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Dominic JL, Ganduboina R, Dutta P, Gubran K, Toussaint ML, Isrow DM. Primary bladder B-cell lymphoma: a rare case report and review of literature. Ann Med Surg (Lond) 2024; 86:3652-3657. [PMID: 38846862 PMCID: PMC11152792 DOI: 10.1097/ms9.0000000000002051] [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: 02/09/2024] [Accepted: 03/28/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction and importance Primary bladder lymphoma accounts for a mere fraction of vesical tumours and extranodal lymphomas, which mostly affect women. IGH-BCL2 translocation, which occurs in 80-100% of Western follicular variants but only 60% in Asian communities, must be studied to determine its effects on prognosis and treatment. This study analyses and compares relevant literature and data for the authors' case report. Case presentation The authors report a 69-year-old Caucasian female with one gross haematuria episode and no smoking history. Computed tomography (CT) showed a bilateral massive intraluminal mass left ureterovesical junction, hydronephrosis, and hydroureter. Clinical discussion Following the removal of a massive transurethral urinary bladder tumour, histological examination revealed lymphoma cells positive for IRTA and LMO2 but negative for IGH-BCL2. After these analyses, the patient received 3 weeks of 30 Gy/15 f IMRT/IGRT. Comparisons were made to previous case reports' histopathology. Conclusion The current case report emphasizes the rarity of primary bladder lymphoma and the absence of the IGH-BCL2 fusion gene. Following the successful administration of 30 Gy of radiation therapy, the patient's prognosis improved. The report emphasizes clinical vigilance and timely management while also urging further investigation.
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Affiliation(s)
- Jerry Lorren Dominic
- Department of General Surgery, University of Miami Miller School of Medicine/Jackson Memorial Hospital
| | | | | | | | | | - Derek Michael Isrow
- Radiation Oncology, University of Miami/Jackson Memorial Hospital & Sylvester Cancer Center, Miami, FL
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Sugitani A, Fukuhara S, Shibata M, Ichihara R, Furukawa H, Maeshima AM. Diffuse large B-cell lymphoma with composite germinal center and non-germinal center types: A report of two cases. J Clin Exp Hematop 2023; 63:181-186. [PMID: 37518270 PMCID: PMC10628827 DOI: 10.3960/jslrt.23020] [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: 05/11/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 08/01/2023] Open
Abstract
We report two cases of diffuse large B-cell lymphoma (DLBCL) with composite germinal center B-cell (GCB) and non-GCB types. Case 1 was a 72-year-old woman with inguinal lymph node swelling. Two morphologically different lesions were concurrently observed in needle biopsy specimens. One lesion was DLBCL with centroblastic morphology and a GCB phenotype (CD10+, BCL6+, and MUM1-), according to the Hans algorithm. The other lesion was DLBCL with anaplastic morphology and a non-GCB phenotype (CD10-, BCL6+, and MUM1+). Considering cellular atypia, the GCB-type DLBCL likely progressed to non-GCB-type DLBCL. Case 2 was a 34-year-old man who underwent ileocecal resection, with four lesions observed in the ileum. All four lesions indicated centroblastic morphology. Three lesions showed a GCB phenotype (CD10+, BCL6+, and MUM1+), while the other showed a non-GCB phenotype (CD10-, BCL6+, and MUM1+). These tumors were clonally related. BCL2 expression and MYC rearrangement were not related to changes in the cell of origin (COO) in either case. In conclusion, changes in the COO in DLBCL may not be uncommon. Therefore, investigation of the COO in other sites or at relapse may be needed if new drugs with different indications for each COO are developed.
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Suzuki A, Hirokawa M, Kanematsu R, Tanaka A, Yamao N, Higuchi M, Hayashi T, Kuma S, Miyauchi A. B-cell to T-cell ratio as a novel indicator in flow cytometry in the diagnosis of thyroid lymphoma. Endocr J 2022; 69:291-297. [PMID: 34670907 DOI: 10.1507/endocrj.ej21-0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Preoperative flow cytometry is recommended to prove the monoclonality and confirm the diagnosis of thyroid lymphoma. However, lymphoma cases without light chain restriction may also have monoclonality. The aim of our study was to identify a novel marker for thyroid lymphomas using aspirated materials for flow cytometry. We retrospectively analyzed 26 patients with primary thyroid lymphomas and 16 patients with benign lymphoproliferative lesions. The materials for flow cytometry were obtained by fine-needle aspiration cytology using a 22-gauge needle under ultrasound guidance. Light chain restriction was defined as a κ to λ ratio of less than 0.5 or more than 3.0. According to the light chain-positive rate, 25% or less and more than 25% were classified as the low and high light chain-positive rate groups, respectively. B-cell predominance was defined as a CD19 to CD4 ratio (B- to T-cell ratio) of more than 2.0. B-cell predominance was more frequently observed in lymphomas (88.5%) than in benign lymphoproliferative lesions (25.0%; p < 0.001). Light chain restriction based on the κ/λ ratio was detected in 69.2% of lymphomas, but not in benign lymphoproliferative lesions. Among lymphomas belonging to the low light chain-positive rate group, 88.9% did not exhibit light chain restriction and B-cell predominance was present. In contrast, benign lymphoproliferative lesions with B-cell predominance were not detected in the low light chain-positive rate group. B-cell predominance was a useful indicator for diagnosing thyroid lymphoma in the low light chain-positive rate group without light chain restriction.
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Affiliation(s)
- Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Risa Kanematsu
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Aki Tanaka
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Naoki Yamao
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Miyoko Higuchi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Toshitetsu Hayashi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Seiji Kuma
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
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4
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Maeshima AM, Taniguchi H, Hori Y, Ida H, Hosoba R, Makita S, Fukuhara S, Munakata W, Suzuki T, Maruyama D, Izutsu K. Diagnostic utility and prognostic significance of the Ki-67 labeling index in diffuse large B-cell lymphoma transformed from follicular lymphoma: a study of 76 patients. Pathol Int 2021; 71:674-681. [PMID: 34339560 DOI: 10.1111/pin.13148] [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: 03/28/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
The diagnosis of histological transformation of follicular lymphoma can be challenging and ambiguous. We investigated the distribution of the Ki-67 labeling index of histological transformation of follicular lymphoma and determined its cutoff value to predict poor outcomes. The diagnostic criteria for histological transformation were a diffuse pattern of proliferation and a proportion of large lymphoma cells ≥20%. Of the 1121 patients with follicular lymphoma, 171 (15%) showed histological transformation to diffuse large B-cell lymphoma. Of these, 76 patients, whose biopsies were obtained from the sites with the highest maximum standardized uptake values, according to the positron emission tomography findings, were included. The Ki-67 index ranged from 16.8% to 98.4% (median, 60.6%). In patients with histological transformation, the most significant differences were found in progression-free survival (p = 0.087, 58% vs. 87% at 2 years) and overall survival (p = 0.024, 53% vs. 85% at 5 years) when a 70% cutoff was used. Additionally, overall survival was significantly shorter in patients with histological transformation with maximum standardized uptake values of ≥20 (p < 0.0001) and absence of a follicular lymphoma component (p = 0.004). A Ki-67 index of ≥70% was a significant adverse factor for overall survival in patients with histological transformation of follicular lymphoma and may predict poor outcomes.
