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El Hussein S, Wang W. Flow Cytometry Profiling of Plasmacytoid Dendritic Cell Neoplasms. Cancers (Basel) 2024; 16:2118. [PMID: 38893237 PMCID: PMC11171351 DOI: 10.3390/cancers16112118] [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: 05/01/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
In this review, we aim to provide a summary of the diverse immunophenotypic presentations of distinct entities associated with plasmacytoid dendritic cell (pDC) proliferation. These entities include the following: (1) blastic plasmacytoid dendritic cell neoplasm (BPDCN); (2) mature pDC proliferation (MPDCP), most commonly seen in chronic myelomonocytic leukemia (CMML); and (3) myeloid neoplasms with pDC differentiation, in which pDCs show a spectrum of maturation from early immature pDCs to mature forms, most commonly seen in acute myeloid leukemia (pDC-AML). Our aim is to provide a flow cytometry diagnostic approach to these distinct and sometimes challenging entities and to clarify the immunophenotypic spectrum of neoplastic pDCs in different disease presentations. In this review, we also cover the strategies in the evaluation of residual disease, as well as the challenges and pitfalls we face in the setting of immune and targeted therapy. The differential diagnosis will also be discussed, as blasts in some AML cases can have a pDC-like immunophenotype, mimicking pDCs.
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Affiliation(s)
- Siba El Hussein
- Department of Pathology, University of Vermont Larner College of Medicine, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Wei Wang
- Department of Hematopathology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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2
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Suzuki H, Takeshita M, Hirai R, Tanimura A, Miwa A. Blastic Plasmacytoid Dendritic Cell Neoplasm Developed in Chronic Myeloid Leukemia in Molecular Remission During a Four-Year Treatment-Free Interval After Six Years of Dasatinib Treatment. Cureus 2024; 16:e61944. [PMID: 38978909 PMCID: PMC11229451 DOI: 10.7759/cureus.61944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy affecting multiple sites, most commonly the skin. About 10-20% of BPDCN cases are accompanied by hematological neoplasms. A 71-year-old male was diagnosed with chronic myeloid leukemia in the chronic phase (CML-CP) 11 years prior (at 60 years of age), and dasatinib treatment was initiated. A major molecular response (MMR) was achieved 18 months after diagnosis, and the molecular response (MR)4.0 lasted beyond 36 months. Due to pancytopenia, dasatinib was discontinued at 74 months, but the CML-CP remained undetectable. One hundred and twenty-two months after the diagnosis, the patient presented with cutaneous lesions on the forehead and abdomen. Immunological and histological analyses of the skin biopsy showed infiltration of atypical cells from the deep epidermis to the entire dermis, expressing clusters of differentiation (CD) 4, CD56, and CD123 without any other markers. The same cells were observed in bone marrow samples. BPDCN was diagnosed, followed by chemotherapy and possibly autologous or allogeneic hematopoietic stem cell transplantation (HSCT). To the best of our knowledge, this is the first case report of the development of BPDCN in a patient with CML in molecular remission. Further studies are required to clarify the pathogenesis of BPDCN in patients with hematological malignancies in remission.
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Affiliation(s)
- Hiroshi Suzuki
- Department of Hematology, Tokyo Kita Medical Center, Tokyo, JPN
| | | | - Risen Hirai
- Department of Hematology, Tokyo Kita Medical Center, Tokyo, JPN
| | - Akira Tanimura
- Department of Hematology, Tokyo Kita Medical Center, Tokyo, JPN
| | - Akiyoshi Miwa
- Department of Hematology, Tokyo Kita Medical Center, Tokyo, JPN
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3
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Peng J, He S, Yang X, Huang L, Wei J. Plasmacytoid dendritic cell expansion in myeloid neoplasms: A novel distinct subset of myeloid neoplasm? Crit Rev Oncol Hematol 2023; 192:104186. [PMID: 37863402 DOI: 10.1016/j.critrevonc.2023.104186] [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] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
Plasmacytoid dendritic cells (pDCs) are a specific dendritic cell type stemming from the myeloid lineage. Clinically and pathologically, neoplasms associated with pDCs are classified as blastic plasmacytoid dendritic cell neoplasm (BPDCN), mature plasmacytoid dendritic myeloid neoplasm (MPDMN) and pDC expansion in myeloid neoplasms (MNs). BPDCN was considered a rare and aggressive neoplasm in the 2016 World Health Organization (WHO) classification. MPDMN, known as mature pDC-derived neoplasm, is closely related to MNs and was first recognized in the latest 2022 WHO classification, proposing a new concept that acute myeloid leukemia cases could show clonally expanded pDCs (pDC-AML). With the advances in detection techniques, an increasing number of pDC expansion in MNs have been reported, but whether the pathogenesis is similar to that of MPDMN remains unclear. This review focuses on patient characteristics, diagnosis and treatment of pDC expansion in MNs to gain further insight into this novel and unique provisional subtype.
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Affiliation(s)
- Juan Peng
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei 430030, China
| | - Shaolong He
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - Xingcheng Yang
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei 430030, China
| | - Liang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei 430030, China.
| | - Jia Wei
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei 430030, China; Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China; Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, 030032 Taiyuan, Shanxi, China.
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4
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Tong J, Aksenov S, Siegel BM, Wei L, Rodgers WH. A Rare Case of Blastic Plasmacytoid Dendritic Cell Neoplasm Occurred in Postchemotherapy of Breast Cancer. Case Rep Hematol 2023; 2023:7573037. [PMID: 37457315 PMCID: PMC10344635 DOI: 10.1155/2023/7573037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/29/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and highly aggressive hematologic malignancy that arises from plasmacytoid dendritic cells. BPDCN typically presents with skin lesions and may involve peripheral blood, bone marrow, lymph nodes, or extranodal sites. It usually arises de novo, and some BPDCN cases are associated with or develop into myeloid neoplasms. Here, we report a case of a 57-year-old female presenting with cervical lymphadenopathy and skin rashes during the COVID-19 pandemic in 2021 following multiple types of postmastectomy therapy for breast cancer. The patient was ultimately diagnosed with BPCDN by lymph node biopsy. To the best of our knowledge, this is the first case report of BPDCN occurring postchemotherapy of breast cancer.
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Affiliation(s)
- Jiankun Tong
- Department of Pathology, New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - Sergei Aksenov
- Department of Pathology, New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
| | - Beth M. Siegel
- Department of Surgery, Section of Breast Surgery, New York Presbyterian Queens, 58-04 Main Street, Flushing, NY 11355, USA
| | - Lihong Wei
- Consultant Hematology & Medical Oncology, Queens Medical Associates, 176-60 Union Tpke # 360, Fresh Meadows, NY 11366, USA
| | - William H. Rodgers
- Department of Pathology, New York Presbyterian Queens, 56-45 Main Street, Flushing, NY 11355, USA
- Weill Cornell Medical College, 525 East 68th Street, Box 130, New York, NY 10065, USA
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5
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Agarwal A, Amit M, Chaffin J, Strobel A. Blastic plasmacytoid dendritic cell neoplasm in an adolescent female: a rare entity with challenging diagnosis and management. BMJ Case Rep 2023; 16:e254008. [PMID: 37258047 PMCID: PMC10254603 DOI: 10.1136/bcr-2022-254008] [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] [Indexed: 06/02/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm is a rare and aggressive haematopoietic neoplasm with poor prognosis. It usually presents with cutaneous lesions and symptoms secondary to bone marrow involvement. Due to rarity and lack of standard treatment protocols, these cases are difficult to diagnose and treat. We report a case of a female in early adolescence who presented with skin nodules on the leg. The diagnosis was established by immunophenotypic studies. We discuss the investigations and treatment options available to diagnose and treat this malignancy.
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Affiliation(s)
- Ankit Agarwal
- Pediatrics, Ascension Sacred Heart Hospital Pensacola, Pensacola, Florida, USA
| | - Michelle Amit
- Pediatrics, Ascension Sacred Heart Hospital Pensacola, Pensacola, Florida, USA
| | - Joanna Chaffin
- Department of Pathology, University of Florida, Gainesville, Florida, USA
| | - Amanda Strobel
- Pediatric Hematology/Oncology, University of Florida, Pensacola, Florida, USA
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6
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Wu SJ, Sadigh S, Lane AA, Pinkus GS. Expanding the Immunophenotypic Spectrum of Neoplastic and Reactive Plasmacytoid Dendritic Cells. Am J Clin Pathol 2023; 159:455-463. [PMID: 36880313 PMCID: PMC10893858 DOI: 10.1093/ajcp/aqac174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/07/2022] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES Targeted therapies for blastic plasmacytoid dendritic cell neoplasm (BPDCN) have presented a diagnostic dilemma for differentiating residual BPDCN from reactive plasmacytoid dendritic cells (pDCs) because these conditions have a similar immunoprofile, necessitating discovery of additional diagnostic markers. METHODS Fifty cases of BPDCN involving bone marrow (26/50) and skin (24/50) as well as other hematologic malignancies (67) and nonneoplastic samples (37) were included. Slides were stained using a double-staining protocol for the following immunohistochemical marker combinations: TCF4/CD123, TCF4/CD56, SOX4/CD123, and IRF8/CD123. RESULTS The nuclear marker SOX4 is expressed in neoplastic pDCs; in our cohort, SOX4/CD123 showed 100% sensitivity and 98% specificity in distinguishing BPDCN from reactive pDCs and other neoplasms. TCF4/CD56 had a 96% sensitivity and 100% specificity for BPDCN. IRF8 is a nonspecific marker that is positive in BPDCN and pDCs as well as other myeloid malignancies. CONCLUSIONS The novel immunohistochemical combination SOX4/CD123 distinguishes BPDCN, including CD56-negative BPDCN, from both reactive pDCs and other neoplasms. Because of their high diagnostic sensitivity and specificity, the double-staining marker combinations TCF4/CD123, TCF4/CD56, and SOX4/CD123 can be used to confirm lineage in BPDCN cases and detect minimal/measurable residual disease in tissue specimens.
