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Bhatti V, Kaur G, Ahuja A, Isaacs R. Hairy Cell Leukemia: Hematological and Immunophenotypic Profile of 13 Patients. Cureus 2023; 15:e44876. [PMID: 37814728 PMCID: PMC10560564 DOI: 10.7759/cureus.44876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Hairy cell leukemia (HCL) is a rare lymphoproliferative disorder of the mature B-cells, mostly seen in men, and is characterized by cytopenia, splenomegaly, myelofibrosis, and the presence of atypical lymphoid cells showing the cytoplasmic hairy projection in the peripheral blood, bone marrow, and spleen. The immunophenotypic (IPT) profile shows the clonal expansion of B-cells with CD19, CD20, and CD22 showing bright expression. The diagnosis requires two hairy cell markers out of CD103, CD123, CD25, and CD11c to be positive. The HCL variant (HCL-v) has a different IPT profile with negative CD25 in most cases. AIM The aim was to study the hematological and IPT of classical HCL and HCL variants. METHODS This cross-sectional study included all the cases of HCL diagnosed over a retrospective period of eight years from 1st January 2015 to 31st December 2022 in a tertiary care hospital in north India. The patients included in the study were those for whom immunophenotyping; that is, flow cytometry and/or immunohistochemistry (IHC) were done for diagnosis. Bone marrow slides, IHC slides, and flow cytometric IPTs were reviewed. RESULTS The study included 13 patients who were diagnosed to have HCL, of which 12 were classical HCL and one was HCL-variant (HCL-v). Among classical HCL, IPT was done by flow cytometry in 10 patients, while in two patients, it was done by IHC. CD19, CD20, and CD22 were positive in all patients of classical HCL (10/10, 10/10, and 5/5, respectively), while CD123, CD103, CD25, and CD11C were positive in 100%, 89%, 80%, and 100% cases, respectively. One patient of HCL-v had CD103 and CD123 positive, while CD25 and CD123 were negative. CONCLUSION The diagnosis of HCL requires a multipronged approach. The use of clinical features, morphology, and immunophenotyping combined with ancillary techniques provides higher diagnostic accuracy and enables its distinction from other B-cell lymphoproliferative disorders (BCLPDs), leading to better patient management and treatment.
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Affiliation(s)
- Vandana Bhatti
- Department of Pathology, Christian Medical College & Hospital, Ludhiana, IND
| | - Gurpreet Kaur
- Department of Pathology, Christian Medical College & Hospital, Ludhiana, IND
| | - Aarzoo Ahuja
- Department of Pathology, Christian Medical College & Hospital, Ludhiana, IND
| | - Roma Isaacs
- Department of Pathology, Christian Medical College & Hospital, Ludhiana, IND
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B-RAF V600E AND B-RAF CODON 464-469 MUTATIONS IN HAIRY CELL LEUKEMIA PATIENTS AND THEIR RELATION WITH CLINICAL PARAMETERS. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.868298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Liu Q, Harris N, Epperla N, Andritsos LA. Current and Emerging Therapeutic Options for Hairy Cell Leukemia Variant. Onco Targets Ther 2021; 14:1797-1805. [PMID: 33727830 PMCID: PMC7955867 DOI: 10.2147/ott.s242247] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/06/2021] [Indexed: 12/11/2022] Open
Abstract
Hairy cell leukemia variant (HCL-v) is a rare B-cell lymphoproliferative disorder with distinct immunophenotypic and molecular characteristics when compared to classical hairy cell leukemia (HCL-c). In contrast to the enormous progress in therapeutic options for HCL-c, HCL-v remains a therapeutic challenge due to inferior outcomes with standard chemoimmunotherapy and BCR signaling pathway inhibitors, and due to the fact that HCL-v has limited molecular therapeutic targets. In addition, because of the rarity of the disease, there is a paucity of later phase studies or multicenter trials to guide treatment decisions. In this article, we briefly review the diagnostic criteria and clinical characteristics of HCL-v and present a comprehensive overview of current therapeutic options in HCL-v.
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Affiliation(s)
- Qiuying Liu
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Nicholas Harris
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Narendranath Epperla
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Leslie A Andritsos
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
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4
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Troussard X, Grever MR. The revised guidelines for the diagnosis and management of hairy cell leukaemia and the hairy cell leukaemia variant. Br J Haematol 2020; 193:11-14. [PMID: 33368172 DOI: 10.1111/bjh.17201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Xavier Troussard
- Department of Haematology, CHU Caen Normandie, Caen cedex 9, France
| | - Michael R Grever
- Division of Hematology, The Ohio State University, Columbus, Ohio, USA
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5
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Parry-Jones N, Joshi A, Forconi F, Dearden C. Guideline for diagnosis and management of hairy cell leukaemia (HCL) and hairy cell variant (HCL-V). Br J Haematol 2020; 191:730-737. [PMID: 33053222 DOI: 10.1111/bjh.17055] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nilima Parry-Jones
- Department of Haematology, Aneurin Bevan University Health Board, Abergavenny, UK
| | - Anurag Joshi
- Department of Cellular Pathology and All Wales Lymphoma Panel, University Hospital of Wales, Cardiff, UK
| | - Francesco Forconi
- Cancer Sciences Unit, Cancer Research UK and NIHR Experimental Cancer Medicine Centres, University of Southampton, UK.,Department of Haematology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Claire Dearden
- Department of Haematology, Royal Marsden NHS Trust, London, UK
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Feurtado J, Kreitman RJ. Moxetumomab Pasudotox: Clinical Experience in Relapsed/Refractory Hairy Cell Leukemia. Clin J Oncol Nurs 2020; 23:E52-E59. [PMID: 31099793 DOI: 10.1188/19.cjon.e52-e59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Moxetumomab pasudotox is a promising new therapy for the treatment of patients with relapsed/refractory hairy cell leukemia (R/R HCL), but practical guidance relating to its administration is limited. OBJECTIVES This article describes clinical guidelines for the administration of moxetumomab pasudotox to patients with R/R HCL and presents related case studies. METHODS A limited review of the literature on HCL was undertaken. FINDINGS Nursing care of patients prescribed moxetumomab pasudotox includes monitoring clinical and laboratory parameters, managing side effects, being aware of signs of serious side effects, and maintaining patient hydration during administration.
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Affiliation(s)
- Julie Feurtado
- National Cancer Institute at the National Institutes of Health
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7
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Abstract
PURPOSE OF REVIEW To summarise diagnostic clinical/laboratory findings and highlight differences between classical hairy cell leukaemia (HCLc) and hairy cell leukaemia variant (HCLv). Discussion of prognosis and current treatment indications including novel therapies, linked to understanding of the underlying molecular pathogenesis. RECENT FINDINGS Improved understanding of the underlying pathogenesis of HCLc, particularly the causative mutation BRAF V600E, leading to constitutive activation of the MEK/ERK signalling pathway and increased cell proliferation. HCLc is caused by BRAF V600E mutation in most cases. Purine nucleoside analogue (PNA) therapy is the mainstay of treatment, with the addition of rituximab, improving response and minimal residual disease (MRD) clearance. Despite excellent responses to PNAs, many patients will eventually relapse, requiring further therapy. Rarely, patients are refractory to PNA therapy. In relapsed/refractory patients, novel targeted therapies include BRAF inhibitors (BRAFi), anti-CD22 immunoconjugate moxetumomab and Bruton tyrosine kinase inhibitors (BTKi). HCLv has a worse prognosis with median overall survival (OS), only 7-9 years, despite the combination of PNA/rituximab improving front-line response. Moxetumomab or ibrutinib may be a viable treatment but lacks substantial evidence.
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Affiliation(s)
- Matthew Cross
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Claire Dearden
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK.
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Yılmaz F, Atilla D, Akkaş N, Bülbül H, Soyer N, Demir D, Kiper D, Avcı A, Vural F, Saydam G, Şahin F, Hekimgil M, Özsan N, Durusoy R, Payzın B. Retrospective Analysis of Hairy Cell Leukemia Patients Treated with Different Modalities as First Line: Real-Life Experience Over 20 years. Indian J Hematol Blood Transfus 2019; 35:692-698. [PMID: 31741621 DOI: 10.1007/s12288-019-01132-7] [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: 01/31/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022] Open
Abstract
We aimed to analyze the characteristics and response rates of different treatment modalities in hairy cell leukemia patients over 20 diagnosed as hairy cell leukemia (HCL). Clinical data, response rates and survival outcome of the patients who were diagnosed with HCL were retrospectively analyzed. Fifty-two patients with a median age of 50 (28-87) years were enrolled in the study. 38 patients (73%) were male and male to female ratio was 2.7. First line therapy was cladrabine in 36 patients (69.2%). The overall response rate was 97%. CR and PR rates were 86.1% and 11.1%, respectively. Interferon was used in 10(19.2%) patients who were diagnosed before 2000s years. CR and PR rates were 70% and 30%, respectively. Although the CR rates were lower in IFN group, this difference could not be reached statistically significance (p = 0.24). The median follow up was 48 months (12-252). The median OS was not reached and median PFS was 150 months (95% CI, 116-214). The OS at 36 and 48 months were 95.9% and 92.3%, respectively and the PFS at 36 and 48 months were 90.2% and 83.4%, respectively. After the introduction of purine analogues, the fate of the HCL patients have been changed. Cladrabin achieved very high response rates in both young and older patients, in our study. Although relapse still constitutes a problem, another single dose of cladrabine results in good response rates.
