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Naciri Bennani H, Banza AT, Terrec F, Noble J, Jouve T, Motte L, Malvezzi P, Rostaing L. Cryoglobulinemia and double-filtration plasmapheresis: Personal experience and literature review. Ther Apher Dial 2023; 27:159-169. [PMID: 35583180 PMCID: PMC10084379 DOI: 10.1111/1744-9987.13885] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cryoglobulinemia is defined as the presence of an abnormal immunoglobulin that may be responsible for vasculitis of small-caliber vessels. Apheresis can be used in order to temporarily eliminate circulating cryoglobulins. The aim of this study was to assess the effectiveness of apheresis (double-filtration plasmapheresis-DFPP-) in symptomatic and/or severe cryoglobulinemias. METHODS Four male patients presenting cryoglobulinemic vasculitis and who received DFPP sessions were included. RESULTS Their mean age was 57 ± 15 years. One patient had hepatitis-C virus (HCV)-related cryoglobulinemia and the other three patients were carriers of an IgM Kappa monoclonal gammopathy. Mean duration of follow-up was 15 ± 2 months. DFPP allowed healing of ulcerative skin lesions in the first patient and remission of nephrotic syndrome in the other patients after a median of 6(5-10) sessions. CONCLUSION DFPP can be used safely in cryoglobulinemic-vasculitis and can be considered early to achieve a faster and sustained clinical-biological response.
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Affiliation(s)
- Hamza Naciri Bennani
- Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, Grenoble, France
| | - Augustin Twite Banza
- Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, Grenoble, France
| | - Florian Terrec
- Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, Grenoble, France
| | - Johan Noble
- Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - Thomas Jouve
- Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - Lionel Motte
- Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, Grenoble, France
| | - Paolo Malvezzi
- Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, Grenoble, France
| | - Lionel Rostaing
- Department of Nephrology, Hemodialysis, Apheresis, and Kidney Transplantation, Grenoble University Hospital, Grenoble, France.,Grenoble Alpes University, Grenoble, France.,Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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2
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Kaji FA, Martinez-Calle N, Sovani V, Fox CP. Rare central nervous system lymphomas. Br J Haematol 2022; 197:662-678. [PMID: 35292959 PMCID: PMC9310777 DOI: 10.1111/bjh.18128] [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: 11/29/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Abstract
Central nervous system (CNS) lymphomas are rare malignancies characterised by lymphoid infiltration into the brain, spinal cord, cranial nerves, meninges and/or eyes in the presence or absence of previous or concurrent systemic disease. Most CNS lymphomas are of the diffuse large B-cell lymphoma (DLBCL) subtype for which treatment strategies, particularly the use of high-dose methotrexate-based protocols and consolidation with autologous stem cell transplantation, are well established. Other histopathological subtypes of CNS lymphoma are comparatively less common with published data on these rare lymphomas dominated by smaller case series and retrospective reports. Consequently, there exists little clinical consensus on the optimal methods to diagnose and manage these clinically and biologically heterogeneous CNS lymphomas. In this review article, we focus on rarer CNS lymphomas, summarising the available clinical data on incidence, context, diagnostic features, reported management strategies, and clinical outcomes.
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Affiliation(s)
- Furqaan Ahmed Kaji
- Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Vishakha Sovani
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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3
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Pan Q, Cao X, Luo Y, Li J, Li F. Semi-quantitative measurements of chemokine receptor 4-targeted 68Ga-pentixafor PET/CT in response assessment of Waldenström macroglobulinemia/lymphoplasmacytic lymphoma. EJNMMI Res 2021; 11:110. [PMID: 34714390 PMCID: PMC8556471 DOI: 10.1186/s13550-021-00852-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose 68Ga-pentixafor PET/CT was reported to have a high sensitivity in detecting tumor involvement of Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) in our previous study. We aimed to further investigate the semi-quantitative measurements of 68Ga-pentixafor PET/CT in response assessment in WM/LPL.
Methods Fifteen patients with WM/LPL were recruited in a prospective cohort study and underwent both 68Ga-pentixafor and 18F-FDG PET/CT at baseline and post-treatment. PET/CT-based responses were analyzed with semi-quantitative assessments of metabolic tumor volume (MTV) and total lesions glycolysis/uptake (TLGFDG and TLUCXCR4), and the correlation between PET/CT-based response and clinical response, monoclonal protein and IgM response was analyzed.