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Affiliation(s)
- Sarah J Wu
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, US
| | - Sam Sadigh
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, US
| | - Andrew A Lane
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, US
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7
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El Hussein S, Wang W. Plasmacytoid dendritic cells in the setting of myeloid neoplasms: Diagnostic guide to challenging pathologic presentations. Br J Haematol 2023; 200:545-555. [PMID: 36606610 DOI: 10.1111/bjh.18632] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
In this article, we describe three broad pathologic presentations of plasmacytoid dendritic cells (pDCs) that may be encountered in clinical practice, in which an association between pDCs and myeloid neoplasms is identified: (1) myeloid neoplasms with mature pDC expansion, most commonly seen in chronic myelomonocytic leukaemia (CMML); (2) myeloid neoplasms with pDC differentiation, in which pDCs show a spectrum of maturation from early immature pDCs to mature forms, most commonly seen in acute myeloid leukaemia (AML); (3) myeloid neoplasms associated with blastic plasmacytoid dendritic cell neoplasm (BPDCN), either stemming from the same precursor or representing an independent clonal process. Additionally, we also discuss AML with pDC-like phenotype, in which myeloblasts show immunophenotypic features that may mimic those seen in pDCs. Using these presentations, we provide a diagnostic algorithm for appropriate pathologic classification, while attempting to clarify and homogenize nomenclatures pertaining to different biologic states of pDCs.
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Affiliation(s)
- Siba El Hussein
- Department of Pathology, University of Rochester Medical Center, Rochester, New York, USA
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Higgins MJ, Harrop S, Lade S, Prince HM, McCormack C, Campbell BA. Unifocal cutaneous blastic plasmacytoid dendritic cell neoplasm with a favorable response following high-dose radiotherapy alone. Leuk Lymphoma 2022; 63:3004-3007. [PMID: 35904420 DOI: 10.1080/10428194.2022.2105326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Martin J Higgins
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sean Harrop
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen Lade
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H Miles Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Christopher McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.,Department of Clinical Pathology, The University of Melbourne, Parkville, Australia
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9
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Renosi F, Callanan M, Lefebvre C. Genetics and Epigenetics in Neoplasms with Plasmacytoid Dendritic Cells. Cancers (Basel) 2022; 14:cancers14174132. [PMID: 36077669 PMCID: PMC9454802 DOI: 10.3390/cancers14174132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Differential diagnosis between Blastic pDC Neoplasm (BPDCN) and Acute Myeloid Leukemia with pDC expansion (pDC-AML) is particularly challenging, and genomic features can help in diagnosis. This review aims at clarifying recent data on genomics features because the past five years have generated a large amount of original data regarding pDC neoplasms. The genetic landscape of BPDCN is now well-defined, with important updates concerning MYC/MYC rearrangements, but also epigenetic defects and novel concepts in oncogenic and immune pathways. Concerning pDC-AML, they now appear to exhibit an original mutation landscape, especially with RUNX1 mutations, which is of interest for diagnostic criteria and for therapeutic purposes. We highlight here these two different profiles, which contribute to differential diagnosis between BPDCN and pDC-AML. This point is particularly important for the study of different therapeutic strategies between BPDCN and AML. Abstract Plasmacytoid Dendritic Cells (pDC) are type I interferon (IFN)-producing cells that play a key role in immune responses. Two major types of neoplastic counterparts for pDC are now discriminated: Blastic pDC Neoplasm (BPDCN) and Mature pDC Proliferation (MPDCP), associated with myeloid neoplasm. Two types of MPDCP are now better described: Chronic MyeloMonocytic Leukemia with pDC expansion (pDC-CMML) and Acute Myeloid Leukemia with pDC expansion (pDC-AML). Differential diagnosis between pDC-AML and BPDCN is particularly challenging, and genomic features can help for diagnosis. Here, we systematically review the cytogenetic, molecular, and transcriptional characteristics of BPDCN and pDC-AML. BPDCN are characterized by frequent complex karyotypes with recurrent MYB/MYC rearrangements as well as recurrent deletions involving ETV6, IKZF1, RB1, and TP53 loci. Epigenetic and splicing pathways are also particularly mutated, while original processes are dysregulated, such as NF-kB, TCF4, BCL2, and IFN pathways; neutrophil-specific receptors; and cholinergic signaling. In contrast, cytogenetic abnormalities are limited in pDC-AML and are quite similar to other AML. Interestingly, RUNX1 is the most frequently mutated gene (70% of cases). These typical genomic features are of potential interest for diagnosis, and also from a prognostic or therapeutic perspective.
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Affiliation(s)
- Florian Renosi
- INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, F-25000 Besancon, France
- Laboratoire d’Hématologie et d’Immunologie Régional, Etablissement Français du Sang Bourgogne Franche-Comté, F-25000 Besancon, France
- Correspondence:
| | - Mary Callanan
- INSERM 1231 and 1209, University of Bourgogne-Franche Comté, F-21000 Dijon, France
- Service d’Oncologie Génétique, CHU Dijon Bourgogne, F-21000 Dijon, France
| | - Christine Lefebvre
- INSERM 1209 and CNRS UMR 5309, Université Grenoble-Alpes, F-38000 Grenoble, France
- Laboratoire de Génétique des hémopathies, Institut de Biologie et de Pathologie, CHU Grenoble Alpes, F-38000 Grenoble, France
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10
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Ashok Kumar P, Ombada M, Pemmasani G, Tambe A, Banki K, Gentile T. Liposomal Daunorubicin and Cytarabine, a Potential Therapy for Blastic Plasmacytoid Dendritic Cell Neoplasm. J Investig Med High Impact Case Rep 2022; 10:23247096221127114. [DOI: 10.1177/23247096221127114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare aggressive malignancy with poor outcomes. Although novel options like tagraxofusp, a CD123-directed cytotoxin, has emerged and is promising, treatment options are very limited in the relapsed and recurrent setting. We present a case of refractory BPDCN in a 62-year-old man who showed a complete bone marrow response to liposomal daunorubicin and cytarabine (vyxeos).
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Affiliation(s)
| | | | | | - Ajay Tambe
- SUNY Upstate University Hospital, Syracuse, USA
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11
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Cianga VA, Dănăilă CD, Antohe I, Oană R, Mențel M, Ivanov I, Dragoș L, Dăscălescu AS. A very rare case of FLT3-D835 positive blastic plasmacytoid dendritic cell neoplasm. Arch Clin Cases 2021; 7:57-62. [PMID: 34754929 PMCID: PMC8565708 DOI: 10.22551/2020.29.0704.10174] [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] [Indexed: 11/25/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasms (BPDCNs) are extremely rare and aggressive hematological malignancies that derive from precursors of plasmacytoid dendritic cells (pDC) and frequently involve skin lesions and bone marrow infiltration. They mostly affect the elderly population and the prognosis is poor with the therapeutic choices currently available. Diagnosis is made with the help of tools such as immunohistochemistry and flow cytometry. Here, we present a particular case of BPDCN with a positive FLT3-D835 mutation and we discuss the possible impact this may have on the evolution of the disease and response to treatment.
