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Yu J, Zhao SS, Chen X, Qiao C, Wang R, Li JY, Wu YJ. [The value of CD200 in differential diagnosis of classic hairy cell leukemia and variant hairy cell leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:775-779. [PMID: 38049324 PMCID: PMC10630581 DOI: 10.3760/cma.j.issn.0253-2727.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 12/06/2023]
Affiliation(s)
- J Yu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - S S Zhao
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - X Chen
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - C Qiao
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - R Wang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - J Y Li
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Y J Wu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
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2
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Cenariu D, Rus I, Bergthorsson JT, Grewal R, Cenariu M, Greiff V, Tigu AB, Dima D, Selicean C, Petrushev B, Zdrenghea M, Fromm J, Aanei CM, Tomuleasa C. Flow Cytometry of CD5-Positive Hairy Cell Leukemia. Mol Diagn Ther 2023; 27:593-599. [PMID: 37291380 DOI: 10.1007/s40291-023-00658-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Hairy cell leukemia (HCL) is a chronic lymphoproliferative disorder for which diagnosis is typically straightforward, based on bone marrow morphology and flow cytometry (FC) or immunohistochemistry. Nevertheless, variants present atypical expressions of cell surface markers, as is the case of CD5, for which the differential diagnosis can be more difficult. The aim of the current paper was to describe diagnosis of HCL with atypical CD5 expression, with an emphasis on FC. METHODS The detailed diagnostic methodology for HCL with atypical CD5 expression is presented, including differential diagnosis from other lymphoproliferative diseases with similar pathologic features, by FC analysis of the bone marrow aspirate. RESULTS Diagnosis of HCL by means of FC started by gating all events based on side scatter (SSC) versus CD45 and B lymphocytes were selected from the lymphocytes gate as CD45/CD19 positive. The gated cells were positive for CD25, CD11c, CD20, and CD103, while CD10 proved to be dim to negative. Moreover, cells positive for CD3, CD4, and CD8, the three pan-T markers, as well as CD19, showed a bright expression of CD5. The atypical CD5 expression is usually correlated with a negative prognosis and thus chemotherapy with cladribine should be initiated. CONCLUSION HCL is an indolent chronic lymphoproliferative disorder and diagnosis is usually straightforward. However, atypical expression of CD5 renders its differential diagnosis more difficult, but FC is a useful tool that allows an optimal classification of the disease and allows initiation of timely satisfactory therapy.
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Affiliation(s)
- Diana Cenariu
- Medfuture Research Center for Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Louis Pasteur Street, Cluj-Napoca, Romania
| | - Ioana Rus
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Jon Thor Bergthorsson
- Stem Cell Research Unit, Biomedical Center, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ravnit Grewal
- Department of Pathology, National Health Laboratory Services, Port Elizabeth, South Africa
| | - Mihai Cenariu
- Department of Clinical Sciences, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania
| | - Victor Greiff
- Laboratory for Computational and Systems Immunology, University of Oslo, Oslo, Norway
| | - Adrian-Bogdan Tigu
- Medfuture Research Center for Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Louis Pasteur Street, Cluj-Napoca, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Cristina Selicean
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Bobe Petrushev
- Medfuture Research Center for Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Louis Pasteur Street, Cluj-Napoca, Romania
| | - Mihnea Zdrenghea
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Jonathan Fromm
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Carmen-Mariana Aanei
- Haematology Laboratory, University Hospital of Saint-Etienne, Saint-Etienne, France
- INSERM U1059-SAINBIOSE, Université de Lyon, Saint-Etienne, France
| | - Ciprian Tomuleasa
- Medfuture Research Center for Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Louis Pasteur Street, Cluj-Napoca, Romania.
