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Paillassa J, Maitre E, Belarbi Boudjerra N, Madani A, Benlakhal R, Matthes T, Van Den Neste E, Cailly L, Inchiappa L, Bekadja MA, Tomowiak C, Troussard X. Recommendations for the Management of Patients with Hairy-Cell Leukemia and Hairy-Cell Leukemia-like Disorders: A Work by French-Speaking Experts and French Innovative Leukemia Organization (FILO) Group. Cancers (Basel) 2024; 16:2185. [PMID: 38927891 PMCID: PMC11201647 DOI: 10.3390/cancers16122185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Hairy-cell leukemia (HCL) is a rare B-cell chronic lymphoproliferative disorder (B-CLPD), whose favorable prognosis has changed with the use of purine nucleoside analogs (PNAs), such as cladribine (CDA) or pentostatin (P). However, some patients eventually relapse and over time HCL becomes resistant to chemotherapy. Many discoveries have been made in the pathophysiology of HCL during the last decade, especially in genomics, with the identification of the BRAFV600E mutation and cellular biology, including the importance of signaling pathways as well as tumor microenvironment. All of these new developments led to targeted treatments, especially BRAF inhibitors (BRAFis), MEK inhibitors (MEKis), Bruton's tyrosine kinase (BTK) inhibitors (BTKis) and recombinant anti-CD22 immunoconjugates. RESULTS The following major changes or additions were introduced in these updated guidelines: the clinical relevance of the changes in the classification of splenic B-cell lymphomas and leukemias; the increasingly important diagnostic role of BRAFV600E mutation; and the prognostic role of the immunoglobulin (IG) variable (V) heavy chain (H) (IGHV) mutational status and repertory. We also wish to insist on the specific involvement of bones, skin, brain and/or cerebrospinal fluid (CSF) of the disease at diagnosis or during the follow-up, the novel targeted drugs (BRAFi and MEKi) used for HCL treatment, and the increasing role of minimal residual disease (MRD) assessment. CONCLUSION Here we present recommendations for the diagnosis of HCL, treatment in first line and in relapsed/refractory patients as well as for HCL-like disorders including HCL variant (HCL-V)/splenic B-cell lymphomas/leukemias with prominent nucleoli (SBLPN) and splenic diffuse red pulp lymphoma (SDRPL).
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Affiliation(s)
- Jérôme Paillassa
- Service des Maladies du Sang, CHU d’Angers, 49000 Angers, France;
| | - Elsa Maitre
- Hématologie Biologique, Structure Fédérative D’oncogénétique Cyto-Moléculaire du CHU de Caen (SF-MOCAE), CHU de Caen, 14000 Caen, France;
- Unité MICAH, INSERM1245, Université Caen-Normandie, 14000 Caen, France
| | | | - Abdallah Madani
- Service d’Hématologie, CHU de Casablanca, Casablanca 20000, Morocco;
| | | | - Thomas Matthes
- Service d’Hématologie, Département d’Oncologie et Service de Pathologie Clinique, Département de Diagnostic, Hôpital Universitaire de Genève, 1205 Genève, Switzerland;
| | - Eric Van Den Neste
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1000 Brussels, Belgium;
| | - Laura Cailly
- Service d’Onco-Hématologie et de Thérapie Cellulaire, CHU de Poitiers, 86000 Poitiers, France; (L.C.)
| | - Luca Inchiappa
- Service d’Hématologie, Institut Paoli-Calmette, 13397 Marseille, France
| | | | - Cécile Tomowiak
- Service d’Onco-Hématologie et de Thérapie Cellulaire, CHU de Poitiers, 86000 Poitiers, France; (L.C.)
