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Rastogi P, Alrwashdeh A, Caza T, Lin M, Obeidat M, Giannini G, Larsen C, Dai DF. Characteristics of Renal Intravascular Large B-cell Lymphoma. Kidney Int Rep 2023; 8:575-583. [PMID: 36938088 PMCID: PMC10014346 DOI: 10.1016/j.ekir.2022.12.001] [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: 09/01/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Renal intravascular large B-cell lymphoma (IVLBCL) is a rare, aggressive B-cell lymphoma with neoplastic cells occupying the vascular lumina with only 53 patients reported to date. Here, we present the largest case series to characterize this rare disease. Methods We performed a multi-institutional, retrospective review of kidney biopsies and autopsies with a diagnosis of kidney IVLBCL and report our findings. Results We identified 20 patients with an average age of 65.7 ± 7.8 years (55% males) with IVLBCL on kidney biopsy. The most common clinical presentation was fever and anemia. Acute kidney injury (AKI) was noted in 70% to 90%, proteinuria in 70% to 84.1%, hematuria in 45%, and nephrotic-range proteinuria in 10% to 26.1% of cases. The median (interquartile range) of serum creatinine was 1.75 (1.14, 3.3) mg/dl. Neoplastic lymphoid cells were present in glomeruli, peritubular capillaries, and arteries or veins. Of the patients, 44.3% showed extrarenal infiltration into bone marrow, liver, spleen, central vervous system, lung and skin. Neoplastic cells express CD20, CD79a, PAX-5, and MUM1+, and were CD10-negative. Available follow-up data showed a median survival of 21 months after diagnosis. Extrarenal involvement is a significant and independent predictor of mortality with a hazard ratio of 4.975 (95% confidence interval:1.38, 17.88) after controlling for age and gender. Serum creatinine, age, sex, and infiltration of intrarenal arteries or veins did not affect survival. Conclusion Kidney IVLBCL is a rare disease that is unexpectedly diagnosed by kidney biopsy, presenting with fever, anemia, mild AKI, and proteinuria. Median survival is 21 months and extrarenal involvement is associated with worse outcome.
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Affiliation(s)
- Prerna Rastogi
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Audai Alrwashdeh
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Mercury Lin
- Department of Pathology and Laboratory Medicine, Cedars Sinai, Los Angeles, California, USA
| | - Mohammad Obeidat
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Dao-Fu Dai
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Correspondence: Dao-Fu Dai, Department of Pathology, University of Iowa Carver College of Medicine, Room MRC106C, 501 Newton Road, Iowa City, Iowa 52242, USA.
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2
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Kline KAF, Lee ST, Law JY, Kallen M. Waldenstrom macroglobulinemia and simultaneous intravascular large B-cell lymphoma: Rare transformation or unhappy coincidence? CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e788-e791. [PMID: 35525836 DOI: 10.1016/j.clml.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Kathryn A F Kline
- University of Maryland Greenebaum Comprehensive Cancer Center, 22 S. Greene Street, S9D10, Baltimore, MD 21201-1995, USA.
| | - Seung Tae Lee
- University of Maryland Greenebaum Comprehensive Cancer Center, 22 S. Greene Street, S9D10, Baltimore, MD 21201-1995, USA; Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jennie Y Law
- University of Maryland Greenebaum Comprehensive Cancer Center, 22 S. Greene Street, S9D10, Baltimore, MD 21201-1995, USA; Division of Hematology/Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Kallen
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
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3
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Kama K, La Rosée P, Czock D, Bosch-Schips J, Illerhaus G. Hemophagocytic Syndrome-Associated Intravascular Large B-cell Lymphoma With Dialysis-Dependent End-Stage Renal Disease Treated With Autologous Stem Cell Transplantation Using a Modified TEAM Regimen. Cureus 2022; 14:e25885. [PMID: 35844314 PMCID: PMC9277097 DOI: 10.7759/cureus.25885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/06/2022] Open
Abstract
Due to the low incidence and the large number of postmortem diagnoses, treatment recommendations for intravascular large B-cell lymphoma (IVLBCL) are largely based on retrospective studies and case reports. There is little data on autologous stem cell transplantation (ASCT) in dialysis-dependent patients and choosing an adequate regimen and dosing is difficult. Here, we report the treatment of a patient with relapsed IVLBCL and end-stage renal disease caused by lymphoma-associated renal AA amyloidosis using a modified TEAM (thiotepa, etoposide, cytarabine, and melphalan) regimen and ASCT. A 42-year-old female had an early relapse of hemophagocytic syndrome-associated intravascular large B-cell lymphoma resulting in terminal renal disease with dialysis dependency. Because of comorbidities (AA amyloidosis with severe hypoalbuminemia and end-stage renal disease), a modified, dose-reduced TEAM regimen was used as a high-dose conditioning regimen based on clinical pharmacologic considerations. The patient developed grade three mucositis and grade four febrile neutropenia as adverse events after transplantation. A modified TEAM regimen is feasible in a patient with end-stage renal disease with manageable toxicity. This is the first report of treatment with thiotepa in a dialysis-dependent patient.
