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Tadros J, Davis A, Awoleye O, Vassiliou E. A case report of early diagnosis of asymptomatic hairy cell leukemia using flow cytometry. Front Immunol 2023; 14:1207443. [PMID: 37283771 PMCID: PMC10239883 DOI: 10.3389/fimmu.2023.1207443] [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] [Received: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
Hairy Cell Leukemia is an infrequent leukemia that can be recognized both microscopically and flow cytometrically once the patient develops symptoms. We present a case where early diagnosis was achieved using flow cytometry long before the patient became symptomatic. This was achieved by focusing on a small percentage (0.9%) of total leukocytes that exhibited a higher side scatter and brighter CD19/CD20 than the remaining lymphocytes. A bone marrow aspirate three weeks later confirmed the presence of malignant B-cells. Shortly after, the patient presented splenomegaly and complained of fatigue.
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Affiliation(s)
| | - Amanda Davis
- Department of Biological Sciences, Kean University, Union, NJ, United States
| | - Oreoluwa Awoleye
- Department of Biological Sciences, Kean University, Union, NJ, United States
| | - Evros Vassiliou
- Department of Biological Sciences, Kean University, Union, NJ, United States
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Polderdijk MCE, Heron M, Kuipers S, Rijkers GT. Deciphering the genotype and phenotype of hairy cell leukemia: clues for diagnosis and treatment. Expert Rev Clin Immunol 2019; 15:857-867. [PMID: 31282776 DOI: 10.1080/1744666x.2019.1641405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Hairy cell leukemia (HCL) is a rare, indolent B-cell neoplasm. The classical variant of the disease is characterized by the BRAF V600E mutation, which is present in virtually all cases. How this mutation leads to the signs and symptoms of the disease is currently not known. Areas covered: This review explores the genetic background of HCL, especially the BRAF V600E driver mutation, but passenger mutations and their effects are also included. The clinical significance of BRAF mutations in other cancer types is discussed, as well as BRAF- induced senescence. An overview of the major forms of treatment of HCL (cytostatic drugs, specific BRAF inhibitors, B cell-specific antibodies) is given. Finally, possible mechanisms of the monocytopenia and hairy morphology so typical of this disease are discussed. Expert opinion: Although being a rare disease, HCL and its pathogenesis can yield important information about BRAF-related cancer metabolism. Many aspects of the disease are still unclear, but with the right resources, this could change. This can lead to a more efficient and specific treatment, thus leading to decreased morbidity.
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Affiliation(s)
- Margot C E Polderdijk
- a Department of Sciences, University College Roosevelt , Middelburg , The Netherlands.,b Laboratory for Medical Microbiology and Immunology, Admiral de Ruyter Hospital , Goes , The Netherlands
| | - Michiel Heron
- b Laboratory for Medical Microbiology and Immunology, Admiral de Ruyter Hospital , Goes , The Netherlands.,c Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital , Tilburg , The Netherlands
| | - Saskia Kuipers
- d Department of Hematology, Admiral de Ruyter Hospital , Goes , The Netherlands
| | - Ger T Rijkers
- a Department of Sciences, University College Roosevelt , Middelburg , The Netherlands.,b Laboratory for Medical Microbiology and Immunology, Admiral de Ruyter Hospital , Goes , The Netherlands.,c Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital , Tilburg , The Netherlands
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Payandeh M, Sadeghi M, Sadeghi E, Iranshahi N. The prevalence of BRAF V600E mutation in hairy cell leukemia: A systematic review and meta-analysis study. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_145_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: BRAF V600E mutations were recently identified in the leukemic cells from patients with hairy cell leukemia (HCL) that this mutation in exon 15 is considered the disease-defining mutation in HCL. Objectives: This meta-analysis aimed to report the prevalence of BRAF V600E mutation in HCL patients. Methods: Three databases including PubMed, Scopus, and Web of Science up to 2017 were searched for the prevalence of BRAF mutation in HCL patients. A random effects meta-analysis was performed using the Comprehensive Meta-Analysis software version 2.0 with the event rate (ER) and 95% confidence interval (95% CI). Results: Out of 552 articles identified from the search, 11 were included included and were analyzed for meta-analysis study. The studies in meta-analysis included 437 patients with HCL, of which 353 (80.8%) patients had BRAF V600E mutation. The pooled ER of the studies was 81.5% (95% CI: 69.5%–89.5%). The Begg's test did not show publication bias, but the Egger's test showed publication bias. Conclusions: With regard to the mentioned limitations, the prevalence of BRAF mutation in HCL patients was >80%. In future studies, considering sex, age, and other variables can exactly show the correlation between these variables with the detection of BRAF mutation.
