey
| | - Ertugrul Keklik
- Medical Doctor, Department of Physiology, Faculty of Medicine, Erciyes University, Turkey
| | - Sirac Ertan
- Medical Doctor, Department of Pathology, Faculty of Medicine, Erciyes University, Turkey
| | - Kemal Deniz
- Associate Professor, Department of Pathology, Faculty of Medicine, Erciyes University, Turkey
| | - Fahir Ozturk
- Medical Doctor, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Turkey
| | - Ibrahim Ileri
- Medical Doctor, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Turkey
| | - Ilkcan Cerci
- Medical Doctor, Department of Internal Medicine, Faculty of Medicine, Erciyes University, Turkey
| | - Demet Camlica
- Laboratory Technician, Flow Cytometry Unit, Faculty of Medicine, Erciyes University, Turkey
| | - Mustafa Cetin
- Professor, Department of Hematology, Faculty of Medicine, Erciyes University, Turkey
| | - Bulent Eser
- Professor, Department of Hematology, Faculty of Medicine, Erciyes University, Turkey
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32
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Mahe E, Akhter A, Le A, Street L, Pournaziri P, Kosari F, Shabani-Rad MT, Stewart D, Mansoor A. PARP1 expression in mantle cell lymphoma: the utility of PARP1 immunohistochemistry and its relationship with markers of DNA damage. Hematol Oncol 2014; 33:159-65. [PMID: 25143154 DOI: 10.1002/hon.2160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/08/2014] [Accepted: 07/10/2014] [Indexed: 11/05/2022]
Abstract
Mantle cell lymphoma (MCL) is an aggressive disease with poor overall survival, attributable in part to frequent defects of the DNA repair genes. In such malignancies, additional inhibition of the ubiquitous DNA damage repair protein, poly-ADP ribose polymerase-1 (PARP1) has shown enhanced cytotoxicity (so-called synthetic lethality). We studied PARP1 expression in a series of clinical cases of MCL, with the secondary aim to ascertain the relationship between PARP1 expression and DNA repair gene expression (namely ATM and p53) by immunohistochemical methods. We also examined the relationship between PARP1 expression and the well-established prognostic biomarker Ki-67, in addition to correlating PARP1 expression with the overall survival. From amongst our series of 79 unselected cases of MCL, we detected PARP1 expression in all but two cases with variable intensity. We also noted correlations between PARP1 expression and ATM and p53 expression. As described in previous studies, we identified a significant survival difference on the basis of Ki-67 and p53 expression. When digital H-score analysis of PARP1 expression was performed, there was a distinct survival advantage noted in patients with lower levels of expression. When our biomarker data were assessed by Cox regression, furthermore, the dominant effects of p53 and PARP1 expression were highlighted. Our data support the need for further research into the potential utility of PARP1 as a biomarker in MCL and for the potential direction of future PARP1 inhibitor-targeted therapy studies.
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Affiliation(s)
- Etienne Mahe
- Department of Pathology & Laboratory Medicine, University of Calgary/Calgary Laboratory Services, Calgary, AB, Canada
| | - Ariz Akhter
- Department of Pathology & Laboratory Medicine, University of Calgary/Calgary Laboratory Services, Calgary, AB, Canada
| | - Anne Le
- Department of Pathology & Laboratory Medicine, University of Calgary/Calgary Laboratory Services, Calgary, AB, Canada
| | - Lelsey Street
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Payam Pournaziri
- Department of Pathology & Laboratory Medicine, University of Calgary/Calgary Laboratory Services, Calgary, AB, Canada
| | - Farid Kosari
- Department of Pathology & Laboratory Medicine, University of Calgary/Calgary Laboratory Services, Calgary, AB, Canada
| | - Meer-Taher Shabani-Rad
- Department of Pathology & Laboratory Medicine, University of Calgary/Calgary Laboratory Services, Calgary, AB, Canada
| | - Douglas Stewart
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adnan Mansoor
- Department of Pathology & Laboratory Medicine, University of Calgary/Calgary Laboratory Services, Calgary, AB, Canada
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33
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Progressive leukemic non-nodal mantle cell lymphoma associated with deletions of TP53, ATM, and/or 13q14. Ann Diagn Pathol 2014; 18:214-9. [DOI: 10.1016/j.anndiagpath.2014.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/27/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022]
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34
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Primary breast lymphoma. Cancer Treat Rev 2014; 40:900-8. [PMID: 24953564 DOI: 10.1016/j.ctrv.2014.05.010] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 01/01/2023]
Abstract
Primary breast lymphoma is a rare form of extranodal lymphoma, defined by the presence of a primary lesion within the breast with or without regional nodal involvement but no other extra-mammary sites of involvement. It comprises diverse histologic subtypes, but diffuse large B-cell lymphoma is the most common. In this review, we describe in detail the clinical features, diagnosis and staging, pathogenesis, risk factors and therapy of primary breast diffuse large B-cell lymphoma. We consider choice and number of cycles of chemotherapy, the indications for radiotherapy and discuss the need for central nervous system prophylaxis. We also provide a brief overview of the less commonly encountered histologic subtypes including marginal zone, follicular, Burkitt and breast implant associated anaplastic large cell lymphoma. We conclude with a suggested treatment approach and potential areas of future research.