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Affiliation(s)
- Vlad Andrei Cianga
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,Department of Clinical Hematology, Regional Institute of Oncology, Iasi, Romania
| | - Cătălin Doru Dănăilă
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,Department of Clinical Hematology, Regional Institute of Oncology, Iasi, Romania
| | - Ion Antohe
- Department of Clinical Hematology, Regional Institute of Oncology, Iasi, Romania
| | - Raluca Oană
- Department of Cytology, Regional Institute of Oncology, Iasi, Romania
| | - Mihaela Mențel
- Department of Immunophenotyping, Regional Institute of Oncology, Iasi, Romania
| | - Iuliu Ivanov
- Department of Molecular Diagnostics, Regional Institute of Oncology, Iasi, Romania
| | - Loredana Dragoș
- Department of Molecular Diagnostics, Regional Institute of Oncology, Iasi, Romania
| | - Angela Smaranda Dăscălescu
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania.,Department of Clinical Hematology, Regional Institute of Oncology, Iasi, Romania
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12
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Cheng W, Yu TT, Tang AP, He Young K, Yu L. Blastic Plasmacytoid Dendritic Cell Neoplasm: Progress in Cell Origin, Molecular Biology, Diagnostic Criteria and Therapeutic Approaches. Curr Med Sci 2021; 41:405-419. [PMID: 34218354 DOI: 10.1007/s11596-021-2393-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/23/2021] [Indexed: 12/13/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy characterized by recurrent skin nodules, an aggressive clinical course with rapid involvement of hematological organs, and a poor prognosis with poor overall survival. BPDCN is derived from plasmacytoid dendritic cells (pDCs) and its pathogenesis is unclear. The tumor cells show aberrant expression of CD4, CD56, interleukin-3 receptor alpha chain (CD123), blood dendritic cell antigen 2 (BDCA 2/CD303), blood dendritic cell antigen 4 (BDCA4) and transcription factor (E protein) E2-2 (TCF4). The best treatment drugs are based on experience by adopting those used for either leukemia or lymphoma. Relapse with drug resistance generally occurs quickly. Stem cell transplantation after the first complete remission is recommended and tagraxofusp is the first targeted therapy. In this review, we summarize the differentiation of BPDCN from its cell origin, its connection with normal pDCs, clinical characteristics, genetic mutations and advances in treatment of BPDCN. This review provides insights into the mechanisms of and new therapeutic approaches for BPDCN.
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Affiliation(s)
- Wei Cheng
- Department of Hematology, the Second Affiliate Hospital of Nanchang University, Nanchang, 330006, China
| | - Tian-Tian Yu
- Department of Hematology, the Second Affiliate Hospital of Nanchang University, Nanchang, 330006, China
| | - Ai-Ping Tang
- Department of Hematology, the Second Affiliate Hospital of Nanchang University, Nanchang, 330006, China
| | - Ken He Young
- Division of Hematopathology and Department of Pathology, Duke University Medical Center, Durham, 27710, USA
| | - Li Yu
- Department of Hematology, the Second Affiliate Hospital of Nanchang University, Nanchang, 330006, China.
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13
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Transcriptomic and genomic heterogeneity in blastic plasmacytoid dendritic cell neoplasms: from ontogeny to oncogenesis. Blood Adv 2021; 5:1540-1551. [PMID: 33687433 DOI: 10.1182/bloodadvances.2020003359] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/30/2020] [Indexed: 12/12/2022] Open
Abstract
Oncogenesis and ontogeny of blastic plasmacytoid dendritic cell neoplasm (BPDCN) remain uncertain, between canonical plasmacytoid dendritic cells (pDCs) and AXL+ SIGLEC6+ DCs (AS-DCs). We compared 12 BPDCN to 164 acute leukemia by Affymetrix HG-U133 Plus 2.0 arrays: BPDCN were closer to B-cell acute lymphoblastic leukemia (ALL), with enrichment in pDC, B-cell signatures, vesicular transport, deubiquitination pathways, and AS-DC signatures, but only in some cases. Importantly, 1 T-cell ALL clustered with BPDCN, with compatible morphology, immunophenotype (cCD3+ sCD3- CD123+ cTCL1+ CD304+), and genetics. Many oncogenetic pathways are deregulated in BPDCN compared with normal pDC, such as cell-cycle kinases, and importantly, the transcription factor SOX4, involved in B ontogeny, pDC ontogeny, and cancer cell invasion. High-throughput sequencing (HaloPlex) showed myeloid mutations (TET2, 62%; ASXL1, 46%; ZRSR2, 31%) associated with lymphoid mutations (IKZF1), whereas single-nucleotide polymorphism (SNP) array (Affymetrix SNP array 6.0) revealed frequent losses (mean: 9 per patient) involving key hematological oncogenes (RB1, IKZF1/2/3, ETV6, NR3C1, CDKN2A/B, TP53) and immune response genes (IFNGR, TGFB, CLEC4C, IFNA cluster). Various markers suggest an AS-DC origin, but not in all patients, and some of these abnormalities are related to the leukemogenesis process, such as the 9p deletion, leading to decreased expression of genes encoding type I interferons. In addition, the AS-DC profile is only found in a subgroup of patients. Overall, the cellular ontogenic origin of BPDCN remains to be characterized, and these results highlight the heterogeneity of BPDCN, with a risk of a diagnostic trap.
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14
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Lee HJ, Park HM, Ki SY, Choi YD, Yun SJ, Lim HS. Blastic plasmacytoid dendritic cell neoplasm of the breast: A case report and review of the literature. Medicine (Baltimore) 2021; 100:e25699. [PMID: 34106594 PMCID: PMC8133119 DOI: 10.1097/md.0000000000025699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an uncommon and aggressive hematologic malignancy that arises from plasmacytoid dendritic cells. BPDCN typically presents with skin lesions with or without involvement of lymph nodes, peripheral blood, or bone marrow. However, breast involvement of BPDCN is rare and there has been no report describing the radiologic features of BPDCN within breast parenchyma. PATIENT CONCERNS We report a case of a 47-year-old woman who presented with an incidentally detected hypermetabolic breast lesion on PET/CT with concurrent right cheek plaque. DIAGNOSES Skin biopsy was performed for the right cheek plaque. Mammography and breast ultrasonography were performed to evaluate the breast lesion. The lesion was depicted as a 2.5 cm sized focal asymmetry on mammogram and an irregular heterogeneous echoic mass within the mammary zone of the right upper outer breast. Core needle biopsy was performed for the breast lesion. Histologic diagnosis of the two lesions was BPDCN. INTERVENTIONS The patient was treated with induction and consolidation chemotherapy and received allogenic peripheral blood stem cell transplantation. OUTCOMES The patient remains in complete remission state without relapse at 34 months since initial diagnosis. LESSONS This is the first case of BPDCN manifested as a breast parenchymal mass and assessed by diagnostic breast imaging tools (mammography and ultrasonography). This case report is significant for BPDCN within the breast parenchyma and presenting rare radiologic description of BPDCN.
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Affiliation(s)
| | | | | | | | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Republic of Korea
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15
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George TI, Bajel A. Diagnosis of rare subtypes of acute myeloid leukaemia and related neoplasms. Pathology 2021; 53:312-327. [PMID: 33676766 DOI: 10.1016/j.pathol.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
The diagnosis of acute myeloid leukaemia and related neoplasms in adults is challenging as this requires the integration of clinical findings, morphology, immunophenotype, cytogenetics, and molecular genetic findings. Lack of familiarity with rare subtypes of acute leukaemia hinders the diagnosis. In this review, we will describe diagnostic findings of several rare acute myeloid leukaemias and related neoplasms that primarily occur in adults including information on presentation, morphology, immunophenotype, genetics, differential diagnosis, and prognosis. Leukaemias discussed include blastic plasmacytoid dendritic cell neoplasm, acute myeloid leukaemia with t(6;9) (p23;q34.1); DEK-NUP214, acute myeloid leukaemia with inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM, acute myeloid leukaemia with BCR-ABL1, acute leukaemias of ambiguous lineage, acute myeloid leukaemia with mutated RUNX1, pure erythroid leukaemia, acute panmyelosis with myelofibrosis, and acute basophilic leukaemia. Case studies with morphological features of the nine subtypes of acute myeloid leukaemia and related neoplasms have been included, and additional evidence available since publication of the 2016 World Health Organization Classification has been added to each subtype.
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Affiliation(s)
- Tracy I George
- University of Utah School of Medicine, Department of Pathology, Salt Lake City, UT, USA.
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre, The Royal Melbourne Hospital, Melbourne, Vic, Australia
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16
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Wang W, Khoury JD, Miranda RN, Jorgensen JL, Xu J, Loghavi S, Li S, Pemmaraju N, Nguyen T, Medeiros LJ, Wang SA. Immunophenotypic characterization of reactive and neoplastic plasmacytoid dendritic cells permits establishment of a 10-color flow cytometric panel for initial workup and residual disease evaluation of blastic plasmacytoid dendritic cell neoplasm. Haematologica 2021; 106:1047-1055. [PMID: 32241840 PMCID: PMC8017819 DOI: 10.3324/haematol.2020.247569] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 12/18/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematopoietic neoplasm whose immunophenotype remains incompletely characterized, particularly with regards to its distinction from reactive plasmacytoid dendritic cells (PDC). This limitation complicates detection of low-level involvement by BPDCN as well as minimal residual disease (MRD) assessment following therapy. We conducted the current study to characterize the immunophenotype of BPDCN in a cohort of 39 patients, and compared it to that of reactive PDC. We found that, in addition to CD56 expression (97%), BPDCN showed a number of aberrancies, including decreased/negative CD38 (82%), positive CD7 (64%), negative CD2 (81%), negative CD303 (56%), increased HLA-DR (69%) and decreased CD123 (78%) expression. Although BPDCN cells were characterized by CD56 expression, reactive PDC consistently included a CD56+ subset, ranging from 1.3%-20% (median 4.5%) of all PDC, challenging the detection of MRD. These CD56+ reactive PDC were, however, consistently positive for CD2 and CD303, brightly positive for CD38, and negative for CD7, distinctively different from BPDCN. Based on these findings, we set up a ten-color flow cytometry assay for BPDCN and validated it to a sensitivity of 0.01%. This panel was prospectively tested in 19 bone marrow samples from seven patients with BPDCN, and it effectively distinguished BPDCN cells from background reactive PDC in all cases. In summary, by understanding the immunophenotype of reactive and neoplastic PDC, BPDCN can be effectively detected by flow cytometry to a very low level using a panel of markers in addition to CD56. Such an assay could be used for initial bone marrow workup as well as MRD detection after therapy.