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Affiliation(s)
- Mehrdad Payandeh
- Department of Hematology and Medical Oncology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Edris Sadeghi
- Department of Nursing, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrin Iranshahi
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Abstract
Hairy cell leukemia (HCL) is a chronic mature B-cell neoplasm with unique clinicopathologic features and an initial exquisite sensitivity to chemotherapy with purine analogs; however, the disease relapses, often repeatedly. The enigmatic pathogenesis of HCL was recently clarified by the discovery of its underlying genetic cause, the BRAF-V600E kinase-activating mutation, which is somatically and clonally present in almost all patients through the entire disease spectrum and clinical course. By aberrantly activating the RAF-MEK-ERK signaling pathway, BRAF-V600E shapes key biologic features of HCL, including its specific expression signature, hairy morphology, and antiapoptotic behavior. Accompanying mutations of the KLF2 transcription factor or the CDKN1B/p27 cell cycle inhibitor are recurrent in 16% of patients with HCL and likely cooperate with BRAF-V600E in HCL pathogenesis. Conversely, BRAF-V600E is absent in other B-cell neoplasms, including mimickers of HCL that require different treatments (eg, HCL-variant and splenic marginal zone lymphoma). Thus, testing for BRAF-V600E allows for a genetics-based differential diagnosis between HCL and HCL-like tumors, even noninvasively in routine blood samples. BRAF-V600E also represents a new therapeutic target. Patients' leukemic cells exposed ex vivo to BRAF inhibitors are spoiled of their HCL identity and then undergo apoptosis. In clinical trials of patients with HCL who have experienced multiple relapses after purine analogs or who are refractory to purine analogs, a short course of the oral BRAF inhibitor vemurafenib produced an almost 100% response rate, including complete remission rates of 35% to 42%, without myelotoxicity. To further improve on these results, it will be important to clarify the mechanisms of incomplete leukemic cell eradication by vemurafenib and to explore chemotherapy-free combinations of a BRAF inhibitor with other targeted agents (eg, a MEK inhibitor and/or an anti-CD20 monoclonal antibody).
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Affiliation(s)
- Enrico Tiacci
- All authors: Institute of Hematology and Center for Hemato-Oncology Research, University and Hospital of Perugia, Perugia, Italy
| | - Valentina Pettirossi
- All authors: Institute of Hematology and Center for Hemato-Oncology Research, University and Hospital of Perugia, Perugia, Italy
| | - Gianluca Schiavoni
- All authors: Institute of Hematology and Center for Hemato-Oncology Research, University and Hospital of Perugia, Perugia, Italy
| | - Brunangelo Falini
- All authors: Institute of Hematology and Center for Hemato-Oncology Research, University and Hospital of Perugia, Perugia, Italy
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Upadhyaya SA, Koschmann C, Muraszko K, Venneti S, Garton HJ, Hamstra DA, Maher CO, Betz BL, Brown NA, Wahl D, Weigelin HC, DuRoss KE, Leonard AS, Robertson PL. Brainstem Low-Grade Gliomas in Children-Excellent Outcomes With Multimodality Therapy. J Child Neurol 2017; 32:194-203. [PMID: 27810966 PMCID: PMC5582383 DOI: 10.1177/0883073816675547] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Safe maximal surgical resection is the initial treatment of choice for pediatric brainstem low-grade gliomas. Optimal therapy for incompletely resected tumors or that progress after surgery is uncertain. We reviewed the clinical characteristics, therapy, and outcomes of all children with nontectal brainstem low-grade gliomas treated at the University of Michigan between 1993 and 2013. Median age at diagnosis was 6 years; histology was confirmed in 23 of 25 tumors, 64% were pilocytic astrocytoma. Nineteen patients underwent initial tumor resection; 14/19 received no upfront adjuvant therapy. Eight patients in the study had progressive disease; 5 initially resected tumors received chemotherapy at tumor relapse, all with partial or complete radiographic responses. Ten-year progression-free survival is 71% and overall survival, 100%. This single-institution retrospective study demonstrates excellent survival rates for children with brainstem low-grade gliomas. The efficacy of the well-tolerated chemotherapy in this series supports its role in the treatment of unresectable or progressive brainstem low-grade gliomas.
