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Araki M, Mitsuhashi T, Yatabe Y, Arai T, Yokota H, Okita H, Sakurai M, Tsukada N, Kataoka K, Matsushita H. Simple flow cytometry method using a myeloma panel that easily reveals clonal proliferation of mature B-cells. Clin Chem Lab Med 2024; 0:cclm-2024-0359. [PMID: 39097836 DOI: 10.1515/cclm-2024-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Affiliation(s)
- Mika Araki
- Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Takayuki Mitsuhashi
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Yatabe
- Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Tomoko Arai
- Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | | | - Hajime Okita
- Department of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Masatoshi Sakurai
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Tsukada
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Hiromichi Matsushita
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
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Montesdeoca S, García-Gisbert N, Calvo X, Arenillas L, Román D, Fernández-Rodríguez C, Navarro R, Costan B, Vela MDC, Camacho L, Abella E, Colomo L, Salido M, Puiggros A, Florensa L, Espinet B, Bellosillo B, Ferrer del Álamo A. Leukemic Involvement Is a Common Feature in Waldenström Macroglobulinemia at Diagnosis. Cancers (Basel) 2023; 15:4152. [PMID: 37627180 PMCID: PMC10452547 DOI: 10.3390/cancers15164152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Waldenström Macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with bone marrow (BM) involvement and IgM monoclonal gammopathy. To date, no studies have focused specifically on peripheral blood (PB) involvement. In this study, 100 patients diagnosed with WM according to the World Health Organization (WHO) criteria were included based on the demonstration of MYD88mut in BM and the availability of PB multiparametric flow cytometry (MFC) analysis. Leukemic involvement by MFC was detected in 50/100 patients. A low percentage of mature small lymphocytes in PB smears was observed in only 15 cases. MYD88mut by AS-qPCR was detected in PB in 65/100 cases. In cases with leukemic expression by MFC, MYD88mut was detected in all cases, and IGH was rearranged in 44/49 cases. In 21/50 patients without PB involvement by MFC, molecular data were consistent with circulating disease (MYD88mut by AS-qPCR 3/50, IGH rearranged 6/50, both 12/50). Therefore, PB involvement by standard techniques was detected in 71/100 patients. MYD88mut was detected in PB by dPCR in 9/29 triple negative cases. Overall, 80% of the patients presented PB involvement by any technique. Our findings support the role of PB MFC in the evaluation of patients with IgM monoclonal gammopathy and provide reliable information on correlation with molecular features. The development of a feasible MFC assay may stand as an objective tool in the classification of mature B cell neoplasms presenting with IgM monoclonal gammopathy.
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Affiliation(s)
- Sara Montesdeoca
- Laboratori d’Hematologia, Servei Diagnòstic de Laboratori, Hospital Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain;
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
| | - Nieves García-Gisbert
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Xavier Calvo
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Leonor Arenillas
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - David Román
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Concepción Fernández-Rodríguez
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Rosa Navarro
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Beatriz Costan
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - María del Carmen Vela
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Laura Camacho
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Eugènia Abella
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
- Servei d’Hematologia Clínica, Hospital del Mar, 08003 Barcelona, Spain
| | - Lluís Colomo
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Marta Salido
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citogenètica Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Anna Puiggros
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citogenètica Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Lourdes Florensa
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Blanca Espinet
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citogenètica Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Beatriz Bellosillo
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Ana Ferrer del Álamo
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
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Sarosiek S, Castillo JJ. Novel Agents in Waldenström Macroglobulinemia. Hematol Oncol Clin North Am 2023:S0889-8588(23)00035-7. [PMID: 37198054 DOI: 10.1016/j.hoc.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Owing to the indolent nature of Waldenström macroglobulinemia, most patients experience a prolonged life expectancy, although many lines of therapy will likely be required to maintain disease control. Despite the currently available therapies, most patients will develop intolerance or resistance to multiple treatments. Therefore, new therapeutic options are being developed with a focus on targeted agents, such as novel Bruton tyrosine kinase (BTK) inhibitors and BTK degraders, as well as C-X-C chemokine receptor type 4, mucosa-associated lymphoid tissue translocation protein 1, and interleukin-1 receptor-associated kinase 4.
