1
|
Djiwa T, Koui BBS, Aman NA, Coulibaly ZI, Kouyate M, Kouame KE. Colonic lymphomatous polyposis mantle cell lymphoma: a case report and review of literature. J Med Case Rep 2024; 18:219. [PMID: 38698463 PMCID: PMC11067287 DOI: 10.1186/s13256-024-04533-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Mantle cell lymphoma is a rare lymphoma of the gastrointestinal tract that may present as multiple lymphomatous polyposis. We report a case of lymphomatous polyposis with a review of the literature. CASE REPORT A 56-year-old man of Black ethnicity and Ivorian nationality with no relevant past medical history, consulted for a sudden onset symptoms of gastrointestinal obstruction, which evolved over 2 days. Macroscopic examination revealed the presence of multiple polyploid formations of the colonic mucosa. Histology showed diffuse lymphomatous proliferation of submucosa consisting off small lymphoid cells with a hyperchromatic crenelated nucleus, suggesting lymphomatous polyposis. Immunohistochemical examination showed expression by the tumor cells of antibodies to CD20, CD5, Bcl2, and cyclin D1. They did not express antibodies to CD10 and CD23. The Ki67 proliferation index was 25%. We have thus retained the diagnosis of mantle cell lymphomatous polyposis. CONCLUSION Multiple lymphomatous polyposis is a rare entity characterized by the presence of numerous gastrointestinal polyploid lesions sometimes involving several segments of the gastrointestinal tract. Typical lymphoma presenting as lymphomatous polyposis is mantle cell lymphoma; although, other tumors may have this aspect.
Collapse
Affiliation(s)
- Toukilnan Djiwa
- Department of Pathological Anatomy, Teaching Hospital of Lomé, BP 1515, Lomé, Togo.
| | - B B S Koui
- Department of Pathological Anatomy, Teaching Hospital of Treichville, Abidjan, Ivory Coast
| | - N A Aman
- Department of Pathological Anatomy, Teaching Hospital of Bouaké, Bouake, Ivory Coast
| | - Z I Coulibaly
- Department of Pathological Anatomy, Teaching Hospital of Treichville, Abidjan, Ivory Coast
| | - M Kouyate
- Department of Pathological Anatomy, Teaching Hospital of Treichville, Abidjan, Ivory Coast
| | - K E Kouame
- Department of Pathological Anatomy, Teaching Hospital of Treichville, Abidjan, Ivory Coast
| |
Collapse
|
2
|
Arun Kumar S, Gao J, Patel SA. The shifting therapeutic paradigm for relapsed/refractory mantle cell lymphoma. Leuk Res 2023; 134:107385. [PMID: 37672954 PMCID: PMC10888497 DOI: 10.1016/j.leukres.2023.107385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
Mantle cell lymphoma (MCL) is a heterogeneous subtype of non-Hodgkin lymphoma that has been historically associated with poor 5-year overall survival rates, especially for aggressive variants. Traditional cytotoxic chemotherapy had been a mainstay of therapy for relapsed/refractory (R/R) MCL for many years until the advent of molecularly targeted therapies and cell-based approaches. However, a significant concern is the lack of definitive consensus guidelines for management of R/R MCL. The managerial conundrum partly stems from the absence of head-to-head comparisons of novel therapies, with conclusions drawn from cross-trial comparisons. In this evidence-based review, we discuss the current therapeutic options for R/R MCL, including the most recent data from the BRUIN study that led to the approval of the first-in-class non-covalent reversible Bruton's tyrosine kinase (BTK) inhibitor pirtobrutinib in 2023, as well as the recent removal of ibrutinib from the market. We discuss outlooks for targeted therapy and tolerability considerations for novel agents, including unique considerations for the elderly population. We highlight emerging data that support the curative potential of chimeric antigen receptor-T (CAR-T) therapy from ZUMA-2, relative to other promising investigational agents in the pipeline, including glofitamab, epcoritamab, and zilovertamab vedotin. We summarize management recommendations based upon the most rigorous clinical evidence to date.