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3
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Dhanesar GK, Livingston J, Maroules M, Lee SH. Hairy Cell Leukemia: Hepatic Affinity Status Post Splenectomy. Cureus 2023; 15:e39830. [PMID: 37397667 PMCID: PMC10314737 DOI: 10.7759/cureus.39830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Hairy cell leukemia (HCL) is a rare neoplasm of the B-cell lineage that is characterized by an indolent course and infiltration of the spleen, the bone marrow, and the reticuloendothelial system. Splenectomy is considered an effective treatment for peripheral cytopenia in patients with HCL. Hepatic involvement of hairy cells with infiltration of the sinusoidal endothelial cells is rarely reported in the literature and is not well understood. We present the case of an 88-year-old male with a history of traumatic splenectomy who was found to have a relapse of classic hairy cell leukemia within the hepatic portal system.
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Affiliation(s)
- Gurneel K Dhanesar
- Internal Medicine, New York Medical College at St. Mary's General Hospital, Passaic and St. Clare's Health, Denville, USA
| | - Jonathan Livingston
- Internal Medicine, New York Medical College at St. Mary's General Hospital, Passaic and St. Clare's Health, Denville, USA
| | - Michael Maroules
- Hematology and Oncology, St. Mary's General Hospital, Passaic, USA
| | - Sheue H Lee
- Hematology and Oncology, St. Mary's General Hospital, Passaic, USA
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4
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Proskuriakova E, Sakhuja A, Khan S, Shrestha DB, Khosla P. Atraumatic Splenic Rupture as an Unusual Presentation of Hairy Cell Leukemia: A Case Report. Cureus 2023; 15:e40180. [PMID: 37431331 PMCID: PMC10329842 DOI: 10.7759/cureus.40180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Hairy cell leukemia (HCL) represents a rare B-cell malignancy with 2% of all leukemias and should be differentiated from HCL-like conditions, including HCL-variant (HCL-V) and splenic diffuse red pulp lymphoma (SDRPL). HCL gets its name from the short, thin projections that look like hair on its cells. It is associated with a specific immunophenotypic profile, cytopenia, and splenomegaly. Spontaneous splenic rupture can be a symptom of hematological malignancy such as HCL and is a life-threatening acute emergency. Here, we present a case of a 37-year-old man who presented to the hospital with signs of acute peritonitis and acute anemia and was found to have atraumatic splenic rupture secondary to splenomegaly. He underwent emergent angiography, where the bleeding splenic vessel was identified, and the patient was successfully treated with embolization. Immunophenotypic profile revealed that B-cells were positive for CD11c, CD103, CD25, and CD5, for which he received five days of cladribine and achieved complete clinical remission.
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Affiliation(s)
| | - Anuradha Sakhuja
- Internal Medicine Department, Mount Sinai Hospital, Chicago, USA
| | - Sarah Khan
- Hematology and Oncology Department, Mount Sinai Hospital, Chicago, USA
| | - Dhan B Shrestha
- Internal Medicine Department, Mount Sinai Hospital, Chicago, USA
| | - Pam Khosla
- Hematology and Oncology Department, Mount Sinai Hosipital, Chicago, USA
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5
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Konrat J, Rösler W, Roiss M, Meier-Abt F, Widmer CC, Balabanov S, Manz MG, Zenz T. BRAF inhibitor treatment of classical hairy cell leukemia allows successful vaccination against SARS-CoV-2. Ann Hematol 2023; 102:403-406. [PMID: 36494600 PMCID: PMC9735012 DOI: 10.1007/s00277-022-05026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022]
Abstract
In classical hairy cell leukemia (HCL), standard treatments including purine analogs achieve a durable response (up to 90%), but lead to severe immunosuppression and long-lasting depletion of CD4 + T lymphocytes. The BRAF inhibitor vemurafenib is effective in HCL, but its use in first-line treatment is restricted to select clinical situations (e.g. active infection). Its impact on immune function or response to vaccines in HCL is unclear. We treated four HCL patients with vemurafenib during the COVID-19 pandemic and monitored immune reconstitution and response to SARS-CoV-2 immunization. All patients responded to HCL treatment with normalization of peripheral blood counts. No severe infections occurred. As an indication of limited immunosuppression by vemurafenib, stable CD4 + and CD8 + T lymphocyte counts and immunoglobulin levels were observed. Three out of four patients received SARS-CoV-2 vaccination (Pfizer-BioNTech) during treatment with vemurafenib. IgG antibody levels against the spike-protein of SARS-CoV-2 were detected (40-818 AE/ml). Our data suggest that vemurafenib has limited effects on cellular and humoral immune function in HCL, which allows for successful SARS-CoV-2 vaccination. These data support the use of BRAF inhibitors during the current pandemic where continued immune response is necessary for minimizing the COVID-19-related risk of non-vaccinated patients.