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Affiliation(s)
- Wei Wang
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Joseph D Khoury
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Roberto N Miranda
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jeffrey L Jorgensen
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jie Xu
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sanam Loghavi
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Shaoying Li
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Naveen Pemmaraju
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Than Nguyen
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - L Jeffrey Medeiros
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sa A Wang
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
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17
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Suzuki A, Abe S, Koyama K, Suzuki S, Nagao M, Kobayashi M, Nomura J, Tsutsumi T, Takeda T, Oka Y, Shirota Y, Takasawa N, Kodera T, Okitsu Y, Takahashi S, Ichinohasama R, Kameoka J. Spontaneous Regression of Blastic Plasmacytoid Dendritic Cell Neoplasm Following Sepsis by Serratia marcescens: A Case Report and Literature Review. Intern Med 2021; 60:927-933. [PMID: 33716255 PMCID: PMC8024952 DOI: 10.2169/internalmedicine.5820-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Spontaneous regression is rare in patients with blastic plasmacytoid dendritic cell neoplasm (BPDCN). An 85-year-old man presented with pancytopenia and skin lesions, and the bone marrow exhibited 79.6% CD4+, CD56+, CD123+, and TCL-1+ abnormal cells, with a normal karyotype; he was thus diagnosed with BPDCN. While being followed without chemotherapy, he was admitted due to sepsis induced by Serratia marcescens, which was successfully treated with antibiotics. Notably, his blood cell counts improved, and the skin lesions disappeared. To our knowledge, this is the first reported case of spontaneous regression of BPDCN with a decrease in tumor cells in the bone marrow following sepsis.
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Affiliation(s)
- Akane Suzuki
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Shori Abe
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Kaori Koyama
- Division of Palliative Care, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Shinju Suzuki
- Division of Palliative Care, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Munenori Nagao
- Division of Palliative Care, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Masahiro Kobayashi
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Jun Nomura
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Tomomi Tsutsumi
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Tomoki Takeda
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Yumiko Oka
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Yuko Shirota
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Naruhiko Takasawa
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Takao Kodera
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Yoko Okitsu
- Department of Clinical Laboratory, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Shinichiro Takahashi
- Department of Clinical Laboratory, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | | | - Junichi Kameoka
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University Hospital, Japan
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18
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Cangini D, Silimbani P, Cafaro A, Giannini MB, Masini C, Ghelli Luserna Di Rorà A, Simonetti G, Martinelli G, Cerchione C. Tagraxofusp and anti-CD123 in blastic plasmacytoid dendritic cell neoplasm: a new hope. Minerva Med 2020; 111:467-477. [PMID: 32955827 DOI: 10.23736/s0026-4806.20.07018-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy, characterized by poor prognosis if treated with conventional therapy. Allogenic hematologic stem cell transplant can improve survival and can be curative, but it is available in a small percentage of patients given that the median age at diagnosis is 70 years. In this scenario it is assumed that only the development of precision medicine-driven therapy will change BPDCN patient prognosis. CD123 (the α-subunit of interleukin (IL)-3 receptor) is over-expressed on BPDCN cells surface and seems to be the ideal marker to develop antibody-based therapies. Tagraxofusp (Elzonris<sup>®</sup>), a recombinant immunotoxin consisting of human interleukin-3 fused to a truncated diphtheria toxin, has been approved by FDA in December 2018 for the treatment of BPDCN in adult and pediatric patients. tagraxofusp has shown promising clinical activity, with a high overall response rate and quite manageable safety profile even in elderly patients. It seems to improve overall survival too, but comparative trials are necessary to confirm this. Adverse events are commonly reported and the most important are transaminitis, thrombocytopenia and capillary leak syndrome (CLS). Therefore, to prevent the onset of severe CLS is recommended to reserve tagraxofusp for patients with preserved hepatic and cardiac functions, and to strictly observe serum albumin level. Further studies are required to resolve many several unanswered questions about tagraxofusp. In this review, we will resume and discuss pharmacological characteristic of tagraxofusp, results of clinical trials leading to its approval by FDA in 2018 and future perspectives about its use in BPDCN and other hematological malignancies.
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Affiliation(s)
- Delia Cangini
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Paolo Silimbani
- Unit of Oncological Pharmacy, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Alessandro Cafaro
- Unit of Oncological Pharmacy, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Maria B Giannini
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Carla Masini
- Unit of Oncological Pharmacy, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Andrea Ghelli Luserna Di Rorà
- Laboratory of Biosciences, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Giorgia Simonetti
- Laboratory of Biosciences, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Giovanni Martinelli
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Claudio Cerchione
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy -
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19
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Ding Y, Yang J, Lindsey K. Cytologic features of blastic plasmacytoid dendritic cell neoplasm involving liver: A case report and literature review. Diagn Cytopathol 2020; 49:E80-E83. [PMID: 32852895 DOI: 10.1002/dc.24594] [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: 02/02/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 11/07/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare but clinically aggressive hematologic malignancy, believed to originate from plasmacytoid dendritic cells (PDCs) although it possesses multilineage potentials. Due to the dismal prognosis, accurate and rapid diagnosis is critical for early management. The disease usually initially involves skin and bone marrow. Here we report the cytopathologic findings in a case of BPDCN involving the liver in a patient previously diagnosed with BPDCN from skin and lymph node biopsies. The fine-needle aspiration specimen from the liver lesion demonstrates a hypercellular smear of atypical epithelioid cells dispersed singly or in loose groups. These cells have enlarged, eccentric, round to irregular nuclei with fine chromatin. The agranular gray-blue cytoplasm shows delicate wispy cytoplasmic extensions and cytoplasmic microvacuoles. Binucleation is common. The concurrent core biopsy shows that the neoplastic plasmacytoid cells with eccentric nuclei were positive for CD4, CD7, CD43, CD56, and CD68, confirming the diagnosis of BPDCN. Mutations of ASXL1 and TET2, classic for BPDCN, and a complex karyotype were detected in skin, bone marrow, and lymph node specimens. We catalog the heterogeneous pathologic features of this rare disease, emphasizing the clinical and histopathological correlation. The differential diagnoses and review of literature are also included. Awareness of this disease and accurate diagnosis are emphasized to aid early management and potentially produce a better clinical outcome.
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Affiliation(s)
- Yanna Ding
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jack Yang
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn Lindsey
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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20
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A Unique Case of a Pediatric Patient With Blastic Plasmacytoid Dendritic Cell Neoplasm, Guillain Barre Syndrome, and Hemophagocytic Lymphohistiocytosis. J Pediatr Hematol Oncol 2020; 42:e392-e393. [PMID: 30933025 DOI: 10.1097/mph.0000000000001464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm is a rare hematopoietic malignancy with a poor prognosis that is seen primarily in the elderly population. We describe a pediatric patient with blastic plasmacytoid dendritic cell neoplasm who subsequently developed Guillain Barre syndrome followed by hemophagocytic lymphohistiocytosis. All 3 conditions are uncommon, particularly in the pediatric population. It is unclear whether this patient developed these disease states independently, whether they were due to a viral trigger or if she has an underlying immune dysfunction that could have contributed to the development of these conditions. The patient is currently in remission and awaiting further immune work-up.
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21
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Blastic plasmacytoid dendritic cell neoplasm: diagnosis, manifestations, and treatment. Curr Opin Hematol 2020; 27:103-107. [PMID: 31972688 DOI: 10.1097/moh.0000000000000569] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy with historically poor outcomes. It typically manifests as asymptomatic skin lesions and cytopenias, which result from bone marrow involvement. Less commonly, it will present in lymph nodes or visceral organs as well. Although rare, BPDCN has been discussed more frequently in recent years as new drugs have been developed that could be effective at treating this disease. RECENT FINDINGS Until recently, treatment for BPDCN commonly included intensive chemotherapy regimens, which are generally reserved for management of acute myeloid leukemia or acute lymphoblastic leukemia. However, in 2018 tagraxofusp (SL-401) was approved as the only treatment specifically indicated for BPDCN. Additional clinical trials are ongoing evaluating the efficacy of newer agents, which could potentially further improve the long-term outcomes for patients with BPDCN. SUMMARY This manuscript reviews the diagnosis, manifestations and treatment of BPDCN.