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Affiliation(s)
- Shayna Sarosiek
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
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Lymphoplasmacytic lymphoma with IgG or IgA paraprotein: a study of 29 cases including cases that can mimic plasma cell neoplasms. Hum Pathol 2022; 130:47-57. [PMID: 36244464 DOI: 10.1016/j.humpath.2022.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022]
Abstract
Lymphoplasmacytic lymphoma (LPL) with IgG or IgA paraprotein is rare and a subset of cases can mimic a plasma cell neoplasm (PCN). We studied 29 such cases to explore their clinicopathological features and the best diagnostic approaches with a focus on bone marrow findings. The cohort included 18 men and 11 women with a median age of 68 years. The median M protein was 3.1 g/dL, IgG in 19 patients (66%), IgA in 9 (31%), and dual IgG/IgA in 1 (3%). All patients had bone marrow involvement with CD138+ plasma cells (PCs) ranging from 1 to 35% (median, 10%). Two patients also had amyloidosis. Immunoglobulin light chain concordant monotypic PCs and monotypic B cells were identified in 96% of cases assessed by flow cytometry. Notably, the neoplastic PCs were consistently positive for CD45 (dim, 100%), CD19 (96%), CD81 (89%), CD27 (83%), rarely and only weakly or partially express CD56 (16%), whereas CD117 was consistently negative. Eleven cases analyzed by fluorescence in situ hybridization were negative for CCND1::IGH and myeloma-related aberrations. MYD88 mutation was detected in 17 of 24 cases (71%), and CXCR4 mutation was identified in 6 of 19 cases (32%), of which 4 had concurrent MYD88 mutation. In conclusion, the results highlight a potential diagnostic pitfall of LPL associated with marked plasmacytic differentiation and an IgG or IgA paraprotein that can resemble a PCN. Useful features in favor of LPL against PCN include the characteristic immunophenotypic profile of the PCs in LPL, absence of CCND1::IGH, and the presence of MYD88 and/or CXCR4 mutations.
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García‐Abellás P, Ferrer Gómez A, Bueno Sacristán D, Piris Villaespesa M, Talavera Yagüe M, Reguero Callejas ME, García‐Cosío M. Lymphoplasmacytic lymphoma and marginal zone lymphoma involving bone marrow: A diagnostic dilemma. Useful clinicopathological features to accurate the diagnosis. EJHAEM 2022; 3:1181-1187. [PMID: 36467836 PMCID: PMC9713066 DOI: 10.1002/jha2.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/18/2022] [Accepted: 09/02/2022] [Indexed: 06/17/2023]
Abstract
Lymphoplasmacytic lymphoma (LPL) and marginal zone lymphoma (MZL) frequently infiltrate the bone marrow with similar histologic and immunohistochemical characteristics posing diagnostic problems. Bone marrow biopsy specimens from 25 LPL and 16 MZL have been studied, correlating with clinical, laboratory parameters and the MYD88_p.L265P mutation. Paratrabecular and interstitial infiltration pattern, serum IgM paraprotein levels, and MYD88_p.L265P mutation were significantly more frequent in LPL. Nodular or intrasinusoidal pattern with lymphocytosis and splenomegaly were associated with MZL diagnosis. Different clinical and histological parameters should be collected when LPL or MZL is suspected in bone marrow biopsy specimens.
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Affiliation(s)
| | - Ana Ferrer Gómez
- Department of PathologyRamón y Cajal Universitary HospitalMadridSpain
| | | | | | | | | | - Mónica García‐Cosío
- Head of Hematopathology DepartmentRamón y Cajal Universitary Hospital; Alcalá University, Madrid, Spain; Instituto Ramon y Cajal de Investigacion Sanitaria, Madrid, Spain; CIBERONCMadridSpain
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Schmieg JJ, Muir JM, Aguilera NS, Auerbach A. CD5-Negative, CD10-Negative Low-Grade B-Cell Lymphoproliferative Disorders of the Spleen. Curr Oncol 2021; 28:5124-5147. [PMID: 34940069 PMCID: PMC8700451 DOI: 10.3390/curroncol28060430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/18/2021] [Accepted: 11/27/2021] [Indexed: 01/20/2023] Open
Abstract
CD5-negative, CD10-negative low-grade B-cell lymphoproliferative disorders (CD5-CD10-LPD) of the spleen comprise a fascinating group of indolent, neoplastic, mature B-cell proliferations that are essential to accurately identify but can be difficult to diagnose. They comprise the majority of B-cell LPDs primary to the spleen, commonly presenting with splenomegaly and co-involvement of peripheral blood and bone marrow, but with little to no involvement of lymph nodes. Splenic marginal zone lymphoma is one of the prototypical, best studied, and most frequently encountered CD5-CD10-LPD of the spleen and typically involves white pulp. In contrast, hairy cell leukemia, another well-studied CD5-CD10-LPD of the spleen, involves red pulp, as do the two less common entities comprising so-called splenic B-cell lymphoma/leukemia unclassifiable: splenic diffuse red pulp small B-cell lymphoma and hairy cell leukemia variant. Although not always encountered in the spleen, lymphoplasmacytic lymphoma, a B-cell lymphoproliferative disorder consisting of a dual population of both clonal B-cells and plasma cells and the frequent presence of the MYD88 L265P mutation, is another CD5-CD10-LPD that can be seen in the spleen. Distinction of these different entities is possible through careful evaluation of morphologic, immunophenotypic, cytogenetic, and molecular features, as well as peripheral blood and bone marrow specimens. A firm understanding of this group of low-grade B-cell lymphoproliferative disorders is necessary for accurate diagnosis leading to optimal patient management.