Collapse
Affiliation(s)
- Sumukh Arun Kumar
- Dept. of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Jenny Gao
- RNA Therapeutics Institute, UMass Chan Medical School, Worcester, MA, USA
| | - Shyam A Patel
- Center for Clinical and Translational Science (CCTS), UMass Chan Medical School, Worcester, MA, USA; Dept. of Medicine - Division of Hematology/Oncology, UMass Memorial Medical Center, UMass Chan Medical School, Worcester, MA, USA.
| |
Collapse
|
3
|
Till KJ, Abdullah M, Alnassfan T, Janet GZ, Marks T, Coma S, Weaver DT, Pachter JA, Pettitt AR, Slupsky JR. Roles of PI3Kγ and PI3Kδ in mantle cell lymphoma proliferation and migration contributing to efficacy of the PI3Kγ/δ inhibitor duvelisib. Sci Rep 2023; 13:3793. [PMID: 36882482 PMCID: PMC9992372 DOI: 10.1038/s41598-023-30148-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
Mantle cell lymphoma (MCL) is an aggressive B-cell non-Hodgkin lymphoma that is incurable with existing therapies, and therefore presents a significant unmet clinical need. The ability of this disease to overcome therapy, including those that target the B cell receptor pathway which has a pathogenic role in MCL, highlights the need to develop new treatment strategies. Herein, we demonstrate that a distinguishing feature of lymph node resident MCL cells is the expression of phosphatidylinositol 3-kinase γ (PI3Kγ), a PI3K isoform that is not highly expressed in other B cells or B-cell malignancies. By exploring the role of PI3K in MCL using different PI3K isoform inhibitors, we provide evidence that duvelisib, a dual PI3Kδ/γ inhibitor, has a greater effect than PI3Kδ- and PI3Kγ-selective inhibitors in blocking the proliferation of primary MCL cells and MCL cell lines, and in inhibiting tumour growth in a mouse xenograft model. In addition, we demonstrated that PI3Kδ/γ signalling is critical for migration of primary MCL cells and cell lines. Our data indicates that aberrant expression of PI3Kγ is a critical feature of MCL pathogenesis. Thus, we suggest that the dual PI3Kδ/γ duvelisib would be effective for the treatment of mantle cell lymphoma.
Collapse
Affiliation(s)
- Kathleen J Till
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK.
| | - Mariah Abdullah
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK
| | - Tahera Alnassfan
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK
| | - Gallardo Zapata Janet
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK
| | - Thomas Marks
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK
| | - Silvia Coma
- Verastem Oncology, 117 Kendrick St #500, Needham, MA, 02494, USA
| | - David T Weaver
- Verastem Oncology, 117 Kendrick St #500, Needham, MA, 02494, USA
| | | | - Andrew R Pettitt
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK
| | - Joseph R Slupsky
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Ashton Street, Liverpool, L69 3GE, UK
| |
Collapse
|
4
|
Karmali R, Switchenko JM, Goyal S, Shanmugasundaram K, Churnetski MC, Kolla B, Bachanova V, Gerson JN, Barta SK, Gordon MJ, Danilov AV, Grover NS, Epperla N, Mathews S, Burkart M, Sawalha Y, Hill BT, Ghosh N, Park SI, Bond DA, Maddocks KJ, Badar T, Fenske TS, Hamadani M, Guo J, Malecek M, Kahl BS, Martin P, Blum KA, Flowers CR, Cohen JB. Multi-center analysis of practice patterns and outcomes of younger and older patients with mantle cell lymphoma in the rituximab era. Am J Hematol 2021; 96:1374-1384. [PMID: 34324220 DOI: 10.1002/ajh.26306] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/21/2022]
Abstract
Clinical outcomes and predictors of survival in patients with newly diagnosed mantle cell lymphoma (MCL) treated in the rituximab era (2000-2015) at 12 US academic centers were assessed to identify determinants of survival across age groups. Objectives were to characterize and compare practice patterns, outcomes and prognostic factors for survival in younger patients (age < 65) and older patients (age ≥ 65 years). Among 1162 patients included, 697 were younger and 465 were older. In younger patients, 2-year progression free survival (PFS) and overall survival (OS) rates were 79% and 92% respectively; blastoid histology, ECOG ≥ 2, and lack of maintenance rituximab (MR) remained statistically relevant to poor OS on univariate analysis (UVA) and multivariate analysis (MVA). In older patients, 2-year PFS and OS rates were 67% and 86% respectively; lack of maintenance rituximab remained significantly associated with inferior PFS and OS on UVA and MVA (p < 0.001). Two-year PFS rates were 79%, and 67% and 2-year OS rates were 92% and 86% for ages < 65 and ≥ 65 respectively (p < 0.001). First-line high-dose cytarabine exposure and/or MR lessened the negative impact of age on survival. Taken collectively, survival outcomes for older patients remain inferior to those of younger patients in the rituximab era. However, maintenance rituximab and potentially high-dose cytarabine-based induction can mitigate the negative impact of age on survival.