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Affiliation(s)
| | | | - Yoshikazu Hori
- Departments of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Hanae Ida
- Departments of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Rika Hosoba
- Departments of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinichi Makita
- Departments of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Suguru Fukuhara
- Departments of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Wataru Munakata
- Departments of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Tatsuya Suzuki
- Departments of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Dai Maruyama
- Departments of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Koji Izutsu
- Departments of Hematology, National Cancer Center Hospital, Tokyo, Japan
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5
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Munakata W, Shirasugi Y, Tobinai K, Onizuka M, Makita S, Suzuki R, Maruyama D, Kawai H, Izutsu K, Nakanishi T, Shiba S, Hojo S, Ando K. Phase 1 study of tazemetostat in Japanese patients with relapsed or refractory B-cell lymphoma. Cancer Sci 2021; 112:1123-1131. [PMID: 33492746 PMCID: PMC7935786 DOI: 10.1111/cas.14822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Tazemetostat is a selective and orally available inhibitor of enhancer of zeste homolog 2 (EZH2), a histone methyltransferase and epigenetic regulator of cellular differentiation programs. We carried out a phase I study of tazemetostat in Japanese patients with relapsed or refractory B‐cell non‐Hodgkin‐type lymphoma (B‐NHL) to evaluate its tolerability, safety, pharmacokinetics, and preliminary antitumor activity. Methods Tazemetostat was given orally at a single dose of 800 mg on the first day and 800 mg twice daily (BID: total 1600 mg/d) on following days in a 28‐day/cycle manner. Tazemetostat dose‐limiting toxicity (DLT) was evaluated up to the end of the first treatment cycle. Archival tumor tissues were analyzed for hotspot EZH2 mutations. Results As of 15 January 2018, seven patients (four follicular lymphoma [FL] and three diffuse large B‐cell lymphoma [DLBCL]) were enrolled. The median age was 73 (range, 59‐85) years, and the median number of prior chemotherapy regimens was three (range, one to five). No DLT was observed (one patient was not evaluable due to early disease progression). The common treatment‐related adverse events (AEs) were thrombocytopenia and dysgeusia (three patients each; 42.9%). No treatment‐related serious AEs were observed. The objective response rate was 57% (4/7 patients), including responses in three of four patients with FL and one of three patients with DLBCL. An EZH2 mutation was detected in one patient with FL responding to treatment. Conclusions Tazemetostat at 800 mg BID showed an acceptable safety profile and promising antitumor activity in Japanese patients with relapsed or refractory B‐NHL.
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Affiliation(s)
- Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Yukari Shirasugi
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Rikio Suzuki
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Hidetsugu Kawai
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Sari Shiba
- Clinical Pharmacology Science Department, Eisai Co., Ltd., Tokyo, Japan
| | - Seichiro Hojo
- Clinical Data Science Department, Eisai Co., Ltd., Tokyo, Japan
| | - Kiyoshi Ando
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
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Kim M, Hwang HS, Son EM, Cho H, Yoon DH, Suh C, Park CS, Go H, Huh J. Clinicopathological and prognostic significance of BCL2, BCL6, MYC, and IRF4 copy number gains and translocations in follicular lymphoma: a study by FISH analysis. Leuk Lymphoma 2020; 61:3342-3350. [PMID: 32921221 DOI: 10.1080/10428194.2020.1815017] [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] [Indexed: 10/23/2022]
Abstract
BCL2 translocation is the genetic hallmark of follicular lymphoma (FL). Besides BCL2 translocation, copy number (CN) gains and translocations of BCL6, MYC, and IRF4 have also been detected in FL, but there is little information regarding their prognostic significance. This retrospective study used fluorescence in situ hybridization (FISH) to analyze BCL2, BCL6, MYC, and IRF4 translocations and CN gains in 105 FL cases. Genetic translocations were detected for BCL2 (n = 64; 72.7%), BCL6 (n = 14; 15.9%), and MYC (n = 2; 2.3%); no case showed IRF4 translocation. Overall, 23 (26.1%), 30 (34.1%), 12 (13.8%), and 10 (11.0%) cases showed CN gains in BCL2, BCL6, MYC, and IRF4, respectively. BCL6 CN gain was a prognostic factor for worse overall survival, demonstrating a trend toward significance in multivariate analysis (HR =8.769, p = 0.056). BCL6 CN gain in FL might be associated with aggressive biologic behavior.
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Affiliation(s)
- Meejeong Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Mi Son
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heounjeong Go
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Histologic transformation of follicular lymphoma remains the leading cause of follicular lymphoma-related mortality in the rituximab era. Both the diverse timing of transformation and heterogeneity in associated genomic events suggest that histologic transformation may itself comprise distinct disease entities. Successive indolent and transformation episodes occur by divergent clonal evolution from an inferred common progenitor cell, representing a potential therapeutic target. Existing biological knowledge largely pre-dates anti-CD20 therapy, and further prospective validation is essential. Inclusion of transformation cases in clinical trials incorporating biomarker discovery, and an integrated understanding of the genetic and microenvironmental factors underpinning transformation, may unearth renewed clinical opportunities.
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Affiliation(s)
- Emil A Kumar
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
| | - Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Jude Fitzgibbon
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK. https://twitter.com/fitzgi02
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Maeshima AM, Taniguchi H, Ida H, Hosoba R, Fujino T, Saito Y, Yuda S, Makita S, Fukuhara S, Munakata W, Suzuki T, Maruyama D, Izutsu K. Non-diffuse large B-cell lymphoma transformation from follicular lymphoma: a single-institution study of 19 cases. Hum Pathol 2020; 102:33-43. [PMID: 32540222 DOI: 10.1016/j.humpath.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/09/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common histological transformation (HT) of follicular lymphoma (FL). Other types of HT are very rare, and their incidence, histopathology, and patient outcomes have not been sufficiently described. Here, we assessed the clinicopathological characteristics of 19 cases of non-DLBCL HT of FL in a single institution in Japan to advance the understanding of the disease. Among 889 consecutive patients diagnosed with FL between 2000 and 2018, 191 suffered HT (21%). The median follow-up period was 94 months (range = 3-225). A total of 172 patients (90%) had DLBCL transformation, whereas the remaining 19 patients (10%) exhibited non-DLBCL transformation. In the latter cases, the following diagnoses were made based on morphology, immunohistochemistry, flow cytometry, and fluorescence in situ hybridization analyses: classic Hodgkin lymphoma (7 patients; 4%); high-grade B-cell lymphoma (HGBL) with MYC and BCL2 rearrangements (4 patients; 2%); HGBL, not otherwise specified (4 patients; 2%); B-cell lymphoblastic leukemia/lymphoma (2 patients; 1%); anaplastic large-cell lymphoma-like lymphoma (1 patient; 0.5%); and plasmablastic lymphoma (1 patient; 0.5%). Epstein-Barr virus-encoded RNA-1 did not associate with HT in any of the cases tested (n = 8). Patients with non-DLBCL transformation showed poor outcomes, with a median overall survival of 13 months (range = 2 days-107 months); 10 of the patients (53%) died of HT. In conclusions, non-DLBCL transformation was observed in 10% of patients with HT from FL. Our data show that timely, accurate, and comprehensive histopathological diagnosis is needed to ensure optimal treatment and improve the outcome of these patients.