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Affiliation(s)
- Fergün Yılmaz
- 1Department of Hematology, Internal Medicine, Marmara University, Istanbul, Turkey
| | - Dilan Atilla
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Nagihan Akkaş
- 3İnternal Medicine, Department of Hematology, İzmir Katip Celebi University, Izmir, Turkey
| | - Hale Bülbül
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Nur Soyer
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Derya Demir
- 4Department of Pathology, Ege University, Izmir, Turkey
| | - Demet Kiper
- 3İnternal Medicine, Department of Hematology, İzmir Katip Celebi University, Izmir, Turkey
| | - Aylin Avcı
- 5Department of Pathology, İzmir Katip Celebi University, Izmir, Turkey
| | - Filiz Vural
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Güray Saydam
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Fahri Şahin
- 2Department of Hematology, Internal Medicine, Ege University, Izmir, Turkey
| | - Mine Hekimgil
- 4Department of Pathology, Ege University, Izmir, Turkey
| | - Nazan Özsan
- 4Department of Pathology, Ege University, Izmir, Turkey
| | - Raika Durusoy
- 6Department of Public Heath, Ege University, Izmir, Turkey
| | - Bahriye Payzın
- 3İnternal Medicine, Department of Hematology, İzmir Katip Celebi University, Izmir, Turkey
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Tadmor T, Levy I, Herishanu Y, Goldschmidt N, Bairey O, Yuklea M, Shvidel L, Fineman R, Aviv A, Ruchlemer R, Braester A, Dally N, Rouvio O, Shaulov A, Greenbaum U, Inbar M, Polliack A. Primary peg-filgrastim prophylaxis versus filgrastim given "on demand" for neutropenia during therapy with cladribine for hairy cell leukemia. Leuk Res 2019; 82:24-28. [PMID: 31152919 DOI: 10.1016/j.leukres.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major advances in the treatment of patients with hairy cell leukemia (HCL) have been made following the introduction of purine analogues. The major significant short-term toxicity of cladribine therapy are neutropenia and neutropenic fever (NF) which may be life-threatening. AIM In this retrospective study, we compared the incidence and duration of neutropenia and hospitalization in patients with HCL treated with cladribine followed by peg-filgrastim as primary prophylaxis versus daily filgrastim given "on demand" according to absolute neutrophil count (ANC). METHODS Medical records of patients with HCL diagnosed and followed in 12 medical centers in Israel during 1985-2015 were examined for details of disease at diagnosis. The efficacy of peg-filgrastim and filgrastim was assessed by evaluating the incidence of neutropenia (ANC < 1.0 × 10 [9]/L), number and length of hospitalizations, and number of days from the last day of therapy to recovery of ANC to >1.0 × 10 [9]/L. RESULTS The study population included 202 patients with HCL, 159 of whom (80.7%) were treated with cladribine; 78 patients (49%) required hospitalization for the administration of broad-spectrum antibiotics due to NF. Twenty-eight (19%) patients were treated with peg-filgrastim as primary prophylaxis, while 74 (64%) received filgrastim "on demand" due to neutropenia. Median length of hospitalization, and nadir duration were 8 and 18 days respectively (p = 0.71, p = 0.44). CONCLUSIONS Infectious complications post-cladribine treatment remain high. No difference was found in terms of incidence of NF, number of febrile days, and nadir duration in patients receiving primary peg-filgrastim prophylaxis compared to filgrastim given on demand. Both approaches are justifiable, and the choice remains at the physician's discretion.
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Affiliation(s)
- Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Ilana Levy
- Internal Medicine B, Bnai Zion Medical Center, Haifa, Israel
| | - Yair Herishanu
- Department of Hematology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Hebrew University Medical center, Jerusalem, Israel
| | - Osnat Bairey
- Department of Hematology, Rabin Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv Petah-Tikvah, Israel
| | - Mona Yuklea
- Department of Hematology, Meir Medical Center, Kfar-Saba, Israel
| | - Lev Shvidel
- Hematology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Riva Fineman
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Ariel Aviv
- Hematology Unit, HaEmek Medical Center, Afula, Israel
| | - Rosa Ruchlemer
- Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Najib Dally
- Hematology Unit, Ziv Medical center, Safed, Israel
| | - Ory Rouvio
- Department of Hematology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Adir Shaulov
- Department of Hematology, Hadassah Hebrew University Medical center, Jerusalem, Israel
| | - Uri Greenbaum
- Department of Hematology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal Inbar
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah Hebrew University Medical center, Jerusalem, Israel
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Lee JW, Choi YM, Yang JY, Han SM, Kim BS, Nam SH. Fludarabine and Rituximab in Relapsed or Refractory Hairy Cell Leukmia Variant: A Case Report and Review of Literature. KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.3.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hairy cell leukemia (HCL) is a rare chronic B cell leukemia morphologically characterized by cells with an abundant cytoplasm and hair-like projections that can be found in the peripheral blood and bone marrow. The treatment for HCL is splenectomy or chemotherapy with the purine analogs pentostatin and cladribine. However, patients continue to relapse. Retreatment with the same or alternate purine analogs produces lower response rates and a shorter duration of response. Fludarabine is another purine analog widely used in treating indolent lymphoid cancers, often in combination with rituximab. Here, we report a case of HCL variant in a 60-year-old man who experienced multiple relapses after splenectomy and retreatment with cladribine. The patient was then treated with fludarabine and rituximab combination chemotherapy. After the treatment, he achieved complete remission that continued for 35 months.
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11
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Cladribine in the remission induction of adult acute myeloid leukemia: where do we stand? Ann Hematol 2018; 98:561-579. [DOI: 10.1007/s00277-018-3562-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023]
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12
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Itamura H, Ide M, Sato A, Sueoka-Aragane N, Sueoka E, Nishida A, Masunari T, Aoki S, Takizawa J, Suzumiya J, Kimura S. Identification of the BRAF V600E mutation in Japanese patients with hairy cell leukemia and related diseases using a quenching probe method. Int J Hematol 2018; 108:416-422. [PMID: 30043333 DOI: 10.1007/s12185-018-2506-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 01/11/2023]
Abstract
Hairy cell leukemia (HCL) is a rare B-cell lymphoid malignancy that is difficult to distinguish from other morphological variants. The frequency of HCL has not been determined accurately in Japan. Recent studies revealed that the BRAF V600E mutation is the causal genetic event in HCL. We assessed the BRAF mutation in Japanese patients with HCL and related diseases using the quenching probe (QP) method, a single-nucleotide polymorphism detection system, and evaluated the incidence rate of HCL among Japanese patients with chronic lymphocytic leukemia, and related diseases. We identified 18 cases (33.3%) harboring the BRAF mutation among 54 patients diagnosed with, or suspected of having HCL. Of BRAF V600E-positive patients, 7 were only detected using the QP method, not by direct sequencing, whereas 11 were positive using both tests. In a larger cohort of Japanese patients diagnosed with chronic lymphoid leukemia or related diseases, the frequency of HCL was 4%. Patients with the BRAF V600E mutation had a significantly higher frequency of neutropenia, thrombocytopenia, and elevated soluble interleukin-2 receptor and common B-cell surface markers than patients without the mutation. Our results confirm that BRAF V600E-positive HCL is a relatively rare disorder in the Japanese leukemia patient population.
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Affiliation(s)
- Hidekazu Itamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masaru Ide
- Department of Internal Medicine, Oda Hospital, Kashima, Japan
| | - Akemi Sato
- Department of Clinical Laboratory Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Eisaburo Sueoka
- Department of Clinical Laboratory Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Aya Nishida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Taro Masunari
- Department of Hematology, Chugoku Central Hospital, Hiroshima, Japan
| | - Sadao Aoki
- Department of Pathophysiology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Junji Suzumiya
- Department of Oncology/Hematology, School of Medicine, Shimane University, Izumo, Japan
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
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Habberstad AH, Tran HTT, Randen U, Spetalen S, Dybedal I, Tjønnfjord GE, Dahm AEA. Neutropenia caused by hairy cell leukemia in a patient with myelofibrosis secondary to polycythemia vera: a case report. J Med Case Rep 2018; 12:105. [PMID: 29685167 PMCID: PMC5914053 DOI: 10.1186/s13256-018-1663-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/21/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Polycythemia vera is a myeloproliferative disease that sometimes evolves to myelofibrosis, causing splenomegaly and neutropenia. In this case report, we describe a patient with polycythemia vera and unexplained neutropenia who later turned out to also have hairy cell leukemia. CASE PRESENTATION A middle-aged Caucasian man with polycythemia vera presented to our hospital with chronic mouth ulcers. Later he developed leukopenia and pancytopenia. Bone marrow biopsies showed fibrosis. Further morphological analyses of bone marrow and blood smears revealed probable transformation into acute myeloid leukemia. However, there were also cells indicating hairy cell leukemia. Morphological and immunohistochemical analyses later confirmed the presence of hairy cell leukemia in biopsies that had been present for 3 years. Treatment with cladribine temporarily reversed the patient's neutropenia. CONCLUSIONS Hairy cell leukemia may mimic development to myelofibrosis in patients with polycythemia vera.