Results After chemotherapy, 5 patients had complete response or very good partial response, 8 had partial response or minimal response and 2 had progressive disease. In quantitative analysis, 68Ga-pentixafor PET/CT-based response (measured in ∆TLUCXCR4%, ∆MTVCXCR4%, ∆SUVpeak%) showed a significant direct correlation with clinical response, monoclonal protein and IgM response (p < 0.01). However, 18F-FDG PET/CT-based response was independent from clinical response (p > 0.05). Conclusions The semi-quantitative measurements of 68Ga-pentixafor PET/CT outperformed 18F-FDG PET/CT in response assessment of WM/LPL. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-021-00852-0.
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Affiliation(s)
- Qingqing Pan
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, People's Republic of China
| | - Xinxin Cao
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yaping Luo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China. .,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, People's Republic of China.
| | - Jian Li
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Fang Li
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, People's Republic of China
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4
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Abeykoon JP, Yanamandra U, Kapoor P. New developments in the management of Waldenström macroglobulinemia. Cancer Manag Res 2017; 9:73-83. [PMID: 28331368 PMCID: PMC5354523 DOI: 10.2147/cmar.s94059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Waldenström macroglobulinemia (WM) is a rare, immunoglobulin M -associated lymphoplasmacytic lymphoma. With the recent discoveries of CXCR warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) and MYD88 mutations, our understanding of the biology of WM has expanded substantially. While WM still remains incurable, the field is rapidly evolving, and a number of promising agents with significant activity in this malignancy are being evaluated currently. In this review, we discuss the new developments that have occurred in WM over the past 15 years, with a focus on the role of ibrutinib, an oral Bruton's tyrosine kinase inhibitor that has recently been approved for WM in the United States, Europe, and Canada.
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Affiliation(s)
| | - Uday Yanamandra
- Department of Hematology and Stem Cell Transplant, Army Hospital (Research & Referral), Delhi, India
| | - Prashant Kapoor
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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5
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Moccia AA, Zucca E, Ghielmini M. Is there a role for a maintenance rituximab in indolent lymphoproliferative diseases other than follicular lymphoma? Leuk Lymphoma 2016; 58:30-36. [PMID: 27813427 DOI: 10.1080/10428194.2016.1248963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Rituximab (R) is an anti-CD20 monoclonal antibody which has become an essential component for the treatment of B-cell lymphomas. When associated to chemotherapy it improves the outcome of the patients with diffuse large B-cell lymphoma, follicular lymphoma, and other lymphoproliferative diseases in comparison to chemotherapy alone. For patients with newly diagnosed follicular lymphoma achieving at least a partial response to initial immuno-chemotherapy, maintenance R was associated with an improvement in progression-free survival and a meta-analysis of randomized maintenance trials suggests an overall survival advantage. The role of maintenance R in other indolent diseases is less well-defined. In this article, we summarize the data available for this strategy in less frequent subtypes of indolent B-cell lymphomas.
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Affiliation(s)
- Alden A Moccia
- a Department of Medical Oncology , Oncology Institute of Southern Switzerland , Bellinzona , Switzerland
| | - Emanuele Zucca
- a Department of Medical Oncology , Oncology Institute of Southern Switzerland , Bellinzona , Switzerland
| | - Michele Ghielmini
- a Department of Medical Oncology , Oncology Institute of Southern Switzerland , Bellinzona , Switzerland
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6
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Howell C, Douglas K, Cho G, El-Ghariani K, Taylor P, Potok D, Rintala T, Watkins S. Guideline on the clinical use of apheresis procedures for the treatment of patients and collection of cellular therapy products. Transfus Med 2015; 25:57-78. [PMID: 26013470 DOI: 10.1111/tme.12205] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 01/19/2023]
Affiliation(s)
- C. Howell
- Diagnostic & Therapeutic Services; NHS Blood and Transplant; Bristol UK
| | - K. Douglas
- Beatson West of Scotland Cancer Centre; Glasgow UK
- Scottish National Blood Transfusion Service; Glasgow UK
| | - G. Cho
- London North West Healthcare NHS Trust; Harrow UK
| | - K. El-Ghariani
- Therapeutics & Tissue Services; NHS Blood and Transplant; Sheffield UK
| | - P. Taylor
- The Rotherham NHS Foundation Trust; Rotherham UK
| | - D. Potok
- Diagnostic & Therapeutic Services; NHS Blood and Transplant; Leeds UK
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7
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[Hyperviscosity syndrome]. Rev Med Interne 2015; 36:588-95. [PMID: 25778852 DOI: 10.1016/j.revmed.2015.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 01/08/2015] [Accepted: 02/07/2015] [Indexed: 12/12/2022]
Abstract
Hyperviscosity syndrome is a life-threatening complication. Clinical manifestations include neurological impairment, visual disturbance and bleeding. Measurement of plasma or serum viscosity by a viscometer assesses the diagnosis. Funduscopic examination is a key exam because abnormalities are well-correlated with abnormal plasma viscosity. Etiologies are various but symptomatic hyperviscosity is more common in Waldenström's macroglobulinemia and multiple myeloma. Prompt treatment is needed: treatment of the underlying disease should be considered, but generally not sufficient. Symptomatic measures aim to not exacerbate blood viscosity while urgent plasmapheresis effectively reduces the paraprotein concentration and relieves symptoms.