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22
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Hirner JP, O'Malley JT, LeBoeuf NR. Blastic Plasmacytoid Dendritic Cell Neoplasm: The Dermatologist's Perspective. Hematol Oncol Clin North Am 2020; 34:501-509. [PMID: 32336415 DOI: 10.1016/j.hoc.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive malignancy derived from the plasmacytoid dendritic cell that commonly involves the skin. Cutaneous involvement is often the initial presentation, with deep purple or red-brown macules, plaques, or tumors. As such, dermatologists may be the first to see these patients and, in addition to oncologists, should be familiar with its presentation to facilitate early diagnosis, helping to distinguish it from acute myelogenous leukemia cutis.
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Affiliation(s)
- Jesse P Hirner
- Department of Dermatology, The Center For Cutaneous Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 375 Longwood Avenue, Boston, MA 02115, USA
| | - John T O'Malley
- Department of Dermatology, The Center For Cutaneous Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 375 Longwood Avenue, Boston, MA 02115, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, The Center For Cutaneous Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 375 Longwood Avenue, Boston, MA 02115, USA.
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23
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Hematopoietic Cell Transplant for Blastic Plasmacytoid Dendritic Cell Neoplasm. Hematol Oncol Clin North Am 2020; 34:621-629. [PMID: 32336425 DOI: 10.1016/j.hoc.2020.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare aggressive hematologic malignancy derived from precursors of plasmacytoid dendritic cells. Historically, BPDCN has had few available treatment options and a poor prognosis. The emergence of novel targeted therapies, namely tagraxofusp, has changed the treatment landscape of BPDCN, but data are lacking regarding the long-term durability of responses. Despite absence of randomized data, allogeneic hematopoietic cell transplant has become the de facto option for patients with BPDCN who achieve a first complete remission. As new therapies continue to emerge, it will be important to evaluate the role of postallograft maintenance/consolidation.
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24
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Brüggen MC, Valencak J, Stranzenbach R, Li N, Stadler R, Jonak C, Bauer W, Porkert S, Blaschke A, Meiss F, Nicolay JP, Wehkamp U, Schlaak M, Nguyen VA, Romani N, Cozzio A, Gayathri N, Dimitriou F, French LE, Dummer R, Guenova E. Clinical diversity and treatment approaches to blastic plasmacytoid dendritic cell neoplasm: a retrospective multicentre study. J Eur Acad Dermatol Venereol 2020; 34:1489-1495. [PMID: 31955469 DOI: 10.1111/jdv.16215] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/04/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive type of haematologic precursor malignancy primarily often manifesting in the skin. We sought to provide a thorough clinical characterization and report our experience on therapeutic approaches to BPDCN. METHODS In the present multicentric retrospective study, we collected all BPDCN cases occurring between 05/1999 and 03/2018 in 10 secondary care centres of the German-Swiss-Austrian cutaneous lymphoma working group. RESULTS A total of 37 BPDCN cases were identified and included. Almost 90% of the patients had systemic manifestations (bone marrow, lymph nodes, peripheral blood) in addition to skin involvement. The latter presented with various types of cutaneous lesions: nodular (in more than 2/3) and bruise-like (in 1/3) skin lesions, but also maculopapular exanthema (in circa 1/6). Therapeutically, 22 patients received diverse combinations of chemotherapeutic regimens and/or radiotherapy. Despite initial responses, all of them ultimately relapsed and died from progressive disease. Eleven patients underwent haematopoietic stem cell transplantation (HSCT; autologous HSCT n = 3, allo-HSCT n = 8). The mortality rate among HSCT patients was only 33.33% with a median survival time of 60.5 months. CONCLUSION Our study demonstrates the clinical diversity of cutaneous BPDCN manifestations and the positive development observed after the introduction of HSCT.
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Affiliation(s)
- M-C Brüggen
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Medical Campus Davos, Davos, Switzerland
| | - J Valencak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - R Stranzenbach
- Department of Dermatology, Venereology, Allergology and Phlebology, Johannes Wesling Medical Centre, University Hospital of Ruhr-University Bochum, Minden, Germany
| | - N Li
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - R Stadler
- Department of Dermatology, Venereology, Allergology and Phlebology, Johannes Wesling Medical Centre, University Hospital of Ruhr-University Bochum, Minden, Germany
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - W Bauer
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - S Porkert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Blaschke
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - F Meiss
- Department of Dermatology and Venereology, Faculty of Medicine, University Medical Center - University of Freiburg, Freiburg, Germany
| | - J P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - U Wehkamp
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - M Schlaak
- Department of Dermatology and Venereology, University Hospital of Cologne, Cologne, Germany.,Department of Dermatology and Allergology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - V A Nguyen
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - N Romani
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - A Cozzio
- Department of Dermatology, Venereology and Allergology, Canton Hospital of St. Gallen, St. Gallen, Switzerland
| | - N Gayathri
- Department for Hematology, University Hospital of Zurich, Zurich, Switzerland
| | - F Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - L E French
- Department of Dermatology and Allergology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - R Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - E Guenova
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
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25
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Sapienza MR, Pileri S. Molecular Features of Blastic Plasmacytoid Dendritic Cell Neoplasm: DNA Mutations and Epigenetics. Hematol Oncol Clin North Am 2020; 34:511-521. [PMID: 32336416 DOI: 10.1016/j.hoc.2020.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic neoplasm with a dismal prognosis and no standard therapy. In the past, its cellular ontogenesis was obscure, and BPDCN had been erroneously named CD56+/TdT+ blastic NK cell tumor and CD4+/CD56+ hematodermic neoplasm. Finally, in 2008, the BPDCN was correctly recognized as a neoplasm deriving from the malignant transformation of plasmacytoid dendritic cell precursors and classified among the myeloid neoplasms. Since then, the understanding of BPDCN biology has improved rapidly: the DNA mutational status of BPDCN has been extensively investigated revealing a spectrum perfectly resembling its myeloid lineage derivation.
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Affiliation(s)
- Maria Rosaria Sapienza
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan 20141, Italy.
| | - Stefano Pileri
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan 20141, Italy
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Zhang X, Sun J, Yang M, Wang L, Jin J. New perspectives in genetics and targeted therapy for blastic plasmacytoid dendritic cell neoplasm. Crit Rev Oncol Hematol 2020; 149:102928. [PMID: 32234682 DOI: 10.1016/j.critrevonc.2020.102928] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 12/26/2019] [Accepted: 03/02/2020] [Indexed: 01/12/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is one rare but clinically aggressive hematological malignancy, and it is typically characterized by skin lesion and bone marrow involvement. Diagnosis of BPDCN relies on the immunophenotype positive for four of CD4, CD56, CD123, TCL1 and BDCA-2, and commonly without the expression of MPO, cytoplasmic CD3, CD13, CD64, cytoplasmic CD79a, CD19 and CD20. Commonly, BPDCN is characterized by high CD123 expression, aberrant NF-κB activation, dependence on TCF4-/BRD4-network, and deregulated cholesterol metabolism. Under conventional therapy, the survival duration is only improved in a small number of BPDCN patients. Therefore, targeted therapy should be developed. Up to now, tagraxofusp is the leading edge and has been approved for BPDCN treatment. However, most of other targeted therapy agents were still not pushed to clinical trials for BPDCN. In this review, we emphatically discuss recent perspectives on BPDCN genetic features and developments of its targeted therapy.
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Affiliation(s)
- Xiang Zhang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China; Key Laboratory of Hematologic Malignancies, Diagnosis and Treatment, Zhejiang, Hangzhou, Zhejiang, China; Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Jiewen Sun
- Center Laboratory, Affiliated Secondary Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Min Yang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China; Key Laboratory of Hematologic Malignancies, Diagnosis and Treatment, Zhejiang, Hangzhou, Zhejiang, China; Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Lei Wang
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China; Key Laboratory of Hematologic Malignancies, Diagnosis and Treatment, Zhejiang, Hangzhou, Zhejiang, China; Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China; Key Laboratory of Hematologic Malignancies, Diagnosis and Treatment, Zhejiang, Hangzhou, Zhejiang, China; Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China.
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Goel D, Bhargava R. Blastic plasmacytoid dendritic cell neoplasm. A rare hematodermic malignancy. Hematol Transfus Cell Ther 2020; 42:384-386. [PMID: 31926915 PMCID: PMC7599254 DOI: 10.1016/j.htct.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Deepa Goel
- Artemis Hospitals, Gurugram, Haryana, India.