| | - Xavier Troussard
- Hématologie Biologique, Structure Fédérative D’oncogénétique Cyto-Moléculaire du CHU de Caen (SF-MOCAE), CHU de Caen, 14000 Caen, France;
- Hematologie CHU Caen Normandie, 14000 Caen, France
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Cailly L, Gruchet C, Maitre E, Guidez S, Delwail V, Systchenko T, Moya N, Sabirou F, Levy A, Bobin A, Gardeney H, Nsiala L, Vonfeld M, Chacon A, Pichon A, Bouyer S, Baslé C, Dindinnaud E, Chomel J, Raimbault A, Borde‐Mougenot F, Troussard X, Tomowiak C. Hairy cell leukemia with isolated bone lesions. Clin Case Rep 2023; 11:e7343. [PMID: 37207087 PMCID: PMC10188895 DOI: 10.1002/ccr3.7343] [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: 01/01/2023] [Revised: 03/24/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
Key Clinical Message 18F-FDG PET/CT has clinical relevance in HCL at diagnosis and for the follow-up of patients treated, especially in case of atypical presentations such as bone involvements (which are probably underestimated) and poor bone marrow infiltration. Abstract Bone lesions are rarely reported in Hairy Cell Leukemia (HCL). We report two BRAFV600E mutated HCL patients presented bone lesions at foreground, poor bone marrow involvement, and the important role 18F-FDG PET/CT played in their management. We discuss the crucial role that 18F-FDG PET/CT could play in HCL routine practice.
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Affiliation(s)
- Laura Cailly
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Cécile Gruchet
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Elsa Maitre
- Department of Hematology, CHU Cote de NacreUniversity HospitalCaenFrance
| | - Stephanie Guidez
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Vincent Delwail
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Thomas Systchenko
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Niels Moya
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Florence Sabirou
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Anthony Levy
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Arthur Bobin
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Hélène Gardeney
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Laly Nsiala
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Mathilde Vonfeld
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Aurélia Chacon
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Aurélien Pichon
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Sabrina Bouyer
- Department of Biology, CHU La MiletrieUniversity HospitalPoitiersFrance
| | - Caroline Baslé
- Department of Biology, CHU La MiletrieUniversity HospitalPoitiersFrance
| | - Elodie Dindinnaud
- Department of Biology, CHU La MiletrieUniversity HospitalPoitiersFrance
| | | | - Anna Raimbault
- Department of Biology, CHU La MiletrieUniversity HospitalPoitiersFrance
| | | | - Xavier Troussard
- Department of Hematology, CHU Cote de NacreUniversity HospitalCaenFrance
| | - Cécile Tomowiak
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
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3
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Robak T, Robak P. Refractory and relapsed hairy-cell leukemia (HCL): casting light on promising experimental drugs in clinical trials. Expert Opin Investig Drugs 2023; 32:311-324. [PMID: 36931901 DOI: 10.1080/13543784.2023.2193323] [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: 03/19/2023]
Abstract
INTRODUCTION Hairy cell leukemia (HCL) is a rare subtype of indolent lymphoid leukemia originating from a mature B lymphocyte. The standard first-line treatment for classic HCL, and HCL variant (HCLv), consists of purine nucleoside analogs (PNA), with or without rituximab. However, almost half of patients relapse and require subsequent therapy. AREAS COVERED This article summarizes recent achievements in the treatment of relapsed and refractory HCL. A literature search was conducted of the PubMed and MEDLINE database for articles in English. Publications from 2010 through January 2023 were scrutinized. The search terms used were hairy cell leukemia in conjunction with BRAF inhibitors, Bruton's tyrosine kinase (BTK) inhibitors, CD20 monoclonal antibodies, relapsed, refractory and variant.The growing understanding of HCL biology has allowed the design of several new, chemotherapy-free targeted drugs which have demonstrated encouraging efficacy in early clinical trials. EXPERT OPINION Novel drugs will soon be available to assist standard therapy for HCL and HCLv among patients with suboptimal results following PNA treatment. In particular, the BRAF inhibitors vemurafenib and dabrafenib, with or without rituximab, have revolutionized treatment of patients with relapsed or refractory disease.