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Affiliation(s)
- Judith Konrat
- Department of Medical Oncology and Hematology, University Hospital Zürich and University of Zürich, Raemistrasse 100, CH-8091 Zürich, Switzerland
| | - Wiebke Rösler
- Department of Medical Oncology and Hematology, University Hospital Zürich and University of Zürich, Raemistrasse 100, CH-8091 Zürich, Switzerland
| | - Michael Roiss
- Department of Medical Oncology and Hematology, University Hospital Zürich and University of Zürich, Raemistrasse 100, CH-8091 Zürich, Switzerland
| | - Fabienne Meier-Abt
- Department of Medical Oncology and Hematology, University Hospital Zürich and University of Zürich, Raemistrasse 100, CH-8091 Zürich, Switzerland ,Institute of Medical Genetics, University of Zürich, Zürich, Switzerland
| | - Corinne C. Widmer
- Department of Medical Oncology and Hematology, University Hospital Zürich and University of Zürich, Raemistrasse 100, CH-8091 Zürich, Switzerland ,Department of Hematology, University Hospital of Basel, Basel, Switzerland
| | - Stefan Balabanov
- Department of Medical Oncology and Hematology, University Hospital Zürich and University of Zürich, Raemistrasse 100, CH-8091 Zürich, Switzerland
| | - Markus G. Manz
- Department of Medical Oncology and Hematology, University Hospital Zürich and University of Zürich, Raemistrasse 100, CH-8091 Zürich, Switzerland
| | - Thorsten Zenz
- Department of Medical Oncology and Hematology, University Hospital Zürich and University of Zürich, Raemistrasse 100, CH-8091 Zürich, Switzerland
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Muacevic A, Adler JR, Chhabra GS, Mujahid Z. Almost a Near Miss: Hairy Cell Leukemia. Cureus 2023; 15:e33949. [PMID: 36820110 PMCID: PMC9938344 DOI: 10.7759/cureus.33949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
Hairy cell leukemia (HCL) is an infrequently encountered chronic B-lymphocyte hematological malignancy, which is found to be more prevalent in males. HCL can present with a myriad of nonspecific symptoms involving the reticuloendothelial system. Usually, patients are diagnosed after an incidental finding of pancytopenia. In the majority of cases, HCL follows an indolent course, and many patients remain asymptomatic. Treatment with nucleoside analogs is the first line of treatment and is indicated for patients with severe anemia, thrombocytopenia, neutropenia, or severe systemic symptoms. Here, we report an atypical case of a 41-year-old Hispanic female who presented with menorrhagia and iron deficiency anemia. She was diagnosed with HCL after a bone marrow biopsy demonstrated the characteristic "hairy projections."