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Affiliation(s)
| | - Hirokazu Taniguchi
- Departments of Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hanae Ida
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Rika Hosoba
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Takahiro Fujino
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yo Saito
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Sayako Yuda
- Departments of Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan; Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Shinichi Makita
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Suguru Fukuhara
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Wataru Munakata
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Tatsuya Suzuki
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Dai Maruyama
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Koji Izutsu
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
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Maeshima AM, Taniguchi H, Ito Y, Hatta S, Suzuki T, Yuda S, Makita S, Fukuhara S, Munakata W, Suzuki T, Maruyama D, Izutsu K. Clinicopathological characteristics of diffuse large B-cell lymphoma involving small and large intestines: an analysis of 126 patients. Int J Hematol 2019; 110:340-346. [PMID: 31187439 DOI: 10.1007/s12185-019-02687-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022]
Abstract
We analyzed the clinicopathologic characteristics of 136 intestinal diffuse large B-cell lymphomas (DLBCLs) among 126 patients. The DLBCL sites were categorized as: duodenum (n = 23), ileocecal region (n = 63), other small intestine (n = 29), rectum (n = 7), and other large intestine (n = 14). Patients with DLBCLs of the ileocecal region or other small intestine frequently underwent surgery for ileus or perforations (P < 0.001), were predominantly male (P = 0.042), and had a higher incidence of limited-stage disease (P = 0.001), lower International Prognostic Index (P = 0.015), and lower incidence of lactate dehydrogenase elevation (P = 0.007) than those with DLBCLs of other regions. Half of the intestinal DLBCLs exhibited the germinal center B-cell phenotype. A low-grade B-cell lymphoma background was found in 21% of the cases; the prevalence was significantly lower in the ileocecal region (13%, P = 0.025), suggesting a higher incidence of de novo DLBCLs. Intestinal follicular lymphoma (FL) and mucosa-associated lymphoid tissue (MALT) lymphoma backgrounds were observed in 10% and 0% of the cases, respectively. Five percent (5/107) of intestinal DLBCL cases were Epstein-Barr virus-encoded RNA-1 positive. The clinicopathologic characteristics of the DLBCLs differed by region. Histologic transformation of intestinal FL was observed in around 10% of the intestinal DLBCL cases.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Female
- Humans
- Intestinal Neoplasms/metabolism
- Intestinal Neoplasms/pathology
- Intestines/pathology
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Follicular/metabolism
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
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Affiliation(s)
- Akiko Miyagi Maeshima
- Pathology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Hirokazu Taniguchi
- Pathology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yuta Ito
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shunsuke Hatta
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tomotaka Suzuki
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Sayako Yuda
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tatsuya Suzuki
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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10
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Follicular lymphoma suggested to transform into EBV-negative plasmablastic lymphoma. Int J Hematol 2019; 109:723-730. [DOI: 10.1007/s12185-019-02591-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/04/2019] [Accepted: 01/16/2019] [Indexed: 12/31/2022]
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11
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Na HY, Kim YA, Lee C, Choe JY, Shin SA, Shim JW, Min SK, Kim HJ, Han JH, Kim JE. Gastric follicular lymphoma: A report of 3 cases and a review of the literature. Oncol Lett 2018; 16:741-748. [PMID: 29963140 PMCID: PMC6019973 DOI: 10.3892/ol.2018.8744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/20/2018] [Indexed: 02/07/2023] Open
Abstract
Follicular lymphoma (FL) occurs primarily in the gastrointestinal tract, with the stomach being one of the rarest sites. According to the literature, <20 cases of primary gastric FL have been reported, with the number of cases with detailed pathological descriptions being even less. The aim of the present study was to compare clinicopathological features of gastric FL with FL at alternative sites. A total of 3 cases of gastric FL were retrieved from among 3,216 cases in the databases of 4 university hospitals in South Korea: Seoul National University (SNU) Hospital, SNU Boramae Hospital, SNU Bundang Hospital (all Seoul, South Korea) and Dongtan Sacred Heart Hospital Hallym University (Dongtan, South Korea), including 2 primary cases and 1 case that was possibly secondary to nodal FL. The 2 primary gastric FL cases were incidentally detected in routine health check-ups. An endoscopy revealed a single polypoid submucosal mass and biopsies failed to confirm the diagnosis due to minimal mucosal involvement. Therefore, a partial gastrectomy was performed. The epicenters of the tumors were submucosal, with focal extension to the muscularis propria. However, 1 case exhibited an isolated FL nodule in the omentum. Histopathological examination revealed FL of grade 1–2 with a follicular pattern and with strong expression of germinal center markers and B-cell lymphoma 2 (BCL2). Rearrangement of BCL2 was not identified using fluorescence in situ hybridization studies in 2 cases. In contrast to these 2 cases, the remaining FL case was confirmed with an endoscopic biopsy. The endoscopy revealed multiple eroded polypoid lesions, and pathology revealed FL of grade 1–2 with a predominantly diffuse pattern, and with immunoglobulin heavy chain IGH/BCL2 translocation. In view of the extensive lymphadenopathy, the last case possibly presented as secondary involvement of nodal FL. It is challenging to diagnose FL in the stomach due to little mucosal involvement, as well as the unfamiliarity of the tumor due to its rarity. However, the results of the present study suggest that primary gastric FL may exhibit unique pathological features, including a predominantly follicular pattern and an absence of BCL2 rearrangement.