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Affiliation(s)
| | - Hoa Thi Tuyet Tran
- Department of Haematology, Akershus University Hospital, Lørenskog, Norway
| | - Ulla Randen
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway
| | - Signe Spetalen
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Ingunn Dybedal
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Geir E Tjønnfjord
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anders Erik Astrup Dahm
- Department of Haematology, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Buoro S, Da Rin G, Fanelli A, Lippi G. Harmonization of interpretative comments in laboratory hematology reporting: the recommendations of the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC). ACTA ACUST UNITED AC 2018; 57:66-77. [DOI: 10.1515/cclm-2017-0972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
Abstract
The goal of harmonizing laboratory testing is contributing to improving the quality of patient care and ultimately ameliorating patient outcome. The complete blood and leukocyte differential counts are among the most frequently requested clinical laboratory tests. The morphological assessment of peripheral blood cells (PB) through microscopic examination of properly stained blood smears is still considered a hallmark of laboratory hematology. Nevertheless, a variable inter-observer experience and the different terminology used for characterizing cellular abnormalities both contribute to the current lack of harmonization in blood smear revision. In 2014, the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC) conducted a national survey, collecting responses from 78 different Italian laboratories. The results of this survey highlighted a lack of harmonization of interpretative comments in hematology, which prompted the WGDH-SIBioC to develop a project on “Harmonization of interpretative comments in the laboratory hematology report”, aimed at identifying appropriate comments and proposing a standardized reporting system. The comments were then revised and updated according to the 2016 revision of the World Health Organization classification of hematologic malignancies. In 2016, the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH SIBioC) published its first consensus based recommendation for interpretative comments in laboratory hematology reporting whit the purpose of evaluating comments and the aim to (a) reducing their overall number, (b) standardizing the language, (c) providing information that could be easily comprehended by clinicians and patients, (d) increasing the quality of the clinical information, and (e) suggesting additional diagnostic tests when necessary. This paper represents a review of the recommendations of the former document.
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Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII , Bergamo , Italy
| | - Giorgio Da Rin
- Laboratory Medicine, San Bassiano Hospital , AULSS 7 Pedemontana, Via dei Lotti, 40 , 36061 Bassano del Grappa , Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry , University Hospital of Verona , Verona , Italy
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15
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Ortiz-Maldonado V, Villamor N, Baumann T, Aymerich M, Magnano L, Mozas P, Rivas-Delgado A, Martínez-Trillos A, Giné E, Campo E, López-Guillermo A, Delgado J. Is there a role for minimal residual disease monitoring in the management of patients with hairy-cell leukaemia? Br J Haematol 2017; 183:127-129. [DOI: 10.1111/bjh.14900] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
| | - Neus Villamor
- Hematopathology Unit; Hospital Clínic; IDIBAPS; Barcelona Spain
- CIBERONC; ISCIII, MINECO; Spain
| | - Tycho Baumann
- Department of Haematology; Hospital Clínic; IDIBAPS; Barcelona Spain
- CIBERONC; ISCIII, MINECO; Spain
| | - Marta Aymerich
- Hematopathology Unit; Hospital Clínic; IDIBAPS; Barcelona Spain
- CIBERONC; ISCIII, MINECO; Spain
| | - Laura Magnano
- Hematopathology Unit; Hospital Clínic; IDIBAPS; Barcelona Spain
| | - Pablo Mozas
- Department of Haematology; Hospital Clínic; IDIBAPS; Barcelona Spain
| | | | | | - Eva Giné
- Department of Haematology; Hospital Clínic; IDIBAPS; Barcelona Spain
- CIBERONC; ISCIII, MINECO; Spain
| | - Elías Campo
- Hematopathology Unit; Hospital Clínic; IDIBAPS; Barcelona Spain
- CIBERONC; ISCIII, MINECO; Spain
| | - Armando López-Guillermo
- Department of Haematology; Hospital Clínic; IDIBAPS; Barcelona Spain
- CIBERONC; ISCIII, MINECO; Spain
| | - Julio Delgado
- Department of Haematology; Hospital Clínic; IDIBAPS; Barcelona Spain
- CIBERONC; ISCIII, MINECO; Spain
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16
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Al-Radi LS, Moiseeva TN, Smirnova SY, Shmakov RG. [Hairy cell leukemia and pregnancy]. TERAPEVT ARKH 2017; 89:99-104. [PMID: 28766548 DOI: 10.17116/terarkh201789799-104] [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: 11/17/2022]
Abstract
The paper presents experience in following up and treating hairy cell leukemia (HCL) during pregnancy. The combination of HCL and pregnancy was observed in 5 patients. The patients' median age was 35 years (range, 28-42 years). The diagnosis of HCL was based on a conventional examination protocol: clinical blood analysis with the morphological assessment of lymphocytes, a myelogram and trepanobiopsy, immunophenotypic analysis of lymphocytes or bone marrow (in all the patients), cytochemical determination of tartrate-resistant acid phosphatase in 3 patients, and identification of BRAFV600E mutation in 3 patients. Three pregnant women were treated for HCL in the postpartum period. In one patient with HCL, pregnancy was seen in remission after treatment with cladribine. In one patient with HCL detected at 11 weeks' gestation, interferon-α therapy during the second trimester of pregnancy was performed for increased cytopenia, which was followed by cladribine therapy after delivery. Pregnancy and delivery were uncomplicated in all the patients; 3 patients had vaginal delivery and 2 patients underwent cesarean section. All infants were healthy, with no developmental abnormalities during a follow-up period of 6-140 months (median 30 months). All the patients with HCL are currently in remission: 4 patients in first remission at a follow-up of 10 to 48 months (median 15 months) and one patient in second remission at a follow-up of 88 months. Possible observational tactics is possible when HCL is detected during pregnancy. Treatment of HCL during pregnancy is necessary in cases of deep or progressive cytopenia and/or splenomegaly. The use of interferon-α or splenectomy is preferable.
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Affiliation(s)
- L S Al-Radi
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - T N Moiseeva
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - S Yu Smirnova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - R G Shmakov
- Acad. V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia
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17
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Alfaraj M, Alsaeed H. Hairy cell leukemia: a case report of atypical presentation without splenomegaly. Blood Res 2017; 52:139-141. [PMID: 28698853 PMCID: PMC5503894 DOI: 10.5045/br.2017.52.2.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 09/27/2016] [Accepted: 11/18/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mona Alfaraj
- Consultant Hematopathologist, Hematology Section of Medical Laboratory Department, Qatif Central Hospital, Saudi Arabia
| | - Hussain Alsaeed
- Consultant Hematologist, Department of Internal Medicine, Qatif Central Hospital, Saudi Arabia
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18
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Jud S, Goede JS, Senn O, Spanaus K, Manz MG, Benz R. sIL2R ratio as early marker for response in hairy cell leukemia and the prognostic relevance of IL28B genotype to interferon-α therapy. Ann Hematol 2017; 96:757-763. [PMID: 28214980 DOI: 10.1007/s00277-017-2943-8] [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: 12/12/2016] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
Interferon-α (IFNα) was the first effective drug therapy for hairy cell leukemia (HCL). Nowadays, it is used as an alternative treatment in selected patients. Due to unlimited treatment time, monitoring and early prediction of response are important. Moreover, IFNα is used in the therapy of chronic hepatitis C, where a single nucleotide polymorphism of interleukin-28B gene (IL28B) correlates with therapy response. The role of this polymorphism in therapy response of IFNα-treated patients with HCL is unknown. Thirty-seven HCL patients treated between 1978 and 2014 were included in this study. Treatment strategy and response parameters (blood cell counts, soluble interleukin-2 receptor (sIL2R), and bone marrow examination) have been assessed. Relative decrease of sIL2R was correlated with outcome parameters. Response parameters of IFNα-treated patients were correlated with IL28B polymorphism. Twenty-one patients were analyzed for the correlation of sIL2R ratio and outcome. After 1 and 3 months of therapy (IFNα or cladribine (CDA)), the median sIL2R level showed a relative decrease of 79 and 91%. These decreases significantly correlate with time to complete remission (CR, p = 0.029 and p = 0.018). Correlation analyses of IL28B genotype with outcome parameters are not significant. Six patients (16%) were diagnosed with secondary malignancies, and one death was registered (median follow-up time 14 years). IFNα is a safe, effective, and well-tolerated long-term treatment in HCL. Relative decreases of sIL2R levels correlate with time to CR and are useful as early predictor for response. There is no significant correlation between IL28B polymorphism and treatment response to IFNα. Graphical abstract.
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Affiliation(s)
- Stéphanie Jud
- Departement of Hematology, University Hospital Zurich, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
| | - Jeroen S Goede
- Departement of Hematology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
- Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Katharina Spanaus
- Departement of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
| | - Markus G Manz
- Departement of Hematology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Rudolf Benz
- Departement of Hematology, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
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19
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Grever MR, Abdel-Wahab O, Andritsos LA, Banerji V, Barrientos J, Blachly JS, Call TG, Catovsky D, Dearden C, Demeter J, Else M, Forconi F, Gozzetti A, Ho AD, Johnston JB, Jones J, Juliusson G, Kraut E, Kreitman RJ, Larratt L, Lauria F, Lozanski G, Montserrat E, Parikh SA, Park JH, Polliack A, Quest GR, Rai KR, Ravandi F, Robak T, Saven A, Seymour JF, Tadmor T, Tallman MS, Tam C, Tiacci E, Troussard X, Zent CS, Zenz T, Zinzani PL, Falini B. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood 2017; 129:553-560. [PMID: 27903528 PMCID: PMC5290982 DOI: 10.1182/blood-2016-01-689422] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 11/06/2016] [Indexed: 12/20/2022] Open
Abstract
Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients.
