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Naresh KN. Understanding splenic B-cell lymphoma/leukaemia with prominent nucleoli: Diagnosis, underpinnings for disease classification and future directions. Br J Haematol 2024. [PMID: 39253895 DOI: 10.1111/bjh.19754] [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: 07/23/2024] [Accepted: 08/26/2024] [Indexed: 09/11/2024]
Abstract
The 5th edition of the WHO classification of haematolymphoid tumours (WHO-HAEM5) introduced a new category, splenic B-cell lymphoma/leukaemia with prominent nucleoli (SBLPN). The diagnostic entity B-cell prolymphocytic leukaemia (B-PLL) has been discontinued and the category of hairy cell leukaemia variant (HCLv) has been conceptually reframed. B-PLL and HCLv diagnoses were uncommon. Overlap existed between B-PLL and other indolent lymphomas like chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL). HCLv lacked consistent cytomorphological, immunophenotypic and genetic features. To address these issues, the WHO-HAEM5 classification has introduced SBLPN to serve as a temporary holding ground for entities that do not neatly fit into the existing classification. Cases previously classified as CD5-negative B-PLL and HCLv fall under the SBLPN category. Some splenic marginal zone lymphoma and splenic diffuse red pulp small B-cell lymphoma cases with higher number of medium or large nucleolated B cells would also be classified as SBLPN under the WHO-HAEM5. This review explores the rationale for discontinuing B-PLL and HCLv diagnoses. It then examines the concept of SBLPN, offers practical guidance for diagnosis and discusses future directions in classifying splenic B-cell lymphomas.
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Affiliation(s)
- Kikkeri N Naresh
- Section of Pathology, Translational Science and Therapeutics Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Tzioni MM, Clipson A, Chen Z, Cucco F, Wotherspoon A, Dojcinov S, Du MQ. Progressive TP53 inactivation in an aggressive splenic diffuse red pulp small B-cell lymphoma. Leuk Lymphoma 2024; 65:1003-1007. [PMID: 38516899 DOI: 10.1080/10428194.2024.2332508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Maria-Myrsini Tzioni
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Alexandra Clipson
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Zi Chen
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Francesco Cucco
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | | | - Stefan Dojcinov
- Department of Pathology, Morriston Hospital, Swansea Bay University Health Board/Swansea University, Swansea, UK
| | - Ming-Qing Du
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
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Paillassa J, Maitre E, Belarbi Boudjerra N, Madani A, Benlakhal R, Matthes T, Van Den Neste E, Cailly L, Inchiappa L, Bekadja MA, Tomowiak C, Troussard X. Recommendations for the Management of Patients with Hairy-Cell Leukemia and Hairy-Cell Leukemia-like Disorders: A Work by French-Speaking Experts and French Innovative Leukemia Organization (FILO) Group. Cancers (Basel) 2024; 16:2185. [PMID: 38927891 PMCID: PMC11201647 DOI: 10.3390/cancers16122185] [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: 04/15/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Hairy-cell leukemia (HCL) is a rare B-cell chronic lymphoproliferative disorder (B-CLPD), whose favorable prognosis has changed with the use of purine nucleoside analogs (PNAs), such as cladribine (CDA) or pentostatin (P). However, some patients eventually relapse and over time HCL becomes resistant to chemotherapy. Many discoveries have been made in the pathophysiology of HCL during the last decade, especially in genomics, with the identification of the BRAFV600E mutation and cellular biology, including the importance of signaling pathways as well as tumor microenvironment. All of these new developments led to targeted treatments, especially BRAF inhibitors (BRAFis), MEK inhibitors (MEKis), Bruton's tyrosine kinase (BTK) inhibitors (BTKis) and recombinant anti-CD22 immunoconjugates. RESULTS The following major changes or additions were introduced in these updated guidelines: the clinical relevance of the changes in the classification of splenic B-cell lymphomas and leukemias; the increasingly important diagnostic role of BRAFV600E mutation; and the prognostic role of the immunoglobulin (IG) variable (V) heavy chain (H) (IGHV) mutational status and repertory. We also wish to insist on the specific involvement of bones, skin, brain and/or cerebrospinal fluid (CSF) of the disease at diagnosis or during the follow-up, the novel targeted drugs (BRAFi and MEKi) used for HCL treatment, and the increasing role of minimal residual disease (MRD) assessment. CONCLUSION Here we present recommendations for the diagnosis of HCL, treatment in first line and in relapsed/refractory patients as well as for HCL-like disorders including HCL variant (HCL-V)/splenic B-cell lymphomas/leukemias with prominent nucleoli (SBLPN) and splenic diffuse red pulp lymphoma (SDRPL).
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Affiliation(s)
- Jérôme Paillassa
- Service des Maladies du Sang, CHU d’Angers, 49000 Angers, France;
| | - Elsa Maitre
- Hématologie Biologique, Structure Fédérative D’oncogénétique Cyto-Moléculaire du CHU de Caen (SF-MOCAE), CHU de Caen, 14000 Caen, France;
- Unité MICAH, INSERM1245, Université Caen-Normandie, 14000 Caen, France
| | | | - Abdallah Madani
- Service d’Hématologie, CHU de Casablanca, Casablanca 20000, Morocco;
| | | | - Thomas Matthes
- Service d’Hématologie, Département d’Oncologie et Service de Pathologie Clinique, Département de Diagnostic, Hôpital Universitaire de Genève, 1205 Genève, Switzerland;
| | - Eric Van Den Neste
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1000 Brussels, Belgium;
| | - Laura Cailly
- Service d’Onco-Hématologie et de Thérapie Cellulaire, CHU de Poitiers, 86000 Poitiers, France; (L.C.)
| | - Luca Inchiappa
- Service d’Hématologie, Institut Paoli-Calmette, 13397 Marseille, France
| | | | - Cécile Tomowiak
- Service d’Onco-Hématologie et de Thérapie Cellulaire, CHU de Poitiers, 86000 Poitiers, France; (L.C.)