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4
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Liu W, Li C, Cao Y, Wang N, Huang L, Shang Z, Wang J, Huang L, Xu J, Xiao M, Zhang Y, Zhou J, Chen L, Xiao Y. Sequential CAR T-Cell Therapy After Autologous Stem Cell Transplantation for the Treatment of Relapsed/Refractory Intravascular Large B-Cell Lymphoma With Central Nervous System Involvement: A Case Report. Front Oncol 2022; 12:817969. [PMID: 35574341 PMCID: PMC9096123 DOI: 10.3389/fonc.2022.817969] [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: 12/05/2021] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intravascular large B-cell lymphoma (IVLBCL) is a rare, aggressive, large B-cell non-Hodgkin’s lymphoma. The prognosis of IVLBCL in patients with central nervous system recurrence after first-line chemotherapy treatment is extremely poor. Among immunotherapies, chimeric antigen receptor (CAR) T-cell immunotherapy has been recently found to be a highly effective treatment for B-cell lymphoma, especially for relapsed or refractory diffuse large B-cell lymphoma. However, no guidelines are available that provide a clear consensus regarding the management of patients with relapsed/refractory IVLBCL. Here, we report, for the first time, the use of autologous hematopoietic stem cell transplantation (ASCT) and CAR T-cell therapy in a patient with relapsed/refractory IVLBCL. Case Presentation A 42‐year‐old woman was diagnosed with IVLBCL based on liver biopsy and developed central nervous system (CNS) progression. The patient received ASCT combined with murine monoclonal anti-CD19 and anti-CD22 CAR T-cell therapy. She achieved complete remission for 22 months so far with negative minimal residual disease and continues to be followed up. Conclusion ASCT combined with CAR T-cell therapy was the best choice for treatment of relapsed/refractory IVLBCL, as it allowed the achievement of a lasting complete remission.
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Affiliation(s)
- Wanying Liu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Chunrui Li
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Yang Cao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Na Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Liang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Zhen Shang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Jue Wang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Lifang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Jinhuan Xu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Min Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Liting Chen
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
| | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China.,Immunotherapy Research Center for Hematologic Diseases of Hubei Province Wuhan, Hubei, China
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5
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CUTANEOUS B-CELL LYMPHOMAS: UPDATE ON DIAGNOSIS, RISK-STRATIFICATION, AND MANAGEMENT. Presse Med 2022; 51:104109. [PMID: 35026390 DOI: 10.1016/j.lpm.2022.104109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/27/2021] [Indexed: 12/18/2022] Open
Abstract
PCBCLs are a group of Non-Hodgkin's B-cell lymphomas originating in and usually confined to the skin, representing approximately one fourth of primary cutaneous lymphomas (PCL). Their current classification system has been the result of the joint World Health Organization (WHO) - European Organization for Research and Treatment of Cancer (EORTC) consensus in 2018. To date, several types of PCBCLs have been described in the scientific literature, with different clinical presentation and prognosis. Primary cutaneous follicle-center lymphoma (PCFCL) and primary cutaneous marginal zone lymphoma (PCMZL) are the most common forms, with a typical indolent course. On the contrary, primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT) is less common, yet more aggressive, with a reported 5-year overall survival of approximatively 50%. In this review, we outline the PCBCLs defining diagnostic criteria, report the features of the less common subtypes and summarize the noteworthy therapeutical options currently available in this field.