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35
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Vose JM. Mantle cell lymphoma: 2013 Update on diagnosis, risk-stratification, and clinical management. Am J Hematol 2013; 88:1082-8. [PMID: 24273091 DOI: 10.1002/ajh.23615] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 12/19/2022]
Abstract
DISEASE OVERVIEW Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma characterized by involvement of the lymph nodes, spleen, blood, and bone marrow with a short remission duration to standard therapies and a median overall survival of 4-5 years. DIAGNOSIS Diagnosis is based on lymph node, bone marrow, or tissue morphology of centrocytic lymphocytes, small cell type, or blastoid variant cells. A chromosomal translocation t(11:14) is the molecular hallmark of MCL, resulting in the overexpression of cyclin D1. Cyclin D1 is detected by immunohistochemistry in 98% of cases. The absence of SOX-11 or a low Ki-67 may correlate with a more indolent form of MCL. The differential diagnosis of MCL includes small lymphocytic lymphoma, marginal zone lymphoma, and follicular lymphoma. RISK STRATIFICATION The Mantle Cell Lymphoma International Prognostic Index (MIPI) is the prognostic model most often used and incorporates ECOG performance status, age, leukocyte count, and lactic dehydrogenase. A modification of the MIPI also adds the Ki-67 proliferative index if available. The median overall survival (OS) for the low risk group was not reached (5-year OS of 60%). The median OS for the intermediate risk group was 51 months and 29 months for the high risk group. RISK-ADAPTED THERAPY For selected indolent, low MIPI MCL patients, initial observation may be appropriate therapy. For younger patients with intermediate or high risk MIPI MCL, aggressive therapy with a cytarabine containing regimen ± autologous stem cell transplantation should be considered. For older MCL patients with intermediate or high risk MIPI, combination chemotherapy with R-CHOP, R-Bendamustine, or a clinical trial should be considered. At the time of relapse, agents directed at activated pathways in MCL cells such as bortezomib (NFkB inhibitor) or lenalidamide (anti-angiogenesis) are approved agents. Clinical trials with Ibruitinib (Bruton's Tyrosine Kinase inhibitor) or Idelalisib (PI3K inhibitor) have demonstrated excellent clinical activity in MCL patients. Autologous or allogeneic stem cell transplantation can also be considered in young patients.
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Affiliation(s)
- Julie M. Vose
- Division of Hematology/OncologyUniversity of Nebraska Medical CenterOmaha Nebraska
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36
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Doorduijn JK, Kluin-Nelemans HC. Management of mantle cell lymphoma in the elderly patient. Clin Interv Aging 2013; 8:1229-36. [PMID: 24072968 PMCID: PMC3783516 DOI: 10.2147/cia.s35082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Mantle cell lymphoma is a relatively rare B-cell lymphoma with a specific genetic lesion and a typical immunophenotypic profile. The median age is 65 years. There is no curative treatment, except allogeneic stem cell transplantation for a selected group of patients. For the majority of patients, especially the elderly, the aim of therapy should therefore be a long progression-free survival. Age and comorbidity may hamper the use of the most active treatment regimen, such as high dose cytarabine and autologous stem cell transplantation. Therefore, it is a challenge to select the most appropriate therapy for an elderly patient. Studies specifically designed for elderly patients are rare. A recently performed large randomized study for elderly patients, however, has shown that R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy followed by maintenance rituximab can result in a long progression-free survival. For patients too frail for R-CHOP chemotherapy, a treatment should be offered that benefits the patient in reducing the symptoms of the disease without causing too many side effects. Progression or relapse will occur in all patients sooner or later. Second-line treatment should again be carefully selected. Several options are mentioned. New drugs are being developed, and new combinations are investigated. Further improvement in the outcome of patients with mantle cell lymphoma is expected. Participation in well-designed clinical trials, also by elderly patients, is important to find the real benefit that can be achieved, and to get information on the tolerability of these treatments in this age group.