| | - Xavier Troussard
- Hématologie Biologique, Structure Fédérative D’oncogénétique Cyto-Moléculaire du CHU de Caen (SF-MOCAE), CHU de Caen, 14000 Caen, France;
- Hematologie CHU Caen Normandie, 14000 Caen, France
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Troussard X, Maître E, Paillassa J. Hairy cell leukemia 2024: Update on diagnosis, risk-stratification, and treatment-Annual updates in hematological malignancies. Am J Hematol 2024; 99:679-696. [PMID: 38440808 DOI: 10.1002/ajh.27240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 03/06/2024]
Abstract
DISEASE OVERVIEW Hairy cell leukemia (HCL) and HCL-like disorders, including HCL variant (HCL-V) and splenic diffuse red pulp lymphoma (SDRPL), are a very heterogenous group of mature lymphoid B-cell disorders characterized by the identification of hairy cells, a specific genetic profile, a different clinical course and the need for appropriate treatment. DIAGNOSIS Diagnosis of HCL is based on morphological evidence of hairy cells, an HCL immunologic score of 3 or 4 based on the CD11c, CD103, CD123, and CD25 expression, the trephine biopsy which makes it possible to specify the degree of tumoral bone marrow infiltration and the presence of BRAFV600E somatic mutation. RISK STRATIFICATION Progression of patients with HCL is based on a large splenomegaly, leukocytosis, a high number of hairy cells in the peripheral blood, and the immunoglobulin heavy chain variable region gene mutational status. VH4-34 positive HCL cases are associated with a poor prognosis, as well as HCL with TP53 mutations and HCL-V. TREATMENT Patients should be treated only if HCL is symptomatic. Chemotherapy with risk-adapted therapy purine analogs (PNAs) are indicated in first-line HCL patients. The use of chemo-immunotherapy combining cladribine (CDA) and rituximab (R) represents an increasingly used therapeutic approach. Management of relapsed/refractory disease is based on the use of BRAF inhibitors (BRAFi) plus R, MEK inhibitors (MEKi), recombinant immunoconjugates targeting CD22, Bruton tyrosine kinase inhibitors (BTKi), and Bcl-2 inhibitors (Bcl-2i). However, the optimal sequence of the different treatments remains to be determined.
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Affiliation(s)
| | - Elsa Maître
- Laboratoire Hématologie, CHU Côte de Nacre, Caen Cedex, France
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Troussard X, Maitre E. Untangling hairy cell leukaemia (HCL) variant and other HCL-like disorders: Diagnosis and treatment. J Cell Mol Med 2024; 28:e18060. [PMID: 38095234 PMCID: PMC10844692 DOI: 10.1111/jcmm.18060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 02/08/2024] Open
Abstract
The variant form of hairy cell leukaemia (HCL-V) is a rare disease very different from hairy cell leukaemia (HCL), which is a very well-defined entity. The 5th WHO edition (Leukemia, 36, 2022 and 1720) classification (WHO-HAEM5) introduced splenic lymphomas/leukaemias including four different entities: (1) HCL, (2) splenic marginal zone lymphoma (SMZL) with circulating villous cells in the peripheral blood, (3) splenic lymphoma with prominent nucleolus (SLPN), which replaced HCL-V and CD5 negative B-prolymphocytic leukaemia (B-PLL), and (4) splenic diffuse red pulp lymphoma (SDRPL). All these entities have to be distinguished because of a different clinical course and the need for a different treatment. The diagnosis can be challenging because of complex cases and overlap and/or grey zones between all the entities and needs integrating clinical, histologic, immunophenotypic, cytogenetic and molecular data. We review the diagnostic criteria including clinical, immunophenotypic and molecular characteristics of patients with HCL-V and other HCL-like disorders including HCL, SDRPL, SMZL, B-PLL and the Japanese form of HCL. We also discuss the different criteria allowing us to separate these different entities and we will update the recent therapeutic options that have emerged, in particular the advances with chemoimmunotherapy and/or targeted therapies.
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Walewska R, Eyre TA, Barrington S, Brady J, Fields P, Iyengar S, Joshi A, Menne T, Parry-Jones N, Walter H, Wotherspoon A, Linton K. Guideline for the diagnosis and management of marginal zone lymphomas: A British Society of Haematology Guideline. Br J Haematol 2024; 204:86-107. [PMID: 37957111 DOI: 10.1111/bjh.19064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Renata Walewska
- Cancer Care, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Toby A Eyre
- Department of Haematology, Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sally Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's Health Partners, Kings College London, London, UK
| | - Jessica Brady
- Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Fields
- Guy's and St Thomas' Hospital, Kings Health Partners, London, UK
| | - Sunil Iyengar
- Department of Haematology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - Anurag Joshi
- All Wales Lymphoma Panel, Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - Tobias Menne
- Department of Haematology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nilima Parry-Jones
- Department of Haematology, Aneurin Bevan University Health Board, Newport, Wales, UK
| | - Harriet Walter
- The Ernest and Helen Scott Haematological Research Institute, Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Andrew Wotherspoon
- Department of Histopathology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Kim Linton
- Division of Cancer Sciences, The Christie NHS Foundation Trust and The University of Manchester, Manchester, UK
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Zamò A, van den Brand M, Climent F, de Leval L, Dirnhofer S, Leoncini L, Ng SB, Ondrejka SL, Quintanilla-Martinez L, Soma L, Wotherspoon A. The many faces of nodal and splenic marginal zone lymphomas. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:317-331. [PMID: 37656249 PMCID: PMC10542713 DOI: 10.1007/s00428-023-03633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
Session 3 of the lymphoma workshop of the XXI joint meeting of the European Association for Haematopathology and the Society for Hematopathology took place in Florence, Italy, on September 22, 2022. The topics of this session were splenic and nodal marginal zone lymphomas, transformation in marginal zone lymphomas, and pediatric nodal marginal zone lymphomas and their differential diagnosis as well as related entities. Forty-two cases in these categories were submitted to the workshop, including splenic lymphomas (marginal zone and diffuse red pulp lymphomas), transformed marginal zone lymphomas (splenic and nodal), nodal marginal zone lymphomas with increased TFH-cells, and pediatric nodal marginal zone lymphomas. The case review highlighted some of the principal problems in the diagnosis of marginal zone lymphomas, including the difficulties in the distinction between splenic marginal zone lymphoma, splenic diffuse red pulp lymphoma, and hairy cell leukemia variant/splenic B-cell lymphoma with prominent nucleoli which requires integration of clinical features, immunophenotype, and morphology in blood, bone marrow, and spleen; cases of marginal zone lymphoma with markedly increased TFH-cells, simulating a T-cell lymphoma, where molecular studies (clonality and mutation detection) can help to establish the final diagnosis; the criteria for transformation of marginal zone lymphomas, which are still unclear and might require the integration of morphological and molecular data; the concept of an overlapping spectrum between pediatric nodal marginal zone lymphoma and pediatric-type follicular lymphoma; and the distinction between pediatric nodal marginal zone lymphoma and "atypical" marginal zone hyperplasia, where molecular studies are mandatory to correctly classify cases.
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Affiliation(s)
- Alberto Zamò
- Institute of Pathology, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.
| | - Michiel van den Brand
- Pathology-DNA, Location Rijnstate Hospital, Wagnerlaan 55, 6815AD, Arnhem, The Netherlands.