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Affiliation(s)
- Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi 13620, Republic of Korea
| | - Young A Kim
- Department of Pathology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea.,Department of Pathology, Seoul National University Boramae Hospital, Seoul 07061, Republic of Korea
| | - Cheol Lee
- Department of Pathology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea
| | - Ji-Young Choe
- Department of Pathology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea.,Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi 14068, Republic of Korea
| | - Seon Ah Shin
- Department of Pathology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea
| | - Jung-Weon Shim
- Department of Pathology, Dongtan Sacred Heart Hospital Hallym University, Dongtan, Gyeonggi 18450, Republic of Korea
| | - Soo Kee Min
- Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi 14068, Republic of Korea
| | - Hyun-Jung Kim
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul 01757, Republic of Korea
| | - Jae Ho Han
- Department of Pathology, Ajou University School of Medicine, Suwon, Gyeonggi 03965, Republic of Korea
| | - Ji Eun Kim
- Department of Pathology, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea.,Department of Pathology, Seoul National University Boramae Hospital, Seoul 07061, Republic of Korea
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12
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Minoia C, Zucca E, Conconi A. Novel acquisitions on biology and management of transformed follicular lymphoma. Hematol Oncol 2018; 36:617-623. [PMID: 29602222 DOI: 10.1002/hon.2508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 11/07/2022]
Abstract
Follicular lymphoma (FL) generally has an indolent clinical course, but in some patients, a histological transformation (HT) into aggressive entities may take place and often lead to a poorer survival. The rituximab era has seen an improved outcome of FL, including those with HT. The current treatment strategies for transformed FL are based on immunochemotherapy for the cases with HT at the time of diagnosis or as the first event after watchful waiting. Patients transforming after prior treatment of FL usually benefit from autologous stem cell transplant. Unfortunately, early assessment of the transformation risk remains elusive. Recent studies delved the mechanisms of HT, showing that this is a complex process, resulting from a number of epigenetic and genetic lesions occurring in the tumour cell population as well as progressive changes in the tumour microenvironment. This novel knowledge has prompted clinical investigations on a variety of new therapeutic strategies.
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Affiliation(s)
- Carla Minoia
- Hematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy.,Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland.,Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Annarita Conconi
- Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland.,Hematology Division, Ospedale degli Infermi, Biella, Italy
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13
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Magnano L, Balagué O, Dlouhy I, Rovira J, Karube K, Pinyol M, Rivas-Delgado A, Costa D, Martínez-Trillos A, González-Farre B, Martínez-Pozo A, Giné E, Colomer D, Delgado J, Villamor N, Campo E, López-Guillermo A. Clinicobiological features and prognostic impact of diffuse large B-cell lymphoma component in the outcome of patients with previously untreated follicular lymphoma. Ann Oncol 2017; 28:2799-2805. [PMID: 29045517 DOI: 10.1093/annonc/mdx407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND The co-existence at diagnosis of follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) components (FL/DLBCL) has been considered a transformed lymphoma and accordingly treated although clinicobiological information on these patients is scarce. The aim of this study was to analyze the initial features and outcome of FL/DLBCL patients in the rituximab era. PATIENTS AND METHODS All patients consecutively diagnosed at a single institution with FL/DLBCL (n = 40), as well as those with pure FL (n = 328) or de novo DLBCL (n = 510) as controls. RESULTS The proportion of the DLBCL component was highly variable (median 50%). In 29 FL/DLBCL cases analyzed, the cell of origin was GCB in 86%, ABC in 10% and unclassifiable in 4%. NOTCH1-2 was mutated in 10% of these cases. The proportion of DLBCL component did not impact on overall survival (OS). Regarding initial characteristics, patients with FL/DLBCL were closer to FL in terms of primary nodal origin, good performance status and advanced stage, whereas the other features were intermediate between FL and DLBCL. FL/DLBCL patients were treated as DLBCL with no further intensification. Complete response and primary refractory rates were 65% and 20%, respectively, with these figures being similar to DLBCL and worse than FL. Progression-free survival and OS were intermediate between FL and DLBCL (5-year OS: 85%, 73% and 63% for FL, FL/DLBCL and DLBCL, respectively). FL/DLBCL histology did not reach independent prognostic value for OS in the multivariate analyses. CONCLUSIONS The outcome of FL/DLBCL patients is not worse than that of de novo DLBCL. These cases should be treated with immunochemotherapy as DLBCL, but intensification with ASCT may not be necessary. The biological insights of FL/DLBCL warrants further genetic and molecular studies.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Case-Control Studies
- Female
- Follow-Up Studies
- Humans
- Lymphoma, Follicular/complications
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Neoplasm Recurrence, Local/complications
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Survival Rate
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Affiliation(s)
- L Magnano
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - O Balagué
- CIBERONC, Barcelona;; Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - I Dlouhy
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - J Rovira
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - K Karube
- Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus;; Faculty of Medicine, University of the Ryukyus, Japan
| | - M Pinyol
- CIBERONC, Barcelona;; Genomics Unit, IDIBAPS, Barcelona, Spain
| | - A Rivas-Delgado
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - D Costa
- Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - A Martínez-Trillos
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - B González-Farre
- CIBERONC, Barcelona;; Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Martínez-Pozo
- CIBERONC, Barcelona;; Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E Giné
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - D Colomer
- Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - J Delgado
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona
| | - N Villamor
- Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - E Campo
- Hematopathology Unit, Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona;; CIBERONC, Barcelona
| | - A López-Guillermo
- Department of Hematology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona;; CIBERONC, Barcelona;.
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14
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Fischer T, Zing NPC, Chiattone CS, Federico M, Luminari S. Transformed follicular lymphoma. Ann Hematol 2017; 97:17-29. [PMID: 29043381 DOI: 10.1007/s00277-017-3151-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 10/05/2017] [Indexed: 12/01/2022]
Abstract
Follicular Lymphoma (FL) is the second most common type of non-Hodgkin lymphoma and is considered to be the prototype of indolent lymphomas. Histologic transformation into an aggressive lymphoma, which is expected to occur at a rate of 2 to 3% each year, is associated with rapid progression, treatment resistance, and poor prognosis. Recent modifications to the physiopathologic mechanism of transformed follicular lymphoma (t-FL) have been proposed, including genetic and epigenetic mechanisms as well as a role for the microenvironment. Although t-FL is considered a devastating complication, as it is associated with treatment-refractory disease and a dismal outcome, recent data in the rituximab era have suggested that not only is the prognosis less severe than reported in the previous literature but the risk of transformation is also lower. Thus, this study aimed to review the most recent research on t-FL in an attempt to better understand the clinical meaning of transformation from FL to diffuse large B cell lymphoma (DLBCL) and the impact of current treatment strategies on the curability of this intriguing subentity of lymphoma.
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Affiliation(s)
- Thais Fischer
- Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Stefano Luminari
- University of Modena and Reggio Emilia, Modena, Italy. .,Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Arcispedale Santa Maria Nuova IRCCS, viale Risorgimento n°80 42123, Reggio Emilia, Italy.