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Demiröz AS, Demirkesen C, Salihoğlu A, Tüzüner N. Blastic Plasmacytoid Dendritic Cell Neoplasia: A Single Center Experience. Turk J Haematol 2019; 37:48-52. [PMID: 31752482 PMCID: PMC7057751 DOI: 10.4274/tjh.galenos.2019.2019.0195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare malignancy with skin tropism. The entity was recently defined and the diagnosis is generally made by skin biopsies. It is necessary to apply appropriate immunohistochemistry to recognize this rare entity. There is no consensus on therapy and the survival rates are low. The aim of this study is to describe the clinical and histopathological features of BPDCN. We retrospectively reviewed 8 BPDCN cases of the Cerrahpaşa Medical Faculty diagnosed between 2005 and 2019. We documented the clinical findings, histopathologic diagnoses, and outcomes. The mean age of the patients was 58.7 years (range=11-86 years), and 7 patients were male. The patients presented with erythematous or purple papules, plaques, and papulonodular or nodular cutaneous lesions. Two had lymphadenomegaly at presentation. In microscopic evaluations, tumor cells infiltrated the entire dermis with a clear-cut subepidermal Grenz zone in all cases. CD4, CD56, and CD123 were the most frequently expressed immunohistochemical markers. The median follow-up of 7 cases was 14 months, ranging from 6 to 48 months. Three patients died of the disease, while 4 patients were still alive. Out of 7 patients, 5 received chemotherapy. We found that the outcomes of some patients were different from others but we did not link any distinct clinical or histopathological characteristics to these different outcomes.
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Affiliation(s)
- Ahu Senem Demiröz
- İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Cuyan Demirkesen
- İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Ayşe Salihoğlu
- İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of İnternal Medicine, Hematology, İstanbul, Turkey
| | - Nükhet Tüzüner
- İstanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pathology, İstanbul, Turkey
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Blastic Plasmacytoid Dendritic Cell Neoplasm–Current Insights. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:545-554. [DOI: 10.1016/j.clml.2019.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/14/2019] [Accepted: 06/04/2019] [Indexed: 12/13/2022]
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Lee J, Kim HY, Han B, Kim M, Park JY, Chung Y, Lee YK. First Report of a Patient With Natural Killer-Lymphoblastic Leukemia/Lymphoma in Korea. Ann Lab Med 2019; 39:493-495. [PMID: 31037869 PMCID: PMC6502956 DOI: 10.3343/alm.2019.39.5.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/04/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jiwon Lee
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ho Young Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Boram Han
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Miyoung Kim
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
| | - Ji Young Park
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Yousun Chung
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Young Kyung Lee
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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Sapienza MR, Pileri A, Derenzini E, Melle F, Motta G, Fiori S, Calleri A, Pimpinelli N, Tabanelli V, Pileri S. Blastic Plasmacytoid Dendritic Cell Neoplasm: State of the Art and Prospects. Cancers (Basel) 2019; 11:cancers11050595. [PMID: 31035408 PMCID: PMC6562663 DOI: 10.3390/cancers11050595] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/16/2019] [Accepted: 04/25/2019] [Indexed: 12/13/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an extremely rare tumour, which usually affects elderly males and presents in the skin with frequent involvement of the bone-marrow, peripheral blood and lymph nodes. It has a dismal prognosis, with most patients dying within one year when treated by conventional chemotherapies. The diagnosis is challenging, since neoplastic cells can resemble lymphoblasts or small immunoblasts, and require the use of a large panel of antibodies, including those against CD4, CD56, CD123, CD303, TCL1, and TCF4. The morphologic and in part phenotypic ambiguity explains the uncertainties as to the histogenesis of the neoplasm that led to the use of various denominations. Recently, a series of molecular studies based on karyotyping, gene expression profiling, and next generation sequencing, have largely unveiled the pathobiology of the tumour and proposed the potentially beneficial use of new drugs. The latter include SL-401, anti-CD123 immunotherapies, venetoclax, BET-inhibitors, and demethylating agents. The epidemiologic, clinical, diagnostic, molecular, and therapeutic features of BPDCN are thoroughly revised in order to contribute to an up-to-date approach to this tumour that has remained an orphan disease for too long.
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Affiliation(s)
- Maria Rosaria Sapienza
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milano, Italy.
| | - Alessandro Pileri
- Unit of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, School of Medicine, Via Massarenti 1, 40138 Bologna, Italy.
| | - Enrico Derenzini
- Division of Haematology, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy.
| | - Federica Melle
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milano, Italy.
| | - Giovanna Motta
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milano, Italy.
| | - Stefano Fiori
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milano, Italy.
| | - Angelica Calleri
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milano, Italy.
| | - Nicola Pimpinelli
- Dermatology Unit, Department of Health and Science, University of Florence, School of Medicine, Viale Michelangiolo 104, 50100 Firenze, Italy.
| | - Valentina Tabanelli
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milano, Italy.
| | - Stefano Pileri
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milano, Italy.
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Lezama L, Ohgami RS. Expounding on the essence of epigenetic and genetic abnormalities in blastic plasmacytoid dendritic cell neoplasms. Haematologica 2019; 104:642-643. [PMID: 30930334 DOI: 10.3324/haematol.2018.211557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Kharfan-Dabaja MA, Pemmaraju N, Mohty M. Therapeutic Approaches for Blastic Plasmacytoid Dendritic Cell Neoplasm: Allogeneic Hematopoietic Cell Transplantation and Novel Therapies. Clin Hematol Int 2019; 1:2-9. [PMID: 34595405 PMCID: PMC8432376 DOI: 10.2991/chi.d.190218.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/18/2019] [Indexed: 01/19/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a clinically aggressive hematologic malignancy derived from precursors of plasmacytoid dendritic cells. There is no established standard therapy for BPDCN and the efficacy of conventional chemotherapy is limited, with an anticipated median overall survival ranging from 8 to 14 months. No randomized controlled trials have ever been performed to evaluate the benefit of frontline consolidation with an allogeneic hematopoietic cell transplant (allo-HCT) in BPDCN. Yet, offering an allograft has become the de facto option in BPDCN, and remains the only known long-term curative option for these patients, even in the modern era of targeted therapies. In our opinion, allo-HCT is recommended as part of frontline consolidation, especially in patients achieving first complete remission and who are deemed capable of tolerating the procedure, as published data show 3- to 4-year progression-free survival ranging from 69% to 74% in this population. Prompt referral to a transplant center, at the time of a diagnosis of BPDCN, is important to confirm allo-HCT candidacy and to initiate the process of identifying a suitable human leukocyte antigen (HLA)-compatible donor. Because disease relapse remains a major concern, additional strategies, such as post-allograft consolidation/maintenance therapy, are certainly needed to help further improve outcomes. Finally, patients deemed ineligible to receive an allo-HCT, due to lack of response and/or poor performance status, should be considered for enrollment in clinical trials.
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Affiliation(s)
- Mohamed A Kharfan-Dabaja
- Blood and Marrow Transplantation Program, Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Naveen Pemmaraju
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamad Mohty
- Hopital Saint-Antoine, Université Pierre & Marie Curie, INSERM UMRs U938, Paris, France
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Han X, Ouyang MQ, Pei Q, Duan MH, Jiang XY, Zhou DB. [Clinical characteristics of 6 patients with blastic plasmacytoid dendritic cell neoplasm]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 38:700-705. [PMID: 28954350 PMCID: PMC7348252 DOI: 10.3760/cma.j.issn.0253-2727.2017.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
目的 探讨母细胞性浆细胞样树突细胞肿瘤(BPDCN)的临床特征、治疗和预后。 方法 回顾性分析2008年1月至2016年5月北京协和医院确诊的6例BPDCN患者的临床资料。 结果 6例患者起病时均有皮肤受累,常见表现包括骨髓受累(5例)、淋巴结肿大(4例)、脾大(4例)和肝大(3例)。皮肤外的结外器官受累包括乳腺、上颌窦、椎体和中枢神经系统各1例。肿瘤细胞特征性的免疫表型CD4、CD56、CD123均为阳性。治疗均采用急性淋巴细胞白血病样方案,4例达到完全缓解。中位随访9.5(7~37)个月,中位无进展生存期7个月,中位总生存期9个月。死亡3例,均在诊断后1年内死于原发病复发或进展。 结论 BPDCN侵袭性强,常以皮肤受累为首发症状,骨髓受累、淋巴结和肝脾大较为常见;特征性免疫标志包括CD4、CD56和CD123;目前缺乏有效、标准的治疗方案,预后不良。
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Affiliation(s)
- X Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
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Kutane Lymphome. MEDIKAMENTÖSE TUMORTHERAPIE IN DER DERMATO-ONKOLOGIE 2019. [PMCID: PMC7121154 DOI: 10.1007/978-3-662-58012-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kutane Lymphome (cutaneous lymphomas: CL) umfassen die Gruppe der kutanen T-Zell-Lymphome (cutaneous T-cell lymphomas: CTCL), kutanen B-Zell-Lymphome (cutaneous B-cell lymphomas: CBCL) und die sog. hämatodermischen Neoplasien (HN). CL gehören zur Gruppe der Non-Hodgkin-Lymphome (NHL) und stellen in der Subgruppe der extranodalen NHL die zweithäufigste Gruppe hinter den gastrointestinalen Lymphomen dar (Jaffe et al. 2009). Man unterscheidet zwischen primären und sekundären CL. Primäre CL haben ihren Ursprung in der Haut und bleiben in der Regel darauf auch längere Zeit beschränkt, während sekundäre CL kutane Manifestationen von primär nodalen oder extranodalen Lymphomen darstellen (Willemze 2005). Die primären CL unterscheiden sich hinsichtlich klinischem Verlauf, Therapieoptionen und Prognose erheblich von nodalen und extrakutanen Lymphomen. So zeigen z. B. die primär kutanen CD30+-T-Zell-Lymphome einen gutartigen Verlauf, wogegen die nodalen Varianten als aggressiv eingestuft werden. Da die CL zumeist weniger aggressiv sind, werden sie auch weniger aggressiv behandelt.