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Fina Climent
- Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laurence de Leval
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Lorinda Soma
- Department of Pathology, City of Hope Medical Center, Duarte, CA, USA
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Christensen LM, Severinsen MT, Katoch P, Ovlisen AK, Hoyer T, Jensen P, Dybkaer K, Kristensen DT. An Aggressive Course of Transformed Splenic Diffuse Red Pulp Small B-Cell Lymphoma With Novel Somatic Loss-of-Function Mutation in RB1. J Hematol 2023; 12:118-122. [PMID: 37435411 PMCID: PMC10332862 DOI: 10.14740/jh1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/09/2023] [Indexed: 07/13/2023] Open
Abstract
Splenic diffuse red pulp small B-cell lymphoma (SDRPL) is an extremely rare B-cell lymphoma. The disease is typically indolent and treatment with splenectomy usually results in durable remissions. Here, we present a case of an extremely aggressive course of SDRPL with transformation to diffuse large B-cell lymphoma and multiple relapses immediately following cessation of immunochemotherapy. We provide results from whole-exome sequencing from debut of SDRPL and from following transformed stages and identified a novel somatic mutation in RB1 as the possible driver of this aggressive disease, which has not been reported earlier in SDRPL.
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Affiliation(s)
- Lisa-Maj Christensen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Pragya Katoch
- Department of Pathology, Aalborg University Hospital, Denmark
| | - Andreas Kiesbye Ovlisen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thor Hoyer
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Paw Jensen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Karen Dybkaer
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Daniel Tuyet Kristensen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Maitre E, Paillassa J, Troussard X. Novel targeted treatments in hairy cell leukemia and other hairy cell-like disorders. Front Oncol 2022; 12:1068981. [PMID: 36620555 PMCID: PMC9815161 DOI: 10.3389/fonc.2022.1068981] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
In the category of mature B-cell neoplasms, splenic B-cell lymphoma and leukemia were clearly identified and include four distinct entities: hairy cell leukemia (HCL), splenic marginal zone lymphoma (SMZL), splenic diffuse red pulp lymphoma (SDRPL) and the new entity named splenic B-cell lymphoma/leukemia with prominent nucleoli (SBLPN). The BRAFV600E mutation is detected in nearly all HCL cases and offers a possibility of targeted therapy. BRAF inhibitors (BRAFi) represent effective and promising therapeutic approaches in patients with relapsed/refractory HCL. Vemurafenib and dabrafenib were assessed in clinical trials. The BRAFV600E mutation is missing in SDRPL and SBLPN: mitogen-activated protein kinase 1 (MAP2K1) mutations were found in 40% of SBLPN and VH4-34+ HCL patients, making possible to use MEK inhibitors (MEKi) such as trametinib, cobimetinib or binimetinib in monotherapy or associated with BRAFi. Other mutations may be associated and other signaling pathways involved, including the B-cell receptor signaling (BCR), cell cycle, epigenetic regulation and/or chromatin remodeling. In SDRPL, cyclin D3 (CCND3) mutations were found in 24% of patients, offering the possibility of using cell cycle inhibitors. Even if new emerging drugs, particularly those involved in the epigenetic regulation, have recently been added to the therapeutic armamentarium in HCL and HCL-like disorders, purine nucleoside analogs more and more associated with anti-CD20 monoclonal antibodies, are still used in the frontline setting. Thanks to the recent discoveries in genetics and signaling pathways in HCL and HCL-like disorders, new targeted therapies have been developed, have proven their efficacy and safety in several clinical trials and become essential in real life: BRAFi, MEKi, Bruton Tyrosine Kinase inhibitors (BTKi) and anti-CD22 immunotoxins. New other drugs emerged and have to be assessed in the future. In this article, we will discuss the main mutations identified in HCL and HCL-like disorders and the signaling pathways potentially involved in the pathogenesis of the different hairy cell disorders. We will discuss the results of the recent clinical trials, which will help us to propose an algorithm useful in clinical practice and we will highlight the different new drugs that may be used in the near future.
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Affiliation(s)
- Elsa Maitre
- Hématologie, Centre Hospitalier Universitaire Caen Normandie, Avenue Côte de Nacre, Caen, France
| | - Jerome Paillassa
- Service des Maladies du Sang, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Xavier Troussard
- Hématologie, Centre Hospitalier Universitaire Caen Normandie, Avenue Côte de Nacre, Caen, France,*Correspondence: Xavier Troussard,
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Deciphering Genetic Alterations of Hairy Cell Leukemia and Hairy Cell Leukemia-like Disorders in 98 Patients. Cancers (Basel) 2022; 14:cancers14081904. [PMID: 35454811 PMCID: PMC9028144 DOI: 10.3390/cancers14081904] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The diagnosis of hairy cell leukemia (cHCL) and HCL-like disorders, including the variant form of HCL (vHCL) and splenic diffuse red pulp lymphoma (SDRPL) can be challenging, particularly in complex situations. The integration of all data, including molecular data, is essential for distinguishing the different entities. The BRAFV600E mutation is identified in most cHCL cases, whereas it is absent in vHCL and SDRPL. MAP2K1 mutations are observed in half of vHCL cases and in cHCL BRAFWT and they are associated with a worse prognosis. The interest in deep sequencing for the diagnosis and prognosis of hairy cell leukemia and HCL-like disorders is essential. Some KLF2 genetic alterations have been localized on the AID consensus motif, suggesting an AID-induced mutation mechanism. KLF2 is the second most altered gene in HCL, and mutations must be investigated to confirm whether AID could be responsible for the genetic alterations in this gene. Clonal evolution can be observed in half of the cases. Abstract Hairy cell leukemia (cHCL) patients have, in most cases, a specific clinical and biological presentation with splenomegaly, anemia, leukopenia, neutropenia, monocytopenia and/or thrombocytopenia, identification of hairy cells that express CD103, CD123, CD25, CD11c and identification of the V600E mutation in the B-Raf proto-oncogene (BRAF) in 90% of cases. Monocytopenia is absent in vHCL and SDRPL patients and the abnormal cells do not express CD25 or CD123 and do not present the BRAFV600E mutation. Ten percent of cHCL patients are BRAFWT and the distinction between cHCL and HCL-like disorders including the variant form of HCL (vHCL) and splenic diffuse red pulp lymphoma (SDRPL) can be challenging. We performed deep sequencing in a large cohort of 84 cHCL and 16 HCL-like disorders to improve insights into the pathogenesis of the diseases. BRAF mutations were detected in 76/82 patients of cHCL (93%) and additional mutations were identified in Krüppel-like Factor 2 (KLF2) in 19 patients (23%) or CDKN1B in 6 patients (7.5%). Some KLF2 genetic alterations were localized on the cytidine deaminase (AID) consensus motif, suggesting AID-induced mutations. When analyzing sequential samples, a clonal evolution was identified in half of the cHCL patients (6/12 pts). Among the 16 patients with HCL-like disorders, we observed an enrichment of MAP2K1 mutations in vHCL/SDRPL (3/5 pts) and genes involved in the epigenetic regulation (KDM6A, EZH2, CREBBP, ARID1A) (3/5 pts). Furthermore, MAP2K1 mutations were associated with a bad prognosis and a shorter time to next treatment (TTNT) and progression-free survival (PFS), independently of the HCL classification.