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7
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Kaddu-Mulindwa D, Thurner L, Christofyllakis K, Bewarder M, Kos IA. Management of Extranodal Marginal Zone Lymphoma: Present and Upcoming Perspectives. Cancers (Basel) 2022; 14:cancers14123019. [PMID: 35740684 PMCID: PMC9220961 DOI: 10.3390/cancers14123019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/04/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Extranodal marginal zone lymphoma distinguishes itself from other indolent lymphomas due to its unique pathophysiology and natural history. This is reflected in its management, where next to traditional treatment strategies such as observation, radiotherapy or chemotherapy, eradication of the causal agent and even surgery represent important aspects of therapy. This review focuses on the particular aspects of this indolent lymphoma that affect management and summarizes the current evidence and different guidelines. Abstract Extranodal marginal zone lymphoma (EMZL) encompasses a subgroup of non-Hodgkin lymphomas that often present with localized involvement and may manifest in a diversity of organs and tissues. EMZL pathogenesis is in some cases linked to chronic inflammation/infection, which may impose additional diagnostic and clinical challenges. The most studied and established connection is the presence of Helicobacter pylori in gastric EMZL. Due to its heterogeneity of presentation and intricate pathological features, treatment can be complex, and staging systems are decisive for the choice of therapy. Nevertheless, there is no consensus regarding the most suitable staging system, and recommendations vary among different countries. As a rule of thumb, in limited stages, a local therapy with surgery or radiation is the preferred option, and it is potentially curative. Of note, eradicating the causal agent may be an important step of treatment, especially in gastric EMZL, in which Helicobacter pylori eradication remains the first-line therapy for the majority of patients. In patients with more advanced stages, watch-and-wait is a valuable option, especially amongst those without clear indications for systemic therapy, and it may be carried on for several years. If watch-and-wait is not an option, systemic therapy may be needed. Even though several agents have been tested as monotherapy or in combination in recent years, there is no consensus regarding the first-line therapy, and decisions can vary depending on individual factors, such as age, clinical performance and stage. This review aims to discuss the several aspects of EMZL, including genetic milieu, pathogenesis and staging systems, that may influence the choice of therapy. In addition, we present a summary of evidence of several systemic therapies, compare different recommendations worldwide and discuss future perspectives and novelties in its therapy.
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8
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Nagy ZF, Ferenczi K, Istenes I, Eid H, Bödör C, Timár B, Demeter J. Case Report: Development of Diffuse Large B Cell Lymphoma a Long Time After Hairy Cell Leukemia. Pathol Oncol Res 2022; 28:1610338. [PMID: 35570843 PMCID: PMC9098676 DOI: 10.3389/pore.2022.1610338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022]
Abstract
Hairy cell leukaemia (HCL) is a rare B cell malignancy with an indolent course leading to pancytopaenia due to bone marrow infiltration. It has been proposed that HCL patients are at risk of developing a secondary malignancy, with a marked likelihood of the development of other hematologic malignancies including Hodgkin lymphoma and high-grade non-Hodgkin lymphomas. Here, we present the case of two patients who developed diffuse large B cell lymphoma after a long course of hairy cell leukaemia. In the case of the female patient, we report on the occurrence of a third malignant disease, which is very uncommon. With our case descriptions we contribute to the very small number of similar cases reported.
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Affiliation(s)
- Zsófia F. Nagy
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Kata Ferenczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Ildikó Istenes
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Hanna Eid
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Bödör
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Botond Timár
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Judit Demeter
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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9
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Tran J, Gaulin C, Tallman MS. Advances in the Treatment of Hairy Cell Leukemia Variant. Curr Treat Options Oncol 2022; 23:99-116. [PMID: 35178674 DOI: 10.1007/s11864-021-00927-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Hairy cell leukemia variant (HCL-V) is a rare B cell lymphoproliferative disorder with a clinical-pathological distinction from the classic form of hairy cell leukemia (HCL-C). HCL-V is more aggressive in nature, has a higher tendency to be refractory to conventional purine analog pharmacotherapies, and leads to a poorer prognosis. Hence, these differing features bring paramount importance to the diagnosis and management of HCL-V. While there is no genetic mutation diagnostic of HCL-V, genetic profiling efforts have identified potential therapeutic targets (i.e., MAP2K1, KDM6A, CREBBP, ARID1A, CCND3, U2AF1, KMT2C) and yielded prognostic markers (i.e., IGHV4-34 rearrangements). To date, combination chemoimmunotherapies, such as cladribine and rituximab, have shown the best results in HCL-V. Future directions include targeted therapies such as moxetumomab pasudotox, ibrutinib, trametinib, and binimetinib and potentially anti-CD22 chimeric antigen receptor T cell therapy. The purpose of this review is to provide an outline of the diagnostic approach and an update on the therapeutic advancements in HCL-V.