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Affiliation(s)
- Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Łódź, Poland
- Department of General Hematology, Copernicus Memorial Hospital, Lodz, Poland
| | - Paweł Robak
- Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland
- Department of Hematooncology, Copernicus Memorial Hospital, Lodz, Poland
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Falini B, De Carolis L, Tiacci E. How I treat refractory/relapsed hairy cell leukemia with BRAF inhibitors. Blood 2022; 139:2294-2305. [PMID: 35143639 PMCID: PMC11022828 DOI: 10.1182/blood.2021013502] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/26/2022] [Indexed: 11/20/2022] Open
Abstract
Hairy cell leukemia (HCL) responds very well to frontline chemotherapy with purine analogs (cladribine and pentostatine). However, approximately half of patients experience 1 or more relapses, which become progressively resistant to these myelotoxic and immunosuppressive agents. At progression, standard therapeutic options include a second course of purine analogs alone or in combination with rituximab and, upon second relapse, therapy with the anti-CD22 immunotoxin moxetumomab pasudotox. Furthermore, blockade of the mutant BRAF-V600E kinase (the pathogenetic hallmark of HCL) through orally available specific inhibitors (vemurafenib or dabrafenib) effaces the peculiar morphologic, phenotypic, and molecular identity of this disease and its typical antiapoptotic behavior and is emerging as an attractive chemotherapy-free strategy in various clinical scenarios. These include patients with, or at risk of, severe infections and, in a highly effective combination with rituximab, patients with relapsed or refractory HCL. Other treatments explored in clinical trials are BTK inhibition with ibrutinib and co-inhibition of BRAF (through dabrafenib or vemurafenib) and its downstream target MEK (through trametinib or cobimetinib). Here, we focus on our experience with BRAF inhibitors in clinical trials and as off-label use in routine practice by presenting 3 challenging clinical cases to illustrate their management in the context of all available treatment options.
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Affiliation(s)
- Brunangelo Falini
- Brunangelo Falini, Section of Hematology and Center for Hemato-Oncological Research (CREO), Department of Medicine and Surgery, University of Perugia and Hospital Santa Maria della Misericordia, Piazzale Menghini 8, 06132 Perugia, Italy
| | - Luca De Carolis
- Section of Hematology and Center for Hemato-Oncological Research (CREO), Department of Medicine and Surgery, University of Perugia and Hospital Santa Maria della Misericordia, Perugia, Italy
| | - Enrico Tiacci
- Enrico Tiacci, Section of Hematology and Center for Hemato-Oncological Research (CREO), Department of Medicine and Surgery, University of Perugia and Hospital Santa Maria della Misericordia, Piazzale Menghini 8, 06132 Perugia, Italy
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5
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Paillassa J, Maitre E, Troussard X. Hairy Cell Leukemia (HCL) and HCL Variant: Updates and Spotlights on Therapeutic Advances. Curr Oncol Rep 2022; 24:1133-1143. [DOI: 10.1007/s11912-022-01285-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/21/2022]
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Puła A, Robak T. Hairy cell leukemia: a brief update on current knowledge and treatment prospects. Curr Opin Oncol 2021; 33:412-419. [PMID: 34264896 DOI: 10.1097/cco.0000000000000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This article provides a brief update on the recommended diagnosis and treatment strategies for patients with the classic form of hairy cell leukemia (HCL) and HCL variant (HCLv). RECENT FINDINGS HCL is a chronic B-cell malignancy with multiple treatment options. In recent years, many novel drugs have been assessed for HCL treatment with promising results. The investigated nonchemotherapy options include moxetumomab pasudotox, which targets CD22; vemurafenib or dabrafenib, which target the BRAFV600E protein; trametinib, which targets mitogen-activated protein kinase enzyme; and ibrutinib, which targets Bruton tyrosine kinase. SUMMARY Purine analogs significantly improve survival in patients with HCL. However, patients often relapse, require multiple treatments, and may become refractory. The introduction of novel agents has expanded the spectrum of therapy possibilities in those patients. In the coming years, they will assist standard therapy for patients with HCL who may currently have suboptimal results.