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15
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Sorigue M, Garcia O, Baptista MJ, Sancho JM, Tapia G, Mate JL, Feliu E, Navarro JT, Ribera JM. Similar prognosis of transformed and de novo diffuse large B-cell lymphomas in patients treated with immunochemotherapy. Med Clin (Barc) 2017; 148:243-249. [PMID: 28038857 DOI: 10.1016/j.medcli.2016.09.050] [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: 03/27/2016] [Revised: 09/23/2016] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prognosis of diffuse large B-cell lymphomas (DLBCL) transformed from indolent lymphoma (TL) has been considered poorer than that of de novo DLBCL. However, it seems to have improved since the introduction of rituximab. PATIENTS AND METHODS We compared the characteristics (including the cell-of-origin), and the prognosis of 29 patients with TL and 101 with de novo DLBCL treated with immunochemotherapy. RESULTS Patients with TL and de novo DLBCL had similar characteristics. All TL cases evolving from follicular lymphoma were germinal-center B-cell-like, while those TL from marginal zone lymphoma or chronic lymphocytic leukemia were non-germinal-center B-cell-like. The complete response rate was similar in TL and de novo DLBCL (62 vs. 66%, P=.825). The 5-year overall and progression-free survival probabilities (95% CI) were 59% (40-78) and 41% (22-60) for TL and 63% (53-73) and 60% (50-70) for de novo DLBCL, respectively (P=.732 for overall survival and P=.169 for progression-free survival). CONCLUSION In this study, the prognosis of TL and de novo DLBCL treated with immunochemotherapy was similar. The role of intensification with stem cell transplantation in the management of TL may be questionable in the rituximab era.
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Affiliation(s)
- Marc Sorigue
- Departamento de Hematología, Hospital ICO-Germans Trias i Pujol, Instituto de Investigación contra la Leucemia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Olga Garcia
- Departamento de Hematología, Hospital ICO-Germans Trias i Pujol, Instituto de Investigación contra la Leucemia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Maria Joao Baptista
- Departamento de Hematología, Hospital ICO-Germans Trias i Pujol, Instituto de Investigación contra la Leucemia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Juan-Manuel Sancho
- Departamento de Hematología, Hospital ICO-Germans Trias i Pujol, Instituto de Investigación contra la Leucemia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Gustavo Tapia
- Departamento de Patología, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - José Luis Mate
- Departamento de Patología, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Evarist Feliu
- Departamento de Hematología, Hospital ICO-Germans Trias i Pujol, Instituto de Investigación contra la Leucemia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - José-Tomás Navarro
- Departamento de Hematología, Hospital ICO-Germans Trias i Pujol, Instituto de Investigación contra la Leucemia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - Josep-Maria Ribera
- Departamento de Hematología, Hospital ICO-Germans Trias i Pujol, Instituto de Investigación contra la Leucemia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
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16
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Abstract
Low-grade B-cell leukemias/lymphomas are a diverse group of indolent lymphoproliferative disorders that are typically characterized by good patient outcomes and long life expectancies. A subset of cases, however, undergo histologic transformation to a higher-grade neoplasm, a transition associated with a more aggressive clinical course and poor survival. Transformation of follicular lymphoma to diffuse large B-cell lymphoma and Richter transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma are best characterized in the literature. This article reviews clinical and pathologic characteristics of these most common forms of transformation, with an emphasis on salient histologic, immunophenotypic, and genetic features.
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Affiliation(s)
- Nathan D Montgomery
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, CB #7525, Chapel Hill, NC 27599-7525, USA
| | - Stephanie P Mathews
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, CB #7525, Chapel Hill, NC 27599-7525, USA.
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17
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Maeshima AM, Taniguchi H, Toyoda K, Yamauchi N, Makita S, Fukuhara S, Munakata W, Maruyama D, Kobayashi Y, Tobinai K. Clinicopathological features of histological transformation from extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue to diffuse large B-cell lymphoma: an analysis of 467 patients. Br J Haematol 2016; 174:923-31. [DOI: 10.1111/bjh.14153] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Akiko Miyagi Maeshima
- Department of Pathology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
| | - Hirokazu Taniguchi
- Department of Pathology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
| | - Kosuke Toyoda
- Department of Hematology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
| | - Nobuhiko Yamauchi
- Department of Hematology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
| | - Shinichi Makita
- Department of Hematology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
| | - Suguru Fukuhara
- Department of Hematology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
| | - Wataru Munakata
- Department of Hematology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
| | - Dai Maruyama
- Department of Hematology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
| | - Yukio Kobayashi
- Department of Hematology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
| | - Kensei Tobinai
- Department of Hematology; National Cancer Centre Hospital; 5-1-1 Tsukiji; Chuo-ku Tokyo 104-0045 Japan
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18
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High-grade Transformation of Low-grade B-cell Lymphoma: Pathology and Molecular Pathogenesis. Am J Surg Pathol 2016; 40:e1-16. [PMID: 26658667 DOI: 10.1097/pas.0000000000000561] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients with low-grade (clinically indolent) lymphomas are at risk to undergo transformation to high-grade (clinically aggressive) lymphoma, although transformation only occurs in a subset of patients. When transformation occurs it is a critical event that determines the course of disease and is associated with unfavorable patient outcomes. Accurate detection of transformation, predictive biomarkers, and identification of specific molecular pathways implicated in the pathobiology of transformation will facilitate personalized therapeutic approaches and underpin advances in clinical outcomes. In this article, we present an update of the clinical and pathologic diagnostic criteria for low-grade B-cell lymphoma transformation and discuss the molecular alterations involved in the pathogenesis of this biological phenomenon.
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19
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Mittal M, Puri A, Nangia R, Sachdeva A. Follicular lymphoma transforming into anaplastic diffuse large B-cell lymphoma of oral cavity: A case report with review of literature. J Oral Maxillofac Pathol 2016; 19:379-84. [PMID: 26980969 PMCID: PMC4774294 DOI: 10.4103/0973-029x.174617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Follicular lymphoma (FL) is a common form of non-Hodgkin's lymphoma (NHL) with the ability to transform into a more aggressive disease, frequently to B cell-lymphoblastic lymphoma. Diffuse large B-cell lymphoma (DLBCL) is a subtype of NHL, which is characterized by diffuse proliferation of large neoplastic B-lymphocytes. It accounts for 30% of all NHL and its occurrence in the mandible is very rare. It is often seen in young adults, but in the present case, a 50-year-old male patient presented with painless swelling in left lower jaw since 25 days following extraction of left lower molar teeth. There was a history of fever and submandibular lymph nodes were enlarged. On incisional biopsy, features of NHL-like lesion were observed and confirmed by immunohistochemistry using CD20, bcl-2, CD10, CD3, CD5, Ki67 markers to be FL (3A) lymphoma transforming into DLBCL. This is a very uncommon presentation.