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Affiliation(s)
- John J. Schmieg
- The Joint Pathology Center, Silver Spring, MD 20910, USA; (J.J.S.); (J.M.M.)
| | - Jeannie M. Muir
- The Joint Pathology Center, Silver Spring, MD 20910, USA; (J.J.S.); (J.M.M.)
| | - Nadine S. Aguilera
- Department of Pathology, University of Virginia Health System, Charlottesville, VA 22904, USA;
| | - Aaron Auerbach
- The Joint Pathology Center, Silver Spring, MD 20910, USA; (J.J.S.); (J.M.M.)
- Correspondence: ; Tel.: +1-301-295-5636
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Rosado F, Guo L, Fuda F. Hematolymphoid neoplasms with a plasma cell phenotype. Semin Diagn Pathol 2020; 37:268-272. [PMID: 32564903 DOI: 10.1053/j.semdp.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | - Ling Guo
- Ohio State University Wexner Medical Center
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Lymphoplasmacytic lymphoma and Waldenström macroglobulinaemia: clinicopathological features and differential diagnosis. Pathology 2020; 52:6-14. [DOI: 10.1016/j.pathol.2019.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
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IgM AL amyloidosis: delineating disease biology and outcomes with clinical, genomic and bone marrow morphological features. Leukemia 2019; 34:1373-1382. [PMID: 31780812 DOI: 10.1038/s41375-019-0667-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/27/2022]
Abstract
This study evaluates newly diagnosed IgM (6%, n = 75/1174) vs. non-IgM light chain amyloidosis patients. IgM amyloid patients had lower light chains (12.5 vs. 22.5 mg/dL; p < 0.001). Heart (56% vs. 73%, p = 0.002) and >1 organ involvement (31% vs. 44%, p = 0.02) was less common in IgM amyloidosis, while soft tissue and peripheral nerve involvement was more common. t(11;14) was less common (27% vs. 50%, p = 0.008) in IgM amyloidosis. Rates of MYD88L265P and CXCR4WHIM mutation in IgM amyloidosis were 58% (29/50) and 17% (8/46). Diagnosis after hematopathology review in IgM amyloidosis was pure plasma cell neoplasm (PPCN) in 23% (16/70), lymphoplasmacytic neoplasm (LPL) in 63% (44/70) patients, and other (14%). LPL vs. PPCN groups had distinct genetic abnormalities: t(11;14): 0% (0/18) vs. 60% (9/15), p < 0.001; MYD88L265P mutation: 84% (27/32) vs. 0% (0/14), p < 0.001; CXCR4 mutation: 29% (8/28) vs. 0% (0/14), p = 0.04. Overall survival was shorter in IgM AL when stratified by Mayo 2012 stage; stage 1/2 (59 vs. 125.9 months, p = 0.003) and stage 3/4 (6.5 vs. 12.9 months, p = 0.075), likely due to lower hematologic response rates (6 months: 39% vs. 59%, p = 0.008). We characterized two subtypes of IgM amyloidosis (LPL/PPCN). This can aid in therapeutic decision-making, with treatment directed at the clonal disease.