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Affiliation(s)
- Anna Puła
- Department of Hematology, Medical University of Lodz, Lodz, Poland
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Paillassa J, Cornet E, Noel S, Tomowiak C, Lepretre S, Vaudaux S, Dupuis J, Devidas A, Joly B, Petitdidier-Lionnet C, Haiat S, Mariette C, Thieblemont C, Decaudin D, Validire-Charpy P, Drenou B, Eisenmann JC, Uribe MO, Olivrie A, Touati M, Lambotte O, Hermine O, Karsenti JM, Feugier P, Vaillant W, Gutnecht J, Lippert E, Huysman F, Ghomari K, Boubaya M, Levy V, Riou J, Damaj G, Tanguy-Schmidt A, Hunault-Berger M, Troussard X. Analysis of a cohort of 279 patients with hairy-cell leukemia (HCL): 10 years of follow-up. Blood Cancer J 2020; 10:62. [PMID: 32461544 PMCID: PMC7253459 DOI: 10.1038/s41408-020-0328-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 11/12/2022] Open
Abstract
In total, 279 patients with hairy-cell leukemia (HCL) were analyzed, with a median follow-up of 10 years. Data were collected up to June 2018. We analyzed responses to treatment, relapses, survival, and the occurrence of second malignancies during follow-up. The median age was 59 years. In total, 208 patients (75%) were treated with purine analogs (PNAs), either cladribine (159) or pentosatin (49), as the first-line therapy. After a median follow-up of 127 months, the median overall survival was 27 years, and the median relapse-free survival (RFS) was 11 years. The cumulative 10-year relapse incidence was 39%. In patients receiving second-line therapy, the median RFS was 7 years. For the second-line therapy, using the same or another PNA was equivalent. We identified 68 second malignancies in 59 patients: 49 solid cancers and 19 hematological malignancies. The 10-year cumulative incidences of cancers, solid tumors, and hematological malignancies were 15%, 11%, and 5.0%, respectively, and the standardized incidence ratios were 2.22, 1.81, and 6.67, respectively. In multivariate analysis, PNA was not a risk factor for second malignancies. HCL patients have a good long-term prognosis. PNAs are the first-line treatment. HCL patients require long-term follow-up because of their relatively increased risk of second malignancies.
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Affiliation(s)
| | - Edouard Cornet
- Laboratoire d'Hematologie Biologique, CHU de Caen, Caen, France
| | - Stephanie Noel
- Service d'Oncologie Hematologique et Therapie Cellulaire, CHU de Poitiers, et CIC Inserm U1402, Poitiers, France
| | - Cecile Tomowiak
- Service d'Oncologie Hematologique et Therapie Cellulaire, CHU de Poitiers, et CIC Inserm U1402, Poitiers, France
| | - Stephane Lepretre
- Inserm U1245 et Service d'Hematologie, Centre Henri Becquerel et Normandie Univ UNIROUEN, Rouen, France
| | - Sandrine Vaudaux
- Inserm U1245 et Service d'Hematologie, Centre Henri Becquerel et Normandie Univ UNIROUEN, Rouen, France
| | - Jehan Dupuis
- Service d'Hematologie Clinique, CHU Henri Mondor, Assistance Publique des Hopitaux de Paris, Creteil, France
| | - Alain Devidas
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | - Bertrand Joly
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | | | - Stephanie Haiat
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | - Clara Mariette
- Service d'Hematologie, CHU de Grenoble, Grenoble, France
| | - Catherine Thieblemont