Collapse
Affiliation(s)
- Reem Karmali
- Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center Chicago Illinois USA
| | | | - Subir Goyal
- Department of Biostatistics and Bioinformatics Emory University Atlanta Georgia USA
| | | | | | | | | | | | - Stefan K. Barta
- Fox Chase Cancer Center Philadelphia Pennsylvania USA
- University of Pennsylvania Philadelphia Pennsylvania USA
| | - Max J. Gordon
- Knight Cancer Institute Oregon Health & Science University Portland Oregon USA
| | - Alexey V. Danilov
- Knight Cancer Institute Oregon Health & Science University Portland Oregon USA
| | - Natalie S. Grover
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center Chapel Hill North Carolina USA
| | | | - Stephanie Mathews
- University of North Carolina, Chapel Hill, Lineberger Comprehensive Cancer Center Chapel Hill North Carolina USA
| | - Madelyn Burkart
- Northwestern University Feinberg School of Medicine; Robert H. Lurie Comprehensive Cancer Center Chicago Illinois USA
| | - Yazeed Sawalha
- The Ohio State University Columbus Ohio USA
- Cleveland Clinic Cleveland Ohio USA
| | | | - Nilanjan Ghosh
- Levine Cancer Institute, Atrium Health Charlotte North Carolina USA
| | - Steven I. Park
- Levine Cancer Institute, Atrium Health Charlotte North Carolina USA
| | | | | | - Talha Badar
- Medical College of Wisconsin Milwaukee Wisconsin USA
| | | | | | - Jin Guo
- Weill Cornell Medical College Manhattan New York USA
| | - Mary Malecek
- Washington University in St. Louis St Louis Missouri USA
| | - Brad S. Kahl
- Washington University in St. Louis St Louis Missouri USA
| | - Peter Martin
- Weill Cornell Medical College Manhattan New York USA
| | - Kristie A. Blum
- Winship Cancer Institute of Emory University Atlanta Georgia USA
- The Ohio State University Columbus Ohio USA
| | | | | |
Collapse
|
5
|
SOX11, CD70 and Treg cells configure the tumor immune microenvironment of aggressive mantle cell lymphoma. Blood 2021; 138:2202-2215. [PMID: 34189576 DOI: 10.1182/blood.2020010527] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/16/2021] [Indexed: 11/20/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a mature B-cell neoplasm with a heterogeneous clinical and biological behavior. SOX11 oncogenic expression contributes to the aggressiveness of these tumors by different mechanisms including tumor and stromal cell interactions. However, the precise composition of the immune cell microenvironment of MCL, its possible relationship to SOX11 expression, and how it may contribute to tumor behavior is not well known. Here, we performed an integrative transcriptome analysis of 730 immune-related genes combined with the immune cell phenotype analysis by immunohistochemistry in SOX11+ and SOX11- primary nodal MCL cases and non-neoplastic reactive lymph nodes (RLN). SOX11+ MCL had a significant lower T-cell intratumoral infiltration compared to negative cases. A reduced expression of MHCI/II-like and T-cell costimulation and signaling activation related transcripts was significantly associated with poor clinical outcome. Moreover, we identified CD70 as a SOX11 direct target gene, whose overexpression was induced in SOX11+ but not SOX11- tumor cells by CD40L in vitro. CD70 was overexpressed in primary SOX11+ MCL and it was associated with an immune unbalance of the tumor microenvironment characterized by increased number of effector Treg cell infiltration, higher proliferation, and aggressive clinical course. CD27 was expressed with moderate to strong intensity in 76% of cases. Overall, our results suggest that SOX11 expression in MCL is associated with an immunosuppressive microenvironment characterized by CD70 overexpression in tumor cells, increased Treg cell infiltration and downmodulation of antigen-processing and -presentation and T-cell activation that could promote MCL progression and represent a potential target for tailored therapies.