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Cheah C, George A, Giné E, Chiappella A, Kluin-Nelemans H, Jurczak W, Krawczyk K, Mocikova H, Klener P, Salek D, Walewski J, Szymczyk M, Smolej L, Auer R, Ritchie D, Arcaini L, Williams M, Dreyling M, Seymour J. Central nervous system involvement in mantle cell lymphoma: clinical features, prognostic factors and outcomes from the European Mantle Cell Lymphoma Network. Ann Oncol 2013; 24:2119-23. [DOI: 10.1093/annonc/mdt139] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ponzoni M, Govi S, Licata G, Mappa S, Giordano Resti A, Politi LS, Spagnuolo L, Di Cairano E, Doglioni C, Ferreri AJM. A reappraisal of the diagnostic and therapeutic management of uncommon histologies of primary ocular adnexal lymphoma. Oncologist 2013; 18:876-84. [PMID: 23814042 DOI: 10.1634/theoncologist.2012-0425] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Lymphoma is the most common malignancy arising in the ocular adnexa, which includes conjunctiva, lachrymal gland, lachrymal sac, eyelids, orbit soft tissue, and extraocular muscles. Ocular adnexal lymphoma (OAL) accounts for 1%-2% of non-Hodgkin lymphoma and 5%-15% of extranodal lymphoma. Histology, stage, and primary localizations are the most important variables influencing the natural history and therapeutic outcome of these malignancies. Among the various lymphoma variants that could arise in the ocular adnexa, marginal zone B-cell lymphoma (OA-MZL) is the most common one. Other types of lymphoma arise much more rarely in these anatomical sites; follicular lymphoma is the second most frequent histology, followed by diffuse large B-cell lymphoma and mantle cell lymphoma. Additional lymphoma entities, like T-cell/natural killer cell lymphomas and Burkitt lymphoma, only occasionally involve orbital structures. Because they are so rare, related literature mostly consists of anecdotal cases included within series focused on OA-MZL and sporadic case reports. This bias hampers a global approach to clinical and molecular properties of these types of lymphoma, with a low level of evidence supporting therapeutic options. This review covers the prevalence, clinical presentation, behavior, and histological and molecular features of uncommon forms of primary OAL and provides practical recommendations for therapeutic management.
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Affiliation(s)
- Maurilio Ponzoni
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
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Clinical practice guidelines for diagnosis, treatment, and follow-up of patients with mantle cell lymphoma. Recommendations from the GEL/TAMO Spanish Cooperative Group. Ann Hematol 2013; 92:1151-79. [PMID: 23716187 DOI: 10.1007/s00277-013-1783-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/02/2013] [Indexed: 12/22/2022]
Abstract
Mantle cell lymphoma (MCL) is considered a distinct type of B-cell lymphoma genetically characterized by the t(11;14) translocation and cyclin D1 overexpression. There is also a small subset of tumors negative for cyclin D1 expression that are morphologically and immunophenotypically indistinguishable from conventional MCL. Although in the last decades, the median overall survival of patients with MCL has improved significantly, it is still considered as one of the poorest prognoses diseases among B-cell lymphomas. Election of treatment for patients with MCL is complex due to the scarcity of solid evidence. Current available data shows that conventional chemotherapy does not yield satisfactory results as in other types of B-cell lymphomas. However, the role of other approaches such as autologous or allogenic stem cell transplantation, immunotherapy, the administration of consolidation or maintenance schedules, or the use of targeted therapies still lack clear indications. In view of this situation, the Spanish Group of Lymphomas/Autologous Bone Marrow Transplantation has conducted a series of reviews on different aspects of MCL, namely its diagnosis, prognosis, first-line and salvage treatment (both in young and elderly patients), new targeted therapies, and detection of minimal residual disease. On the basis of the available evidence, a series of recommendations have been issued with the intention of providing guidance to clinicians on the diagnosis, treatment, and monitoring of patients with MCL.