- Service Hemato-Oncologie, Hopital Saint Louis, Assistance Publique des Hopitaux de Paris, Paris, France
| | - Didier Decaudin
- Unite d'Investigation Clinique, Departement de Medecine Oncologique, Institut Curie, Paris, France
| | | | - Bernard Drenou
- Service d'Hematologie Clinique, Groupe Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Jean-Claude Eisenmann
- Service d'Hematologie Clinique, Groupe Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Mario Ojeda Uribe
- Service d'Hematologie Clinique, Groupe Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Agnès Olivrie
- Service d'Hematologie Clinique et Therapie Cellulaire, CHU de Limoges, Limoges, France
| | - Mohamed Touati
- Service d'Hematologie Clinique et Therapie Cellulaire, CHU de Limoges, Limoges, France
| | - Olivier Lambotte
- Service de Medecine Interne et Immunologie Clinique, Hopital Bicêtre, Assistance Publique des Hopitaux de Paris, Paris, France
| | - Olivier Hermine
- Service d'Hematologie Adulte, Hopital Necker-Enfants Malades, Assistance Publique des Hopitaux de Paris, Paris, France
| | | | | | - Willy Vaillant
- Service de Medecine Interne, Maladies Infectieuses, Oncologie et Hematologie, CH d'Auch, Auch, France
| | - Jean Gutnecht
- Service de Medecine Interne, CHI Frejus Saint Raphaël, Frejus, France
| | - Eric Lippert
- Laboratoire d'Hematologie Biologique, CHU de Brest, Brest, France
| | - Fabienne Huysman
- Service d'Hematologie Oncologie, CH de Beauvais, Beauvais, France
| | - Kamel Ghomari
- Service d'Hematologie Oncologie, CH de Beauvais, Beauvais, France
| | - Marouane Boubaya
- Unite de Recherche Clinique, Hopital Avicenne, Assistance Publique des Hopitaux de Paris, Bobigny, France
| | - Vincent Levy
- Unite de Recherche Clinique, Hopital Avicenne, Assistance Publique des Hopitaux de Paris, Bobigny, France
| | - Jeremie Riou
- MINT UMR INSERM 1066, CNRS 6021, Universite d'Angers, Angers, France
| | - Gandhi Damaj
- Institut d'Hematologie de Basse-Normandie, CHU de Caen, Caen, France
| | - Aline Tanguy-Schmidt
- Service des Maladies du Sang, CHU d'Angers, Angers, France
- Federation Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), Angers, France
- UFR Sante, Universite d'Angers, Angers, France
- CRCINA, INSERM, Universite de Nantes, Universite d'Angers, Angers, France
| | - Mathilde Hunault-Berger
- Service des Maladies du Sang, CHU d'Angers, Angers, France
- Federation Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), Angers, France
- UFR Sante, Universite d'Angers, Angers, France
- CRCINA, INSERM, Universite de Nantes, Universite d'Angers, Angers, France
| | - Xavier Troussard
- Laboratoire d'Hematologie Biologique, CHU de Caen, Caen, France.
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Iwashige A, Hirosawa M, Tsukada J. Hairy cell leukemia presenting with progressive pericarditis and pleuritis. Ann Hematol 2018; 97:2527-2528. [PMID: 29846761 PMCID: PMC6208684 DOI: 10.1007/s00277-018-3378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/21/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Atsushi Iwashige
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8556, Japan
- Palliative Care Center, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Makoto Hirosawa
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8556, Japan
| | - Junichi Tsukada
- Hematology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8556, Japan.
