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Cheah CY, Opat S, Trotman J, Marlton P. Front-line management of indolent non-Hodgkin lymphoma in Australia. Part 2: mantle cell lymphoma and marginal zone lymphoma. Intern Med J 2020; 49:1070-1080. [PMID: 30816618 DOI: 10.1111/imj.14268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/13/2018] [Accepted: 02/16/2019] [Indexed: 12/17/2022]
Abstract
Mantle cell lymphoma (MCL) and the marginal zone lymphoma (MZL) subtypes (nodal MZL, extra-nodal MZL of mucosa-associated lymphoid tissue (MALT lymphoma) and splenic MZL) are uncommon lymphoma subtypes, accounting for less than 5-10% of all non-Hodgkin lymphoma. The evidence base for therapy is therefore limited and enrolment into clinical trials is preferred. Outcomes for patients with MCL have been steadily improving mainly due to the adoption of more intense strategies in younger patients, the use of rituximab maintenance and the recent introduction of bendamustine in older patients. MZL is a more heterogeneous group of cancer with both nodal, extra-nodal and splenic subtypes. Extranodal MZL may be associated with autoimmune or infectious aetiologies, and can respond to eradication of the causative pathogen. Proton pump inhibitor plus dual antibiotics in Helicobacter pylori positive gastric MALT lymphoma is curative in many patients. Watchful waiting is appropriate in most patients with asymptomatic advanced stage disease, which tends to behave in a particularly indolent manner. Other options for symptomatic disease include splenectomy, chemoimmunotherapy with rituximab and, more recently, targeted therapies.
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Affiliation(s)
- Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Department of Haematology, Pathwest Laboratory Medicine WA, Western Australia, Australia.,Medical School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Stephen Opat
- Clinical Haematology and School of Clinical Sciences, Monash Health, Clayton, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Judith Trotman
- Department of Haematology, Concord Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Paula Marlton
- Division of Cancer Services, Clinical Haematology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,University of Queensland School of Medicine, Brisbane, Queensland, Australia
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Maqbool MG, Tam CS, Morison IM, Simpson D, Mollee P, Schneider H, Chan H, Juneja S, Harvey Y, Nath L, Hissaria P, Prince HM, Wordsworth H, Opat S, Talaulikar D. A practical guide to laboratory investigations at diagnosis and follow up in Waldenström macroglobulinaemia: recommendations from the Medical and Scientific Advisory Group, Myeloma Australia, the Pathology Sub-committee of the Lymphoma and Related Diseases Registry and the Australasian Association of Clinical Biochemists Monoclonal Gammopathy Working Group. Pathology 2020; 52:167-178. [PMID: 31902622 DOI: 10.1016/j.pathol.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 01/30/2023]
Abstract
Waldenström macroglobulinaemia (WM) is an indolent non-Hodgkin lymphoma which usually presents with symptoms related to infiltration of bone marrow or other tissues like lymph nodes, liver or spleen and has certain unusual clinical manifestations, e.g., renal and central nervous system (CNS) involvement. It also has an array of laboratory features including hypersecretion of IgM, cryoglobulinaemia, increased plasma viscosity and identification of mutated MYD88L265P in more than 90% of cases. In this review, we aim to provide a guide to the laboratory investigations recommended for WM at initial diagnosis and at follow-up. A discussion on the nuances of diagnosis and differential diagnoses is followed by bone marrow (BM) assessment, measurement of paraprotein and other ancillary investigations. Recommendations are provided on laboratory work-up at diagnosis, in the asymptomatic follow-up phase, and during and post-treatment. Finally, we briefly discuss the implications of laboratory diagnosis in regard to recruitment and monitoring on clinical trials.
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Affiliation(s)
- M Gohar Maqbool
- Department of Haematology, ACT Pathology, Canberra Hospital, ACT, Australia; ANU Medical School, College of Medicine and Health, Australian National University, Canberra, ACT, Australia
| | - Constantine S Tam
- Peter MacCallum Cancer Center, St Vincent's Hospital and University of Melbourne, Melbourne, Vic, Australia
| | - Ian M Morison
- Southern Community Laboratories, Dunedin, New Zealand; Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia
| | - David Simpson
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Medical and Scientific Advisory Group, Myeloma Australia
| | - Peter Mollee
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Medical and Scientific Advisory Group, Myeloma Australia; Department of Haematology, Princess Alexandra Hospital and University of Queensland Medical School, Brisbane, Qld, Australia
| | - Hans Schneider
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Alfred Pathology Service and Monash University, Melbourne, Vic, Australia
| | - Henry Chan
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Medical and Scientific Advisory Group, Myeloma Australia
| | - Surender Juneja
- Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia
| | - Yasmin Harvey
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Lakshmi Nath
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Department of Haematology and Transfusion Medicine, Clinpath Pathology, Adelaide, SA, Australia
| | - Pravin Hissaria
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Royal Adelaide Hospital, University of Adelaide and SA Pathology, Adelaide, SA, Australia
| | - H Miles Prince
- Medical and Scientific Advisory Group, Myeloma Australia; Epworth Healthcare, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Vic, Australia
| | - Helen Wordsworth
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Stephen Opat
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Department of Haematology, Monash Health, Melbourne, Vic, Australia
| | - Dipti Talaulikar
- Department of Haematology, ACT Pathology, Canberra Hospital, ACT, Australia; ANU Medical School, College of Medicine and Health, Australian National University, Canberra, ACT, Australia; Medical and Scientific Advisory Group, Myeloma Australia; Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia.