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Affiliation(s)
- Santhosh A Upadhyaya
- 1 Department of Oncology, Division of Neuro-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carl Koschmann
- 2 Department of Pediatrics, Division of Pediatric Hematology Oncology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Karin Muraszko
- 3 Department of Neurosurgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Sriram Venneti
- 4 Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Hugh J Garton
- 3 Department of Neurosurgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | | | - Cormac O Maher
- 3 Department of Neurosurgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Bryan L Betz
- 4 Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Noah A Brown
- 4 Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Wahl
- 6 Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Helmut C Weigelin
- 4 Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Kathleen E DuRoss
- 4 Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Annette S Leonard
- 4 Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Patricia L Robertson
- 2 Department of Pediatrics, Division of Pediatric Hematology Oncology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.,7 Departments of Pediatrics and Neurology, Division of Pediatric Neurology, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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6
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BRAF V600E mutation in hairy cell leukemia: from bench to bedside. Blood 2016; 128:1918-1927. [DOI: 10.1182/blood-2016-07-418434] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/15/2016] [Indexed: 12/13/2022] Open
Abstract
AbstractHairy cell leukemia (HCL) is a distinct clinicopathological entity whose underlying genetic lesion has remained a mystery for over half a century. The BRAF V600E mutation is now recognized as the causal genetic event of HCL because it is somatic, present in the entire tumor clone, detectable in almost all cases at diagnosis (encompassing the whole disease spectrum), and stable at relapse. BRAF V600E leads to the constitutive activation of the RAF-MEK-extracellular signal-regulated kinase (ERK) signaling pathway which represents the key event in the molecular pathogenesis of HCL. KLF2 and CDNK1B (p27) mutations may cooperate with BRAF V600E in promoting leukemic transformation. Sensitive molecular assays for detecting BRAF V600E allow HCL (highly responsive to purine analogs) to be better distinguished from HCL-like disorders, which are treated differently. In vitro preclinical studies on purified HCL cells proved that BRAF and MEK inhibitors can induce marked dephosphorylation of MEK/ERK, silencing of RAF-MEK-ERK pathway transcriptional output, loss of the HCL-specific gene expression profile signature, change of morphology from “hairy” to “smooth,” and eventually apoptosis. The overall response rate of refractory/relapsed HCL patients to the BRAF inhibitor vemurafenib approached 100%, with 35% to 40% complete remissions (CRs). The median relapse free-survival was about 19 months in patients who had achieved CR and 6 months in those who had obtained a partial response. Future therapeutic perspectives include: (1) combining BRAF inhibitors with MEK inhibitors or immunotherapy (anti-CD20 monoclonal antibody) to increase the percentage of CRs and (2) better understanding of the molecular mechanisms underlying resistance of HCL cells to BRAF inhibitors.
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Lakiotaki E, Levidou G, Angelopoulou MK, Adamopoulos C, Pangalis G, Rassidakis G, Vassilakopoulos T, Gainaru G, Flevari P, Sachanas S, Saetta AA, Sepsa A, Moschogiannis M, Kalpadakis C, Tsesmetzis N, Milionis V, Chatziandreou I, Thymara I, Panayiotidis P, Dimopoulou M, Plata E, Konstantopoulos K, Patsouris E, Piperi C, Korkolopoulou P. Potential role of AKT/mTOR signalling proteins in hairy cell leukaemia: association with BRAF/ERK activation and clinical outcome. Sci Rep 2016; 6:21252. [PMID: 26893254 PMCID: PMC4759548 DOI: 10.1038/srep21252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/20/2016] [Indexed: 01/04/2023] Open
Abstract
The potential role of AKT/mTOR signalling proteins and its association with the Raf-MEK-ERK pathway was investigated in hairy cell leukaemia (HCL). BRAFV600E expression and activated forms of AKT, mTOR, ERK1/2, p70S6k and 4E-BP1 were immunohistochemically assessed in 77 BM biopsies of HCL patients and correlated with clinicopathological and BM microvascular characteristics, as well as with c-Caspase-3 levels in hairy cells. Additionally, we tested rapamycin treatment response of BONNA-12 wild-type cells or transfected with BRAFV600E. Most HCL cases expressed p-p70S6K and p-4E-BP1 but not p-mTOR, being accompanied by p-ERK1/2 and p-AKT. AKT/mTOR activation was evident in BONNA-12 cells irrespective of the presence of BRAFV600E mutation and was implicated in cell proliferation enhancement. In multivariate analysis p-AKT/p-mTOR/p-4E-BP1 overexpression was an adverse prognostic factor for time to next treatment conferring earlier relapse. When p-AKT, p-mTOR and p-4E-BP1 were examined separately only p-4E-BP1 remained significant. Our findings indicate that in HCL, critical proteins up- and downstream of mTOR are activated. Moreover, the strong associations with Raf-MEK-ERK signalling imply a possible biologic interaction between these pathways. Most importantly, expression of p-4E-BP1 alone or combined with p-AKT and p-mTOR is of prognostic value in patients with HCL.