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Clinicopathologic and molecular features in hairy cell leukemia-variant: single institutional experience. Mod Pathol 2018; 31:1717-1732. [PMID: 29955146 DOI: 10.1038/s41379-018-0093-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/05/2018] [Accepted: 05/06/2018] [Indexed: 12/13/2022]
Abstract
Hairy cell leukemia-variant is rare. Only a small number of cases have been reported in the literature with little cytogenetic or molecular data available. In this study, we describe the clinicopathologic and genetic features of 23 patients with hairy cell leukemia-variant (16 men and 7 women) with a median age of 70 years. Most patients had splenomegaly (90%), leukocytosis (77%), and lymphocytosis (82%); no patients had monocytopenia. Histologically, the bone marrow biopsy specimens showed a mixed pattern of predominantly interstitial and lesser intrasinusoidal infiltration by leukemic cells. In bone marrow aspirate smears most cells had villous cytoplasmic features and a small nucleolus. We describe unusual sites of hairy cell leukemia-variant involvement in 4 patients, including brain, omentum, terminal ileum, and skin at the time of initial presentation. Immunophenotyping showed monotypic B-cells positive for pan B-cell antigens, CD11c, and CD103, and negative for CD25 and annexin A1. Conventional cytogenetic or fluorescence in situ hybridization analysis showed deletions of 17p13/TP53 and 11q22/ATM gene in 5/12 (42%) and 2/9 (22%) cases, respectively. Sequencing of the variable region of IGVH showed mutations (>2% deviation from germline) in 40% of the cases assessed. MAP2K1 mutation (p.C121S) was seen in 1 of 14 (7%) patients tested. No BRAF V600E mutations were detected. The patients were treated in a heterogeneous manner, but most often with therapies designed for classical hairy cell leukemia and the 5-year overall survival was 84%. In summary, hairy cell leukemia-variant exhibits a heterogeneous spectrum of clinical, morphologic, immunophenotypic, and genetic features that may overlap with classic hairy cell leukemia and other hairy cell-like B-cell neoplasms. A subset of patients can have an aggressive clinical course. In our experience MAP2K1 mutations are uncommon in this disease.
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Cortazar JM, DeAngelo DJ, Pinkus GS, Morgan EA. Morphological and immunophenotypical features of hairy cell leukaemia involving lymph nodes and extranodal tissues. Histopathology 2017; 71:112-124. [PMID: 28261866 DOI: 10.1111/his.13206] [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: 01/04/2017] [Accepted: 02/28/2017] [Indexed: 12/01/2022]
Abstract
AIMS Hairy cell leukaemia (HCL) is a rare B cell neoplasm that mainly affects bone marrow (BM), peripheral blood (PB) and spleen. Involvement of lymph nodes and extranodal structures is considered infrequent. Herein we describe our institutional experience of nodal (n = 10) and extranodal (n = 3) HCL during a 30-year period. METHODS AND RESULTS Ten patients had prior evidence of HCL within the BM or PB at a median 35.8 months before nodal/extranodal diagnosis (range: <1-175 months), and HCL was diagnosed concurrently within the bone marrow of one additional patient. Nodal involvement showed distinct architectural patterns, including diffuse (62% of cases), sinusoidal (25%) and nodular (13%). Extranodal involvement was characterized as diffuse infiltration through underlying structures in all cases. Morphological features ranged from classic 'fried-egg' cytology to a plasmacytoid appearance. Nodal/extranodal disease showed an overlapping immunophenotypical profile with other small B cell lymphomas, including expression of cyclin D1 (70%), CD43 (55%), CD10 (38%) and CD5 (8%). Rates of both CD43 and CD10 reactivity were higher than described previously in leukaemic HCL, suggesting that expression may be enriched in cases with extramedullary extension. CONCLUSIONS Although uncommon, HCL should be considered in the differential diagnosis of small B cell neoplasms involving nodal/extranodal sites, given the therapeutic implications. In particular, recent discoveries including detection of the BRAFV600E mutation in nearly all cases of HCL and the availability of an antibody to CD103 for use in paraffin-embedded tissues will facilitate the distinction of HCL from other small B cell lymphomas in the nodal/extranodal setting.
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Affiliation(s)
- Jacqueline M Cortazar
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Geraldine S Pinkus
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Morgan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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11
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Wang L, Tadros AS, Hoh CK, Wang HY. CD10-Positive Hairy Cell Leukemia Involving Multiple Deep Lymph Nodes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:e51-3. [PMID: 27013179 DOI: 10.1016/j.clml.2016.02.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Ling Wang
- Department of Pathology, University of California San Diego Health System, La Jolla, CA
| | - Anthony S Tadros
- Department of Radiology, University of California San Diego Health System, La Jolla, CA
| | - Carl K Hoh
- Department of Radiology, University of California San Diego Health System, La Jolla, CA
| | - Huan-You Wang
- Department of Pathology, University of California San Diego Health System, La Jolla, CA.
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