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Talaulikar D, Biscoe A, Lim JH, Gibson J, Arthur C, Mackinlay N, Saxena K, Cheng YY, Chen VM. Genetic analysis of Diffuse Large B‐cell Lymphoma occurring in cases with antecedent Waldenström Macroglobulinaemia reveals different patterns of clonal evolution. Br J Haematol 2018; 185:767-770. [DOI: 10.1111/bjh.15610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Dipti Talaulikar
- Haematology Translational Research Unit Canberra Hospital Canberra Australia
- Australian National University Medical School Canberra Australia
| | - Amber Biscoe
- Haematology Concord Repatriation General Hospital Sydney Australia
| | - Jun H. Lim
- Australian National University Medical School Canberra Australia
| | - John Gibson
- Royal Prince Alfred Hospital Sydney Australia
| | | | | | - Kartik Saxena
- Haematology Translational Research Unit Canberra Hospital Canberra Australia
| | - Yuen Y. Cheng
- Asbestos Diseases Research Institute The University of Sydney Sydney Australia
| | - Vivien M. Chen
- Haematology Concord Repatriation General Hospital Sydney Australia
- ANZAC Research Institute Sydney Australia
- University of Sydney Sydney Australia
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Kawada S, Kuriyama M, Kotani Y, Tsushima S, Tanabe A, Kioka Y. Nonbacterial thrombotic endocarditis involving all four cardiac valves. Asian Cardiovasc Thorac Ann 2017; 26:44-46. [PMID: 29212343 DOI: 10.1177/0218492317748091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This report describes a case of nonbacterial thrombotic endocarditis caused by Waldenström macroglobulinemia, with diffuse endocardial lesions and involvement of all 4 cardiac valves. A 77-year-old man presented with heart failure due to severe regurgitation of all 4 cardiac valves; surgical repair using bioprosthetic valves was indicated. A pathological study revealed fibrin-triggered thrombus formation that confirmed the diagnosis of nonbacterial thrombotic endocarditis. In cases of nonbacterial thrombotic endocarditis, the underlying cause should be investigated.
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Affiliation(s)
- Sachiko Kawada
- 1 Department of Cardiovascular Surgery, Cardiovascular Centre, 13757 Fukuyama City Hospital , Hiroshima, Japan
| | - Mitsuhito Kuriyama
- 1 Department of Cardiovascular Surgery, Cardiovascular Centre, 13757 Fukuyama City Hospital , Hiroshima, Japan
| | - Yasuhiro Kotani
- 2 Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Shou Tsushima
- 3 Department of Cardiovascular Internal Medicine, Cardiovascular Centre, Fukuyama City Hospital, Hiroshima, Japan
| | - Atsushi Tanabe
- 1 Department of Cardiovascular Surgery, Cardiovascular Centre, 13757 Fukuyama City Hospital , Hiroshima, Japan
| | - Yukio Kioka
- 1 Department of Cardiovascular Surgery, Cardiovascular Centre, 13757 Fukuyama City Hospital , Hiroshima, Japan
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Kim I, Wu G, Chai NN, Klein AS, Jordan S. Ibrutinib suppresses alloantibody responses in a mouse model of allosensitization. Transpl Immunol 2017; 45:59-64. [PMID: 28951258 DOI: 10.1016/j.trim.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ibrutinib is a Bruton's tyrosine Kinase (BTK) antagonist that inhibits B cell receptor (BCR) signaling. Complete BTK deficiency is associated with absence of B-cells. Ibrutinb is currently approved by FDA for treatment of B-cell malignancies, including Waldenström macroglobulinaemia. We recently carried out studies to determine if ibrutinib could modify alloantibody responses. MATERIALS AND METHODS A mouse model of allogenic sensitization using a C57BL/6 mouse as the recipient of a skin allograft from an HLA-A2 transgenic mouse was utilized to examine the effects of ibrutinib on alloantibody responses and B cell effector functions. Donor-specific antibody (DSA) levels were measured in a flow-cytometric antibody binding assay. Splenic T and B cell subsets and plasma cells were analyzed in flow cytometry. RESULTS Control mice developed peak levels of DSA IgM at day 14 PTx while the ibrutinib treated mice had significantly lower levels of DSA IgM (p=0.0047). Control mice developed HLA.A2-specific IgG antibodies at day 14 (230±60 MFI) and reached peak levels at day 21 (426±61 MFI). In contrast, mice in the treatment group had low levels of HLA.A2-specific IgG at day 14 (109±59 MFI, p=0.004) and day 21 (241±86 MFI, p=0.003). FACS analysis found a reduction of B220+ or CD19+ B cell population (p<0.05). In addition, ibrutinib attenuated recall DSA IgG responses to re-sensitization (p<0.05) and reduced CD38+CD138+ plasma cells (p<0.05) in the spleens. CONCLUSIONS Ibrutinib is effective in suppressing alloantibody responses through blocking BTK-mediated BCR signaling, leading to reduction of B cells and short-lived plasma cells in the spleens. Use of ibrutinib may provide benefits to HLA-sensitized transplant patients for alloantibody suppression.
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Affiliation(s)
- Irene Kim
- Comprehensive Transplant Center at Cedars-Sinai Medical Center, 9700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Gordon Wu
- Comprehensive Transplant Center at Cedars-Sinai Medical Center, 9700 Beverly Blvd, Los Angeles, CA 90048, USA.
| | - Ning-Ning Chai
- Comprehensive Transplant Center at Cedars-Sinai Medical Center, 9700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Andrew S Klein
- Comprehensive Transplant Center at Cedars-Sinai Medical Center, 9700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Stanley Jordan
- Comprehensive Transplant Center at Cedars-Sinai Medical Center, 9700 Beverly Blvd, Los Angeles, CA 90048, USA
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