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Affiliation(s)
- Michael R Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Omar Abdel-Wahab
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leslie A Andritsos
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Versha Banerji
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jacqueline Barrientos
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | | | - Daniel Catovsky
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Claire Dearden
- Department of Haemato-Oncology, Royal Marsden Biomedical Research Centre, London, United Kingdom
| | - Judit Demeter
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Francesco Forconi
- Haematology Department, University Hospital Trust and Cancer Sciences Unit, Cancer Research UK and National Institute for Health Research Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | - Anthony D Ho
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - James B Johnston
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey Jones
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Gunnar Juliusson
- Department of Hematology, Skåne University Hospital and Stem Cell Center, Lund University, Lund, Sweden
| | - Eric Kraut
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Loree Larratt
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Francesco Lauria
- Hematology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Emili Montserrat
- Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aaron Polliack
- Department of Hematology, Hadassah University Hospital and Hebrew University Medical School, Jerusalem, Israel
| | - Graeme R Quest
- Department of Laboratory Medicine and Pathology, University Health Network, Toronto, ON, Canada
| | - Kanti R Rai
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - Farhad Ravandi
- Section of Developmental Therapeutics, Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, and the Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Constantine Tam
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Enrico Tiacci
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Côte de Nacre, Caen, France
| | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Thorsten Zenz
- Department of Molecular Therapy in Hematology and Oncology, National Center for Tumor Diseases and German Cancer Research Center (DKFZ), Heidelberg, Germany; and
| | - Pier Luigi Zinzani
- Institute of Hematology "Seràgnoli," University of Bologna, Bologna, Italy
| | - Brunangelo Falini
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
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Rossi ED, Martini M, Bizzarro T, Schmitt F, Longatto-Filho A, Larocca LM. Somatic mutations in solid tumors: a spectrum at the service of diagnostic armamentarium or an indecipherable puzzle? The morphological eyes looking for BRAF and somatic molecular detections on cyto-histological samples. Oncotarget 2017; 8:3746-3760. [PMID: 27738305 PMCID: PMC5356915 DOI: 10.18632/oncotarget.12564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/03/2016] [Indexed: 12/12/2022] Open
Abstract
This review article deals with the analysis and the detection of the morphological features associated with somatic mutations, mostly BRAFV600E mutation, on both cytological and histological samples of carcinomas. Few authors demonstrated that some architectural and specific cellular findings (i.e. polygonal eosinophilic cells defined as "plump cells" and sickle-shaped nuclei) are able to predict BRAF V600E mutation in both cytological and histological samples of papillary thyroid carcinoma (PTC) as well as in other carcinomas. In the current review article we evaluated the first comprehensive analysis of the morphological prediction of BRAFV600E and other somatic mutations in different malignant lesions with the description of the possible mechanisms beneath these morphologic features. The detection of predictive morphological features, mostly on FNAC, may add helpful information to the stratification of the malignant risk and personalized management of cancers. Additionally, the knowledge of the molecular mechanism of different oncogenic drivers can lead to the organ-specific triaging selection of cases and can provide significant insight for targeted therapies in different malignant lesions.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Fernando Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
- Department of Medicine and Pathology, Laboratoire National de Santé, Luxembourg
| | - Adhemar Longatto-Filho
- Department of Pathology, Laboratory of Medical Investigation, University of São Paulo School of Medicine, Brazil
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
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21
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Chihara D, Kantarjian H, O'Brien S, Jorgensen J, Pierce S, Faderl S, Ferrajoli A, Poku R, Jain P, Thompson P, Brandt M, Luthra R, Burger J, Keating M, Ravandi F. Long-term durable remission by cladribine followed by rituximab in patients with hairy cell leukaemia: update of a phase II trial. Br J Haematol 2016; 174:760-6. [PMID: 27301277 DOI: 10.1111/bjh.14129] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/09/2016] [Indexed: 11/29/2022]
Abstract
Nucleoside analogues are highly active in patients with hairy cell leukaemia (HCL); however, patients continue to relapse. This phase II study evaluated the efficacy and safety of cladribine followed by rituximab in patients with untreated HCL (N = 59), relapsed HCL (N = 14) and HCL variant (HCLv, N = 7). Cladribine 5·6 mg/m(2) was given intravenously (IV) daily for 5 d and was followed approximately 1 month later with rituximab 375 mg/m(2) IV weekly for 8 weeks. Complete response rate in patients with untreated HCL, relapsed HCL and HCLv was 100%, 100% and 86%, respectively. With a median follow up of 60 months, 5-year failure-free survival (FFS) in patients with untreated HCL, relapsed HCL and HCLv was 95%, 100% and 64%, respectively. Median duration of response to the cladribine followed by rituximab was significantly longer than the first-line cladribine single agent in patients who received this treatment as second-line treatment (72 months vs not reached, P = 0·004). Almost all patients (94%) achieved negative minimal residual disease (MRD) after the treatment. Positive MRD during the follow up did not necessarily result in clinically relevant relapse. Cladribine followed by rituximab is highly effective even in patients with relapsed disease and HCLv, and can achieve durable remission.
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Affiliation(s)
- Dai Chihara
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan O'Brien
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Jorgensen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stefan Faderl
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Poku
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Preetesh Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Phillip Thompson
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Brandt
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan Burger
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Audit of compliance with the British Committee for Standards in Haematology (BCSH) revised guidelines for the diagnosis and assessment of treatment response of hairy cell leukemia in University Hospital Galway. Ir J Med Sci 2016; 186:345-347. [PMID: 27170271 DOI: 10.1007/s11845-016-1460-4] [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: 07/05/2015] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hairy cell leukemia (HCL) is an uncommon B cell lymphoproliferative disorder. The object of the present audit was to assess whether the investigation and management of HCL in University College Hospital Galway (UCHG) complies with the British Committee for Standards in Haematology (BCSH) guidelines. METHODS Following a review of the records in our Haematology Department, 18 cases of HCL were identified between January 2006 and October 2014. RESULTS Blood film examination had been performed in all cases. Flow cytometry of liquid material had been undertaken in 89 % (n = 16) of cases, of which only 31 % (n = 5) included all four hairy cell panel markers (CD11c, CD25, CD103, CD123). Although all initial trephine biopsies included CD20, none analyzed DBA44. Only 65 % (n = 11) of treated patients had a post-treatment bone marrow biopsy preformed. CONCLUSION This audit highlights areas of improvement in the diagnosis and management of HCL in UCHG, which do not currently adhere to the BCSH recommendations.
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23
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BRAF inhibition in hairy cell leukemia with low-dose vemurafenib. Blood 2016; 127:2847-55. [PMID: 26941398 DOI: 10.1182/blood-2015-11-680074] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/13/2016] [Indexed: 11/20/2022] Open
Abstract
The activating mutation of the BRAF serine/threonine protein kinase (BRAF V600E) is the key driver mutation in hairy cell leukemia (HCL), suggesting opportunities for therapeutic targeting. We analyzed the course of 21 HCL patients treated with vemurafenib outside of trials with individual dosing regimens (240-1920 mg/d; median treatment duration, 90 days). Vemurafenib treatment improved blood counts in all patients, with platelets, neutrophils, and hemoglobin recovering within 28, 43, and 55 days (median), respectively. Complete remission was achieved in 40% (6/15 of evaluable patients) and median event-free survival was 17 months. Response rate and kinetics of response were independent of vemurafenib dosing. Retreatment with vemurafenib led to similar response patterns (n = 6). Pharmacodynamic analysis of BRAF V600E downstream targets showed that vemurafenib (480 mg/d) completely abrogated extracellular signal-regulated kinase phosphorylation of hairy cells in vivo. Typical side effects also occurred at low dosing regimens. We observed the development of acute myeloid lymphoma (AML) subtype M6 in 1 patient, and the course suggested disease acceleration triggered by vemurafenib. The phosphatidylinositol 3-kinase hotspot mutation (E545K) was identified in the AML clone, providing a potential novel mechanism for paradoxical BRAF activation. These data provide proof of dependence of HCL on active BRAF signaling. We provide evidence that antitumor and side effects are observed with 480 mg vemurafenib, suggesting that dosing regimens in BRAF-driven cancers could warrant reassessment in trials with implications for cost of cancer care.