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Affiliation(s)
- Julie Tran
- University of Arizona College of Medicine, 475 N 5th St, HSEB C536, Phoenix, AZ, 85004, USA.
| | - Charles Gaulin
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Martin S Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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10
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Oscier D, Stamatopoulos K, Mirandari A, Strefford J. The Genomics of Hairy Cell Leukaemia and Splenic Diffuse Red Pulp Lymphoma. Cancers (Basel) 2022; 14:697. [PMID: 35158965 PMCID: PMC8833447 DOI: 10.3390/cancers14030697] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Classical hairy cell leukaemia (HCLc), its variant form (HCLv), and splenic diffuse red pulp lymphoma (SDRPL) constitute a subset of relatively indolent B cell tumours, with low incidence rates of high-grade transformations, which primarily involve the spleen and bone marrow and are usually associated with circulating tumour cells characterised by villous or irregular cytoplasmic borders. The primary aim of this review is to summarise their cytogenetic, genomic, immunogenetic, and epigenetic features, with a particular focus on the clonal BRAFV600E mutation, present in most cases currently diagnosed with HCLc. We then reflect on their cell of origin and pathogenesis as well as present the clinical implications of improved biological understanding, extending from diagnosis to prognosis assessment and therapy response.
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Affiliation(s)
- David Oscier
- Department of Haematology, Royal Bournemouth and Christchurch NHS Trust, Bournemouth BH7 7DW, UK
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, 57001 Thessaloniki, Greece;
| | - Amatta Mirandari
- Cancer Genomics Group, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; (A.M.); (J.S.)
| | - Jonathan Strefford
- Cancer Genomics Group, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; (A.M.); (J.S.)
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11
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Expert-independent classification of mature B-cell neoplasms using standardized flow cytometry: a multicentric study. Blood Adv 2021; 6:976-992. [PMID: 34814179 PMCID: PMC8945320 DOI: 10.1182/bloodadvances.2021005725] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/02/2021] [Indexed: 11/20/2022] Open
Abstract
Reproducible expert-independent flow-cytometric criteria for the differential diagnoses between mature B-cell neoplasms are lacking. We developed an algorithm-driven classification for these lymphomas by flow cytometry and compared it to the WHO gold standard diagnosis. Overall, 662 samples from 662 patients representing nine disease categories were analyzed at 9 laboratories using the previously published EuroFlow 5-tube-8-color B-cell chronic lymphoproliferative disease antibody panel. Expression levels of all 26 markers from the panel were plotted by B-cell entity to construct a univariate, fully standardized diagnostic reference library. For multivariate data analysis we subsequently utilized Canonical Correlation Analysis of 176 training cases to project the multi-dimensional space of all 26 immunophenotypic parameters into 36 two-dimensional plots for each possible pair-wise differential diagnosis. Diagnostic boundaries were fitted according to the distribution of the immunophenotypes of a given differential diagnosis. A diagnostic algorithm based on these projections was developed and subsequently validated using 486 independent cases. Negative predictive values exceeding 92.1% were observed for all disease categories except for follicular lymphoma. Particularly high positive predictive values were returned in chronic lymphocytic leukemia (99.1%), hairy cell leukemia (97.2%), follicular lymphoma (97.2%) and mantle cell lymphoma (95.4%). Burkitt and CD10+ diffuse large B-cell lymphomas were difficult to distinguish by the algorithm. A similar ambiguity was observed between marginal zone, lymphoplasmacytic, and CD10- diffuse large B-cell lymphomas. The specificity of the approach exceeded 98% for all entities. The univariate immunophenotypic library and the multivariate expert-independent diagnostic algorithm might contribute to increased reproducibility of future diagnostics in mature B-cell neoplasms.
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12
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Broccoli A, Terragna C, Nanni L, Martello M, Armuzzi S, Agostinelli C, Morigi A, Casadei B, Pellegrini C, Stefoni V, Sabattini E, Argnani L, Zinzani PL. Droplet digital polymerase chain reaction for the assessment of disease burden in hairy cell leukemia. Hematol Oncol 2021; 40:57-62. [PMID: 34653277 PMCID: PMC9291464 DOI: 10.1002/hon.2932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 11/08/2022]
Abstract
BRAFV600E mutation is the pathogenic driver of hairy cell leukemia (HCL) found in the vast majority of cases both at onset and during recurrences. The identification of the mutated allele in blood and marrow correlates with the presence of neoplastic cells and can be considered a marker of active disease. Likewise, the absence of the mutation after treatment may indicate a state of deep response. The BRAFV600E burden was measured by droplet digital polymerase chain reaction (ddPCR) and expressed as fractional abundance in 35 HCL patients at different stages of disease (onset, relapse, complete response [CR] after treatment, long-term remission) in peripheral blood and/or bone marrow (when available). Mean values of fractional abundance for patients at diagnosis, relapse and response, respectively, were 12.26%, 16.52% and 0.02% in peripheral blood and 23.51%, 13.96% and 0.26% in bone marrow. Four patients out of 6 evaluated at response were molecularly negative for BRAFV600E in peripheral blood. Mean fractional abundance in peripheral blood tested in 14 patients with long lasting CR was 0.05%, and 10 patients were BRAFV600E negative. These preliminary results suggest that ddPCR permits to assess the active tumor burden in HCL at different disease phases and support the hypothesis that some patients in CR qualify for a molecular CR.
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Affiliation(s)
- Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Carolina Terragna
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Laura Nanni
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Marina Martello
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Silvia Armuzzi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Claudio Agostinelli
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy.,Hematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alice Morigi
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Beatrice Casadei
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Cinzia Pellegrini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Vittorio Stefoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Elena Sabattini
- Hematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lisa Argnani
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
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13
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Grever M, Andritsos L, Banerji V, Barrientos JC, Bhat S, Blachly JS, Call T, Cross M, Dearden C, Demeter J, Dietrich S, Falini B, Forconi F, Gladstone DE, Gozzetti A, Iyengar S, Johnston JB, Juliusson G, Kraut E, Kreitman RJ, Lauria F, Lozanski G, Parikh SA, Park J, Polliack A, Ravandi F, Robak T, Rogers KA, Saven A, Seymour JF, Tadmor T, Tallman MS, Tam CS, Tiacci E, Troussard X, Zent C, Zenz T, Zinzani PL, Wörmann B. Hairy cell leukemia and COVID-19 adaptation of treatment guidelines. Leukemia 2021; 35:1864-1872. [PMID: 33947938 PMCID: PMC8093591 DOI: 10.1038/s41375-021-01257-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/11/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022]
Abstract
Standard treatment options in classic HCL (cHCL) result in high response rates and near normal life expectancy. However, the disease itself and the recommended standard treatment are associated with profound and prolonged immunosuppression, increasing susceptibility to infections and the risk for a severe course of COVID-19. The Hairy Cell Leukemia Foundation (HCLF) has recently convened experts and discussed different clinical strategies for the management of these patients. The new recommendations adapt the 2017 consensus for the diagnosis and management with cHCL to the current COVID-19 pandemic. They underline the option of active surveillance in patients with low but stable blood counts, consider the use of targeted and non-immunosuppressive agents as first-line treatment for cHCL, and give recommendations on preventive measures against COVID-19.
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Grants
- P30 CA008748 NCI NIH HHS
- Hairy Cell Leukemia Research Foundation
- TG Therapeutics
- AbbVie (AbbVie Inc.)
- MingSitght Pharmaceuticals
- Royal Marsden NHS Foundation Trust (Royal Marsden)
- Janseen and Cilag SPA
- AstraZeneca
- Novartis
- Pfizer (Pfizer Inc.)
- Teva Pharmaceutical Industries (Teva Pharmaceutical Industries Ltd.)