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Parmley M, Gagan J, Imam M, Chen W. Polar/villous lymphocytes in peripheral blood and exclusively intrasinusoidal lymphoma infiltrate in bone marrow: A clue to splenic diffuse red pulp lymphoma. Int J Lab Hematol 2022; 44:970-971. [PMID: 35272395 DOI: 10.1111/ijlh.13825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle Parmley
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey Gagan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Ito M, Harada T, Lang L, Saga T, Kanagawa M, Matsuda R, Yashiro S, Kano S, Sasaki Y, Nakamine H. Hairy Cell Leukemia-Japanese Variant: Report of a Patient and Literature Review. Int J Surg Pathol 2022; 30:828-838. [PMID: 35234079 DOI: 10.1177/10668969221081432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hairy cell leukemia-Japanese variant (HCL-jv) shares some features with, but differs in other features from, HCL variant. Recently, it has been pointed out that HCL-jv and splenic diffuse red pulp small B-cell lymphoma (SDRPL) possibly constitute the same disease. We report a patient with HCL-jv, in which the neoplastic cells in the resected spleen were positive for CD11c, CD103, tartrate-resistant acid phosphatase (by immunohistochemistry), and weakly positive for cyclin D3. They were negative for CD25, CD123, annexin A1, and BRAF V600E-derived protein. Meta-analysis of HCL-jv cases in the literature showed considerable variation in the expression of HCL-related molecules. Although the clinical features and pattern of splenic involvement of HCL-jv are similar to those of SDRPL, some cytomorphological and phenotypical differences can be pointed out. To confirm whether the weak expression of cyclin D3 in our case suggests a spectrum from HCL-jv to SDRPL or one of the characteristics of HCL-jv, further studies on a large number of cases are necessary.
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Affiliation(s)
- Mariko Ito
- 13726Kin-ikyo Chuo Hospital, Sapporo, Japan
| | | | - Lang Lang
- 13726Kin-ikyo Chuo Hospital, Sapporo, Japan
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Immunophenotypic Analysis of Hairy Cell Leukemia (HCL) and Hairy Cell Leukemia-like (HCL-like) Disorders. Cancers (Basel) 2022; 14:cancers14041050. [PMID: 35205796 PMCID: PMC8870214 DOI: 10.3390/cancers14041050] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Hairy cell leukemia (HCL) is a rare B cell neoplasm that accounts for 2% of B-cell lymphomas. The diagnosis was based on the presence of abnormal lymphoid cells that expressed CD103, CD123, CD25 and CD11c. The aim of this retrospective study was to describe the immunophenotypic profile of HCL and HCL-like disorders using 13 markers and to assess the added value of immunophenotypic row data and unsupervised analysis. We confirmed that the immunological profile alone is not sufficient and that morphologic, phenotypic and molecular data need to be integrated. Abstract Hairy cell leukemia (HCL) is characterized by abnormal villous lymphoid cells that express CD103, CD123, CD25 and CD11c. HCL-like disorders, including hairy cell leukemia variant (vHCL) and splenic diffuse red pulp lymphoma (SDRPL), have similar morphologic criteria and a distinct phenotypic and genetic profile. We investigated the immunophenotypic features of a large cohort of 82 patients: 68 classical HCL, 5 vHCL/SDRPL and 9 HCL-like NOS. The HCL immunophenotype was heterogeneous: positive CD5 expression in 7/68 (10%), CD10 in 12/68 (18%), CD38 in 24/67 (36%), CD23 in 22/68 (32%) and CD43 in 19/65 (31%) patients. CD26 was expressed in 35/36 (97%) of HCL patients, none of vHCL/SDRPL and one of seven HCL-like NOS (14%). When adding CD26 to the immunologic HCL scoring system (one point for CD103, CD123, CD25, CD11c and CD26), the specificity was improved, increasing from 78.6% to 100%. We used unsupervised analysis of flow cytometry raw data (median fluorescence, percentage of expression) and the mutational profile of BRAF, MAP2K1 and KLF2. The analysis showed good separation between HCL and vHCL/SDRPL. The HCL score is not sufficient, and the use of unsupervised analysis could be promising to achieve a distinction between HCL and HCL-like disorders. However, these preliminary results have to be confirmed in a further study with a higher number of patients.
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14
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Troussard X, Maître E, Cornet E. Hairy cell leukemia 2022: Update on diagnosis, risk-stratification, and treatment. Am J Hematol 2022; 97:226-236. [PMID: 34710243 DOI: 10.1002/ajh.26390] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Abstract
DISEASE OVERVIEW Hairy cell leukemia (HCL) and HCL-like disorders, including HCL variant (HCL-V) and splenic diffuse red pulp lymphoma (SDRPL), are a very heterogeneous group of mature lymphoid B-cell disorders characterized by the identification of hairy cells, a specific genetic profile, a different clinical course, and the need for appropriate treatment. DIAGNOSIS Diagnosis of HCL is based on morphological evidence of hairy cells, an HCL immunologic score of 3 or 4 based on the CD11C, CD103, CD123, and CD25 expression, the trephine biopsy which makes it possible to specify the degree of tumoral medullary infiltration and the presence of BRAFV600E somatic mutation. RISK STRATIFICATION Progression of patients with HCL is based on a large splenomegaly, leukocytosis, a high number of hairy cells in the peripheral blood, and the immunoglobulin heavy chain variable region gene mutational status. VH4-34-positive HCL cases are associated with a poor prognosis. TREATMENT Patients should be treated only if HCL is symptomatic. Chemotherapy with risk adapted therapy purine analogs (PNAs) are indicated in first-line HCL patients. The use of chemo-immunotherapy combining PNAs and rituximab (R) represents an increasingly used therapeutic approach. Management of relapsed/refractory disease is based on the use of BRAF inhibitors (BRAFi) plus rituximab or MEK inhibitors (MEKi), recombinant immunoconjugates targeting CD22 or Bruton Tyrosine Kinase inhibitors (BTKi). However, the optimal sequence of the different treatments remains to be determined. The Bcl2-inhibitors (Bcl-2i) can play a major role in the future.
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Affiliation(s)
- Xavier Troussard
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
- Université Caen Normandie Caen Cedex France
| | - Elsa Maître
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
- Université Caen Normandie Caen Cedex France
| | - Edouard Cornet
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
- Université Caen Normandie Caen Cedex France
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15
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Oscier D, Stamatopoulos K, Mirandari A, Strefford J. The Genomics of Hairy Cell Leukaemia and Splenic Diffuse Red Pulp Lymphoma. Cancers (Basel) 2022; 14:697. [PMID: 35158965 PMCID: PMC8833447 DOI: 10.3390/cancers14030697] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Classical hairy cell leukaemia (HCLc), its variant form (HCLv), and splenic diffuse red pulp lymphoma (SDRPL) constitute a subset of relatively indolent B cell tumours, with low incidence rates of high-grade transformations, which primarily involve the spleen and bone marrow and are usually associated with circulating tumour cells characterised by villous or irregular cytoplasmic borders. The primary aim of this review is to summarise their cytogenetic, genomic, immunogenetic, and epigenetic features, with a particular focus on the clonal BRAFV600E mutation, present in most cases currently diagnosed with HCLc. We then reflect on their cell of origin and pathogenesis as well as present the clinical implications of improved biological understanding, extending from diagnosis to prognosis assessment and therapy response.