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Affiliation(s)
- Megha Mittal
- Department of Oral Pathology and Microbiology, Himachal Institute of Dental Sciences, Sirmour, Himachal Pradesh, India
| | - Abhiney Puri
- Department of Oral Pathology and Microbiology, Himachal Institute of Dental Sciences, Sirmour, Himachal Pradesh, India
| | - Rajat Nangia
- Department of Oral Pathology and Microbiology, Himachal Institute of Dental Sciences, Sirmour, Himachal Pradesh, India
| | - Alisha Sachdeva
- Department of Oral Pathology and Microbiology, Himachal Institute of Dental Sciences, Sirmour, Himachal Pradesh, India
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20
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van den Brand M, van der Velden WJFM, Diets IJ, Ector GICG, de Haan AFJ, Stevens WBC, Hebeda KM, Groenen PJTA, van Krieken HJM. Clinical features of patients with nodal marginal zone lymphoma compared to follicular lymphoma: similar presentation, but differences in prognostic factors and rate of transformation. Leuk Lymphoma 2015; 57:1649-56. [DOI: 10.3109/10428194.2015.1106535] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Montes-Moreno S, Climent F, González de Villambrosía S, González Barca EM, Batlle A, Insunza A, Pané-Foix M, Colorado M, Martin-Sánchez G, Espiga CR, Conde E, Piris MA. CD 30-positive transformed follicular lymphoma: two case reports and literature review. Histopathology 2015; 67:918-22. [DOI: 10.1111/his.12733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Santiago Montes-Moreno
- Pathology and Hematology Departments; Hospital Universitario Marqués de Valdecilla/IDIVAL; Santander Spain
| | - Fina Climent
- Pathology and Hematology Departments; ICO; Hospital Universitari de Bellvitge; Barcelona Spain
| | | | - Eva M González Barca
- Pathology and Hematology Departments; ICO; Hospital Universitari de Bellvitge; Barcelona Spain
| | - Ana Batlle
- Pathology and Hematology Departments; Hospital Universitario Marqués de Valdecilla/IDIVAL; Santander Spain
| | - Andrés Insunza
- Pathology and Hematology Departments; Hospital Universitario Marqués de Valdecilla/IDIVAL; Santander Spain
| | - María Pané-Foix
- Pathology and Hematology Departments; ICO; Hospital Universitari de Bellvitge; Barcelona Spain
| | - Mercedes Colorado
- Pathology and Hematology Departments; Hospital Universitario Marqués de Valdecilla/IDIVAL; Santander Spain
| | - Guillermo Martin-Sánchez
- Pathology and Hematology Departments; Hospital Universitario Marqués de Valdecilla/IDIVAL; Santander Spain
| | - Carlos Richard Espiga
- Pathology and Hematology Departments; Hospital Universitario Marqués de Valdecilla/IDIVAL; Santander Spain
| | - Eulogio Conde
- Pathology and Hematology Departments; Hospital Universitario Marqués de Valdecilla/IDIVAL; Santander Spain
| | - Miguel A Piris
- Pathology and Hematology Departments; Hospital Universitario Marqués de Valdecilla/IDIVAL; Santander Spain
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22
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BCL2 mutations are associated with increased risk of transformation and shortened survival in follicular lymphoma. Blood 2014; 125:658-67. [PMID: 25452615 DOI: 10.1182/blood-2014-04-571786] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Follicular lymphoma (FL), an indolent neoplasm caused by a t(14;18) chromosomal translocation that juxtaposes the BCL2 gene and immunoglobulin locus, has a variable clinical course and frequently undergoes transformation to an aggressive lymphoma. Although BCL2 mutations have been previously described, their relationship to FL progression remains unclear. In this study, we evaluated the frequency and nature of BCL2 mutations in 2 independent cohorts of grade 1 and 2 FLs, along with the correlation between BCL2 mutations, transformation risk, and survival. The prevalence of BCL2 coding sequence mutations was 12% in FL at diagnosis and 53% at transformation (P < .0001). The presence of these BCL2 mutations at diagnosis correlated with an increased risk of transformation (hazard ratio 3.6; 95% CI, 2.0-6.2; P < .0001) and increased risk of death due to lymphoma (median survival of 9.5 years with BCL2 mutations vs 20.4 years without; P = .012). In a multivariate analysis, BCL2 mutations and high FL international prognostic index were independent risk factors for transformation and death due to lymphoma. Some mutant Bcl-2 proteins exhibited enhanced antiapoptotic capacity in vitro. Accordingly, BCL2 mutations can affect antiapoptotic Bcl-2 function, are associated with increased activation-induced cytidine deaminase expression, and correlate with increased risk of transformation and death due to lymphoma.
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23
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Maeshima AM, Taniguchi H, Fukuhara S, Maruyama D, Kim SW, Watanabe T, Kobayashi Y, Tobinai K, Tsuda H. Clinicopathological prognostic indicators in 107 patients with diffuse large B-cell lymphoma transformed from follicular lymphoma. Cancer Sci 2013; 104:952-7. [PMID: 23521357 DOI: 10.1111/cas.12158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/17/2013] [Accepted: 03/19/2013] [Indexed: 11/29/2022] Open
Abstract
Follicular lymphoma (FL) frequently transforms into diffuse large B-cell lymphoma (DLBCL). To clarify the associated clinicopathological prognostic parameters, we examined the correlation of 11 histopathological parameters with progression-free survival (PFS) and overall survival (OS) in 107 consecutive patients who had DLBCL with pre-existing (asynchronous) or synchronous FL. The patients comprised 58 men and 49 women with a median age of 56 years. For DLBCL, the complete response rate was 81%, overall response rate was 88%, and 5-year PFS and OS rates were 55% and 79%, respectively. Immunohistochemical analysis of the DLBCL component revealed the following positivity rates: CD10, 64%; Bcl-2, 83%; Bcl-6, 88%; MUM1, 42%; GCB, 82%; cMyc index ≥80%, 17%; and Ki-67 index ≥90%, 19%. IGH/BCL2 fusion was positive in 57% of DLBCL cases. In univariate analyses, asynchronous FL and DLBCL (24%, P = 0.021), 100% proportion of DLBCL (29%, P = 0.004), Bcl-2 positivity (P = 0.04), and high Ki-67 index (P = 0.003) were significantly correlated with shorter PFS. Asynchronous FL and DLBCL (P = 0.003), 100% proportion of DLBCL (P = 0.001), and high Ki-67 index (P = 0.004) were significantly correlated with shorter OS. In a multivariate analysis, asynchronous FL and DLBCL (P = 0.035) and 100% proportion of DLBCL (P = 0.016) were significantly correlated with shorter OS. Thus, asynchronism and 100% proportion of DLBCL, that is, FL relapsed as pure DLBCL, or FL and DLBCL at different sites, were significant predictors of unfavorable outcome of patients with DLBCL transformed from FL.
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Affiliation(s)
- Akiko M Maeshima
- Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan.