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Humala K, Younes A. Current and emerging new treatment strategies for mantle cell lymphoma. Leuk Lymphoma 2013; 54:912-21. [DOI: 10.3109/10428194.2012.726719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Yonal I, Ciftcibasi A, Gokturk S, Yenerel MN, Akyuz F, Karaca C, Demir K, Besisik F, Kalayoglu-Besisik S. Massive ascites as the initial manifestation of mantle cell lymphoma: a challenge for the gastroenterologist. Case Rep Gastroenterol 2013; 6:803-9. [PMID: 23341805 PMCID: PMC3551400 DOI: 10.1159/000346290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Involvement of the serosa may be the presenting feature in a wide and complex variety of lymphoproliferative diseases, with differing clinical outcomes covering a spectrum of benign and malignant conditions. Effusions involving peritoneal and pericardial cavities are uncommon during the course of hematological malignancies. Obstructive and/or infiltrative tumor mass or vascular leakage due to stimulation by vascular endothelial growth factor contribute to the pathogenesis. In addition to clinical findings, cytomorphology and flow cytometric immunophenotyping of the serosal fluid yield valuable information in the differential diagnosis of lymphocytic infiltrates. Herein, we describe the case of primary mantle cell lymphoma in a 75-year-old man presenting with abdominal fullness and weight loss, suggesting a gastrointestinal pathology.
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Affiliation(s)
- Ipek Yonal
- Division of Hematology, Department of Internal Medicine, Istanbul University Medical Faculty, Istanbul, Turkey
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Chhuy J, Morel D, Goeddert G, Magaud JP, Felman P, Baseggio L. Pertinence of the Sysmex XE-5000™ parameters: rule of slide review in a context of ‘normal’ lymphocyte count (defined from control and mantle cell lymphoma blood specimens). Int J Lab Hematol 2012; 35:510-6. [DOI: 10.1111/ijlh.12042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 11/13/2012] [Indexed: 11/30/2022]
Affiliation(s)
- J. Chhuy
- Service d'Hématologie Biologique; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - D. Morel
- Service d'Hématologie Biologique; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
- UMR5239 Pathologies des cellules lymphoïdes; Université Claude Bernard; Lyon France
| | - G. Goeddert
- Service d'Hématologie Biologique; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - J.-P. Magaud
- Service d'Hématologie Biologique; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
- UMR5239 Pathologies des cellules lymphoïdes; Université Claude Bernard; Lyon France
| | - P. Felman
- Service d'Hématologie Biologique; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
- UMR5239 Pathologies des cellules lymphoïdes; Université Claude Bernard; Lyon France
| | - L. Baseggio
- Service d'Hématologie Biologique; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
- UMR5239 Pathologies des cellules lymphoïdes; Université Claude Bernard; Lyon France
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Hamborg KH, Bentzen HHN, Grubach L, Hokland P, Nyvold CG. A highly sensitive and specific qPCR assay for quantification of the biomarker SOX11 in mantle cell lymphoma. Eur J Haematol 2012; 89:385-94. [PMID: 22827557 DOI: 10.1111/j.1600-0609.2012.01837.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Mantle cell lymphoma (MCL) is one of the most heterogeneous lymphoid neoplasms with a variable course of disease. Although t(11;14)(q13;q32) is the hallmark of MCL resulting in cyclin D1 (CCND1) overexpression in 90% of patients, this is difficult to validate by immunohistochemistry. We hypothesised that SOX11 could be a robust molecular biomarker for MCL. METHODS We have developed very sensitive and specific RT-qPCR assay employing a poly-A specific RT primer to circumvent contamination from gDNA caused by the intron-less nature of SOX11. RESULTS We found a significant difference between the expression levels of SOX11 in patients with MCL at diagnosis (n = 21) and in healthy donors (n = 18) (blood: P < 0.0001; marrow: P = 0.0001). SOX11 expression of very low levels close to the assay sensitivity was detected in only 2 of 18 healthy donors, while low levels of CCND1 expression was observed in all blood and 12 of 13 marrow samples within the defined detection limit of Cq = 40. In spiking experiments of the GRANTA-519 MCL cell line into mononuclear cells from normal donor, the sensitivity of the SOX11 assay was found to be 2 × 10(-4) , while the sensitivity of the CCND1 assay was estimated to 2 × 10(-3) because of the normal background expression. In longitudinal sampling from patients with MCL the minimal residual disease (MRD) values based on the SOX11 expression mirrored the clinical disease development. CONCLUSION This SOX11 RT-qPCR assay could be a useful tool for MRD monitoring in patients with MCL.