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Affiliation(s)
- David Oscier
- Department of Haematology, Royal Bournemouth and Christchurch NHS Trust, Bournemouth BH7 7DW, UK
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology-Hellas, 57001 Thessaloniki, Greece;
| | - Amatta Mirandari
- Cancer Genomics Group, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; (A.M.); (J.S.)
| | - Jonathan Strefford
- Cancer Genomics Group, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; (A.M.); (J.S.)
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16
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Yilmaz E, Chhina A, Nava VE, Aggarwal A. A Review on Splenic Diffuse Red Pulp Small B-Cell Lymphoma. Curr Oncol 2021; 28:5148-5154. [PMID: 34940070 PMCID: PMC8700110 DOI: 10.3390/curroncol28060431] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/10/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022] Open
Abstract
Splenic diffuse red pulp small B-cell lymphoma (SDRPL) is a rare disease, representing <1% of all non-Hodgkin lymphomas (NHL). The most common clinical manifestations include splenomegaly, lymphocytosis, and hemocytopenia. A diagnosis of SDRPL can be challenging, as it shares multiple clinical and laboratory features with splenic marginal zone lymphoma (SMZL), hairy cell leukemia (HCL), and HCL variant (HCL-v). Obtaining splenic tissue remains the gold standard for diagnosis. In the cases where splenic tissue is not available, diagnosis can be established by a review of peripheral blood and bone marrow studies. SDRPL is characterized by a diffuse involvement of the splenic red pulp by monomorphous small-to-medium sized mature B lymphocytes effacing the white pulp. The characteristic immunophenotype is positive for CD20, DBA.44 (20 to 90%), and IgG, and typically negative for CD5, CD10, CD23, cyclin D1, CD43, annexin A1, CD11c, CD25, CD123, and CD138. The Ki-67 proliferative index is characteristically low. Cyclin D3 is expressed in the majority of SDRPL in contrast with other types of small B-cell lymphomas, thus facilitating the recognition of this disease. There is no standard treatment regimen for SDRPL. Initial treatment options include splenectomy, rituximab monotherapy, or a combination of both. Chemoimmunotherapy should be considered in patients with advanced disease at baseline or progression.
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Affiliation(s)
- Elif Yilmaz
- Department of Hematology and Oncology, Georgetown University Medical Center, Washington, DC 20007, USA;
| | - Arashpreet Chhina
- Department of Hematology and Oncology, Veterans Affair Medical Center, Washington, DC 20422, USA; (A.C.); (V.E.N.)
| | - Victor E. Nava
- Department of Hematology and Oncology, Veterans Affair Medical Center, Washington, DC 20422, USA; (A.C.); (V.E.N.)
| | - Anita Aggarwal
- Department of Hematology and Oncology, Veterans Affair Medical Center, Washington, DC 20422, USA; (A.C.); (V.E.N.)
- Correspondence:
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17
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[Hairy cell leukemia: What are the best treatment options for relapsed or refractory patients?]. Bull Cancer 2021; 108:771-778. [PMID: 34023063 DOI: 10.1016/j.bulcan.2021.03.011] [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: 12/09/2020] [Revised: 02/04/2021] [Accepted: 03/20/2021] [Indexed: 11/20/2022]
Abstract
Hairy cell leukemia is a rare form of leukemia: three hundred new cases are diagnosed each year in France. The diagnosis is based on: (1) morphological examination of the blood and bone marrow smear, (2) analysis by flow cytometry of hairy cells, which express three or the four following markers: CD11c, CD25, CD103 and CD123, (3) identification of the BRAFV600E mutation, a true molecular marker of the disease. The management of treatment has evolved considerably in recent years. As of today, the purine analogues remain the standard treatment in the first line. Relapses are however observed in about 40% of cases. In the event of a first relapse, the preferred option is treatment with immunochemotherapy i.e. a combination of cladribine plus rituximab. Subsequent relapses are treated with moxetumomab pasudotox or BRAF inhibitors which provide indisputable benefits if third-line treatment is required. We will discuss in patients with relapsed/refractory hairy cell leukemia the needs for personalized medicine and the advantages and disadvantages of each treatment modality. The good prognosis for LT requires treatments that are not immunosuppressive, non-myelotoxic, and do not increase the risk of secondary cancers.
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18
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Matutes E. Diagnostic and therapeutic challenges in hairy cell leukemia-variant: where are we in 2021? Expert Rev Hematol 2021; 14:355-363. [PMID: 33759673 DOI: 10.1080/17474086.2021.1908121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hairy cell leukemia-variant (HCL-V) is a rare B-cell neoplasm arising or homing primarily in the spleen. It has been considered in the WHO classification of Hemopoietic and Lymphoid Tumors as a provisional entity since 2008 and included under the umbrella of unclassifiable splenomegalic B-cell leukemia/lymphomas. The diagnosis is a challenge to hematopathologists and management of these patients by the clinicians is difficult due to the lack of diagnostic and therapeutic guidelines and prospective studies. AREAS COVERED This manuscript is a comprehensive review of the clinical features, pathology, immunophenotypic profile, genomic alterations and therapeutic options of HCL-V. Diagnostic and therapeutic dilemmas are extensively outlined considering the information derived from a literature search covering from 1980 to 2019. Integration of all the data is needed and recommended for establishing the diagnosis of this leukemia. EXPERT OPINION More extensive information of genomic aberrations underlying the pathogenesis of the disease would be a solid stone for the diagnosis. To this end, a collaborative work among scientists and pathologists from different centers is required and expected. In turn, this might have a relevant clinical translation by allowing to identify putative targets for therapy and to improve the outlook of these patients.