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8
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Coimbra S, Neves R, Lima M, Belo L, Santos-Silva A. Waldenström's macroglobulinemia - a review. Rev Assoc Med Bras (1992) 2014. [DOI: 10.1590/1806-9282.60.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Waldenström's macroglobulinemia (WM) is a lymphoproliferative disease of B lymphocytes, characterized by a lymphoplasmocytic lymphoma in the bone marrow and by IgM monoclonal hypergammaglobulinemia. It was first described in 1944 by Jan Gösta Waldenström, reporting two patients with oronasal bleeding, lymphadenopathy, anemia, thrombocytopenia, high erythrocyte sedimentation rate and serum viscosity, normal radiography and bone marrow infiltrated by lymphoid cells. The WM is a rare disease with a typically indolent clinical course, affecting mainly individuals aged between 63 and 68 years. Most patients have clinical signs and symptoms related to hyperviscosity resulting from IgM monoclonal gammopathy, and/or cytopenias resulting from bone marrow infiltration by lymphoma. The differential diagnosis with other lymphomas is essential for the assessment of prognosis and therapeutic approach. Treatment of patients with asymptomatic WM does not improve the quality of life of patients, or increase their survival, being recommended, therefore, their follow-up. For the treatment of symptomatic patients, alkylating agents, purine analogs and anti-CD20 monoclonal antibodies are used. However, the disease is incurable and the response to therapy is not always favorable. Recent studies have shown promising results with bortezomib, an inhibitor of proteasomes, and some patients respond to thalidomide. In patients with relapse or refractory to therapy, autologous transplantation may be indicated. The aim of this paper is to describe in detail the current knowledge on the pathophysiology of WM, main clinical manifestations, diagnosis, prognosis and treatment.
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Affiliation(s)
| | | | | | - Luís Belo
- University of Porto, Portugal; University of Porto, Portugal
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9
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Owen RG, Pratt G, Auer RL, Flatley R, Kyriakou C, Lunn MP, Matthey F, McCarthy H, McNicholl FP, Rassam SM, Wagner SD, Streetly M, D'Sa S. Guidelines on the diagnosis and management of Waldenström macroglobulinaemia. Br J Haematol 2014; 165:316-33. [PMID: 24528152 DOI: 10.1111/bjh.12760] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/06/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Roger G Owen
- St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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10
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Telek B, Batár P, Váróczy L, Gergely L, Rejtő L, Szász R, Miltényi Z, Simon Z, Udvardy M, Illés A. [Waldenström macroglobulinemia]. Orv Hetil 2013; 154:1970-4. [PMID: 24317355 DOI: 10.1556/oh.2013.29776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Waldenström macroglobulinemia is a rare lymphoproliferative disease of B-cell origin.These tumorous B-cells produce monoclonal IgM type protein. Diagnosis is based on the detection of lymphoplasmacytic invasion of the bone marrow and serum electrophoresis. Clinical symptoms such as anemia, hyperviscosity and neuropathy are the commom consequences of bone marrow infiltration and serum monoclonal IgM protein. Former use of alkylating agents are replaced by purine analogues, rituximab and bortezomib. Additional clinical data have also accumulated regarding autologous and allogenous stem-cell transplantation. The authors present their own clinical experience and give a detailed review of current therapeutic approaches. Orv. Hetil., 154(50), 1970-1974.