Collapse
|
6
|
Zanubrutinib for the treatment of relapsed or refractory mantle cell lymphoma. Blood Adv 2021; 5:2577-2585. [PMID: 34152395 DOI: 10.1182/bloodadvances.2020004074] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
Zanubrutinib, a highly selective Bruton tyrosine kinase inhibitor, was evaluated in a phase 1/2 study in patients with various B-cell malignancies. In the subgroup of patients with relapsed/refractory (R/R) mantle cell lymphoma (MCL), zanubrutinib was administered as 160 mg twice daily (n = 14), 320 mg once daily (n = 18), or ≤160 mg total dose (n = 5). Herein, we report results for patients receiving a total daily dose of 320 mg (N = 32). Median study follow-up was 18.8 months. Eighteen patients discontinued treatment, 10 because of progressive disease and 8 because of adverse events (AEs); 1 AE (peripheral edema) was considered to be related to zanubrutinib treatment. The most common AEs were diarrhea (43.8%), contusion (37.5%), constipation (31.3%), and upper respiratory tract infection (31.3%). Infection was the most commonly reported AE of interest (18.8% of patients experienced grade ≥3 infection). At least 1 AE of grade ≥3 was reported in 59.4% of patients; grade ≥3 AEs that were reported in >2 patients were anemia (12.5%), pneumonia (9.4%), and myalgia (9.4%). Overall response rate was 84%, with 25% achieving a complete response. Median duration of response was 18.5 months. Median progression-free survival (PFS) was 21.1 months. Zanubrutinib was well tolerated and demonstrated activity in patients with R/R MCL. The trial is registered at www.clinicaltrials.gov as #NCT02343120.
Collapse
|
7
|
Buege MJ, Kumar A, Dixon BN, Tang LA, Pak T, Orozco J, Peterson TJ, Maples KT. Management of Mantle Cell Lymphoma in the Era of Novel Oral Agents. Ann Pharmacother 2020; 54:879-898. [PMID: 32079411 PMCID: PMC8330616 DOI: 10.1177/1060028020909117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objectives: To discuss (1) recent and emerging data for pharmacological management of untreated and relapsed/refractory (R/R) mantle cell lymphoma (MCL) with agents approved in the United States, (2) important considerations for toxicity monitoring and management, and (3) preliminary data and ongoing studies for agents in MCL-specific clinical trials. Data Sources: PubMed/MEDLINE, EMBASE, Google Scholar, product labeling, National Comprehensive Cancer Network, American Cancer Society, and ClinicalTrials.gov were searched for studies published between January 1, 2017, and January 31, 2020, and key historical trials. Study Selection and Data Extraction: Relevant studies conducted in humans and selected supporting preclinical data were reviewed. Data Synthesis: MCL is a rare but usually aggressive non-Hodgkin lymphoma that most commonly affects the older population. Traditionally, the treatment of MCL has been determined based on transplant eligibility. Newer data suggest that more tolerable frontline therapy may produce outcomes similar to intensive historical induction regimens, possibly precluding fewer patients from autologous stem cell transplant and producing better long-term outcomes in transplant-ineligible patients. In the R/R setting, novel regimens are improving outcomes and changing the landscape of treatment. Relevance to Patient Care and Clinical Practice: This review summarizes and discusses recent and emerging data for management of newly diagnosed and R/R MCL; key supportive care considerations for agents are also discussed. Conclusions: Recent study results are changing management of MCL. Although these data have complicated the picture of regimen selection, increasingly effective and tolerable therapy and additional anticipated data point to a brighter future for patients with MCL.
Collapse
Affiliation(s)
| | - Anita Kumar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Laura A Tang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Terry Pak
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Tim J Peterson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
8
|
Dunleavy K. Epigenetic targeting in mantle cell lymphoma. Br J Haematol 2019; 186:805-806. [PMID: 31489625 DOI: 10.1111/bjh.16192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kieron Dunleavy
- George Washington University Cancer Center, Washington, DC, USA
| |
Collapse
|