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Fang H, Kapoor P, Gonsalves WI, Frederick LA, Viswanatha D, Howard MT, He R, Morice WG, McPhail ED, Greipp PT, Ansell SM, Kyle RA, Gertz MA, Paludo J, Abeykoon J, King RL. Defining Lymphoplasmacytic Lymphoma: Does MYD88L265P Define a Pathologically Distinct Entity Among Patients With an IgM Paraprotein and Bone Marrow-Based Low-Grade B-Cell Lymphomas With Plasmacytic Differentiation? Am J Clin Pathol 2018; 150:168-176. [PMID: 29868855 DOI: 10.1093/ajcp/aqy041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Lymphoplasmacytic lymphoma (LPL) remains a poorly defined entity, even with the discovery of MYD88L265P mutations and association with Waldenström macroglobulinemia (WM). Among bone marrow (BM)-based, low-grade B-cell lymphoma with plasmacytic differentiation (LGBLPD) and immunoglobulin M (IgM) paraproteins, we sought to determine whether MYD88L265P defines a distinct entity and can help refine diagnostic criteria for LPL. METHODS BMs diagnosed with LGBLPD or LPL and serum IgM paraprotein were studied (2007-2013). Clinicopathologic features were reviewed and specimens were tested for MYD88L265P. RESULTS In total, 138 (87%) of 159 cases had MYD88L265P, and 158 of 159 were clinically considered WM. MYD88L265P cases had higher disease burden than MYD88WT. Features associated with MYD88L265P include increased mast cells and lymphocyte (not plasma cell)-predominant infiltrate. Hemosiderin, Dutcher bodies, and paratrabecular growth were not associated with MYD88L265P. CONCLUSIONS Our data support a clinicopathologic approach to LPL diagnosis and recognition that it may manifest with varying morphologies, phenotypes, and molecular features.
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Affiliation(s)
- Hong Fang
- Division of Hematopathology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN
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Gao Q, Yellapantula V, Fenelus M, Pichardo J, Wang L, Landgren O, Dogan A, Roshal M. Tumor suppressor CD99 is downregulated in plasma cell neoplasms lacking CCND1 translocation and distinguishes neoplastic from normal plasma cells and B-cell lymphomas with plasmacytic differentiation from primary plasma cell neoplasms. Mod Pathol 2018; 31:881-889. [PMID: 29403080 PMCID: PMC5998376 DOI: 10.1038/s41379-018-0011-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Abstract
CD99(MIC2) is a widely expressed cell surface glycoprotein and functions as a tumor suppressor involved in downregulation of SRC family of tyrosine kinase. CD99 expression is tightly regulated through B-cell development. The principal aims of this study were to investigate the clinical utility of CD99 expression (i) in distinguishing normal plasma cells from primary plasma cell neoplasms; (ii) in detection of minimal residual disease in primary plasma cell neoplasms; and (iii) in distinguishing plasma cell component of B-cell lymphomas from primary plasma cell neoplasms. We analyzed expression of CD99 by flow cytometry and immunohistochemistry in lymph nodes, peripheral blood, and bone marrow samples. CD99 showed stage-specific expression with highest expression seen in precursor B and plasma cells. In contrast to the uniform bright expression on normal plasma cells, CD99 expression on neoplastic plasma cells was lost in 39 out of 56 (69.6%) cases. Furthermore, 8 out of 56 samples (14%) showed visibly (>10-fold) reduced CD99 expression. Overall, CD99 expression was informative (absent or visibly dimmer than normal) in 84% of primary plasma cell neoplasm. In the context of minimal residual disease detection, CD99 showed superior utility in separating normal and abnormal plasma cells over currently established antigens CD117, CD81, and CD27 by principal component analysis. Preservation of CD99 expression was strongly associated with cyclin D1 translocation in myeloma (p < 0.05). B-cell lymphomas with plasma cell component could be distinguished from myeloma by CD99 expression. In summary, we established that tumor suppressor CD99 is markedly downregulated in multiple myeloma. The loss is highly specific for identification of abnormal cells in primary plasma cell neoplasms, and can be exploited for diagnostic purposes. The role of CD99 in myeloma pathogenesis requires further investigation.