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19
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Kohla S, Ibrahim FA, Aldapt MB, ELSabah H, Mohamed S, Youssef R. A Rare Case of Hairy Cell Leukemia with Unusual Loss of CD123 Associated with COVID-19 at the Time of Presentation. Case Rep Oncol 2020; 13:1430-1440. [PMID: 33442367 PMCID: PMC7772869 DOI: 10.1159/000512830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has been a serious threat and has been reported with different presentations and complications. Older age, along with comorbidities such as diabetes, hypertension, or cardiac disease, increases the risk factors for COVID-19 severity and death [N Engl J Med. 2020;382(18):1708–20 and Lancet Respir Med. 2020 05;8(5):475–81]. It is proposed that cancer patients have a significantly higher incidence of severe incidents including admission to the intensive care unit, the necessity for assisted ventilation, and even death after catching the virus compared with non-cancer patients [Lancet Oncol. 2020;21(3):335–7]. It is also described that cancer patients appear to be twice as likely to contract infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [JAMA Oncol. 2020;6(7):1108–10]. Hairy cell leukemia (HCL) is a rare B-cell lymphoproliferative disorder, with patients typically presenting with cytopenias, marked splenomegaly in 80–90% of patients, circulating leukemia cells, bone marrow infiltration and the presence of BRAF V600E somatic mutation [Indian J Hematol Blood Transfus. 2014;30(Suppl 1):413–7]. Leukemic cells classically have central nuclei and abundant cytoplasm with hairy-like projections and express CD11c, CD25, CD103, and CD123 [Indian J Hematol Blood Transfus. 2014;30(Suppl 1):413–7]. Loss of CD123 in HCL has been rarely reported in the literature [Am J Hematol. 2019;94(12):1413–22]. We describe a unique case of a COVID-19-positive male who presented with severe respiratory symptoms, deteriorated quickly, and was intubated. Workup of severe progressive pancytopenia and bone marrow examination revealed HCL without splenomegaly and with atypical unusual loss of CD123. To our knowledge, this is the first case of CD123-negative HCL without splenomegaly associated with COVID-19 infection as the initial presentation.
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Affiliation(s)
- Samah Kohla
- Department of Lab Medicine and Pathology, Hematology Division, Hamad Medical Corporation, Doha, Qatar.,Department of Clinical Pathology, Hematology Division, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.,Weill Cornell Medicine, Doha, Qatar
| | - Feryal A Ibrahim
- Department of Lab Medicine and Pathology, Hematology Division, Hamad Medical Corporation, Doha, Qatar
| | - Mahmood B Aldapt
- Department of Hematology-Oncology, Hamad Medical Corporation, Doha, Qatar
| | - Hesham ELSabah
- Department of Hematology-Oncology, Hamad Medical Corporation, Doha, Qatar
| | - Shehab Mohamed
- Department of Hematology-Oncology, Hamad Medical Corporation, Doha, Qatar
| | - Reda Youssef
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
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20
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Xu Y, Fan X, Sun C, Yin L, Qiu T, Xia J, Zhong X, Xu L, Li D, Li Z, Zhu F, Xu K. Splenic Diffuse Red Pulp Small B-Cell Lymphoma with Gastrointestinal Hemorrhage: A Case Report and Literature Review. Cancer Manag Res 2020; 12:9627-9633. [PMID: 33116822 PMCID: PMC7547812 DOI: 10.2147/cmar.s275292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Splenic diffuse red pulp small B-cell lymphoma (SDRPSBCL) is rare and accounts for less than 1% of non-Hodgkin's lymphoma. As the first or accompanying symptoms of SDRPSBCL, gastrointestinal hemorrhage (GIH) is rather unusual. Patients and Methods We reported on a patient with SDRPSBCL complicated with GIH. According to the enteroscopy, pathological sections of spleen and intestine, immunohistochemistry and other related laboratory examinations, the patient was diagnosed as SDRPSBCL (stage IVb) complicated with colon and rectal ulcers. The clinical manifestations were hematochezia, unformed stool, continuous anal pain and poor quality of life. Subsequently, the patient was treated by six cycles of CHOP (cyclophosphamide + doxorubicin + vincristine + hydroprednisone) regimens. The clinical features, diagnosis and treatment were analyzed retrospectively and the relevant literatures were reviewed. Results After the first course of chemotherapy, the patient did not have any more bloody stool and the stool was shaped. After six cycles of chemotherapy, the patient's anus was no longer painful and he has been in complete remission according to the result of positron emission tomography CT. Conclusion Through analysis of this case, we could elucidate that after the primary disease was alleviated, the bleeding degree of digestive tract was relieved, which provided the basis for the clinical treatment of this rare disease.
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Affiliation(s)
- Yanqiu Xu
- Blood Disease Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China
| | - Xiaohui Fan
- Blood Disease Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China
| | - Cai Sun
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China
| | - Lingling Yin
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China
| | - Tingting Qiu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China
| | - Jieyun Xia
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China
| | - Xiaomin Zhong
- Department of Oncology, Affiliated Huai'an First People's Hospital of Nanjing Medical University, Huai'an, Jiangsu Province 223300, People's Republic of China
| | - Linyan Xu
- Blood Disease Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China.,Key Laboratory of Bone Marrow Stem Cell, Xuzhou, Jiangsu Province 221002, People's Republic of China
| | - Depeng Li
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China
| | - Zhenyu Li
- Blood Disease Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China.,Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China.,Key Laboratory of Bone Marrow Stem Cell, Xuzhou, Jiangsu Province 221002, People's Republic of China
| | - Feng Zhu
- Blood Disease Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China.,Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China
| | - Kailin Xu
- Blood Disease Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China.,Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, People's Republic of China.,Key Laboratory of Bone Marrow Stem Cell, Xuzhou, Jiangsu Province 221002, People's Republic of China
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21
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Geyer JT, Prakash S, Orazi A. B-cell neoplasms and Hodgkin lymphoma in the spleen. Semin Diagn Pathol 2020; 38:125-134. [PMID: 32839024 DOI: 10.1053/j.semdp.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 11/11/2022]
Abstract
B-cell lymphoma of spleen may be primary (most commonly splenic diffuse large B-cell lymphoma) or secondary (typically low-grade non-Hodgkin lymphoma). Depending on the specific lymphoma subtype, there may be a predominantly white pulp pattern of involvement, a predominantly red pulp pattern or a focal nodular pattern. Splenectomy is the ideal specimen for a multiparametric integrative diagnosis of splenic lymphoma, as it allows for a combined study of morphology, immunohistology, flow cytometry, cytogenetics, and molecular genetic techniques. This review article describes the clinicopathologic characteristics of all the relevant B-cell neoplasms that may be encountered in a splenic biopsy or a splenectomy specimen.