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Affiliation(s)
- Béla Telek
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Általános Orvostudományi Kar Belgyógyászati Intézet, Hematológiai Tanszék Debrecen Pf. 20 4012
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11
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Mori N, Ohwashi M, Yoshinaga K, Mitsuhashi K, Tanaka N, Teramura M, Okada M, Shiseki M, Tanaka J, Motoji T. L265P mutation of the MYD88 gene is frequent in Waldenström's macroglobulinemia and its absence in myeloma. PLoS One 2013; 8:e80088. [PMID: 24224040 PMCID: PMC3818242 DOI: 10.1371/journal.pone.0080088] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022] Open
Abstract
L265P mutation in the MYD88 gene has recently been reported in Waldenström’s macroglobulinemia; however the incidence has been different according to the methods used. To determine the relevance and compare the incidence by different methods, we analyzed the L265P mutation in bone marrow mononuclear cells from lymphoid neoplasms. We first performed cloning and sequencing in 10 patients: 8 Waldenström’s macroglobulinemia; 1 non-IgM-secreting lymphoplasmacytic lymphoma; and 1 low grade B-cell lymphoma with monoclonal IgG protein. The L265P mutation was detected in only 1/8 Waldenström’s macroglobulinemia patients (2 of 9 clones). To confirm these results, direct sequencing was performed in the 10 patients and an additional 17 Waldenström’s macroglobulinemia patients and 1 lymphoplasmacytic lymphoma patient. Nine of 28 patients (7/25 Waldenström’s macroglobulinemia, 1/2 lymphoplasmacytic lymphoma, and B-cell lymphoma) harbored the mutation. We next tested for the mutation with BSiE1 digestion and allele-specific polymerase chain reaction in the 28 patients and 38 patients with myeloma. Aberrant bands corresponding to the mutation were detected by BSiE1 digestion in 19/25 patients with Waldenström’s macroglobulinemia (76%), 1/2 lymphoplasmacytic lymphoma and B-cell lymphoma, but not in the 38 myeloma patients. The L265P mutation was more frequent in patients with Waldenström’s macroglobulinemia than in those with myeloma (p=1.3x10-10). The mutation was detected by allele-specific polymerase chain reaction in 18/25 Waldenström’s macroglobulinemia patients (72%). In the 25 Waldenström’s macroglobulinemia patients, the L265P was more frequently detected by BSiE1 digestion than by direct sequencing (p=5.3x10-4), and in males (15/16, 94%) than in females (4/9, 44%) (p=1.2x10-2). No siginificant difference was observed in the incidence of the L265P mutation between BSiE1 digestion and allele-specific polymerase chain reaction (p=0.32). These results suggest that the L265P mutation is involved in the majority of Waldenström’s macroglobulinemia. BSiE1 digestion and allele-specific polymerase chain reaction may detect a small fraction of mutated cells in some cases.
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Affiliation(s)
- Naoki Mori
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
- * E-mail:
| | - Mari Ohwashi
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kentaro Yoshinaga
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kenjiro Mitsuhashi
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Norina Tanaka
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masanao Teramura
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Michiko Okada
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masayuki Shiseki
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Junji Tanaka
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Toshiko Motoji
- Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan
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Xu M, Hou Y, Sheng L, Peng J. Therapeutic effects of thalidomide in hematologic disorders: a review. Front Med 2013; 7:290-300. [PMID: 23856973 DOI: 10.1007/s11684-013-0277-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/22/2013] [Indexed: 12/22/2022]
Abstract
The extensive autoimmune, anti-inflammatory, and anticancer applications of thalidomide have inspired a growing number of studies and clinical trials. As an inexpensive agent with relatively low toxicity, thalidomide is regarded as a promising therapeutic candidate, especially for malignant diseases. We review its therapeutic effects in hematology, including those on multiple myeloma, Waldenstroem macroglobulinemia, lymphoma, mantle-cell lymphoma, myelodysplastic syndrome, hereditary hemorrhagic telangiectasia, and graftversus-host disease. Most studies have shown satisfactory results, although several have reported the opposite. Aside from optimal outcomes, the toxicities and adverse effects of thalidomide should also be examined. The current work includes a discussion of the mechanisms through which the novel biological effects of thalidomide occur, although more studies should be devoted to this aspect. With appropriate safeguards, thalidomide may benefit patients suffering from a broad variety of disorders, particularly refractory and resistant diseases.