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Affiliation(s)
- Qi Gao
- Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Venkata Yellapantula
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Maly Fenelus
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Janine Pichardo
- Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Lu Wang
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Ola Landgren
- Myeloma Service, Memorial Sloan Kettering Cancer Center
| | - Ahmet Dogan
- Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Mikhail Roshal
- Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Shi M, Ternus JA, Ketterling RP, Jevremovic D, McPhail ED. Immunophenotypic and laboratory features of t(11;14)(q13;q32)-positive plasma cell neoplasms. Leuk Lymphoma 2017; 59:1913-1919. [DOI: 10.1080/10428194.2017.1410885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Min Shi
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jessica A. Ternus
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rhett P. Ketterling
- Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ellen D. McPhail
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Growková K, Kryukova E, Kufová Z, Filipová J, Ševčíková T, Říhová L, Kaščák M, Kryukov F, Hájek R. Waldenström's macroglobulinemia: Two malignant clones in a monoclonal disease? Molecular background and clinical reflection. Eur J Haematol 2017; 99:469-478. [PMID: 28886236 DOI: 10.1111/ejh.12959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 12/12/2022]
Abstract
Waldenström's macroglobulinemia (WM) is a complex disease characterized by apparent morphological heterogeneity within the malignant clonal cells representing a continuum of small lymphocytes, plasmacytoid lymphocytes, and plasma cells. At the molecular level, the neoplastic B cell-derived clone has undergone somatic hypermutation, but not isotype switching, and retains the capability of plasmacytic differentiation. Although by classical definition, WM is formed by monoclonal expansion, long-lived clonal B lymphocytes are of heterogeneous origin. Even more, according to current opinion, plasma cells also conform certain population with pathogenic and clinical significance. In this article, we review the recent advances in the WM clonal architecture, briefly describe B-cell development during which the molecular changes lead to the malignant transformation and mainly focus on differences between two principal B-lineage clones, including analysis of their genome and transcriptome profiles, as well as immunophenotype features. We assume that the correct identification of a number of specific immunophenotypic molecular and expression alterations leading to proper aberrant clone detection can help to guide patient monitoring throughout treatment and successfully implement therapy strategies directed against both B- and plasma cell tumor WM clones.
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Affiliation(s)
- Kateřina Growková
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic.,Department of Clinical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Elena Kryukova
- Department of Clinical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Haemato-Oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Zuzana Kufová
- Department of Clinical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Experimental Biology, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Jana Filipová
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic.,Department of Clinical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Tereza Ševčíková
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic.,Department of Clinical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lucie Říhová
- Department of Clinical Haematology, University Hospital Brno, Brno, Czech Republic
| | - Michal Kaščák
- Department of Haemato-Oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Fedor Kryukov
- Department of Clinical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Haemato-Oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Roman Hájek
- Department of Clinical Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Haemato-Oncology, University Hospital Ostrava, Ostrava, Czech Republic
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14
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Li S, Jaye DL, Bradley KT, Zhang L, Saxe D, Deeb G, Hill CE, Mann KP. Multimodality Technologies in the Assessment of Hematolymphoid Neoplasms. Arch Pathol Lab Med 2017; 141:341-354. [DOI: 10.5858/arpa.2016-0260-sa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Accurate assessment of tissues for hematolymphoid neoplasms requires an integrated multiparameter approach. Although morphologic examination by light microscopy remains the mainstay of initial assessment for hematolymphoid neoplasms, immunophenotypic analysis by immunohistochemistry and/or flow cytometry is essential to determine the pattern of differentiation and to detect minimal disease when morphology is inconclusive. In some cases, immunophenotypic analysis provides additional information for targeted immunotherapy and prognostication. Genotypic studies, including cytogenetics, fluorescence in situ hybridization, DNA microarray, polymerase chain reaction, and/or next-generation sequencing, are also imperative for subclassification of the genetically defined disease entities in the current World Health Organization classification of hematolymphoid neoplasms. Moreover, genotypic studies can establish clonality, stratify patients to determine appropriate treatment, and monitor patients for treatment response.
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Affiliation(s)
| | | | | | | | | | | | | | - Karen P. Mann
- From the Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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15
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Abstract
This article provides an overview of the role of flow cytometry in the diagnosis and follow-up of plasma cell myeloma. A brief introduction to the general immunophenotypic features of normal and myeloma plasma cells is provided, followed by a discussion of technical issues as they relate to the application of flow cytometry in this entity. The prognostic and therapeutic utility of flow cytometric immunophenotyping in myeloma is also analyzed, with an emphasis on the growing role of minimal residual analysis as potential biomarker for evaluating treatment efficacy and for tailoring risk-adapted treatment, in prospective clinical trials.
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Affiliation(s)
- Horatiu Olteanu
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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16
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Simultaneous Manifestation of Chronic Myelomonocytic Leukemia and Multiple Myeloma during Treatment by Prednisolone and Eltrombopag for Immune-Mediated Thrombocytopenic Purpura. Case Rep Hematol 2016; 2016:4342820. [PMID: 27597907 PMCID: PMC5002293 DOI: 10.1155/2016/4342820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/09/2016] [Accepted: 07/10/2016] [Indexed: 11/17/2022] Open
Abstract
An 80-year-old man was admitted to our hospital because of severe thrombocytopenia. He was diagnosed with idiopathic thrombocytopenia, and prednisolone together with eltrombopag was started, leading to significant improvement of platelet counts. Four years later, there was a prominent increase of peripheral blood monocytes, which was accompanied by recurrence of thrombocytopenia. Bone marrow aspirates and serum electrophoresis revealed coexistence of chronic myelomonocytic leukemia (CMML) and multiple myeloma (MM). The patient received lenalidomide plus dexamethasone therapy but died due to exacerbation of the disorder. It was supposed that thrombocytopenia was secondarily caused by CMML and MM developed at a later period.