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6
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Davis JW, Auerbach A, Crothers BA, Lewin E, Lynch DT, Teschan NJ, Schmieg JJ. Intravascular Large B-Cell Lymphoma. Arch Pathol Lab Med 2022; 146:1160-1167. [PMID: 34979566 DOI: 10.5858/arpa.2021-0165-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Intravascular large B-cell lymphoma (IVLBCL) is a rare hematopathologic entity, posing both a clinical and histologic challenge for diagnosis. Numerous pitfalls can hinder making the diagnosis. OBJECTIVE.— To summarize recent developments in literature pertaining to IVLBCL and point out key pitfalls pathologists should be prepared to encounter. DATA SOURCES.— Literature review via PubMed search and hospital (Darnall Medical Library) resources. CONCLUSIONS.— The 3 primary pitfalls of IVLBCL include masking of IVLBCL, mimicry by IVLBCL, and mimicry of IVLBCL. These scenarios illustrate the importance of histologic pattern recognition and subsequent usage of immunohistochemistry, especially in context of a clinical history that may be noncharacteristic.
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Affiliation(s)
- Joshua W Davis
- From Clinical and Anatomic Pathology Residency Program, Walter Reed National Military Medical Center, Bethesda, Maryland (Davis)
| | - Aaron Auerbach
- The Joint Pathology Center, Silver Spring, Maryland (Auerbach, Crothers, Schmieg III)
| | - Barbara A Crothers
- The Joint Pathology Center, Silver Spring, Maryland (Auerbach, Crothers, Schmieg III)
| | - Eleanor Lewin
- the Department of Pathology, Women & Infants Hospital, Providence, Rhode Island (Lewin)
| | - David T Lynch
- and the Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas (Lynch, Teschan)
| | - Nathan J Teschan
- and the Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas (Lynch, Teschan)
| | - John J Schmieg
- The Joint Pathology Center, Silver Spring, Maryland (Auerbach, Crothers, Schmieg III)
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7
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Ho M, Zanwar S, Duggan P, Carr R, Habermann T, Navin PJ, Salama ME, Parikh SA. Hiding in (not so) plain sight: Spontaneous tumor Lysis syndrome due to intravascular large B cell lymphoma. Am J Hematol 2022; 97:151-159. [PMID: 34677833 DOI: 10.1002/ajh.26383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew Ho
- Division of General Internal Medicine, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Saurabh Zanwar
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Patrick Duggan
- Division of General Internal Medicine, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Ryan Carr
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Thomas Habermann
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Mohamed E. Salama
- Division of Hematopathology, Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Sameer A. Parikh
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
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8
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Dou L, Wu C, Zeng Z, Zhu J, Su L, Wang T. Hemophagocytic syndrome and neurological involvement in a case of intravascular large B-cell lymphoma. J Int Med Res 2021; 49:3000605211006644. [PMID: 34590922 PMCID: PMC8489774 DOI: 10.1177/03000605211006644] [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] [Indexed: 12/22/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin's lymphoma, and is divided into Western and Asian variants. The latter is rarely found to have neurological system involvement. In China, there have only been a few diagnosed cases of IVLBCL. Here, we present a Chinese case of Asian-variant IVLBCL with neurological symptoms. A 32-year-old Chinese man presented with bilateral lower limb numbness and persistent fever. He also complained of difficulties in urination and defecation. In addition, splenomegaly and pancytopenia were observed. We identified 3% dysplastic lymphocytes in his peripheral blood film, and his bone marrow biopsy led to a diagnosis of Asian-variant IVLBCL. Lumbar spine magnetic resonance imaging, which revealed an edematous spinal cord, further confirmed neurological involvement. The patient refused treatment from the time of diagnosis, and died 2 months after being discharged. IVLBCL is a highly aggressive but nonspecific clinical manifestation that is difficult to diagnose; therefore, a greater understanding of the disease is needed. The current first-line therapy involves R-CHOP combination therapy (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab); however, the overall prognosis of IVLBCL remains poor.
