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Croci GA, Appio L, Cecchetti C, Tabano S, Alberti-Violetti S, Berti E, Rahal D, Cavallaro F, Onida F, Tomasini D, Todisco E. Primary cutaneous, epidermotropic mycosis fungoides-like presentation: critical appraisal and description of two novel cases, broadening the spectrum of ALK+ T-cell lymphoma. Virchows Arch 2024:10.1007/s00428-024-03832-6. [PMID: 38780617 DOI: 10.1007/s00428-024-03832-6] [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: 03/16/2024] [Revised: 04/18/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024]
Abstract
Leading from a two-case series, including two patients receiving a diagnosis of epidermotropic T-cell lymphoma, featuring a mycosis fungoides (MF)-like clinical pattern and ALK expression and molecular alteration, we performed a critical appraisal of ALK+ primary cutaneous T-cell lymphomas (pcTCL). Considering our patients and the literature, 32 cases were retrieved, 7 of which featured an MF-like clinical picture over a 4-to-20-year period. MF-like cases show distinctive histology, comprising a predominantly epidermotropic infiltration of small-to-large, atypical-to-pleomorphic, with few anaplastic cells, negligible-to-intense CD30-expression, and a CD4+/cytotoxic granule+ phenotype. These features should prompt a search for ALK expression captured by the ALK D5F3 clone. Bona fide ALK+ pcTCL is very rare, and existent data suggest the presence of a broader pattern of disease, including instances mimicking MF and/or primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma. The major challenges in dealing with this subset include prodromal phases, misinterpreted as inflammatory dermatosis or parapsoriasis/early phase MF both clinically and histologically, while recognition of its ALK-driven biology is hampered both by the unusual clinic-pathologic pattern of the disease, which stands apart from the classical (i.e., nodal) picture of ALK+ anaplastic large cell lymphoma and by the low sensitivity of ALK1 clone. Data on its optimal management are far from being conclusive: An MF-like approach is currently chosen, but depending on CD30 and, most notably, ALK expression, a targeted therapy could be envisaged in advanced stages, as clinical response to ALK inhibition was documented in one patient.
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Affiliation(s)
- Giorgio Alberto Croci
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
- Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy.
| | - Lorena Appio
- Division of Hematology, ASST ValleOlona Ospedale di Busto Arsizio, Busto Arsizio, Italy
| | - Caterina Cecchetti
- Division of Hematology, ASST ValleOlona Ospedale di Busto Arsizio, Busto Arsizio, Italy
| | - Silvia Tabano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Alberti-Violetti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Dermatology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emilio Berti
- Dermatology Unit, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daoud Rahal
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesca Cavallaro
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Onida
- Hematology Unit, ASST-Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Dario Tomasini
- Division of Dermatology, ASST ValleOlona Ospedale di Busto Arsizio, Busto Arsizio, Italy
| | - Elisabetta Todisco
- Division of Hematology, ASST ValleOlona Ospedale di Busto Arsizio, Busto Arsizio, Italy
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2
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Noguchi K, Ikawa Y. Strategy for Pediatric Patients with Relapsed or Refractory Anaplastic Lymphoma Kinase-Positive Anaplastic Large Cell Lymphoma: A Review. Cancers (Basel) 2023; 15:5733. [PMID: 38136278 PMCID: PMC10741612 DOI: 10.3390/cancers15245733] [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: 10/08/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL) is an aggressive T-cell lymphoma characterized by large T-cells with strong CD30 and ALK expression. Although conventional chemotherapy is effective in most patients, approximately 30% experience a relapse or refractory disease and have a poor prognosis. Several risk factors associated with poor prognosis have been identified in pediatric ALK-positive ALCL. These include morphological patterns with the small cell variant or lymphohistiocytic variant, leukemic presentation, the presence of minimal disseminated disease, or involvement of the central nervous system. Relapsed or refractory ALK-positive ALCL is often resistant to conventional chemotherapy; therefore, salvage therapy is required. In recent years, targeted therapies such as ALK inhibitors and brentuximab vedotin (BV) have been developed. ALK inhibitors block the continuous activation of ALK kinase, a driver mutation that leads to cell proliferation in ALK-positive ALCL. Additionally, BV is an antibody-drug conjugate that targets CD30-positive cells. Both ALK inhibitors and BV have displayed dramatic effects in chemoresistant ALK-positive ALCL. Weekly vinblastine treatment and hematopoietic stem cell transplantation have also been reported to be effective therapies. This article reviews pediatric ALK-positive ALCL, focusing on risk factors and treatment strategies for pediatric patients with relapsed or refractory ALK-positive ALCL.