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Hairy Cell Leukemia Presenting with Isolated Skeletal Involvement Successfully Treated by Radiation Therapy and Cladribine: A Case Report and Review of the Literature. Case Rep Hematol 2015; 2015:803921. [PMID: 26788382 PMCID: PMC4695657 DOI: 10.1155/2015/803921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/01/2015] [Indexed: 11/18/2022] Open
Abstract
We describe an unusual case of hairy cell leukemia (HCL) in a 55-year-old male presenting with isolated skeletal disease as the initial manifestation without abnormal peripheral blood counts, bone marrow involvement, or splenomegaly. To the best of our knowledge, there have been only two previous reports of a similar case. The patient presented with pain in the right femur. Anteroposterior radiographs of both femurs revealed mixed lytic-sclerotic lesions. PET scan showed multiple metastatic lesions on axial skeleton, pelvis, and both femurs. Histopathological examination of the bone biopsy revealed an infiltrate of HCL. Localized radiation therapy to both proximal femurs and subsequently 4 weeks later, a 7-day course of 0.1 mg/kg/day cladribine provided complete remission with relief of symptoms and resolution of bone lesions. We addressed the manifestations and management of HCL patients with skeletal involvement.
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25
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Efficacy and Safety of Cladribine: Subcutaneous versus Intravenous Administration in Hairy Cell Leukemia Patients. Mediterr J Hematol Infect Dis 2015; 7:e2015058. [PMID: 26543527 PMCID: PMC4621169 DOI: 10.4084/mjhid.2015.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 09/09/2015] [Indexed: 11/22/2022] Open
Abstract
Cladribine induces durable complete remission (CR) in approximately 85% of hairy cell leukemia (HCL) patients. In Egypt, cladribine is mainly used as IV continuous infusion at a dose of 0.1 mg/kg/day for 7 days and as SC bolus injection at a dose of 0.14 mg/kg/day for 5 days. We aimed to compare the outcome and toxicity between these two regimens. We retrospectively collected data from HCL patients treated at the National Cancer Institute and its affiliated center, Nasser Institute, Cairo, Egypt. Forty-nine patients were identified, 18 treated with the IV regimen (IV group) and 31 with the SC regimen (SC group). Forty-one patients were newly diagnosed. Patient characteristics were balanced across the two groups. The CR rates in the IV and the SC group were 94% and 97%, respectively. The main complications in the IV group and the SC were neutropenia G3–4 (67% vs. 87%), mucositis mainly G1–2 (67% vs 32%) and infections (mainly viral, 78% vs 34%). In the IV group, five patients died, three of progression and infection, one of unknown cause and one of late heart failure. In the SC group, one patient died of disease progression and one of second cancer. After 33.5 months, median follow-up, the 3-year event free survival was 60% and 96%, respectively (p=0.104). The 3-year overall survival was 81% and 100%, respectively (p=0.277). In conclusion, SC cladribine is an excellent alternative to the IV regimen for the treatment of HCL.
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26
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Wotherspoon A, Attygalle A, Mendes LST. Bone marrow and splenic histology in hairy cell leukaemia. Best Pract Res Clin Haematol 2015; 28:200-7. [PMID: 26614898 DOI: 10.1016/j.beha.2015.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
Hairy cell leukaemia is a rare chronic neoplastic B-cell lymphoproliferation that characteristically involves blood, bone marrow and spleen with liver, lymph node and skin less commonly involved. Histologically, the cells have a characteristic appearance with pale/clear cytoplasm and round or reniform nuclei. In the spleen, the infiltrate involves the red pulp and is frequently associated with areas of haemorrhage (blood lakes). The cells stain for B-cell related antigens as well as with antibodies against tartrate-resistant acid phosphatase, DBA44 (CD72), CD11c, CD25, CD103, CD123, cyclin D1 and annexin A1. Mutation of BRAF -V600E is present and antibody to the mutant protein can be used as a specific marker. Bone marrow biopsy is essential in the initial assessment of disease as the bone marrow may be inaspirable or unrepresentative of degree of marrow infiltration as a result of the tumour associated fibrosis preventing aspiration of the tumour cell component. Bone marrow biopsy is important in the assessment of therapy response but in this context staining for CD11c and Annexin A1 is not helpful as they are also markers of myeloid lineage and identification of low level infiltration may be obscured. In this context staining for CD20 may be used in conjunction with morphological assessment and staining of serial sections for cyclin D1 and DBA44 to identify subtle residual infiltration. Staining for CD79a and CD19 is not recommended as these antibodies will identify plasma cells and can lead to over-estimation of disease. Staining for CD20 should not be used in patients following with anti-CD20 based treatments. Down regulation of cyclin D1 and CD25 has been reported in patients following BRAF inhibitor therapy and assessment of these antigens should not be used in this context. Histologically, hairy cell leukaemia needs to be distinguished from other B-cell lymphoproliferations associated with splenomegaly including splenic marginal zone lymphoma, splenic diffuse red pulp small B-cell lymphoma and hairy cell leukaemia variant. This can be done by assessment of the spleen but as this is now rarely performed in this disorder distinction is almost always possible by a combination of morphological and immunophenotypic studies on bone marrow trephine biopsy, which can be supplemented by assessment of BRAF-V600E mutation assessment in borderline cases.
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Affiliation(s)
- Andrew Wotherspoon
- Department of Histopathology, Royal Marsden Hopsital, Fulham Road, London SW3 6JJ, UK.
| | - Ayoma Attygalle
- Department of Histopathology, Royal Marsden Hopsital, Fulham Road, London SW3 6JJ, UK.
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Else M, Dearden CE, Catovsky D. Long-term follow-up after purine analogue therapy in hairy cell leukaemia. Best Pract Res Clin Haematol 2015; 28:217-29. [PMID: 26614900 PMCID: PMC5509559 DOI: 10.1016/j.beha.2015.09.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/11/2015] [Accepted: 09/28/2015] [Indexed: 11/30/2022]
Abstract
Since 2006 when we last reviewed the literature concerning the use of purine analogues in hairy cell leukaemia (HCL), results from several new and updated series have been published. Here we examine these reports and consider their implications for patient management. The two purine analogues pentostatin and cladribine remain the first-line treatments of choice for all patients with HCL. Although they have not been compared in randomised trials, they appear to be equally effective. A complete response is important for the long-term outcome and we look at how best this can be achieved. Evidence is emerging which supports the use of either purine analogue plus an anti-CD20 monoclonal antibody after relapse, though questions remain concerning the scheduling of the monoclonal antibody. Patients refractory to the purine analogues may require alternative agents.
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Affiliation(s)
- Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.
| | - Claire E Dearden
- Department of Haemato-Oncology, Royal Marsden NHS Foundation Trust, London, UK.
| | - Daniel Catovsky
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.
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28
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Sarid N, Ahmad HN, Wotherspoon A, Dearden CE, Else M, Catovsky D. An unusual indication for splenectomy in hairy cell leukaemia: a report of three cases with persistent splenomegaly after chemoimmunotherapy. Br J Haematol 2015; 171:784-7. [PMID: 26403440 PMCID: PMC4832259 DOI: 10.1111/bjh.13767] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/03/2015] [Indexed: 11/29/2022]
Abstract
We describe three cases of relapsed hairy cell leukaemia (HCL) treated with pentostatin plus rituximab. All three achieved bone marrow complete remission but had persistent splenomegaly and hypersplenism. Because of the clinical uncertainty of its significance, they were all splenectomized. The spleen histology showed no evidence of HCL, but a five‐fold thickening of the splenic capsule and areas of fibrosis in the red pulp. This process may have contributed to the lack of elasticity and caused the persistent splenomegaly. We discuss the clinical implications for future patient management. The three patients remain in remission at 1 + , 5 + and 9 + years.
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Affiliation(s)
- Nadav Sarid
- Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | | | | | | | - Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Daniel Catovsky
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
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29
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Robak T, Wolska A, Robak P. Potential breakthroughs with investigational drugs for hairy cell leukemia. Expert Opin Investig Drugs 2015; 24:1419-31. [DOI: 10.1517/13543784.2015.1081895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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30
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Robak T, Matutes E, Catovsky D, Zinzani PL, Buske C. Hairy cell leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v100-7. [PMID: 26269205 DOI: 10.1093/annonc/mdv200] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- T Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - E Matutes
- Haematopathology Unit, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - D Catovsky
- Haemato-Oncology Research Unit, The Institute of Cancer Research, Sutton, Surrey, UK
| | - P L Zinzani
- Seràgnoli Institute of Hematology, University of Bologna, Bologna, Italy
| | - C Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital, Ulm, Germany
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31
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López-Rubio M, Garcia-Marco JA. Current and emerging treatment options for hairy cell leukemia. Onco Targets Ther 2015; 8:2147-56. [PMID: 26316784 PMCID: PMC4548752 DOI: 10.2147/ott.s70316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hairy cell leukemia (HCL) is a lymphoproliferative B-cell disorder characterized by pancytopenia, splenomegaly, and characteristic cytoplasmic hairy projections. Precise diagnosis is essential in order to differentiate classic forms from HCL variants, such as the HCL-variant and VH4-34 molecular variant, which are more resistant to available treatments. The current standard of care is treatment with purine analogs (PAs), such as cladribine or pentostatin, which provide a high rate of long-lasting clinical remissions. Nevertheless, ~30%–40% of the patients relapse, and moreover, some of these are difficult-to-treat refractory cases. The use of the monoclonal antibody rituximab in combination with PA appears to produce even higher responses, and it is often employed to minimize or eliminate residual disease. Currently, research in the field of HCL is focused on identifying novel therapeutic targets and potential agents that are safe and can universally cure the disease. The discovery of the BRAF mutation and progress in understanding the biology of the disease has enabled the scientific community to explore new therapeutic targets. Ongoing clinical trials are assessing various treatment strategies such as the combination of PA and anti-CD20 monoclonal antibodies, recombinant immunotoxins targeting CD22, BRAF inhibitors, and B-cell receptor signal inhibitors.