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Zaki MMAF, Zalata K, El-Hawary AK, Eisa N, El Ashwah S, Shamaa S. Blastic Plasmacytoid Dendritic Cell Neoplasm: A Case Report and Clinicopathological Review. J Hematol 2018; 7:124-127. [PMID: 32300426 PMCID: PMC7155830 DOI: 10.14740/jh428w] [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: 05/31/2018] [Accepted: 07/24/2018] [Indexed: 11/22/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is aggressive hematopoietic malignancy derived from the precursors of plasmacytoid dendritic cells. The present study reported a case of a 35-year-old BPDCN patient, who presented with scalp lesions without extracutaneous involvement of the lymph nodes (LNs), peripheral or bone marrow. Histopathological examination of scalp lesion revealed monomorphous diffuse infiltrate of small to medium-sized cells with irregular nuclear contours, pleomorphic nuclei, finely dispersed chromatin, inconspicuous nucleoli and scant amount of cytoplasm. Immunohistochemical staining showed diffuse positivity for CD45, CD4, CD 56, CD45 and negative for CD3, CD5, CD7, CD8, CD19, CD20, CD30, CD33, CD34, CD79a, CD99, CD117, TDT, and myeloperoxidase. Patient started treatment with acute lymphoblastic lymphoma protocol (Hyper-CVAD). Reevaluation after the second course showed marked regression of scalp lesion. The patient continued Hyper-CVAD protocol and planned for allogeneic stem cell transplant.
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Affiliation(s)
| | - Khaled Zalata
- Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Noha Eisa
- Medical Oncology Department, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Shaimaa El Ashwah
- Medical Oncology Department, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sameh Shamaa
- Medical Oncology Department, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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[Dermatopathology histoseminar. Case 5]. Ann Pathol 2018; 38:236-240. [PMID: 29980305 DOI: 10.1016/j.annpat.2018.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 11/20/2022]
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ZEB Proteins in Leukemia: Friends, Foes, or Friendly Foes? Hemasphere 2018; 2:e43. [PMID: 31723771 PMCID: PMC6745990 DOI: 10.1097/hs9.0000000000000043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 01/06/2023] Open
Abstract
ZEB1 and ZEB2 play pivotal roles in solid cancer metastasis by allowing cancer cells to invade and disseminate through the transcriptional regulation of epithelial-to-mesenchymal transition. ZEB expression is also associated with the acquisition of cancer stem cell properties and therapy resistance. Consequently, expression levels of ZEB1/2 and of their direct target genes are widely seen as reliable prognostic markers for solid tumor aggressiveness and cancer patient outcome. Recent loss-of-function mouse models demonstrated that both ZEBs are also essential hematopoietic transcription factors governing blood lineage commitment and fidelity. Interestingly, both gain- and loss-of-function mutations have been reported in multiple hematological malignancies. Combined with emerging functional studies, these data suggest that ZEB1 and ZEB2 can act as tumor suppressors and/or oncogenes in blood borne malignancies, depending on the cellular context. Here, we review these novel insights and discuss how balanced expression of ZEB proteins may be essential to safeguard the functionality of the immune system and prevent leukemia.
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40
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8q24/MYC rearrangement is a recurrent cytogenetic abnormality in blastic plasmacytoid dendritic cell neoplasms. Leuk Res 2018; 66:73-78. [DOI: 10.1016/j.leukres.2018.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 11/20/2022]
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Abstract
This article focuses on cutaneous hematopoietic neoplasms that are more likely to be encountered in the pediatric age-group and includes both lymphoproliferative and histiocytic disorders. The cutaneous hematologic disorders in children have a different epidemiologic profile to what is seen during adulthood. Although mycosis fungoides is the most frequent form of cutaneous lymphoma in adults, it is very rare in children. Because lymphoblastic leukemias and lymphomas are more frequent in the pediatric setting, cutaneous leukemic infiltrates are relatively common in this age-group. Similarly, histiocytic disorders are more common in children, particularly Langerhans cell histiocytosis and juvenile xanthogranuloma. Notably, the histiocytic disorders have undergone significant modifications on their nomenclature in the basis of the molecular characteristics that are present in them. A summary of the most frequent cutaneous hematopoietic disorders in children will be discussed further in this review.
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Affiliation(s)
- Alejandro A Gru
- 1 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 2 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital and Dermatopathology, Washington University Medical Center, St. Louis, Missouri
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42
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Krause JR, Baugh L, Swink A, Burch M. Blastic plasmacytoid dendritic cell neoplasm following acquired erythropoietic protoporphyria. Proc (Bayl Univ Med Cent) 2018; 30:450-451. [PMID: 28966462 DOI: 10.1080/08998280.2017.11930225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
A 56-year-old Texas rancher with a prior diagnosis of acquired erythropoietic protoporphyria secondary to an underlying myelodysplastic disorder developed an uncommon tumor, blastic plasmacytoid dendritic cell neoplasm (BPDCN). During his initial disease, analysis revealed a TET2 mutation, which is the most common mutation associated with BPDCN. This article discusses this unusual hematopoietic neoplasm, the possible evolution from erythropoietic protoporphyria, and the underlying myelodysplastic process.
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Affiliation(s)
- John R Krause
- Division of Hematopathology, Department of Pathology (Krause, Baugh) and the Department of Hematology/Oncology (Swink, Burch), Baylor University Medical Center at Dallas and Baylor Sammons Cancer Center, Dallas, Texas
| | - Laura Baugh
- Division of Hematopathology, Department of Pathology (Krause, Baugh) and the Department of Hematology/Oncology (Swink, Burch), Baylor University Medical Center at Dallas and Baylor Sammons Cancer Center, Dallas, Texas
| | - Alicia Swink
- Division of Hematopathology, Department of Pathology (Krause, Baugh) and the Department of Hematology/Oncology (Swink, Burch), Baylor University Medical Center at Dallas and Baylor Sammons Cancer Center, Dallas, Texas
| | - Micah Burch
- Division of Hematopathology, Department of Pathology (Krause, Baugh) and the Department of Hematology/Oncology (Swink, Burch), Baylor University Medical Center at Dallas and Baylor Sammons Cancer Center, Dallas, Texas
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43
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Chu C, Rudnick EW, Motaparthi K. Blastic plasmacytoid dendritic cell neoplasm with centrocyte-like morphology clinically simulating a melanocytic nevus. J Cutan Pathol 2018; 45:249-253. [PMID: 29293270 DOI: 10.1111/cup.13099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/29/2017] [Accepted: 12/27/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Christopher Chu
- Department of Dermatology, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Eric W Rudnick
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
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44
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Trottier AM, Cerquozzi S, Owen CJ. Blastic plasmacytoid dendritic cell neoplasm: challenges and future prospects. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2017; 7:85-93. [PMID: 31360087 PMCID: PMC6467341 DOI: 10.2147/blctt.s132060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare CD4+ CD56+ myeloid malignancy that is challenging to diagnose and treat. BPDCN typically presents with nonspecific cutaneous lesions with or without extra-cutaneous manifestations before progressing to leukemia. Currently, there is no standard of care for the treatment of BPDCN and various approaches have been used including acute myeloid leukemia, acute lymphoblastic leukemia, and lymphoma-based regimens with or without stem cell transplantation. Despite these treatment approaches, the prognosis of BPDCN remains poor and there is a lack of prospective data upon which to base treatment decisions. Recent work examining the mutational landscape and gene expression profiles of BPDCN has identified a number of potential therapeutic targets. One such target is CD123, the α subunit of the human interleukin-3 receptor, which is the subject of intervention studies using the novel agent SL-401. Other investigational therapies include UCART123, T-cell immunotherapy, and venetoclax. Prospective trials are needed to determine the best treatment for this uncommon and aggressive neoplasm.
