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Elliott J, Avdic S, Selim AG, Clancy L, Atkins E, Blyth E, Ritchie D, Gottlieb D, Bajel A. An atypical case of Epstein-Barr virus-positive plasma cell post-transplant lymphoproliferative disorder successfully treated with adoptive cell therapy. Br J Haematol 2021; 195:140-143. [PMID: 34180535 DOI: 10.1111/bjh.17633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Jessica Elliott
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Selmir Avdic
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia
| | - Adrian G Selim
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Leighton Clancy
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia
| | - Elissa Atkins
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia
| | - Emily Blyth
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.,Blood Transplant and Cell Therapies Program, Westmead Hospital, Westmead, New South Wales, Australia
| | - David Ritchie
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Gottlieb
- Cell Therapies, Westmead Institute of Medical Research, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.,Blood Transplant and Cell Therapies Program, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ashish Bajel
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Leeman-Neill RJ, Soderquist CR, Montanari F, Raciti P, Park D, Radeski D, Mansukhani MM, Murty VV, Hsiao S, Alobeid B, Bhagat G. Phenogenomic heterogeneity of post-transplant plasmablastic lymphomas. Haematologica 2020; 107:201-210. [PMID: 33297669 PMCID: PMC8719101 DOI: 10.3324/haematol.2020.267294] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Indexed: 11/14/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and clinically aggressive neoplasm that typically occurs in immunocompromised individuals, including those infected with human immunodeficiency virus (HIV) and solid organ allograft recipients. Most prior studies have focused on delineating the clinico-pathological features and genetic attributes of HIVrelated PBL, in which MYC deregulation, Epstein-Barr virus (EBV) infection and, more recently, mutations in JAK/STAT, MAP kinase, and NOTCH pathway genes have been implicated in disease pathogenesis. The phenotypic spectrum of post-transplant (PT)-PBL is not well characterized and data on underlying genetic alterations are limited. This led us to perform comprehensive histopathological and immunophenotypic evaluation and targeted sequencing of 18 samples from 11 patients (8 males, 3 females; age range, 12-76 years) with PT-PBL; eight de novo and three preceded by other types of post-transplant lymphoproliferative disorders. Post-transplant PBL displayed morphological and immunophenotypic heterogeneity and some features overlapped those of plasmablastic myeloma. Six (55%) cases were EBV positive and five (45%) showed MYC rearrangement by fluorescence in situ hybridization. Recurrent mutations in epigenetic regulators (KMT2/MLL family, TET2) and DNA damage repair and response (TP53, mismatch repair genes, FANCA, ATRX), MAP kinase (KRAS, NRAS, HRAS, BRAF), JAK/STAT (STAT3, STAT6, SOCS1), NOTCH (NOTCH1, NOTCH3, SPEN), and immune surveillance (FAS, CD58) pathway genes were observed, with the mutational profiles of EBV+ and EBV– cases exhibiting both similarities and differences. Clinical outcomes also varied, with survival ranging from 0-15.9 years after diagnosis. Besides uncovering the biological heterogeneity of PT-PBL, our study highlights similarities and distinctions between PT-PBL and PBL occurring in other settings and reveals potentially targetable oncogenic pathways in subsets of the disease.