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Affiliation(s)
- Liwen Dou
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Chunbo Wu
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Zhi Zeng
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Jihong Zhu
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Lina Su
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Tianbing Wang
- Department of Trauma Center, Peking University People's Hospital, Beijing, China
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9
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Episodic Visual Distortions and Stroke-Like Symptoms in a 56-Year-Old Man With Intravascular Lymphoma. J Neuroophthalmol 2021; 40:265-270. [PMID: 32028452 DOI: 10.1097/wno.0000000000000900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A healthy 56-year-old man presented with vision changes and left upper extremity motor and sensory changes. MRI of the brain without contrast was significant for multifocal areas of restricted diffusion in multiple vascular territories. Neuro-Ophthalmic evaluation revealed an inferonasal visual field defect in the left eye, thickened choroid on optical coherence tomography, and bilateral delayed arteriovenous and choroidal filling on fluorescein angiogram. Repeat MRI demonstrated interval enlargement of many of the same foci of abnormal diffusion-weighted imaging signal. Computed tomography of the abdomen and pelvis revealed 3 distinct lobulated retroperitoneal masses that were biopsied and found to be consistent with diffuse large B-cell lymphoma. Brain biopsy specimens showed intravascular lymphocytes, confirming a diagnosis of intravascular lymphoma (IVL). In this diagnostically challenging case, a link was established between the presence of multiple strokes (some of which showed slow evolution over time) and retinochoroidal hypoperfusion, which provided a critical clue to the ultimate diagnosis of IVL.
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10
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Morigi A, Stefoni V, Argnani L, Broccoli A, Zinzani PL. Intravascular Large B-cell Lymphoma Successfully Treated with Autologous Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e678-e679. [PMID: 33972187 DOI: 10.1016/j.clml.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Alice Morigi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italy
| | - Vittorio Stefoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italy
| | - Lisa Argnani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italy
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, 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 degli Studi, Bologna, Italy.
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11
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Yoon SE, Kim WS, Kim SJ. Asian variant of intravascular large B-cell lymphoma: a comparison of clinical features based on involvement of the central nervous system. Korean J Intern Med 2020; 35:946-956. [PMID: 31752477 PMCID: PMC7373974 DOI: 10.3904/kjim.2018.396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/17/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND/AIMS There are limited data about the influence of the central nervous system (CNS) involvement on the prognosis for patients with the Asian variant of intravascular large B-cell lymphoma (IVLBCL). METHODS We analyzed 46 patients who were diagnosed with IVLBCL between 2001 and 2018. All patients were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). RESULTS CNS involvement was diagnosed by cerebrospinal fluid analysis (n = 6) and brain imaging (n = 5) in 11 patients at diagnosis, and four cases with CNS relapse were found. Thus, 15 patients had CNS involvement (15/46, 33%). The clinical characteristics were not different between patients with and without CNS involvement, but all patients with CNS involvement belonged to the high-risk group of CNS-International Prognostic Index (IPI). Thirty-one patients achieved a complete response (67%, 31/46) whereas eight patients showed disease progression and six patients died after the first or second cycle of R-CHOP. CNS-directed therapy such as high-dose methotrexate was combined with R-CHOP for patients with CNS involvement, and five patients were alive without relapse. The median overall survival of all patients was 45.0 months, and overall survival was not different according to the involvement of CNS. CONCLUSION The treatment outcome of patients with the Asian variant of IVLBCL is still not satisfactory. The prediction of CNS involvement based on the clinical features including CNS-IPI score might not serve to identify patients at high risk of CNS involvement, either. Thus, more effective strategies for diagnosis and treatment should be developed.