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24
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Tada K, Kim SW, Asakura Y, Hiramoto N, Yakushijin K, Kurosawa S, Tajima K, Mori SI, Heike Y, Tanosaki R, Maeshima AM, Taniguchi H, Furuta K, Kagami Y, Matsuno Y, Tobinai K, Takaue Y, Fukuda T. Comparison of outcomes after allogeneic hematopoietic stem cell transplantation in patients with follicular lymphoma, diffuse large B-cell lymphoma associated with follicular lymphoma, or de novo diffuse large B-cell lymphoma. Am J Hematol 2012; 87:770-5. [PMID: 22641292 DOI: 10.1002/ajh.23246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/28/2012] [Accepted: 04/18/2012] [Indexed: 12/20/2022]
Abstract
The outcome after allogeneic hematopoietic stem cell transplantation (allo-HCT) for diffuse large B-cell lymphoma (DLBCL) associated with follicular lymphoma (FL), which includes DLBCL with pre- or co-existing FL, remains controversial, and few previous reports have compared the outcomes after allo-HCT for FL, DLBCL associated with FL, and de novo DLBCL. We retrospectively analyzed 97 consecutive patients with FL (n = 46), DLBCL associated with FL (n = 22), or de novo DLBCL (n = 29) who received allo-HCT at our institute between 2000 and 2010. With a median follow-up of 53 months, the 5-year overall survival (OS) and progression-free survival (PFS) were, respectively, 77% and 70% for FL, 62% and 57% for DLBCL associated with FL, and 26% and 23% for de novo DLBCL. The 5-year cumulative incidences of non-relapse mortality and disease progression/relapse were, respectively, 16% and 15% for FL, 19% and 24% for DLBCL associated with FL, and 36% and 41% for de novo DLBCL. By a multivariate analysis, the OS and PFS for DLBCL associated with FL were significantly better than those for de novo DLBCL, whereas they were not significantly different from those for FL. These results suggest that allo-HCT may be a promising option for patients with not only advanced FL but also DLBCL associated with FL.
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Affiliation(s)
- Kohei Tada
- Department of Hematology and Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
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25
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Shikata H, Yakushijin Y, Matsushita N, Sakai A, Sugita A, Nakamura N, Yamanouchi J, Azuma T, Hato T, Yasukawa M. Role of activation-induced cytidine deaminase in the progression of follicular lymphoma. Cancer Sci 2012; 103:415-21. [PMID: 22168746 DOI: 10.1111/j.1349-7006.2011.02186.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Activation-induced cytidine deaminase (AID/AICDA) is required for somatic hypermutation and class-switch recombination of the immunoglobulin gene, and for c-myc translocation of germinal center-derived B-cell lymphoma. In the present study, we attempted to clarify the significance of AID associated with c-myc in the progression of follicular lymphoma (FL) using RT-PCR and quantitative real-time PCR. Tissues from the patients with grade 3 FL expressed relatively higher levels of c-myc and AID. The samples taken from a patient with FL who died within 2 years after the start of treatment showed either no or low expression of AID, despite expressing high levels of c-myc. In order to examine the role of AID expression in rapidly progressive FL, the full-length AID transcript was transfected into AID-negative cell lines established from different patients with rapidly progressive FL. This led to the establishment of AID-expressing transfectants with a low proliferation rate and a significantly increased incidence of G(0)/G(1) arrest compared with controls. Our results indicate that AID may act as a negative regulator of cell survival in FL when sufficient c-myc is expressed. Switch-off or low expression of AID after c-myc amplification may correlate with the clinical outcomes of FL.
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Affiliation(s)
- Hisaharu Shikata
- Department of Bioregulatory Medicine, Ehime University Hospital, Ehime University Graduate School of Medicine, Toon, Japan
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26
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Abstract
Histological transformation of follicular lymphoma (FL) to a more aggressive non-Hodgkin's lymphomas is a pivotal event in the natural history of FL and is associated with poor outcome. While commonly observed in clinical practice and despite multiple studies designed to address its pathogenesis, the biology of this process represents an enigma. In this chapter we present a state of the art review summarizing the definition of histologic transformation, its incidence, pathogenesis, clinical manifestations, treatment and outcome. Furthermore, we specifically emphasize gaps in our knowledge that should be addressed in future studies.
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MESH Headings
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/biosynthesis
- Biopsy
- Burkitt Lymphoma/etiology
- Burkitt Lymphoma/genetics
- Burkitt Lymphoma/mortality
- Burkitt Lymphoma/pathology
- Burkitt Lymphoma/therapy
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/pathology
- Chromosome Aberrations
- Disease Progression
- Disease-Free Survival
- Humans
- Lymphoma, Follicular/complications
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/etiology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Mutation
- Prognosis
- Salvage Therapy
- Stem Cell Transplantation
- Transplantation, Autologous
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Affiliation(s)
- Izidore S Lossos
- Department of Medicine & Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami, 1475NW 12th Ave, D8-4, Miami, FL 33136, USA.
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27
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Maruyama D, Watanabe T, Maeshima AM, Nomoto J, Taniguchi H, Azuma T, Mori M, Munakata W, Kim SW, Kobayashi Y, Matsuno Y, Tobinai K. Modified cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy with or without rituximab in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL. Int J Hematol 2010; 92:732-43. [PMID: 21120644 DOI: 10.1007/s12185-010-0728-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 11/07/2010] [Accepted: 11/11/2010] [Indexed: 11/27/2022]
Abstract
The feasibility and efficacy of cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL (intermediate DLBCL/BL) have never been reported. The effects of adding rituximab to CODOX-M/IVAC have not been published either. Fifteen consecutive patients with a median age of 39 years were treated with modified CODOX-M/IVAC regimen (particularly, reducing the dose of methotrexate to 3 g/m(2)) with or without rituximab at our institution. Although all patients developed grade 4 neutropenia and grade 3/4 thrombocytopenia/anemia, 93% had febrile neutropenia, 60% showed transaminase elevation, and 40% had mucositis/stomatitis (all grade 3), there were no treatment-related deaths. Two of nine patients treated with rituximab developed biphasic late-onset neutropenia. Thirteen patients (87%) showed complete responses. The remaining two patients had refractory disease; one had presented with peritoneal dissemination and complex chromosomal abnormalities, while the other had double IGH-MYC and IGH-BCL2 translocations. The estimated 5-year overall and progression-free survival were 87% each, with a median follow-up of 74 months. In conclusion, our modified CODOX-M/IVAC regimen is well tolerated and highly effective in Japanese adult patients with BL and intermediate DLBCL/BL, warranting a larger study for confirmation.