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Affiliation(s)
| | | | - Francesca Montanari
- Division of Hematology/Oncology, Columbia University Irving Medical Center, NY Presbyterian Hospital, New York, NY
| | | | | | - Dejan Radeski
- Department of Haematology, Sir Charles Gairdner Hospital, Perth
| | | | - Vundavalli V Murty
- Department of Medicine, Division of Cytogenetics, Columbia University Irving Medical Center, NY Presbyterian Hospital, New York, NY
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Ofori K, Soderquist CR, Murty VV, Park D, Vlad G, Leeman‐Neill RJ, Lentzsch S, Alobeid B, Bhagat G. The clinical and pathological features of plasma cell myeloma post solid organ transplantation. Am J Hematol 2020; 95:1531-1541. [PMID: 32864761 DOI: 10.1002/ajh.25988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
Plasma cell neoplasms (PCNs), comprising plasma cell myelomas (PCMs) and plasmacytomas, which occur after solid organ transplantation, represent rare subtypes of monomorphic post-transplant lymphoproliferative disorders (M-PTLDs). Data regarding the clinical and pathological features of post-transplant (PT)-PCMs are limited. To gain a better understanding of disease biology, we performed comprehensive immunophenotypic analysis, reviewed cytogenetic analysis results and evaluated clinical outcomes of PT-PCMs diagnosed and treated at our institution. Fifteen PT-PCM (M: F - 4:1) and two PT-MGUS (two males) cases were identified. The median age of PT-PCM patients was 68 years (29-79 years) and PCMs presented at a median of 9.7 years (0.5-24.7 years) after transplantation. The PT-PCMs accounted for 11.6% of all M-PTLDs and the period prevalence was 9/3108 (0.29%), 3/1071 (0.28%), 2/1345 (0.15%) and 1/878 (0.11%) post kidney, heart, liver and lung transplantation. Lytic bone disease was observed in 1/11 (9%) patients. Marrow plasma cell infiltration ranged from 10%-70% (median 20%), with 10/15 (67%) and 5/15 (33%) cases manifesting immature and plasmablastic morphology. The immunophenotype of all cases and cytogenetic abnormalities, identified in 60% of cases, were similar to multiple myeloma (MM) of immunocompetent individuals. All PT-PCMs were EBER negative. Ten of 11 (91%) patients with active MM were treated, all with proteasome inhibitor-based therapy. Treatment response and 5-year overall survival (54.5%) was comparable to MM of immunocompetent individuals. However, the survival of patients with plasmablastic PCMs was inferior to those with immature PCMs. 0ur findings indicate PT-PCMs to be predominantly late onset PTLDs that have similar clinicopathologic characteristics as conventional MM.
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Affiliation(s)
- Kenneth Ofori
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Craig R. Soderquist
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Vundavalli V. Murty
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - David Park
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - George Vlad
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Rebecca J. Leeman‐Neill
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Suzanne Lentzsch
- Division of Hematology/Oncology Columbia University Irving Medical Center New York City New York US
| | - Bachir Alobeid
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Govind Bhagat
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
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Láinez Ramos-Bossini AJ, Moyano Portillo Á, Ruiz Carazo E. Plasmacytoma-like post-transplantation lymphoproliferative disorder in renal allograft. Med Clin (Barc) 2020; 155:323-324. [PMID: 31447086 DOI: 10.1016/j.medcli.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/27/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - Álvaro Moyano Portillo
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Eduardo Ruiz Carazo
- Servicio de Radiodiagnóstico, Hospital Universitario Virgen de las Nieves, Granada, España
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Epperly R, Ozolek J, Soltys K, Cohen D, Goyal R, Friehling E. Treatment of pediatric plasma cell myeloma type post-transplant lymphoproliferative disorder with modern risk-directed therapy. Pediatr Blood Cancer 2018; 65:e27283. [PMID: 29893485 DOI: 10.1002/pbc.27283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/08/2023]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) related plasma cell neoplasms are rare in pediatric patients. We report a pediatric liver transplant recipient with plasma cell myeloma type PTLD. Cytogenetics included 1q duplication, associated with poor prognosis in adult multiple myeloma, and t(8;14). High-risk cytogenetics has not been reported in pediatric plasma cell myeloma type PTLD. The patient was treated with bortezomib, dexamethasone, and lenalidomide with subsequent autologous stem cell transplant. He achieved a 6-year remission, demonstrating tolerance to and efficacy of this modern myeloma regimen in a pediatric patient. Unfortunately, he subsequently died from complications of repeat liver transplant.
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Affiliation(s)
- Rebecca Epperly
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - John Ozolek
- Department of Pathology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Kyle Soltys
- Thomas E. Starzl Transplantation Institute, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Debra Cohen
- Pediatric Hematology-Oncology, University of Florida, Pensacola, Florida
| | - Rakesh Goyal
- Department of Hematology/Oncology/BMT, Children's Mercy, Kansas City, Missouri
| | - Erika Friehling
- Division of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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