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Affiliation(s)
| | - Yasuhiro Ikawa
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan;
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Santonja C, Morillo-Giles D, Prieto-Pareja E, Soto-de Ozaeta C, Serrano-del Castillo C, Salgado-Sánchez R, Yi-Shi AWY, Manso R, Rodríguez-Pinilla SM. Leukaemic Presentation of Small-Cell Alk-Positive Anaplastic Large Cell Lymphoma in a Young Woman-Report of a Case with 9-Year Survival. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1628. [PMID: 37763746 PMCID: PMC10537167 DOI: 10.3390/medicina59091628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Anaplastic large cell lymphoma (ALCL) with leukaemic presentation (either ab initio or along the course of the disease) has been rarely reported. Irrespective of ALK expression in the neoplastic cells, it features a dismal prognosis. We report a rare case of leukaemic, small cell variant ALK-positive ALCL with 9-year survival in a young woman who was treated upfront with corticosteroids and standard chemotherapy, and review thoroughly the previously published cases. Such an unexpected, good outcome hints at the existence of different clinical subgroups in the leukaemic variant of ALK-positive ALCL.
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Affiliation(s)
- Carlos Santonja
- Departments of Pathology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (C.S.); (A.-W.-Y.Y.-S.); (S.M.R.-P.)
| | - Daniel Morillo-Giles
- Departments of Haematology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (D.M.-G.); (E.P.-P.); (C.S.-d.O.); (C.S.-d.C.); (R.S.-S.)
| | - Elena Prieto-Pareja
- Departments of Haematology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (D.M.-G.); (E.P.-P.); (C.S.-d.O.); (C.S.-d.C.); (R.S.-S.)
| | - Carlos Soto-de Ozaeta
- Departments of Haematology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (D.M.-G.); (E.P.-P.); (C.S.-d.O.); (C.S.-d.C.); (R.S.-S.)
| | - Cristina Serrano-del Castillo
- Departments of Haematology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (D.M.-G.); (E.P.-P.); (C.S.-d.O.); (C.S.-d.C.); (R.S.-S.)
| | - Rocío Salgado-Sánchez
- Departments of Haematology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (D.M.-G.); (E.P.-P.); (C.S.-d.O.); (C.S.-d.C.); (R.S.-S.)
| | - Ana-Wu-Yang Yi-Shi
- Departments of Pathology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (C.S.); (A.-W.-Y.Y.-S.); (S.M.R.-P.)
| | - Rebeca Manso
- Departments of Pathology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (C.S.); (A.-W.-Y.Y.-S.); (S.M.R.-P.)
| | - Socorro María Rodríguez-Pinilla
- Departments of Pathology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain; (C.S.); (A.-W.-Y.Y.-S.); (S.M.R.-P.)
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Noguchi K, Ikawa Y, Takenaka M, Sakai Y, Fujiki T, Kuroda R, Ikeda H, Abe T, Sakai S, Wada T. Acquired L1196M ALK mutation in anaplastic lymphoma kinase-positive anaplastic large cell lymphoma during alectinib administration. EJHAEM 2023; 4:305-308. [PMID: 36819147 PMCID: PMC9928650 DOI: 10.1002/jha2.646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Affiliation(s)
- Kazuhiro Noguchi
- Department of Pediatrics, School of Medicine, Institute of MedicalPharmaceutical and Health Sciences, Kanazawa UniversityKanazawaJapan
| | - Yasuhiro Ikawa
- Department of Pediatrics, School of Medicine, Institute of MedicalPharmaceutical and Health Sciences, Kanazawa UniversityKanazawaJapan
| | - Mika Takenaka
- Department of Pediatrics, School of Medicine, Institute of MedicalPharmaceutical and Health Sciences, Kanazawa UniversityKanazawaJapan
| | - Yuta Sakai
- Department of Pediatrics, School of Medicine, Institute of MedicalPharmaceutical and Health Sciences, Kanazawa UniversityKanazawaJapan
| | - Toshihiro Fujiki
- Department of Pediatrics, School of Medicine, Institute of MedicalPharmaceutical and Health Sciences, Kanazawa UniversityKanazawaJapan
| | - Rie Kuroda
- Department of Pediatrics, School of Medicine, Institute of MedicalPharmaceutical and Health Sciences, Kanazawa UniversityKanazawaJapan
| | - Hiroko Ikeda
- Department of Diagnostic PathologyKanazawa University HospitalKanazawaJapan
| | - Takatoshi Abe
- Department of Pediatric SurgeryKanazawa University HospitalKanazawaJapan
| | - Seisho Sakai
- Department of Pediatric SurgeryKanazawa University HospitalKanazawaJapan
| | - Taizo Wada
- Department of Pediatrics, School of Medicine, Institute of MedicalPharmaceutical and Health Sciences, Kanazawa UniversityKanazawaJapan
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