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Affiliation(s)
- Montserrat López-Rubio
- Department of Hematology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Jose Antonio Garcia-Marco
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
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32
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Abstract
Hairy cell leukemia was initially described as a distinct entity in 1958. It is rare B-cell malignancy characterized by an indolent course. Advances in the treatment and understanding of the biology of hairy cell leukemia have made the disease exquisitely amenable to treatment. This review summarizes the present understanding of hairy cell leukemia with a particular focus on the development of novel and targeted approaches to treatment.
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33
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Sreedharanunni S, Sachdeva MUS, Malhotra P, Ahluwalia J, Naseem S, Prakash G, Khadwal A, Sharma P, Kumar N, Varma N, Varma S, Das R. Role of blood and bone marrow examination in the diagnosis of mature lymphoid neoplasms in patients presenting with isolated splenomegaly. ACTA ACUST UNITED AC 2015; 20:530-7. [PMID: 25760312 DOI: 10.1179/1607845415y.0000000005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Mature lymphoid neoplasms presenting with 'prominent splenomegaly without significant lymphadenopathy' are uncommon and pose unique diagnostic challenges as compared to those associated with lymphadenopathy. Their descriptions in the literature are largely limited to a few case series. We analyzed the spectrum of these lymphomas diagnosed by peripheral blood (PB) and/or bone marrow (BM) examination. METHODS Over a period of 6 years, 75 patients were diagnosed with a lymphoma from PB/BM who had presented with predominant splenomegaly. Their clinical and laboratory records including PB and BM morphology; immunophenotyping using multi-parametric flow-cytometry and immunohistochemistry were reviewed. Wherever indicated, an extended panel of immunohistochemistry (IHC) was performed on BM biopsies for accurate sub-classification. RESULTS AND DISCUSSION The commonest lymphomas were hairy cell leukemia (HCL) (32%) and splenic marginal zone lymphoma (SMZL) (24%). Others included diffuse large B cell lymphoma (8%), chronic lymphocytic leukemia/small lymphocytic lymphoma (8%), mantle cell lymphoma (2.7%), and follicular lymphoma (1.3%), all of which usually presents with lymphadenopathy. SMZL was the commonest lymphoma among females and those with massive splenomegaly and lymphocytosis; while HCL was commonest in patients with pancytopenia. SMZL commonly presented with lymphocytosis; however, 22% of them also presented with pancytopenia. CONCLUSION The high diagnostic efficacy of PB and BM examination using flow-cytometry and immunohistochemistry in confirming and sub-classifying splenic lymphomas suggests that a thorough hematological evaluation should always precede a diagnostic splenectomy. Immunohistochemistry remains the best modality to identify sparse or intra-sinusoidal infiltration on BM biopsy and is particularly useful in patients with fibrotic marrows and pancytopenia.
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MESH Headings
- Adolescent
- Adult
- Aged
- Bone Marrow/pathology
- Diagnosis, Differential
- Female
- Flow Cytometry
- Humans
- Immunohistochemistry
- Immunophenotyping
- Leukemia, Hairy Cell/diagnosis
- Leukemia, Hairy Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukocytes, Mononuclear/pathology
- Lymphatic Diseases/diagnosis
- Lymphatic Diseases/pathology
- Lymphocytosis/diagnosis
- Lymphocytosis/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/pathology
- Male
- Middle Aged
- Pancytopenia/diagnosis
- Pancytopenia/pathology
- Retrospective Studies
- Splenic Neoplasms/diagnosis
- Splenic Neoplasms/pathology
- Splenomegaly/diagnosis
- Splenomegaly/pathology
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34
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Akinosoglou K, Melachrinou M, Makatsoris T, Sakellakis M, Papakonstantinou C, Gogos CA, Solomou EE. Rituximab as frontline monotherapy in untreated hairy cell leukemia patients. Ann Hematol 2015; 94:1069-70. [DOI: 10.1007/s00277-015-2328-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/31/2015] [Indexed: 10/24/2022]
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35
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Okada K, Kunitomi A, Sakai K, Muranushi H, Okamoto Y, Tsukamoto T, Sugiura H, Matsui H, Jo T, Ueda T, Onishi T, Ide M, Kimura S, Notohara K, Ueda Y. Hairy Cell Leukemia with Systemic Lymphadenopathy: Detection of BRAF Mutations in Both Lymph Node and Peripheral Blood Specimens. Intern Med 2015; 54:1397-402. [PMID: 26027995 DOI: 10.2169/internalmedicine.54.2944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 47-year-old woman with pancytopenia, excessive systemic lymphadenopathy and splenomegaly was referred to our hospital. The peripheral blood (PB) smear findings indicated neutropenia with lymphoid cells exhibiting hairy projections, while the histological findings of the cervical lymph node (LN) suggested hairy cell leukemia (HCL). In addition, the BRAF V600E mutation was detected, and the immunoglobulin gene rearrangement patterns were identical in both the cervical LN and PB specimens. Based on these findings, we diagnosed the patient with systemic lymphadenopathy due to HCL. This is the first report of a BRAF mutation detected in both the PB and LN at the onset of HCL.
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Affiliation(s)
- Kazuya Okada
- Department of Hematology and Oncology, Kurashiki Central Hospital, Japan
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36
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Hacioglu S, Bilen Y, Eser A, Sivgin S, Gurkan E, Yildirim R, Aydogdu I, Dogu MH, Yilmaz M, Kayikci O, Tombak A, Kuku I, Celebi H, Akay MO, Esen R, Korkmaz S, Keskin A. Multicenter retrospective analysis regarding the clinical manifestations and treatment results in patients with hairy cell leukemia: twenty-four year Turkish experience in cladribine therapy. Hematol Oncol 2014; 33:192-8. [PMID: 25393847 DOI: 10.1002/hon.2177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 11/09/2022]
Abstract
In this multicenter retrospective analysis, we aimed to present clinical, laboratory and treatment results of 94 patients with Hairy cell leukemia diagnosed in 13 centers between 1990 and 2014. Sixty-six of the patients were males and 28 were females, with a median age of 55. Splenomegaly was present in 93.5% of cases at diagnosis. The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis. Most of the patients with an indication for treatment were treated with cladribine as first-line treatment. Total and complete response of cladribine was 97.3% and 80.7%. The relapse rate after cladribine was 16.6%, and treatment related mortality was 2.5%. Most preferred therapy (95%) was again cladribine at second-line, and third line with CR rate of 68.4% and 66.6%, respectively. The 28-month median OS was 91.7% in all patients and 25-month median OS 96% for patients who were given cladribine as first-line therapy. In conclusion, the first multicenter retrospective Turkish study where patients with HCL were followed up for a long period has revealed demographic characteristics of patients with HCL, and confirmed that cladribine treatment might be safe and effective in a relatively large series of the Turkish study population.
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Affiliation(s)
- Sibel Hacioglu
- Pamukkale University, Department of Hematology, Denizli, Turkey
| | - Yusuf Bilen
- Ataturk University, Department of Hematology, Erzurum, Turkey
| | - Ali Eser
- Marmara University, Department of Hematology, Istanbul, Turkey
| | - Serdar Sivgin
- Erciyes University, Department of Hematology, Kayseri, Turkey
| | - Emel Gurkan
- Cukurova University, Department of Hematology, Adana, Turkey
| | - Rahsan Yildirim
- Ataturk University, Department of Hematology, Erzurum, Turkey
| | - Ismet Aydogdu
- Celal Bayar University, Department of Hematology, Manisa, Turkey
| | | | - Mehmet Yilmaz
- Gaziantep University, Department of Hematology, Gaziantep, Turkey
| | - Omur Kayikci
- Ankara Oncology Education and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Anil Tombak
- Mersin University, Department of Hematology, Mersin, Turkey
| | - Irfan Kuku
- Inonu University, Department of Hematology, Malatya, Turkey
| | - Harika Celebi
- Diskapi Yildirim Beyazit Education and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Meltem Olga Akay
- Osmangazi University, Department of Hematology, Eskisehir, Turkey
| | - Ramazan Esen
- Yuzuncu Yil University, Department of Hematology, Van, Turkey
| | - Serdal Korkmaz
- Cumhuriyet University, Department of Hematology, Sivas, Turkey
| | - Ali Keskin
- Pamukkale University, Department of Hematology, Denizli, Turkey
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37
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A comparison of high resolution melting, allele-specific priming and Sanger sequencing for the detection of BRAFV600E mutation in hairy cell leukaemia from different haematological specimens. Pathology 2014; 46:533-7. [DOI: 10.1097/pat.0000000000000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Rituximab therapy for hairy cell leukemia: a retrospective study of 41 cases. Ann Hematol 2014; 94:89-95. [DOI: 10.1007/s00277-014-2175-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/24/2014] [Indexed: 10/24/2022]
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39
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Primary hairy cell leukemia/lymphoma of the breast: a case report and review of the literature. Case Rep Pathol 2014; 2014:497027. [PMID: 25133005 PMCID: PMC4123510 DOI: 10.1155/2014/497027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/12/2014] [Indexed: 01/28/2023] Open
Abstract
Hairy cell leukemia/lymphoma (HCL) is a rare B-cell neoplasm primarily involving spleen, bone marrow, and blood. However, other sites of primary involvement do occur and can present a diagnostic and therapeutic challenge. We present an unusual case of HCL involving predominantly the breast that was diagnosed as an incidental finding during an elective reduction mammoplasty in an otherwise healthy asymptomatic woman. Bone marrow performed for staging revealed limited involvement by HCL. Notably, there was no splenomegaly and/or involvement of other extramedullary sites. The peripheral blood revealed minimal involvement detected by flow cytometry. Extensive immunohistochemical studies supported by positive BRAF V600E mutational status confirmed the diagnosis of HCL. The patient remains asymptomatic without treatment one year following the diagnosis. This is the first case of a well-documented HCL presenting primarily in the breast in an asymptomatic patient. We review the literature on extramedullary, extrasplenic involvement by HCL and discuss the diagnostic challenges as well as the utility of immunohistochemistry and molecular studies in the diagnosis of atypical presentations of HCL.