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Affiliation(s)
- Amy M Trottier
- Division of Hematology and Hematological Malignancies, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada,
| | - Sonia Cerquozzi
- Division of Hematology and Hematological Malignancies, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada,
| | - Carolyn J Owen
- Division of Hematology and Hematological Malignancies, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada,
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Suzuki Y, Kato S, Kohno K, Satou A, Eladl AE, Asano N, Kono M, Kato Y, Taniwaki M, Akiyama M, Nakamura S. Clinicopathological analysis of 46 cases with CD4+
and/or CD56+
immature haematolymphoid malignancy: reappraisal of blastic plasmacytoid dendritic cell and related neoplasms. Histopathology 2017; 71:972-984. [DOI: 10.1111/his.13340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Yuka Suzuki
- Department of Pathology and Laboratory Medicine; Nagoya University Hospital; Nagoya Japan
| | - Seiichi Kato
- Department of Pathology and Laboratory Medicine; Nagoya University Hospital; Nagoya Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine; Nagoya University Hospital; Nagoya Japan
| | - Akira Satou
- Department of Pathology; Aichi Medical University Hospital; Nagakute Japan
| | - Ahmed E Eladl
- Department of Pathology and Laboratory Medicine; Nagoya University Hospital; Nagoya Japan
- Department of Pathology; Faculty of Medicine; Mansoura University; Mansoura Egypt
| | - Naoko Asano
- Department of Molecular Diagnostics; Nagano Prefectural Suzaka Hospital; Suzaka Japan
| | - Michihiro Kono
- Department of Dermatology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Yuichi Kato
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology; Yamagata University; Yamagata Japan
| | - Masafumi Taniwaki
- Center for Molecular Diagnostics and Therapeutics; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Masashi Akiyama
- Department of Dermatology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine; Nagoya University Hospital; Nagoya Japan
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47
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Kim HS, Kim HJ, Kim SH, Choi JY, Ko YH, Kim WS, Jung CW, Kim SJ. Clinical features and treatment outcomes of blastic plasmacytoid dendritic cell neoplasm: a single-center experience in Korea. Korean J Intern Med 2017; 32:890-899. [PMID: 28870016 PMCID: PMC5583450 DOI: 10.3904/kjim.2015.406] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy that typically presents in the form of skin manifestations with or without lymph node and bone marrow involvement. Given its rarity and recent recognition as a distinct pathological entity, no standard of treatment exists for this aggressive disease and its prognosis is particularly dismal. METHODS We retrospectively analyzed clinical features and treatment outcomes of patients who were diagnosed with BPDCN between 2000 and 2014. RESULTS Ten patients had a median age at diagnosis of 41 years (range, 18 to 79), and seven patients were male. Sites of disease involvement were the skin (n = 7), lymph node (n = 5), bone marrow (n = 2), liver (n = 2), spleen (n = 2), and soft tissue (n = 1). Intensified chemotherapy regimens such as hyperCVAD regimen (cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine), and VPDL (vincristine, methylprednisolone, daunorubicin, L-asparaginase) were used as a first-line treatment. Although all patients treated with intensified chemotherapy showed an objective response (five patients with complete response) with median progression-free survival of 11.2 months (range 6.2 to 19.4), complete remission was not sustained for more than 2 years in any case. The response was relatively long-lived compared with previously reported CHOP (doxorubicin, cyclophosphamide, vincristine, prednisone)-like regimens, but the above regimens do not result in long-term remission. CONCLUSIONS All patients treated with hyperCVAD or VPDL showed an objective response, but the duration of response was relatively short. Thus, the development of more effective induction as well as consolidation treatment strategy should be warranted to improve this rare disease entity.
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Affiliation(s)
- Hae Su Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Hematology-Oncology, Department of Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Hee-Jin Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Hee Kim
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, 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
| | - Chul Won Jung
- 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 & Technology, Sungkyunkwan University, Seoul, Korea
- Correspondence to Seok Jin Kim, M.D. Division of HematologyOncology, 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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48
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Deng W, Yang M, Kuang F, Liu Y, Zhang H, Cao L, Xie M, Yang L. Blastic plasmacytoid dendritic cell neoplasm in children: A review of two cases. Mol Clin Oncol 2017; 7:709-715. [PMID: 28856005 DOI: 10.3892/mco.2017.1370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 08/01/2017] [Indexed: 01/02/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a newly characterized, rare malignant tumor of the skin and hematopoietic system. BPDCN occurs mainly in the elderly, whereas it is rarer among children, and has variable clinical manifestations. Optimal chemotherapeutic regimens for the treatment of BPDCN have not yet been determined and this tumor has a poor prognosis. In this study, two pediatric cases of BPDCN, including a 7-year-old female and a 9-year-old male patient, diagnosed at the Xiangya Hospital of Central South University over the past 2 years, were retrospectively reviewed. Both cases exhibited multiple organ involvement, although the clinical manifestations differed; they were diagnosed with BPDCN based on the clinical manifestations, pathological and immunohistochemical findings, which included positivity for CD4, CD56 and CD123. A high-risk acute lymphocytic leukemia (ALL) chemotherapy regimen was administered to both patients. The patient in the first case achieved a complete remission, but unfortunately her parents refused follow-up treatment and she succumbed to the disease 9 months after the initial diagnosis. The second patient was treated for a total of three courses with a chemotherapy regimen including daunorubicin, cytarabine and etoposide, followed by two courses of the high-risk ALL chemotherapy regimen; unfortunately, a remission was not achieved and the patient was scheduled to receive hematopoietic stem cell transplantation. Thus, not all pediatric BPDCN patients may be able to achieve complete remission following chemotherapy with the high-risk ALL regimen, and other treatment options must be investigated in the future.
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Affiliation(s)
- Wenjun Deng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Minghua Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Feimei Kuang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Yingting Liu
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Hui Zhang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Lizhi Cao
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Min Xie
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Liangchun Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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Magro CM, Momtahen S, Verma S, Abraham RM, Friedman C, Nuovo GJ, Tam W. Cutaneous myeloid dendritic cell dyscrasia: A cutaneous clonal monocytosis associated with chronic myeloproliferative disorders and peripheral blood monocytosis. Ann Diagn Pathol 2016; 25:85-91. [DOI: 10.1016/j.anndiagpath.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/01/2016] [Indexed: 01/18/2023]
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50
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Ceribelli M, Hou ZE, Kelly PN, Huang DW, Wright G, Ganapathi K, Evbuomwan MO, Pittaluga S, Shaffer AL, Marcucci G, Forman SJ, Xiao W, Guha R, Zhang X, Ferrer M, Chaperot L, Plumas J, Jaffe ES, Thomas CJ, Reizis B, Staudt LM. A Druggable TCF4- and BRD4-Dependent Transcriptional Network Sustains Malignancy in Blastic Plasmacytoid Dendritic Cell Neoplasm. Cancer Cell 2016; 30:764-778. [PMID: 27846392 PMCID: PMC5175469 DOI: 10.1016/j.ccell.2016.10.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/27/2016] [Accepted: 10/03/2016] [Indexed: 12/21/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive and largely incurable hematologic malignancy originating from plasmacytoid dendritic cells (pDCs). Using RNAi screening, we identified the E-box transcription factor TCF4 as a master regulator of the BPDCN oncogenic program. TCF4 served as a faithful diagnostic marker of BPDCN, and its downregulation caused the loss of the BPDCN-specific gene expression program and apoptosis. High-throughput drug screening revealed that bromodomain and extra-terminal domain inhibitors (BETis) induced BPDCN apoptosis, which was attributable to disruption of a BPDCN-specific transcriptional network controlled by TCF4-dependent super-enhancers. BETis retarded the growth of BPDCN xenografts, supporting their clinical evaluation in this recalcitrant malignancy.
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Affiliation(s)
- Michele Ceribelli
- Lymphoid Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD 20892, USA; Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Bethesda, MD 20892, USA
| | - Zhiying Esther Hou
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032, USA
| | - Priscilla N Kelly
- Lymphoid Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Da Wei Huang
- Lymphoid Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - George Wright
- Biometric Research Branch, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Karthik Ganapathi
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Moses O Evbuomwan
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Stefania Pittaluga
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Arthur L Shaffer
- Lymphoid Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Guido Marcucci
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Stephen J Forman
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Wenming Xiao
- Division of Bioinformatics and Biostatistics, NCTR/FDA, Jefferson, AR 72079, USA
| | - Rajarshi Guha
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Bethesda, MD 20892, USA
| | - Xiaohu Zhang
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Bethesda, MD 20892, USA
| | - Marc Ferrer
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Bethesda, MD 20892, USA
| | - Laurence Chaperot
- R&D Laboratory, EFS Rhone-Alpes Grenoble, La Tronche 38701, France; Institute for Advanced Biosciences UGA, INSERM U1209, CNRS UMR 5309, Grenoble 38000, France
| | - Joel Plumas
- R&D Laboratory, EFS Rhone-Alpes Grenoble, La Tronche 38701, France; Institute for Advanced Biosciences UGA, INSERM U1209, CNRS UMR 5309, Grenoble 38000, France
| | - Elaine S Jaffe
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD 20892, USA
| | - Craig J Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Bethesda, MD 20892, USA
| | - Boris Reizis
- Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032, USA; Department of Pathology, New York University School of Medicine, New York, NY 10016, USA.
| | - Louis M Staudt
- Lymphoid Malignancies Branch, National Cancer Institute, NIH, Bethesda, MD 20892, USA.
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