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Affiliation(s)
- Miao Xu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, 250012, China
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13
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Evidence-based use of serum protein electrophoresis in laboratory medicine. Clin Chem Lab Med 2013; 51:e113-5. [DOI: 10.1515/cclm-2012-0711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/15/2012] [Indexed: 11/15/2022]
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Kratochvil D, Amann K, Bruck H, Büttner M. Membranoproliferative glomerulonephritis complicating Waldenström's macroglobulinemia. BMC Nephrol 2012; 13:172. [PMID: 23259458 PMCID: PMC3541200 DOI: 10.1186/1471-2369-13-172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 12/19/2012] [Indexed: 11/25/2022] Open
Abstract
Background Lymphoproliferative disorders causing paraproteinemia can be associated with various kidney injuries including the deposition of monoclonal immunoglobulins (Ig). A known glomerular manifestation of Waldenström’s macroglobulinemia is characterized by prominent intracapillary hyaline thrombi and lack of conspicuous glomerular proliferation. The present case was special in 2 aspects: 1. the diagnosis of glomerulonephritis was unexpected before renal biopsy, 2. the prominent glomerular proliferation paired with large intracapillary hyaline thrombi is uncommon in Waldenström’s macroglobulinemia-associated glomerulonephritis. Case presentation A 73-year-old Caucasian woman with a long-standing history of rheumatoid arthritis and Waldenström’s macroglobulinemia was admitted for acute renal failure (ARF), which initially was presumed to be the consequence of extrarenal causes. Proteinuria and hematuria were only mild. In renal core biopsy, a membranoproliferative glomerulonephritis (MPGN) and prominent intracapillary hyaline monoclonal IgM thrombi were found in addition to acute tubular necrosis. Of note, the patient’s history was positive for purpuric skin changes, suspicious for cryoglobulinemia. However, serological tests for cryoglobulins were repeatedly negative. The ARF resolved before the start of immunomodulatory therapy for Waldenström’s macroglobulinemia. Conclusion The presence of MPGN with prominent hyaline thrombi in the context of Waldenström’s macroglobulinemia is uncommon and can be oligosymptomatic. We discuss this case in the context of previous literature and classifications suggested for monoclonal Ig-related renal pathologies.
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Affiliation(s)
- David Kratochvil
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
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15
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Bayat E, Kelly JJ. Neurological complications in plasma cell dyscrasias. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:731-46. [PMID: 22230530 DOI: 10.1016/b978-0-444-53502-3.00020-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Elham Bayat
- Department of Neurology, The George Washington University, Washington, DC, USA
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Laszlo D, Andreola G, Rigacci L, Fabbri A, Rabascio C, Pinto A, Negri M, Martinelli G. Rituximab and Subcutaneous 2-Chloro-2′-Deoxyadenosine as Therapy in Untreated and Relapsed Waldenström's Macroglobulinemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:130-2. [DOI: 10.3816/clml.2011.n.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Kawano Y, Nakama T, Hata H, Kimura E, Maruyoshi N, Uchino M, Mitsuya H. Successful treatment with rituximab and thalidomide of POEMS syndrome associated with Waldenstrom macroglobulinemia. J Neurol Sci 2010; 297:101-4. [DOI: 10.1016/j.jns.2010.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/16/2010] [Accepted: 06/23/2010] [Indexed: 11/28/2022]
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18
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Laszlo D, Andreola G, Rigacci L, Fabbri A, Rabascio C, Mancuso P, Pruneri G, Radice D, Pinto A, Frigeri F, Calabrese L, Billio A, Bertolini F, Martinelli G. Rituximab and Subcutaneous 2-Chloro-2′-Deoxyadenosine Combination Treatment for Patients With Waldenström Macroglobulinemia: Clinical and Biologic Results of a Phase II Multicenter Study. J Clin Oncol 2010; 28:2233-8. [DOI: 10.1200/jco.2009.23.6315] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess the efficacy of 2-chloro-2′-deoxyadenosine (2-CdA) given subcutaneously (SC) in combination with rituximab in the treatment of newly diagnosed/pretreated patients with Waldenström macroglobulinemia (WM) and to correlate the response to treatment with biologic findings (immunophenotypic and pharmacogenomic analysis). Patients and Methods From December 2003 to February 2007, 29 patients were enrolled. Intended therapy consisted of a combination of rituximab (375 mg/m2) on day 1 followed by 2-CdA 0.1 mg/kg (SC injection) for 5 consecutive days, administered monthly for four cycles. Anemia (n = 16), neurologic symptoms (n = 6), symptomatic cryoglobulinemia (n = 4), and thrombocytopenia (n = 3) represented the reasons for starting treatment. The expression of ζ chain–associated protein kinase 70 (Zap-70) and of seven genes involved in 2-CdA metabolism as markers of response to the combination treatment was evaluated. Results With a median follow-up of 43 months, the overall response rate observed was 89.6%, with seven complete responses (CR), 16 partial responses, and three minor response, without any difference between newly or pretreated patients (P = .522). The therapy was well tolerated, except for transitory cardiac toxicity (n = 2) and intolerance to rituximab (n = 2). No major infections were observed despite the lack of antimicrobial prophylaxis. No patients developed transformation to high-grade non-Hodgkin's lymphoma nor myelodysplasia. Low expression levels of human concentrative nucleoside transporter 1 (hCNT1) were correlated with the failure to achieve a CR (P = .024), whereas no association with Zap-70 expression was found. Conclusion The combination of rituximab and SC 2-CdA is safe and effective in patients with WM requiring treatment. The pharmacogenomic analysis associated with the study suggests hCNT1 might be beneficial in predicting clinical response to such a combination treatment.
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Affiliation(s)
- Daniele Laszlo
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Giovanna Andreola
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Luigi Rigacci
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Alberto Fabbri
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Cristina Rabascio
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Patrizia Mancuso
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Giancarlo Pruneri
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Davide Radice
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Antonello Pinto
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Ferdinando Frigeri
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Liliana Calabrese
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Atto Billio
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Francesco Bertolini
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
| | - Giovanni Martinelli
- From the Department of Hematology, Department of Epidemiology and Biostatistics, and Division of Pathology, European Institute of Oncology, Milan; Department of Hematology, University of Florence, Firenze; Department of Hematology, University of Siena, Siena; Department of Hematology, Istituto Nazionale dei Tumori, Naples; and Central Hospital, Bolzano, Italy
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Rabascio C, Laszlo D, Andreola G, Saronni L, Radice D, Rigacci L, Fabbri A, Frigeri F, Calabrese L, Billio A, Bertolini F, Martinelli G. Expression of the human concentrative nucleotide transporter 1 (hCNT1) gene correlates with clinical response in patients affected by Waldenström's Macroglobulinemia (WM) and small lymphocytic lymphoma (SLL) undergoing a combination treatment with 2-chloro-2'-deoxyadenosine (2-CdA) and Rituximab. Leuk Res 2009; 34:454-7. [PMID: 19647871 DOI: 10.1016/j.leukres.2009.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 06/25/2009] [Accepted: 07/02/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE Resistance to nucleoside analogues agents is likely to be multifactorial and could involve a number of mechanisms affecting drug penetration, metabolism and targeting. In vitro studies of resistant human cell lines have confirmed that human concentrative nucleoside transporter 1 (hCNT1)-deficient cells display resistance. EXPERIMENTAL DESIGN We applied real-time PCR method to assess the mRNA expression of equilibrative and concentrative nucleoside transporter (hENT1, hCNT1), deoxycytidine and deoxyguanosine kinase (dCK, dGK), 5'-nucleotidase (5'-NT), ribonucleotide reductase catalytic and regulatory (RR1, RR2) subunits in bone marrow cells from 32 patients with Waldenström's Macroglobulinemia (WM) and small lymphocytic lymphoma (SLL) who received 2CdA-based chemotherapy. Responses to chemotherapy, were then correlated to the expression of these markers. RESULTS All 32 patients enrolled expressed lower levels of hCNT1 as compared to healthy donors. In univariate analysis, lower expression level of hCNT1 (p=0.0021) and RR2 (p=0.02) correlated with response to chemotherapy. In particular, patients with low levels of hCNT1 achieved inferior clinical response. No significant correlation between these genes expression and age, stage of disease was found. This study suggests that nucleotidase expression levels can be used to identify subgroups of WM and SLL patients who will likely respond differently to a 2CdA-based therapy.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Cladribine/administration & dosage
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Male
- Membrane Transport Proteins/genetics
- Middle Aged
- Models, Biological
- Prognosis
- Rituximab
- Treatment Outcome
- Waldenstrom Macroglobulinemia/diagnosis
- Waldenstrom Macroglobulinemia/drug therapy
- Waldenstrom Macroglobulinemia/genetics
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Affiliation(s)
- C Rabascio
- Dept of Haematology, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy.
