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Soleimani A, Navarro A, Liu D, Herman SEM, Chuang SS, Slavutsky I, Narbaitz M, Safah H, Schmieg J, Lefante J, Roschewski M, Wilson WH, Wiestner A, Saba NS. CD5-negative mantle cell lymphoma: clinicopathologic features of an indolent variant that confers a survival advantage. Leuk Lymphoma 2021; 63:911-917. [PMID: 34781807 DOI: 10.1080/10428194.2021.2002317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Conventionally, mantle cell lymphoma (MCL) is an aggressive CD5-positive B-cell malignancy with poor prognosis and limited survival. However, a small subset of patients presents with indolent disease and can be managed on a 'watch and wait' approach. CD5-negative MCL has recently been recognized as a more favorable variant of MCL, but its clinical and biological implications remain ill-defined. We performed the most extensive review to-date of all reported cases of CD5-negative MCL and included unpublished cases diagnosed at our institutions to further characterize this disease subset. Based on our analysis of 356 cases of CD5-negative MCL, we conclude that median overall survival exceeds 14 years and is independent of favorable prognostic markers such as leukemic non-nodal disease, absence of SOX11, and low Ki-67.
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Affiliation(s)
- Arshia Soleimani
- Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Alba Navarro
- Hematopathology Section, Department of Anatomic Pathology, Hospital Clínic, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Delong Liu
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sarah E M Herman
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Irma Slavutsky
- Laboratorio de Genética de Neoplasias Linfoides, Instituto de Medicina Experimental, CONICET-Academia Nacional de Medicina, Buenos Aires, Argentina
| | - Marina Narbaitz
- División Patología, Instituto de Investigaciones Hematológicas, ANM, Buenos Aires, Argentina
| | - Hana Safah
- Section of Hematology and Medical Oncology, Department of Medicine, Tulane University, New Orleans, LA
| | - John Schmieg
- Department of Pathology, Tulane University, New Orleans, LA, USA
| | - John Lefante
- Department of Biostatistics of Pathology, Tulane University, New Orleans, LA, USA
| | - Mark Roschewski
- Department of Biostatistics and Data Science, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wyndham H Wilson
- Department of Biostatistics and Data Science, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Adrian Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nakhle S Saba
- Section of Hematology and Medical Oncology, Department of Medicine, Tulane University, New Orleans, LA
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CD5-negative Mantle Cell Lymphoma: Clinicopathologic Correlations and Outcome in 58 Patients. Am J Surg Pathol 2020; 43:1052-1060. [PMID: 31045891 DOI: 10.1097/pas.0000000000001278] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mantle cell lymphoma (MCL) represents 4% to 9% of all non-Hodgkin lymphomas and is characterized by CD5 and cyclin D1 expression and t(11;14)(q13;q32). However, about 5% of MCL lack CD5 expression and is poorly characterized. Here, we present 58 patients with CD5 negative (CD5) MCL and compared them with a group of 212 typical CD5 positive (CD5) MCL cases. There were 39 men and 19 women with a median age of 66 years (range, 36 to 88). Compared with CD5 positive (CD5) MCL patients, patients with CD5 MCL showed a lower male-to-female ratio (P=0.006) and a higher frequency of "bone marrow non-nodal" presentation (P=0.01). All other clinicopathologic features, including the frequency of SOX11 expression, were similar between the 2 groups. Treated with similar regimens, patients with CD5 MCL showed a significantly longer progression-free survival (PFS) (P=0.01) and a tendency for longer overall survival (OS; P=0.078) than CD5 positive (CD5) MCL patients. Univariate analysis showed of the well-known poor prognostic factors, only Mantle Cell Lymphoma International Prognostic Index was an inferior prognostic factor and blastoid/pleomorphic morphology and high Ki67 were not associated with prognosis in CD5 MCL patients. Multivariate Cox regression analysis showed CD5 expression was an independent prognostic factor for PFS (P=0.031) but not OS in MCL patients. In conclusion, the results suggest that patients with CD5 MCL have a more favorable prognosis than CD5 MCL patients, although the clinicopathologic features of both groups are largely similar. CD5 MCL may represent a distinct variant of MCL and needs to be included in the differential diagnosis of CD5 small B-cell lymphomas.
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Lee W, Shin E, Kim BH, Kim H. Inconsistency associated with SOX11 immunohistochemistry in mantle cell lymphoma: a meta-analysis. J Hematop 2019. [DOI: 10.1007/s12308-019-00361-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Mesa H, Rawal A, Gupta P. Diagnosis of Lymphoid Lesions in Limited Samples: A Guide for the General Surgical Pathologist, Cytopathologist, and Cytotechnologist. Am J Clin Pathol 2018; 150:471-484. [PMID: 30084952 DOI: 10.1093/ajcp/aqy077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Advances in interventional techniques allow obtaining samples from most body sites through minimally invasive procedures that yield limited samples. We provide practical guidelines for diagnosis of lymphoid lesions in these samples. METHODS Guidelines for selection of biopsy site and triage of the specimen according to results of rapid on-site evaluation (ROSE), and description of the advantages and limitations of currently available ancillary studies are described, based on the experience of the authors, complemented by a comprehensive review of the literature. RESULTS Five diagnostic categories are observed at ROSE: (1) preponderance of small cells, (2) large cells, (3) mixed small and large cells, (4) blast-like cells, and (5) rare large pleomorphic cells. Detailed description of the diagnostic work-up and subsequent classification for each of these groups is provided. CONCLUSIONS A definitive diagnosis of lymphoid neoplasms in limited samples is possible in most cases through correlation of morphology, ancillary studies, and clinical scenario.
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Affiliation(s)
- Hector Mesa
- Department of Pathology, Veterans Administration Health Care Service, Minneapolis, MN
| | - Ajay Rawal
- Department of Pathology, Methodist Hospital, St Louis Park, MN
| | - Pankaj Gupta
- Department of Hematology Oncology, Veterans Administration Health Care Service, Minneapolis, MN
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