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Affiliation(s)
- Dai Maruyama
- Hematology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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28
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Ouansafi I, He B, Fraser C, Nie K, Mathew S, Bhanji R, Hoda R, Arabadjief M, Knowles D, Cerutti A, Orazi A, Tam W. Transformation of follicular lymphoma to plasmablastic lymphoma with c-myc gene rearrangement. Am J Clin Pathol 2010; 134:972-81. [PMID: 21088162 DOI: 10.1309/ajcpwy1sgj9ieaor] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Follicular lymphoma (FL) is an indolent lymphoma that transforms to high-grade lymphoma, mostly diffuse large B-cell lymphoma, in about a third of patients. We present the first report of a case of FL that transformed to plasmablastic lymphoma (PBL). Clonal transformation of the FL to PBL was evidenced by identical IGH/BCL2 gene rearrangements and VDJ gene usage in rearranged IGH genes. IGH/ BCL2 translocation was retained in the PBL, which also acquired c-myc gene rearrangement. Genealogic analysis based on somatic hypermutation of the rearranged IGH genes of both FL and PBL suggests that transformation of the FL to PBL occurred most likely by divergent evolution from a common progenitor cell rather than direct evolution from the FL clone. Our study of this unusual case expands the histologic spectrum of FL transformation and increases our understanding of the pathogenetic mechanisms of transformation of indolent lymphomas to aggressive lymphomas.
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Smith SD, Smith SD, Bolwell BJ, Advani AS, Andresen SW, Chan JL, Dean RM, Hsi ED, Kalaycio ME, Pohlman BL, Rybicki LA, Sweetenham JW. High rate of survival in transformed lymphoma after autologous stem cell transplant: pathologic analysis and comparison withde novodiffuse large B-cell lymphoma. Leuk Lymphoma 2009; 50:1625-31. [DOI: 10.1080/10428190903128652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Maeshima AM, Taniguchi H, Nomoto J, Maruyama D, Kim SW, Watanabe T, Kobayashi Y, Tobinai K, Matsuno Y. Secondary CD5+ diffuse large B-cell lymphoma not associated with transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma (Richter syndrome). Am J Clin Pathol 2009; 131:339-46. [PMID: 19228640 DOI: 10.1309/ajcp58fetfglckkw] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Few cases of secondary CD5+ diffuse large B-cell lymphoma (DLBCL) that are not Richter syndrome have been reported previously. We report 9 cases of non-Richter syndrome secondary CD5+ DLBCL. Among 529 cases of DLBCL, 38 (7.2%) were CD5+ DLBCL, including 9 of secondary CD5+ DLBCL. Five cases gained CD5 expression during the clinical course of DLBCL (group 1). Three cases showed transformation from CD5- low-grade B-cell lymphoma to CD5+ DLBCL (group 2). The remaining case showed coexistence of CD5+ DLBCL and CD5+ follicular lymphoma. The clonal relationships of CD5- and CD5+ tumors were confirmed in all 4 available cases. Cases of secondary CD5+ DLBCL that were not Richter syndrome were classifiable into 3 groups. Groups 1 and 2 showed the gain of CD5 during the clinical course or transformation of the tumors, suggesting that CD5 expression is closely associated with the progression of B-cell lymphoma.
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31
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Kim JE, Kim YA, Chang MS, Jeon Y, Paik J, Yoon SO. Expression of P-glycoprotein and Apoptosis in Diffuse Large B-cell Lymphoma. KOREAN JOURNAL OF PATHOLOGY 2009. [DOI: 10.4132/koreanjpathol.2009.43.4.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ji Eun Kim
- Department of Pathology, Seoul National University Boramae Hospital, Korea
| | - Young A Kim
- Department of Pathology, Seoul National University Boramae Hospital, Korea
| | - Mee Soo Chang
- Department of Pathology, Seoul National University Boramae Hospital, Korea
| | - Yunkyeong Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - JinHo Paik
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Seon-Og Yoon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
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Abstract
Treatment of patients with transformed lymphoma presents a significant challenge to the practicing physician. Indeed, the transformation of follicular lymphoma to a more aggressive histology is inherent to the biology of this disease and is often associated with an aggressive clinical course, resulting in a poor prognosis. Recent population-based studies have better defined the incidence of this event, and recent laboratory studies have defined the molecular and immunological processes associated with transformation. These studies will be discussed in this review, as will the treatment options for these patients.
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33
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Abstract
AbstractTreatment of patients with transformed lymphoma presents a significant challenge to the practicing physician. Indeed, the transformation of follicular lymphoma to a more aggressive histology is inherent to the biology of this disease and is often associated with an aggressive clinical course, resulting in a poor prognosis. Recent population-based studies have better defined the incidence of this event, and recent laboratory studies have defined the molecular and immunological processes associated with transformation. These studies will be discussed in this review, as will the treatment options for these patients.
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34
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Maeshima AM, Taniguchi H, Nomoto J, Maruyama D, Kim SW, Watanabe T, Kobayashi Y, Tobinai K, Matsuno Y. Histological and immunophenotypic changes in 59 cases of B-cell non-Hodgkin's lymphoma after rituximab therapy. Cancer Sci 2009; 100:54-61. [PMID: 19038008 PMCID: PMC11158374 DOI: 10.1111/j.1349-7006.2008.01005.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 09/04/2008] [Accepted: 09/12/2008] [Indexed: 11/27/2022] Open
Abstract
Rituximab is a chimeric monoclonal antibody that recognizes the CD20 antigen. It has been used to treat B-cell non-Hodgkin lymphoma (B-NHL), but recently rituximab resistance has been a cause for concern. We examined histological and immunohistochemical changes in 59 patients with B-NHL after rituximab therapy. The patients comprised 32 men and 27 women with a median age of 59 years. Pre-rituximab specimens comprised 34 follicular lymphomas (FL), 11 diffuse large B-cell lymphomas (DLBCL), 10 mantle cell lymphomas, two marginal zone B-cell lymphomas (MZBCL), and two chronic lymphocytic leukemias (CLL). CD20 expression in lymphoma cells was evaluated by immunohistochemistry or flow cytometry. Post-rituximab materials were taken a median of 6 months (4 days to 59 months) after rituximab therapy. Sixteen cases (27%) showed loss of CD20 expression with four histological patterns: pattern 1, no remarkable histological change (FL, 5; DLBCL, 3; and CLL, 2); pattern 2, proliferation of plasmacytoid cells (FL, 2; DLBCL, 1; and MZBCL, 1); pattern 3, transformation to classical Hodgkin's lymphoma (FL, 1); and pattern 4, transformation to anaplastic large cell lymphoma-like undifferentiated lymphoma (FL, 1). Loss of CD20 was unrelated to the interval of biopsies, treatment regimen, clinical response, and frequency of rituximab administration. Loss of CD20 within 1 month of rituximab therapy (3/14, 21%) and regain of CD20 (2/7, 29%) were not frequent. CD20-positive relapse with transformation occurred most frequently in cases of early relapse. In conclusion, B-NHL showed various histological and immunophenotypic changes after rituximab therapy, including not only CD20 loss but also proliferation of plasmacytoid cells or transformation to special subtypes of lymphoma.
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