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Affiliation(s)
| | - Georgia Levidou
- Department of Pathology, University of Athens, Medical School, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Christos Adamopoulos
- Department of Biological Chemistry, University of Athens, Medical School, Greece
| | | | - George Rassidakis
- Department of Pathology, University of Athens, Medical School, Greece.,Department of Oncology-Pathology, Cancer Centrum Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Theodoros Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Gabriella Gainaru
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Pagona Flevari
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Sotirios Sachanas
- Department of Haematology, Athens Medical Centre, Psychikon Branch, Greece
| | - Angelica A Saetta
- Department of Pathology, University of Athens, Medical School, Greece
| | - Athanasia Sepsa
- Department of Pathology, University of Athens, Medical School, Greece
| | | | | | - Nikolaos Tsesmetzis
- Department of Oncology-Pathology, Cancer Centrum Karolinska, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Irene Thymara
- Department of Pathology, University of Athens, Medical School, Greece
| | - Panayiotis Panayiotidis
- 1st Department of Propaedeutic Internal Medicine, University of Athens, Medical School, Greece
| | - Maria Dimopoulou
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | - Eleni Plata
- Department of Haematology and Bone Marrow Transplantation, University of Athens, Medical School, Greece
| | | | | | - Christina Piperi
- Department of Biological Chemistry, University of Athens, Medical School, Greece
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Ahmadzadeh A, Shahrabi S, Jaseb K, Norozi F, Shahjahani M, Vosoughi T, Hajizamani S, Saki N. BRAF Mutation in Hairy Cell Leukemia. Oncol Rev 2014; 8:253. [PMID: 25992240 PMCID: PMC4419648 DOI: 10.4081/oncol.2014.253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/06/2014] [Accepted: 07/08/2014] [Indexed: 01/28/2023] Open
Abstract
BRAF is a serine/threonine kinase with a regulatory role in the mitogen-activated protein kinase (MAPK) signaling pathway. A mutation in the RAF gene, especially in BRAF protein, leads to an increased stimulation of this cascade, causing uncontrolled cell division and development of malignancy. Several mutations have been observed in the gene coding for this protein in a variety of human malignancies, including hairy cell leukemia (HCL). BRAF V600E is the most common mutation reported in exon15 of BRAF, which is observed in almost all cases of classic HCL, but it is negative in other B-cell malignancies, including the HCL variant. Therefore it can be used as a marker to differentiate between these B-cell disorders. We also discuss the interaction between miRNAs and signaling pathways, including MAPK, in HCL. When this mutation is present, the use of BRAF protein inhibitors may represent an effective treatment. In this review we have evaluated the role of the mutation of the BRAF gene in the pathogenesis and progression of HCL.
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Affiliation(s)
- Ahmad Ahmadzadeh
- Health Research Institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
| | - Saeid Shahrabi
- Department of Biochemistry and Hematology, Semnan University of Medical Sciences , Semnan, Iran
| | - Kaveh Jaseb
- Health Research Institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
| | - Fatemeh Norozi
- Health Research Institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
| | - Mohammad Shahjahani
- Health Research Institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
| | - Tina Vosoughi
- Health Research Institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
| | - Saeideh Hajizamani
- Health Research Institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
| | - Najmaldin Saki
- Health Research Institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences , Ahvaz
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