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Affiliation(s)
- Julia T Geyer
- Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, 525 E 68th Street, Starr Pavilion 715, New York, NY 10065, United States.
| | - Sonam Prakash
- University of California San Francisco, Department of Laboratory Medicine, Box 0100, Parnassus Avenue, Room 569C, San Francisco, CA 94143, United States
| | - Attilio Orazi
- Texas Tech University Health Sciences Center, PL Foster School of Medicine, Department of Pathology, MSC 41022, 5001 El Paso Drive, El Paso, TX 79905, United States
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22
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Abstract
OPINION STATEMENT Despite its rarity, hairy cell leukemia (HCL) remains a fascinating disease and the physiopathology is becoming more and more understood. The accurate diagnosis of HCL relies on the recognition of hairy cells by morphology and flow cytometry (FCM) in the blood and/or bone marrow (BM). The BRAF V600E mutation, an HCL-defining mutation, represents a novel diagnostic parameter and a potential therapeutic target. The precise cellular origin of HCL is a late-activated postgerminal center memory B cell. BRAF mutations were detected in hematopoietic stem cells (HSCs) of patients with HCL, suggesting that this is an early HCL-defining event. Watch-and-wait strategy is necessary in approximately 10% of asymptomatic HCL patients, sometimes for several years. Purine analogs (PNAs) are the established first-line options for symptomatic HCL patients. In second-line treatment, chemoimmunotherapy combining PNA plus rituximab should be considered in high-risk HCL patients. The three options for relapsed/refractory HCL patients include recombinant immunoconjugates targeting CD22, BRAF inhibitors, and BCR inhibitors. The clinical interest to investigate blood minimal residual disease (MRD) was recently demonstrated, with a high risk of relapse in patients with positive testing for MRD and a low risk in patients with negative testing. However, efforts must be made to standardize MRD analyses in the near future. Patients with HCL are at risk of second malignancies. The increased risk could be related to the disease and/or the treatment, and the respective role of PNAs in the development of secondary malignancies remains a topic of debate.
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Affiliation(s)
- Jérôme Paillassa
- Department of Hematology, Academic Hospital of Angers, Angers, Pays de la Loire, France
| | - Xavier Troussard
- Laboratory of Hematology, Academic Hospital of Caen, Caen, Normandy, France.
- Laboratoire d'Hématologie Biologique, CHU de Caen, Avenue de la Côte de Nacre, 14 033, Caen Cedex, France.
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23
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Maitre E, Cornet E, Troussard X. Hairy cell leukemia: 2020 update on diagnosis, risk stratification, and treatment. Am J Hematol 2019; 94:1413-1422. [PMID: 31591741 DOI: 10.1002/ajh.25653] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Abstract
DISEASE OVERVIEW Hairy cell leukemia (HCL) and HCL-like disorders, including HCL variant (HCL-V) and splenic diffuse red pulp lymphoma (SDRPL), are a very heterogeneous group of mature lymphoid B-cell disorders. They are characterized by the identification of hairy cells, a specific genetic profile, a different clinical course and the need for appropriate treatment. DIAGNOSIS Diagnosis of HCL is based on morphological evidence of hairy cells, an HCL immunologic score of three or four based on the CD11C, CD103, CD123, and CD25 expression. Also, the trephine biopsy which makes it possible to specify the degree of tumoral medullary infiltration and the presence of BRAF V600E somatic mutation. RISK STRATIFICATION Progression of patients with HCL is based on a large splenomegaly, leukocytosis, a high number of hairy cells in the peripheral blood and the immunoglobulin heavy chain variable region gene mutational status. The VH4-34 positive HCL cases are associated with poor prognosis. TREATMENT Risk adapted therapy with purine nucleoside analogs (PNA) are indicated in symptomatic first line HCL patients. The use of PNA followed by rituximab represents an alternative option. Management of progressive or refractory disease is based on the use of BRAF inhibitors associated or not with MEK inhibitors, recombinant immunoconjugates targeting CD22 or BCR inhibitors.
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Affiliation(s)
- Elsa Maitre
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
| | - Edouard Cornet
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
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24
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Falini B, Tiacci E. New treatment options in hairy cell leukemia with focus on BRAF inhibitors. Hematol Oncol 2019; 37 Suppl 1:30-37. [PMID: 31187521 DOI: 10.1002/hon.2594] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hairy cell leukemia (HCL) responds initially very well to chemotherapy with purine analogues. However, up to 50% of patients relapse, often multiple times, and become progressively less sensitive to these myelotoxic and immune-suppressive drugs. At progression, viable therapeutic strategies include addition of rituximab to purine analogues, and treatment with the anti-CD22 immunotoxin moxetumomab pasudotox, which has been recently approved by the FDA in HCL patients after at least two prior therapies. Identification of the BRAF-V600E kinase mutation as the genetic cause of HCL has opened the way, in the relapsed/refractory experimental setting, to targeted and non-myelotoxic effective strategies that are based on inhibition of BRAF with vemurafenib, co-inhibition of BRAF and its target MEK with dabrafenib and trametinib, and BRAF inhibition with vemurafenib combined with anti-CD20 immunotherapy. In particular, vemurafenib plus rituximab is emerging as a short, safe, chemotherapy-free regimen able to induce deep complete remissions in most HCL patients refractory to, or relapsed multiple times, after chemo(immuno)therapy.
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Affiliation(s)
- Brunangelo Falini
- Institute of Hematology and CREO (Center for Hemato-Oncological Research), Ospedale S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Enrico Tiacci
- Institute of Hematology and CREO (Center for Hemato-Oncological Research), Ospedale S. Maria della Misericordia, University of Perugia, Perugia, Italy
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25
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Villous lymphocytes in splenic large B-cell lymphoma with diffuse red pulp infiltration. Int J Hematol 2018; 109:133-134. [PMID: 30519992 DOI: 10.1007/s12185-018-02566-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
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26
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Maitre E, Bertrand P, Maingonnat C, Viailly PJ, Wiber M, Naguib D, Salaün V, Cornet E, Damaj G, Sola B, Jardin F, Troussard X. New generation sequencing of targeted genes in the classical and the variant form of hairy cell leukemia highlights mutations in epigenetic regulation genes. Oncotarget 2018; 9:28866-28876. [PMID: 29989027 PMCID: PMC6034755 DOI: 10.18632/oncotarget.25601] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/24/2018] [Indexed: 11/25/2022] Open
Abstract
Classical hairy cell leukemia (HCL-c) is a rare lymphoid neoplasm. BRAFV600E mutation, detected in more than 80% of the cases, is described as a driver mutation, but additional genetic abnormalities appear to be necessary for the disease progression. For cases of HCL-c harboring a wild-type BRAF gene, the differential diagnosis of the variant form of HCL (HCL-v) or splenic diffuse red pulp lymphoma (SDRPL) is complex. We selected a panel of 21 relevant genes based on a literature review of whole exome sequencing studies (BRAF, MAP2K1, DUSP2, MAPK15, ARID1A, ARID1B, EZH2, KDM6A, CREBBP, TP53, CDKN1B, XPO1, KLF2, CXCR4, NOTH1, NOTCH2, MYD88, ANXA1, U2AF1, BCOR, and ABCA8). We analyzed 20 HCL-c and 4 HCL-v patients. The analysis of diagnostic samples mutations in BRAF (n = 18), KLF2 (n = 4), MAP2K1 (n = 3), KDM6A (n = 2), CDKN1B (n = 2), ARID1A (n = 2), CREBBP (n = 2) NOTCH1 (n = 1) and ARID1B (n = 1). BRAFV600E was found in 90% (18/20) of HCL-c patients. In HCL-c patients with BRAFV600E, other mutations were found in 33% (6/18) of cases. All 4 HCL-v patients had mutations in epigenetic regulatory genes: KDM6A (n = 2), CREBBP (n = 1) or ARID1A (n = 1). The analysis of sequential samples (at diagnosis and relapse) from 5 patients (2 HCL-c and 3 HCL-v), showed the presence of 2 new subclonal mutations (BCORE1430X and XPO1E571K) in one patient and variations of the mutated allele frequency in 2 other cases. In the HCL-v disease, we described new mutations targeting KDM6A that encode a lysine demethylase protein. This opens new perspectives for personalized medicine for this group of patients.