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Vose JM. Mantle cell lymphoma: 2012 update on diagnosis, risk-stratification, and clinical management. Am J Hematol 2012; 87:604-9. [PMID: 22615102 DOI: 10.1002/ajh.23176] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
DISEASE OVERVIEW Mantle cell lymphoma (MCL) is a non-Hodgkin lymphoma characterized by involvement of the lymph nodes, spleen, blood, and bone marrow with a short remission duration to standard therapies and a median overall survival of 4-5 years. DIAGNOSIS Diagnosis is based on lymph node, bone marrow, or tissue morphology of centrocytic lymphocytes, small cell type, or blastoid variant cells. A chromosomal translocation t(11:14) is the molecular hallmark of MCL, resulting in the overexpression of cyclin D1. Cyclin D1 is detected by immunohistochemistry in 98% of cases. The absence of SOX-11 or a low Ki-67 may correlate with a more indolent form of MCL. The differential diagnosis of MCL includes small lymphocytic lymphoma, marginal zone lymphoma, and follicular lymphoma. RISK STRATIFICATION The mantle cell lymphoma international prognostic index (MIPI) is the prognostic model most often used and incorporates ECOG performance status, age, leukocyte count, and lactic dehydrogenase. A modification of the MIPI also adds the Ki-67 proliferative index if available. The median overall survival (OS) for the low-risk group was not reached (5-year OS of 60%). The median OS for the intermediate risk group was 51 and 29 months for the high-risk group. RISK-ADAPTED THERAPY For selected indolent, low MIPI MCL patients, initial observation may be appropriate therapy. For younger patients with intermediate or high risk MIPI MCL, aggressive therapy with a cytarabine containing regimen ± autologous stem cell transplantation should be considered. For older MCL patients with intermediate or high risk MIPI, combination chemotherapy with R-CHOP, R-Bendamustine, or a clinical trial should be considered. At the time of relapse, agents directed at activated pathways in MCL cells such as bortezomib (NFkB inhibitor), BTK inhibitors or CAL-101 (B-cell receptor inhibitors) or lenalidamide (antiangiogenesis) have clinical activity in MCL patients. Autologous or allogeneic stem cell transplantation can also be considered in young patients.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Asymptomatic Diseases
- Biomarkers, Tumor/analysis
- Bone Marrow Examination
- Chemoradiotherapy
- Chromosomes, Human, Pair 11/ultrastructure
- Chromosomes, Human, Pair 14/ultrastructure
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Cytarabine/administration & dosage
- Dexamethasone/administration & dosage
- Disease Management
- Doxorubicin/administration & dosage
- Female
- Genes, bcl-1
- Humans
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/epidemiology
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, Mantle-Cell/therapy
- Male
- Methotrexate/administration & dosage
- Middle Aged
- Multicenter Studies as Topic
- Randomized Controlled Trials as Topic
- Risk Assessment
- Rituximab
- Salvage Therapy
- Stem Cell Transplantation
- Translocation, Genetic
- Vincristine/administration & dosage
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Affiliation(s)
- Julie M Vose
- Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
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Kirschey S, Wagner S, Hess G. Relapsed and/or Refractory Mantle Cell Lymphoma: What Role for Temsirolimus? CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2012; 6:153-64. [PMID: 22550404 PMCID: PMC3306245 DOI: 10.4137/cmo.s7327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mantle Cell Lymphoma (MCL) is associated with a dismal prognosis. Recently, along with the improved understanding of the pathophysiology of this disease, new first line regimens have been established and in addition novel treatment options have entered the clinical arena. In consequence, prognosis of the disease has fortunately improved. We here focus on the rationale, current clinical knowledge and future concepts of Temsirolimus, an inhibitor of mTOR, in the treatment of MCL. At this time this drug has been shown to be effective as single agent for relapsed disease and early combination data show promising results. In addition, with a brief outline of other treatment options, we aim to guide at which place in the current treatment algorithms Temsirolimus can be integrated into the treatment of MCL patients.