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Abstract
Abstract
Recently, many new drugs have been developed for the treatment of Waldenström macroglobulinemia (WM). To optimize the treatment according to the prognosis and to facilitate the comparison of trials, we developed an International Prognostic Scoring System for WM in a series of 587 patients with clearly defined criteria for diagnosis and for initiation of treatment. The median survival after treatment initiation was 87 months. Five adverse covariates were identified: advanced age (>65 years), hemoglobin less than or equal to 11.5 g/dL, platelet count less than or equal to 100 × 109/L, β2-microglobulin more than 3 mg/L, and serum monoclonal protein concentration more than 7.0 g/dL. Low-risk patients (27%) presented with no or 1 of the adverse characteristics and advanced age, intermediate-risk patients (38%) with 2 adverse characteristics or only advanced age, and high-risk patients (35%) with more than 2 adverse characteristics. Five-year survival rates were 87%, 68%, and 36%, respectively (P < .001). The ISSWM retained its prognostic significance in subgroups defined by age, treatment with alkylating agent, and purine analog. Thus, the ISSWM may provide a means to design risk-adapted studies. However, independent validation and new biologic markers may enhance its significance.
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Vitolo U, Ferreri AJ, Montoto S. Lymphoplasmacytic lymphoma–Waldenstrom's macroglobulinemia. Crit Rev Oncol Hematol 2008; 67:172-85. [DOI: 10.1016/j.critrevonc.2008.03.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 03/19/2008] [Accepted: 03/27/2008] [Indexed: 10/22/2022] Open
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Lowinger JS, Kaye KI. Evaluation of the off-label usage of rituximab in a large teaching hospital in New South Wales. Intern Med J 2008; 38:146-8. [DOI: 10.1111/j.1445-5994.2007.01609.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Kryczka T, Kazimierczuk Z, Kozłowska M, Chrapusta SJ, Vilpo L, Vilpo J, Stachnik K, Janisz M, Grieb P. Two novel nucleoside ester derivatives of chlorambucil as potential antileukemic prodrugs: a preliminary study. Anticancer Drugs 2007; 18:301-10. [PMID: 17264763 DOI: 10.1097/cad.0b013e328011512d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
2-Chloro-2'-deoxyadenosine (cladribine) and chlorambucil are two drugs used in the treatment of lymphoid malignancies. We have synthesized 5'-O-esters of cladribine and its parental nucleoside 2'-deoxyadenosine with chlorambucil (2-chloro-2'-deoxyadenosine-chlorambucil and 2'-deoxyadenosine-chlorambucil, respectively) and compared some properties of the esters with regard to their potential use as antileukemic prodrugs. The 5'-O-ester bond showed no spontaneous hydrolysis at pH 7.4, but was susceptible to hydrolysis by porcine liver esterase and enzymes present in human lymphocyte lysate and blood plasma. Both 2-chloro-2'-deoxyadenosine-chlorambucil and 2'-deoxyadenosine-chlorambucil were taken up more avidly than their parental nucleosides by normal and malignant human lymphoid cells. 2-Chloro-2'-deoxyadenosine-chlorambucil was by an order of magnitude more toxic than 2'-deoxyadenosine-chlorambucil to human leukemic MOLT4 cells in culture. On the other hand, 2-chloro-2'-deoxyadenosine-chlorambucil cytotoxicity did not exceed that of its parental 2-chloro-2'-deoxyadenosine in MOLT4 cells, whereas 2'-deoxyadenosine-chlorambucil was considerably more cytotoxic than free chlorambucil in a variety of myeloid and lymphoid human malignant cell lines. Moreover, acute toxicity of 2'-deoxyadenosine-chlorambucil was lower than that of chlorambucil in mice. In summary, 2'-deoxyadenosine-chlorambucil, but not 2-chloro-2'-deoxyadenosine-chlorambucil, shows promise for clinical utility as a chlorambucil prodrug and thus warrants a more detailed study in vivo.
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Affiliation(s)
- Tomasz Kryczka
- Department of Experimental Pharmacology, Polish Academy of Sciences Medical Research Center, Warsaw, Poland.
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