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40
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Grever MR, Blachly JS, Andritsos LA. Hairy cell leukemia: Update on molecular profiling and therapeutic advances. Blood Rev 2014; 28:197-203. [PMID: 25110197 DOI: 10.1016/j.blre.2014.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 02/07/2023]
Abstract
Hairy cell leukemia was initially described as a clinicopathologic entity more than 50 years ago. We have subsequently discovered that HCL is really at least two diseases: classical HCL and the hairy cell leukemia variant. The former is among a small group of cancers exceptional for being (nearly) unified by a single genetic lesion, the BRAF V600E mutation. Over the past three decades, tremendous progress in both diagnostic and prognostic clarification has been accompanied by therapeutic advances in classical HCL. Consequently, this once uniformly fatal disease has been converted in most cases into a chronic illness enabling patients to live long and productive lives. In response to standard therapy, patients have high complete remission rates. Unfortunately, the long-term survival curves have not plateaued, revealing that this disease is controlled but not cured. Though rare and representing only about 10% of an already rare disease, those patients with the variant fare exceptionally poorly with standard therapy: complete response rates to purine nucleoside analogs are reported to be less than 50%, whereas the complete response rates in classical HCL are up to 90%. Novel small molecules targeting BRAF and the B-cell receptor signaling complex, and biologic agents like antibodies and immunotoxin conjugates are being explored for those patients who have relapsed. Substantial opportunities for continued research remain. This complex and multi-faceted disease incorporates challenges from altered immunity associated with the underlying disease and its treatments. Considering the rarity of this malignancy, optimization of patient management requires multi-institutional collaboration. The Hairy Cell Leukemia Foundation (www.hairycellleukemia.org) was formed to coordinate these efforts.
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Affiliation(s)
- Michael R Grever
- 395 W. 12th Ave, Room 392, Columbus, OH 43210, USA; Department of Internal Medicine, Division of Hematology at The Ohio State University, Columbus, OH, USA.
| | - James S Blachly
- 320 W. 10th Ave, 406C Starling Loving Hall, Columbus, OH 43210, USA; Department of Internal Medicine, Division of Hematology at The Ohio State University, Columbus, OH, USA.
| | - Leslie A Andritsos
- 320 W. 10th Ave, A352 Starling Loving Hall, Columbus, OH 43210, USA; Department of Internal Medicine, Division of Hematology at The Ohio State University, Columbus, OH, USA.
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41
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Cornet E, Delmer A, Feugier P, Garnache-Ottou F, Ghez D, Leblond V, Levy V, Maloisel F, Re D, Zini JM, Troussard X. Recommendations of the SFH (French Society of Haematology) for the diagnosis, treatment and follow-up of hairy cell leukaemia. Ann Hematol 2014; 93:1977-83. [PMID: 24994538 PMCID: PMC4221655 DOI: 10.1007/s00277-014-2140-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/16/2014] [Indexed: 12/31/2022]
Abstract
Hairy cell leukaemia (HCL) is a rare haematological malignancy, with approximately 175 new incident cases in France. Diagnosis is based on a careful examination of the blood smear and immunophenotyping of the tumour cells, with a panel of four markers being used specifically to screen for hairy cells (CD11c, CD25, CD103 and CD123). In 2011, the V600E mutation of the BRAF gene in exon 15 was identified in HCL; being present in HCL, it is absent in the variant form of HCL (HCL-v) and in splenic red pulp lymphoma (SRPL), two entities related to HCL. The management of patients with HCL has changed in recent years. A poorer response to purine nucleoside analogues (PNAs) is observed in patients with more marked leukocytosis, bulky splenomegaly, an unmutated immunoglobulin variable heavy chain (IgVH) gene profile, use of VH4–34 or with TP53 mutations. We present the recommendations of a group of 11 experts belonging to a number of French hospitals. This group met in November 2013 to examine the criteria for managing patients with HCL. The ideas and proposals of the group are based on a critical analysis of the recommendations already published in the literature and on an analysis of the practices of clinical haematology departments with experience in managing these patients. The first-line treatment uses purine analogues: cladribine or pentostatin. The role of BRAF inhibitors, whether or not combined with MEK inhibitors, is discussed. The panel of French experts proposed recommendations to manage patients with HCL, which can be used in a daily practice.
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MESH Headings
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antigens, CD/analysis
- Antigens, Neoplasm/analysis
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- B-Lymphocytes/pathology
- Biomarkers, Tumor
- Diagnosis, Differential
- Exons/genetics
- Female
- Gene Rearrangement, B-Lymphocyte, Heavy Chain
- Humans
- Immunophenotyping
- Interferon-alpha/administration & dosage
- Interferon-alpha/therapeutic use
- Leukemia, Hairy Cell/blood
- Leukemia, Hairy Cell/diagnosis
- Leukemia, Hairy Cell/genetics
- Leukemia, Hairy Cell/pathology
- Leukemia, Hairy Cell/therapy
- Lymphoma, Non-Hodgkin/diagnosis
- Male
- Mutation
- Neoplasm Proteins/genetics
- Pregnancy
- Pregnancy Complications, Neoplastic/drug therapy
- Prognosis
- Protein Kinase Inhibitors/administration & dosage
- Protein Kinase Inhibitors/therapeutic use
- Proto-Oncogene Proteins B-raf/genetics
- Rituximab
- Salvage Therapy
- Splenic Neoplasms/diagnosis
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Affiliation(s)
- Edouard Cornet
- Haematology Laboratory, Caen University Hospital, 14033 Caen Cedex, France
| | - Alain Delmer
- Department of Clinical Haematology, Reims University Hospital, 51092 Reims Cedex, France
| | - Pierre Feugier
- Haematology Division, Nancy University Hospital, 54035 Nancy Cedex, France
| | | | - David Ghez
- Gustave Roussy, 94805 Villejuif Cedex, France
| | - Véronique Leblond
- Department of Clinical Haematology, Pitié Salpêtrière Hospital, 75651 Paris Cedex, France
| | - Vincent Levy
- Haematology Oncology Thorax Division, Hôpital Avicenne, 93003 Bobigny Cedex, France
| | | | - Daniel Re
- Antibes Hospital, 06100 Nice Cedex, France
- Antoine Lacassagne Centre (Nice), 06100 Nice Cedex, France
| | | | - Xavier Troussard
- Haematology Laboratory, Caen University Hospital, 14033 Caen Cedex, France
- Haematology Laboratory, CHU de Caen, 14000 Caen, France
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42
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Basheer F, Bloxham DM, Scott MA, Follows GA. Hairy cell leukemia - immunotargets and therapies. Immunotargets Ther 2014; 3:107-20. [PMID: 27471703 PMCID: PMC4918239 DOI: 10.2147/itt.s31425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hairy cell leukemia (HCL) is an indolent low-grade B-cell lymphoproliferative disorder that is reasonably sensitive to standard first-line purine analog therapy. However, in many cases, repeat relapses occur, requiring multiple courses of purine analog therapy, promoting eventual drug resistance. This, coupled with the concerning side effects of repeated purine analog exposure, has prompted the search for alternative targets and therapies that may provide deeper remissions. Novel strategies employing immune-mediated targeting via monoclonal antibody therapies and recombinant immunotoxins appear promising in HCL and are currently under investigation. More recently, the concept of targeted kinase inhibition using small-molecule inhibitors in HCL has emerged as another potentially viable option. As a deeper understanding of the aberrant molecular pathways contributing to the pathogenesis of HCL develops, the landscape of management for HCL, particularly in the relapse setting, may change significantly in the future as a result of these promising immunotargets and therapies.