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King RL, Gonsalves WI, Ansell SM, Greipp PT, Frederick LA, Viswanatha DS, He R, Kyle RA, Gertz MA, Kapoor P, Morice WG, Howard MT. Lymphoplasmacytic Lymphoma With a Non-IgM Paraprotein Shows Clinical and Pathologic Heterogeneity and May Harbor MYD88 L265P Mutations. Am J Clin Pathol 2016; 145:843-51. [PMID: 27329639 DOI: 10.1093/ajcp/aqw072] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Lymphoplasmacytic lymphoma (LPL) with non-immunoglobulin M (IgM) paraproteinemia remains poorly understood. The goal of this study was to investigate the clinicopathologic features of LPL in the bone marrow in patients with immunoglobulin G (IgG) or immunoglobulin A (IgA) paraproteins and evaluate MYD88 L265P mutation status to determine the relationship of these cases to Waldenström macroglobulinemia (WM). METHODS Bone marrows from LPL cases with IgG or IgA paraproteins diagnosed between January 1, 2007, and June 30, 2014, were retrieved from the clinical archive. Clinicopathologic features were retrospectively reviewed. MYD88 L265P mutation status was assessed by allele-specific polymerase chain reaction prospectively on all cases. RESULTS Of 27 cases, four were reclassified as multiple myeloma, all MYD88 mutation negative. MYD88 L265P mutations were present in 10 (43%) of 23 remaining cases. No association between MYD88 status and bone marrow morphologic or phenotypic features, including the presence of Dutcher bodies, mast cells, expression of CD19 by plasma cells, or hemosiderin, was identified, although these features were present in a subset of cases, similar to WM. Clinical features of WM such as hyperviscosity were uncommon in this group and did not correlate with MYD88 status. CONCLUSIONS Non-IgM LPLs are a clinically and pathologically heterogeneous group and often harbor MYD88 L265P mutation, albeit at a lower rate than classic WM. MYD88 status does not correlate with any specific pathologic or clinical manifestations.
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Affiliation(s)
| | | | | | | | | | | | - Rong He
- From the Division of Hematopathology
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The many faces of small B cell lymphomas with plasmacytic differentiation and the contribution of MYD88 testing. Virchows Arch 2015; 468:259-75. [PMID: 26454445 DOI: 10.1007/s00428-015-1858-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/23/2015] [Indexed: 12/11/2022]
Abstract
Plasmacytic differentiation may occur in almost all small B cell lymphomas (SBLs), although it varies from being uniformly present (as in lymphoplasmacytic lymphoma (LPL)) to very uncommon (as in mantle cell lymphomas (MCLs)). The discovery of MYD88 L265P mutations in the vast majority of LPLs has had a major impact on the study of these lymphomas. Review of the cases contributed to the 2014 European Association for Haematopathology/Society for Hematopathology slide workshop illustrated how mutational testing has helped refine the diagnostic criteria for LPL, emphasizing the importance of identifying a clonal monotonous lymphoplasmacytic population and highlighting how LPL can still be diagnosed with extensive nodal architectural effacement, very subtle plasmacytic differentiation, follicular colonization, or uncommon phenotypes such as CD5 or CD10 expression. MYD88 L265P mutations were found in 11/11 LPL cases versus only 2 of 28 other SBLs included in its differential diagnosis. Mutational testing also helped to exclude other cases that would have been considered LPL in the past. The workshop also highlighted how plasmacytic differentiation can occur in chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, SOX11 negative MCL, and particularly in marginal zone lymphomas, all of which can cause diagnostic confusion with LPL. The cases also highlighted the difficulty in distinguishing lymphomas with marked plasmacytic differentiation from plasma cell neoplasms. Some SBLs with plasmacytic differentiation can be associated with amyloid, other immunoglobulin deposition, or crystal-storing histiocytosis, which may obscure the underlying neoplasm. Finally, although generally indolent, LPL may transform, with the workshop cases suggesting a role for TP53 abnormalities.
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