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Affiliation(s)
- Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
- Correspondence to Seok Jin Kim, M.D. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-1766 Fax: +82-2-3410-1754 E-mail:
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12
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Ong YC, Kao HW, Chuang WY, Hung YS, Lin TL, Chang H, Kuo MC. Intravascular Large B-cell lymphoma: A case series and review of literatures. Biomed J 2020; 44:479-488. [PMID: 32344119 PMCID: PMC8514799 DOI: 10.1016/j.bj.2020.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/04/2019] [Accepted: 04/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkin lymphoma with uncommon clinical presentations and poor prognosis. The purpose of this study is to report the clinical features and outcome of IVLBCL in a single institution of Taiwan. Methods Ten patients with IVLBCL diagnosed from June 2006 to January 2018 were retrospectively reviewed. Results The median age was 61 (range 39–88) years. The most common presentation was fever (90%), cytopenia (90%), and confusion (50%). For all patients, the median progression free survival (PFS) and overall survival (OS) were 12.6 (95% confidence interval [CI] 0.0–76.1) and 18.8 (95% CI 0–59.3) months, respectively. Six patients received rituximab combined chemotherapy, and the other one patient was treated with chemotherapy alone. Six of seven (85.7%) patients achieved complete response after chemotherapy. The median PFS and OS for six patients who completed treatment were not reached. Three-year PFS and OS rates were 80% and 75%, respectively. Conclusion Our study showed that patients might achieve durable remission after rituximab-based chemotherapy. The outcome of IVLBCL patients may further improve if early diagnosis and prompt treatment were made.
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Affiliation(s)
- Yuen-Chin Ong
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Hsiao-Wen Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Wen-Yu Chuang
- School of Medicine, Chang Gung University, Taiwan; Division of Pathology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yu-Shin Hung
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan; School of Medicine, Chang Gung University, Taiwan
| | - Tung-Liang Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Hung Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan; Center of Hemophilia and Coagulation Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Ming-Chung Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan; School of Medicine, Chang Gung University, Taiwan.
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13
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Kyle R, Mount G, Li SS, Thain J. Severe peripheral oedema as the only presenting symptom of intravascular large B-cell lymphoma: a diagnosis too frequently made on autopsy. BMJ Case Rep 2019; 12:12/5/e228802. [PMID: 31088816 DOI: 10.1136/bcr-2018-228802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Intravascular large B-cell lymphoma is seen in less than one per million people and can be an extremely difficult antemortem diagnosis to make due to a vast diversity of presenting symptoms. We present a case of an otherwise healthy 74-year-old woman whose predominant symptom was pitting oedema, and who likely died from multiorgan failure after >14 months of extensive workup that was unable to secure a definitive diagnosis.
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Affiliation(s)
- Rachel Kyle
- Department of Medicine, Division of Geriatric Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Gillian Mount
- Department of Medicine, Division of Hematology, London Health Sciences Centre, London, Ontario, Canada
| | - Shao Shi Li
- Department of Pathology, London Health Sciences Centre, London, Ontario, Canada
| | - Jenny Thain
- Department of Medicine, Division of Geriatric Medicine, London Health Sciences Centre, London, Ontario, Canada
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Pituitary Gland and Neurological Involvement in a Case of Hemophagocytic Syndrome Revealing an Intravascular Large B-Cell Lymphoma. Case Rep Hematol 2019; 2019:9625075. [PMID: 31183225 PMCID: PMC6512020 DOI: 10.1155/2019/9625075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/04/2019] [Indexed: 12/26/2022] Open
Abstract
Intravascular large B-cell lymphoma is a rare entity characterized by the proliferation of neoplastic lymphocytes in the lumen of small blood vessels and high mortality. Diagnosis of intravascular lymphoma is often delayed or established postmortem. Here, we report the case of a 48-year-old woman presenting hemophagocytic syndrome, with pituitary gland and neurological involvement. Diagnosis of intravascular large B-cell lymphoma was made on perisplenic vessels, while liver and bone marrow biopsy was noncontributive. This case demonstrates the importance of thorough histopathologic investigations in the setting of high suspicion.