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Affiliation(s)
- Sebastian Kirschey
- Department of Hematology, Oncology, and Pneumology, University Medical School, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz
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Abstract
Mantle cell lymphoma (MCL) is a relatively rare lymphoma, accounting for less than 10% only of all lymphomas. Its morphology is quite homogeneous, but it varies strikingly in about 10% of the cases, making the diagnosis of MCL challenging for histopathologists. The definition of the disease was greatly influenced by the discovery of the translocation t(11;14)(q13,q32), which juxtaposes the cyclin D1 and the immunoglobulin heavy chain genes and is present in the vast majority of MCL cases. The introduction of monoclonal antibodies for the detection of cyclin D1 expression into the diagnostic procedure substantially improved the reproducibility and reliability of the pathological diagnosis. However, new challenges for histopathologists have arisen over the last years, among which are the detection of cyclin D1-negative MCL cases and clinically relevant prognostic subgroups.
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Affiliation(s)
- Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University of Kiel, Kiel, Germany.
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Pott C. Minimal residual disease detection in mantle cell lymphoma: technical aspects and clinical relevance. Semin Hematol 2012; 48:172-84. [PMID: 21782059 DOI: 10.1053/j.seminhematol.2011.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prognostic impact of minimal residual disease (MRD) has been demonstrated for several hematologic malignancies. While in acute lymphoblastic leukemias MRD assessment by polymerase chain reaction (PCR)-based methods has been established as an important tool for clinical risk assessment and is part of clinical management, data demonstrating a prognostic value of MRD in mantle cell lymphoma (MCL) were sparse and results from randomized trials have been published only recently. In the present review technical aspects of different MRD detection methods are discussed, as well as the prognostic relevance of MRD in the context of clinical trials in patients with MCL. Furthermore, recommendations are given for workflow and useful implication of MRD in future clinical trials design.
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Affiliation(s)
- Christiane Pott
- Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Royo C, Salaverria I, Hartmann EM, Rosenwald A, Campo E, Beà S. The complex landscape of genetic alterations in mantle cell lymphoma. Semin Cancer Biol 2011; 21:322-34. [DOI: 10.1016/j.semcancer.2011.09.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 09/12/2011] [Indexed: 11/29/2022]
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Cortelazzo S, Ponzoni M, Ferreri AJM, Dreyling M. Mantle cell lymphoma. Crit Rev Oncol Hematol 2011; 82:78-101. [PMID: 21658968 DOI: 10.1016/j.critrevonc.2011.05.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 05/02/2011] [Accepted: 05/04/2011] [Indexed: 10/25/2022] Open
Abstract
MCL is a well-characterized clinically aggressive lymphoma with a poor prognosis. Recent research findings have slightly improved the outcome of this neoplasm. The addition of rituximab to conventional chemotherapy has increased overall response rates, but it does not improve overall survival with respect to chemotherapy alone. The use of intensive frontline therapies including rituximab and consolidated by ASCT ameliorates response rate and prolongs progression-free survival, but any impact on survival remains to be proven. Furthermore, the optimal timing, cytoreductive regimen and conditioning regimen, and the clinical implications of achieving a disease remission even at molecular level remain to be elucidated. The development of targeted therapies as the consequence of better dissection of pathogenetic pathways in MCL might improve the outcome of conventional chemotherapy in most patients and spare the toxicity of intense therapy in a minority of MCL patients characterized by a relatively indolent disease. Patients not eligible for intensive regimens, such as hyperC-VAD, may be considered for less demanding therapies, such as the combination of rituximab either with CHOP or with purine analogues, or bendamustine. Allogeneic SCT can be an effective option for relapsed disease in patients who are fit enough and have a compatible donor. Maintenance rituximab may be considered after response to immunochemotherapy for relapsed disease, although there are currently no data to recommend this approach as the first-line strategy. As the optimal approach to the management of MCL is still evolving, it is critical that these patients be enrolled in clinical trials to identify better treatment options.
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Affiliation(s)
- Sergio Cortelazzo
- Hematology and Bone Marrow Transplantation Unit, Azienda Ospedaliera Bolzano, Italy
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