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Affiliation(s)
- Faisal Basheer
- Department of Haematology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - David M Bloxham
- Department of Haematology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - Mike A Scott
- Department of Haematology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
| | - George A Follows
- Department of Haematology, Addenbrookes Hospital, University of Cambridge, Cambridge, UK
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43
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Cornet E, Tomowiak C, Tanguy-Schmidt A, Lepretre S, Dupuis J, Feugier P, Devidas A, Mariette C, Leblond V, Thiéblemont C, Validire-Charpy P, Sutton L, Gyan E, Eisenmann JC, Cony-Makhoul P, Ysebaert L, Troussard X. Long-term follow-up and second malignancies in 487 patients with hairy cell leukaemia. Br J Haematol 2014; 166:390-400. [PMID: 24749839 DOI: 10.1111/bjh.12908] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/17/2014] [Indexed: 12/23/2022]
Abstract
A large, multicentre, retrospective survey of patients with hairy cell leukaemia (HCL) was conducted in France to determine the frequency of second malignancies and to analyse the long-term effects of the established purine nucleoside analogues (PNAs), cladribine and pentostatin. The survey retrospectively reviewed the medical history of patients and their immediate family, clinical and biological presentation at the time of HCL diagnosis, treatment choice, response to treatment, time to relapse and cause of death. Data were collected for 487 patients with HCL. Of the patients included in the survey, 18% (88/487) had a familial history of cancers, 8% (41/487) presented with malignancies before HCL diagnosis and 10% (48/487) developed second malignancies after HCL was diagnosed. An excess incidence of second malignancies was observed, with a standardized incidence ratio (SIR) of 1·86 (95% confidence interval (CI): 1·34-2·51), with no significant difference between PNAs. For second haematological malignancies alone, the SIR was markedly increased at 5·32 (95% CI: 2·90-8·92). This study highlights the high frequency of cancers in HCL patients and their family members. The frequency of second malignancies is notably increased, particularly for haematological malignancies. The respective role of pentostatin and cladribine in the development of second malignancies is debatable.
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Affiliation(s)
- Edouard Cornet
- Caen University Hospital, Laboratory of Haematology, Caen, France; University of Caen, Medical School, EA4652, Caen, France; Caen University Hospital, Regional Registry of Malignant Haemopathies of Lower-Normandy, Caen, France
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44
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Garnache Ottou F, Chandesris MO, Lhermitte L, Callens C, Beldjord K, Garrido M, Bedin AS, Brouzes C, Villemant S, Rubio MT, Belanger C, Suarez F, Deau B, Lefrère F, Hermine O, Asnafi V, Varet B, Macintyre E. Peripheral blood 8 colour flow cytometry monitoring of hairy cell leukaemia allows detection of high-risk patients. Br J Haematol 2014; 166:50-9. [PMID: 24661013 DOI: 10.1111/bjh.12839] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/23/2014] [Indexed: 11/26/2022]
Abstract
Although purine analogues have significantly improved the outcome of hairy cell leukaemia (HCL) patients, 30-40% relapse, illustrating the need for minimal residual disease (MRD) markers that can aid personalized therapeutic management. Diagnostic samples from 34 HCL patients were used to design an 8-colour flow cytometry (8-FC) tube for blood MRD (B/RD) analysis (188 samples) which was compared to quantitative IGH polymerase chain reaction (Q-PCR) on 83 samples and to qualitative consensus IGH PCR clonality analysis on 165 samples. Despite heterogeneous HCL phenotypes at diagnosis, discrimination from normal B lymphocytes was possible in all cases using a single 8-FC tube, with a robust sensitivity of detection of 10(-4) , comparable to Q-PCR at this level, but preferable in terms of informativeness, simplicity and cost. B/RD assessment of 15 patients achieving haematological complete remission after purine analogues was predictive of a clinically significant relapse risk: with a median follow-up of 95 months; only one of the nine patients with reproducible 8-FC B/RD levels below 10(-4) (B/RD(neg) ) relapsed, compared to 5/6 in the B/RD(pos) group (P = 0.003). These data demonstrate the clinical interest of a robust 8-FC HCL B/RD strategy that could become a surrogate biomarker for therapeutic stratification and new drug assessment, which should be evaluated prospectively.
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Affiliation(s)
- Francine Garnache Ottou
- Laboratoire d'Hématologie and CNRS UMR8147, Hôpital Necker - Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75743, Paris Cedex 15, France; INSERM UMR1098, Université de Franche-Comté, EFS-B/FC Plateforme de BioMonitoring, 1 Bd Fleming, 25000, Besançon, France
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45
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Lemež P, Kačírková P. Variations of hairy cell nuclei shapes with regard to ring-shaped nuclei simulating dysplastic neutrophilic granulocytes and review of the literature. Int J Lab Hematol 2014; 36:580-6. [DOI: 10.1111/ijlh.12195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 01/10/2014] [Indexed: 01/01/2023]
Affiliation(s)
- P. Lemež
- Department of Hematology and Blood Transfusion; Hospital Jihlava; Jihlava Czech Republic
| | - P. Kačírková
- Department of Hematology; Institute of Laboratory Diagnostics; Faculty Hospital Královské Vinohrady; Prague Czech Republic
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46
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Hairy cell leukemia: short review, today's recommendations and outlook. Blood Cancer J 2014; 4:e184. [PMID: 24531447 PMCID: PMC3944661 DOI: 10.1038/bcj.2014.3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/23/2013] [Indexed: 02/08/2023] Open
Abstract
Hairy cell leukemia (HCL) is part of the low-grade non-Hodgkin lymphoma family and represents approximately 2% of all leukemias. Treatment with splenectomy and interferon-α historically belonged to the first steps of therapeutic options, achieving partial responses/remissions (PR) in most cases with a median survival between 4 and 6 years in the 1980s. The introduction of the purine analogs (PA) pentostatin and cladribine made HCL a well-treatable disease: overall complete response rates (CRR) range from 76 to 98%, with a median disease-free survival (DFS) of 16 years a normal lifespan can be reached and HCL-related deaths are rare. However, insufficient response to PA with poorer prognosis and relapse rates of 30–40% after 5–10 years of follow-up may require alternative strategies. Minimal residual disease can be detected by additional examinations of bone marrow specimens after treatment with PA. The use of immunotherapeutic monoclonal antibodies (mAB) like rituximab as a single agent or in combination with a PA or more recently clinical trials with recombinant immunotoxins (RIT) show promising results to restrict these problems. Recently, the identification of the possible disease-defining BRAF V600E mutation may allow the development of new therapeutic targets.
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47
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BRAF--a new player in hematological neoplasms. Blood Cells Mol Dis 2014; 53:77-83. [PMID: 24495477 DOI: 10.1016/j.bcmd.2014.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/31/2013] [Indexed: 01/07/2023]
Abstract
BRAF oncogenic kinase has become a target for specific therapy in oncology. Genetic characterization of a predominant V600E mutation in melanoma, thyroid cancer, and other tumors became a focus for developing specific inhibitors, such as vemurafenib or dabrafenib. Our knowledge regarding the role of mutated BRAF in hematological malignancies has grown quickly as a result of new genetic techniques such as next-generation sequencing. This review summarizes current knowledge regarding the role of BRAF in lymphoid and myeloid neoplasms, with a focus on hairy-cell leukemia, Langerhans cell histiocytosis, and Erdheim-Chester disease.
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48
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Lad DP, Malhotra P, Khadwal A, Prakash G, Suri V, Kumari S, Jain S, Das R, Varma N, Varma S. Outcomes of splenectomy versus cladribine for hairy cell leukemia in resource limited settings. Leuk Lymphoma 2013; 55:1428-30. [PMID: 24001131 DOI: 10.3109/10428194.2013.839786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Deepesh P Lad
- Clinical Hematology, Department of Internal Medicine
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Abstract
Monoclonal B cell Lymphocytosis (MBL) or similar terms have been used for decades to describe the presence of light-chain restricted B lymphocytes with uncertain clinical significance, usually having a phenotype consistent with chronic lymphocytic leukemia (CLL). As diagnostic technology improved, ever smaller monoclonal B cell populations were identifiable in the population, and approximately half of people over 90 years old have a minimal (<1 cell/μL) circulating CLL-like B cell population. These minimal CLL-like B cell populations share some molecular characteristics with CLL, but have no clinical significance. In contrast, CLL-like MBL cases detected through hospital investigations are biologically indistinguishable from early stage CLL, but the neoplastic B cell levels are usually stable over time and the risk of progressive disease requiring treatment is much lower than for early stage CLL. However, there is usually partial or complete depletion of normal B cells, with an increased relative risk of severe infection, comparable to early stage CLL, which may impair overall survival.
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50
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Dietrich S, Hüllein J, Hundemer M, Lehners N, Jethwa A, Capper D, Acker T, Garvalov BK, Andrulis M, Blume C, Schulte C, Mandel T, Meissner J, Fröhling S, von Kalle C, Glimm H, Ho AD, Zenz T. Continued Response Off Treatment After BRAF Inhibition in Refractory Hairy Cell Leukemia. J Clin Oncol 2013; 31:e300-3. [DOI: 10.1200/jco.2012.45.9495] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jennifer Hüllein
- National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | | | | | - Alexander Jethwa
- National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | - David Capper
- Institute of Pathology, University of Heidelberg; and Clinical Cooperation Unit Neuropathology, German Cancer Research Center, Heidelberg, Germany
| | - Till Acker
- Institute of Neuropathology, University of Giessen, Giessen, Germany
| | - Boyan K. Garvalov
- Institute of Neuropathology, University of Giessen, Giessen, Germany
| | | | - Carolin Blume
- National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | | | - Thomas Mandel
- Klinikum am Plattenwald, Bad Friedrichshall, Germany
| | | | - Stefan Fröhling
- National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | - Christof von Kalle
- National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | - Hanno Glimm
- National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | | | - Thorsten Zenz
- University of Heidelberg; National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
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