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Kato K, Mori T, Kim SW, Sawa M, Sakai T, Hashimoto H, Taguchi J, Oyake T, Kurahashi S, Imada K, Ohno H, Tanaka J, Ichinohe T, Atsuta Y, Suzuki R, Suzumiya J. Outcome of patients receiving consolidative autologous peripheral blood stem cell transplantation in the frontline treatment of intravascular large B-cell lymphoma: Adult Lymphoma Working Group of the Japan Society for Hematopoietic Cell Transplantation. Bone Marrow Transplant 2019; 54:1515-1517. [DOI: 10.1038/s41409-019-0491-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/03/2019] [Accepted: 02/17/2019] [Indexed: 11/09/2022]
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Zhang Y, Zhu TN, Sun J, Zhong DR, Zhang W, Zhou DB. [Clinical characteristics of intravascular large B cell lymphoma: a single-center retrospective study]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:1004-1009. [PMID: 30612402 PMCID: PMC7348217 DOI: 10.3760/cma.j.issn.0253-2727.2018.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 提高对血管内大B细胞淋巴瘤(IVLBCL)的认识。 方法 回顾性分析北京协和医院自2010年1月至2016年6月收治的12例IVLBCL患者的临床资料。 结果 ①12例患者中,男6例,女6例,中位年龄为58.5(32~76)岁。临床表现:发热最为常见(10/12),其次为呼吸系统症状(咳嗽、呼吸困难、胸腔积液等,6/12)、噬血细胞综合征(6/12)、神经系统症状(1/12);所有患者均有LDH升高(367~1 700 U/L)、铁蛋白升高(805~1 527 µg/L)、结外器官受累(肺6例,骨髓3例,脑2例,软脑膜、肾上腺、副鼻窦、胆囊、甲状腺各1例)。②组织病理特征:光镜下可见分布于小血管内的单个或小簇状淋巴瘤细胞,毛细血管或血窦结构得以保留,免疫组化显示CD20、CD79a等B淋巴细胞标志阳性。③疗效及预后:11例患者接受CHOP或R-CHOP方案化疗,其总反应率为90.1%,完全缓解率为66.7%。患者平均随访20(1~40)个月,中位生存期及中位无进展生存期尚未达到。单因素Cox回归分析未能发现年龄、分期、IPI等临床参数与预后相关。 结论 IVLBCL临床罕见,出现肺部受累比例高,肺活检有较高阳性率;R-CHOP方案目前仍是最主要的治疗方案。
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Affiliation(s)
- Y Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Intravascular large B-cell lymphoma: a chameleon with multiple faces and many masks. Blood 2018; 132:1561-1567. [DOI: 10.1182/blood-2017-04-737445] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/01/2018] [Indexed: 12/20/2022] Open
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Small Cell Variant of Intravascular Large B-Cell Lymphoma: Highlighting a Potentially Fatal and Easily Missed Diagnosis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9413015. [PMID: 29850589 PMCID: PMC5903319 DOI: 10.1155/2018/9413015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/23/2018] [Accepted: 03/04/2018] [Indexed: 11/18/2022]
Abstract
Context Intravascular large B-cell lymphoma (IVLBCL) is a rare non-Hodgkin B-cell lymphoma with a poor prognosis. While typically described as comprising large atypical cells restricted to the lumina of small blood vessels, it can show variability in cell size. Objective To report the clinicopathologic features of the IVLBCL with small cell morphology and discuss the practical implications of our findings. Design We searched our archives for all IVLBCL diagnosed in our institution for the last 25 years (1992–2017). Slides were reviewed independently by two hematopathologists. Results We found a total of 11 cases of IVLBCL. Bone marrow, brain, lymph node, pericardium, small bowel, and fallopian tube and ovary were the organs in which the lymphoma was initially diagnosed. One of the cases initially diagnosed in the marrow showed intrasinusoidal involvement by a small cell lymphoma; the diagnosis was confirmed by random skin biopsies showing intravascular large cells with the same phenotype. Retrospective review of the liver on this case also showed the intrasinusoidal involvement by the disease consisting of small cells. In another case, IVLBCL that was initially diagnosed in a small bowel biopsy was retrospectively found in a breast biopsy, but with small cell morphology. Conclusions Our findings suggest that, in the presence of high clinical suspicion, IVLBCL should be high in the differential diagnosis when lymphoma is predominantly intravascular, even when the tumor cells are small. A timely diagnosis of this entity can be critical. Hence, awareness of a small cell variant of IVLBCL should be increased.
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