- Innate, Gennetech
- Pharmacyclics, Janssen, AstraZeneca, TG Therapeutics, Merck, AbbVie, and Ascentage Pharma
- Genentech, Servier, Takeda, Fate Therapeutics and Amgen
- BMS, Amgen, Xencor, Macrogenics, Orsenix, Abbvie, Taiho, Prelude, Astex
- AstraZeneca, Medimmune, Roche, Janssen, Abbvie
- Janssen, AbbVie and Beigene
- Hairy Cell Leukemia Foundation, the Leukemia and Lymphoma Society and the Associazione Italiana Ricerca sul Cancro (AIRC).
- Funding through the University of Rochester for laboratory research, from Acerta/AstraZeneca and TG Therapeutics, and from the Hairy Cell Leukemia Foundation
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Affiliation(s)
- Michael Grever
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Leslie Andritsos
- Division of Hematology Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Versha Banerji
- Department of Internal Medicine & Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Jacqueline C Barrientos
- Department of Medicine, Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Feinstein Institute for Medical Research, New York, NY, USA
| | - Seema Bhat
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - James S Blachly
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Timothy Call
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Judit Demeter
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Sasha Dietrich
- Department of Hematology, University Hospital, Heidelberg, Germany
| | - Brunangelo Falini
- Institute of Hematology, Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Francesco Forconi
- Cancer Sciences and Haematology Department, University of Southampton Hospital Trust, Southampton, UK
| | | | | | | | - James B Johnston
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Gunnar Juliusson
- Stem Cell Centre, Department of Laboratory Medicine, Lund University, and Department of Hematology, Skåne University Hospital, Lund, Sweden
| | - Eric Kraut
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Francesco Lauria
- University of Siena Policlinico S Maria alle Scotte, Siena, Italy
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | | | - Jae Park
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aaron Polliack
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Farhad Ravandi
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Kerry A Rogers
- Division of Hematology, Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA, USA
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center and Rappaport Faculty of Medicine, Technion Institute Technology, Haifa, Israel
| | - Martin S Tallman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Constantine S Tam
- Haematology Department, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Enrico Tiacci
- Institute of Hematology, Department of Medicine and Surgery, University and Hospital of Perugia, Perugia, Italy
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Côte de Nacre, Caen, France
| | - Clive Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Thorsten Zenz
- Department of Medical Oncology and Haematology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna and Instituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, Bologna, Italy
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14
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15
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Moore JE, Delibert K, Baran AM, Evans AG, Liesveld JL, Zent CS. Targeted therapy for treatment of patients with classical hairy cell leukemia. Leuk Res 2021; 102:106522. [PMID: 33582427 DOI: 10.1016/j.leukres.2021.106522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
Most patients with treatment naïve classical hairy cell leukemia (cHCL) have durable responses with purine nucleoside analogues. In contrast, options are limited for cHCL patients with co-morbidities, purine analogue intolerance, or resistant disease. We report the utility of targeted therapy for nine cHCL patients presenting with treatment naïve cHCL and severe neutropenia and infection (n = 3), purine analogue intolerance (n = 2), or purine analogue resistant disease (n = 4). BRAF inhibitor vemurafenib was started at 240-480 mg twice daily (planned 90-day treatment) and combined with rituximab in seven patients. Therapy was tolerable with no severe adverse events. All patients responded with rapid blood count recovery (median time 1.52 months, range 0.43-4.33). Median progression free and overall survival was not reached at a median follow up of 18.1 months (range 3.2-68.9). These data suggest targeted therapy could be an option for patients unable to be treated with purine analogues.
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Affiliation(s)
- Jeremiah E Moore
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, United States; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Kendra Delibert
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, United States; James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Andrea M Baran
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States
| | - Andrew G Evans
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Jane L Liesveld
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States; Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States.
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16
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Vittoria L, Bozzi F, Capone I, Carniti C, Lorenzini D, Gobbo M, Bolli N, Aiello A. A rare biclonal Hairy Cell Leukemia disclosed by an integrated diagnostic approach: A case report. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:692-694. [PMID: 33337573 DOI: 10.1002/cyto.b.21980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Laura Vittoria
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Bozzi
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Iolanda Capone
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristiana Carniti
- Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniele Lorenzini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Morena Gobbo
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Niccolò Bolli
- Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Antonella Aiello
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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