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Affiliation(s)
- Elsa Maitre
- Normandie Univ, INSERM U1245, Université de Caen, Caen, France
| | | | | | | | | | - Dina Naguib
- Laboratoire d'hématologie, CHU Caen, Caen, France
| | | | - Edouard Cornet
- Normandie Univ, INSERM U1245, Université de Caen, Caen, France.,Laboratoire d'hématologie, CHU Caen, Caen, France
| | - Gandhi Damaj
- Normandie Univ, INSERM U1245, Université de Caen, Caen, France.,Institut d'Hématologie de Basse-Normandie, CHU Caen, Caen, France
| | - Brigitte Sola
- Normandie Univ, INSERM U1245, Université de Caen, Caen, France
| | - Fabrice Jardin
- Normandie Univ, INSERM U1245, Université de Rouen, Rouen, France.,Service d'hématologie, Centre Henri Becquerel, Rouen, France
| | - Xavier Troussard
- Normandie Univ, INSERM U1245, Université de Caen, Caen, France.,Laboratoire d'hématologie, CHU Caen, Caen, France.,Institut d'Hématologie de Basse-Normandie, CHU Caen, Caen, France
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27
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Verney A, Traverse-Glehen A, Callet-Bauchu E, Jallades L, Magaud JP, Salles G, Genestier L, Baseggio L. Toll-like receptor expression and function differ between splenic marginal zone B cell lymphoma and splenic diffuse red pulp B cell lymphoma. Oncotarget 2018; 9:23589-23598. [PMID: 29805758 PMCID: PMC5955093 DOI: 10.18632/oncotarget.25283] [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: 03/21/2017] [Accepted: 04/07/2018] [Indexed: 11/25/2022] Open
Abstract
In splenic marginal zone lymphoma (SMZL), specific and functional Toll-like Receptor (TLR) patterns have been recently described, suggesting their involvement in tumoral proliferation. Splenic diffuse red pulp lymphoma with villous lymphocytes (SDRPL) is close to but distinct from SMZL, justifying here the comparison of TLR patterns and functionality in both entities. Distinct TLR profiles were observed in both lymphoma subtypes. SDRPL B cells showed higher expression of TLR7 and to a lesser degree TLR9, in comparison to SMZL B cells. In both entities, TLR7 and TLR9 pathways appeared functional, as shown by IL-6 production upon TLR7 and TLR9 agonists stimulations. Interestingly, circulating SDRPL, but not SMZL B cells, constitutively expressed CD86. In addition, stimulation with both TLR7 and TLR9 agonists significantly increased CD80 expression in circulating SDRPL but not SMZL B cells. Finally, TLR7 and TLR9 stimulations had no impact on proliferation and apoptosis of SMZL or SDRPL B cells. In conclusion, SMZL and SDRPL may derive from different splenic memory B cells with specific immunological features that can be used as diagnosis markers in the peripheral blood.
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Affiliation(s)
- Aurélie Verney
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France
| | - Alexandra Traverse-Glehen
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.,Service d'Anatomie-pathologique, Centre Hospitalier Lyon-Sud/Hospices Civils de Lyon, Pierre-Bénite, France
| | - Evelyne Callet-Bauchu
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.,Laboratoire d'Hématologie Cellulaire, Centre Hospitalier Lyon-Sud/Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Jallades
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.,Laboratoire d'Hématologie Cellulaire, Centre Hospitalier Lyon-Sud/Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jean-Pierre Magaud
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.,Laboratoire d'Hématologie Cellulaire, Centre Hospitalier Lyon-Sud/Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gilles Salles
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.,Service d'Hématologie, Centre Hospitalier Lyon-Sud/Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Genestier
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France
| | - Lucile Baseggio
- Université de Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.,Laboratoire d'Hématologie Cellulaire, Centre Hospitalier Lyon-Sud/Hospices Civils de Lyon, Pierre-Bénite, France
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28
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Vig T, Kodiatte TA, Manipadam MT, Aboobacker FN. A rare case of splenic diffuse red pulp small B-cell lymphoma (SDRPL): a review of the literature on primary splenic lymphoma with hairy cells. Blood Res 2018; 53:74-78. [PMID: 29662866 PMCID: PMC5898999 DOI: 10.5045/br.2018.53.1.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/25/2017] [Accepted: 06/03/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tanush Vig
- Department of Pathology, Christian Medical College and Hospital, Vellore, India
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29
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Favre R, Manzoni D, Traverse-Glehen A, Verney A, Jallades L, Callet-Bauchu E, Sujobert P, Salles G, Baseggio L. Usefulness of CD200 in the differential diagnosis of SDRPL, SMZL, and HCL. Int J Lab Hematol 2018; 40:e59-e62. [DOI: 10.1111/ijlh.12824] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- R. Favre
- Department of Hematologic Laboratory; Hospices Civils De Lyon/GHS; Lyon France
| | - D. Manzoni
- Department of Hematologic Laboratory; Hospices Civils De Lyon/GHS; Lyon France
| | - A. Traverse-Glehen
- Department of Anatomic Pathology; Hospices Civils De Lyon/GHS; Lyon France
- Cancer Research Center of Lyon; INSERM 1052-CNRS UMR5286 « Clinical and Experimental Models of Lymphomagenesis »; Lyon France
| | - A. Verney
- Cancer Research Center of Lyon; INSERM 1052-CNRS UMR5286 « Clinical and Experimental Models of Lymphomagenesis »; Lyon France
| | - L. Jallades
- Department of Hematologic Laboratory; Hospices Civils De Lyon/GHS; Lyon France
- Cancer Research Center of Lyon; INSERM 1052-CNRS UMR5286 « Clinical and Experimental Models of Lymphomagenesis »; Lyon France
| | - E. Callet-Bauchu
- Department of Hematologic Laboratory; Hospices Civils De Lyon/GHS; Lyon France
- Cancer Research Center of Lyon; INSERM 1052-CNRS UMR5286 « Clinical and Experimental Models of Lymphomagenesis »; Lyon France
| | - P. Sujobert
- Department of Hematologic Laboratory; Hospices Civils De Lyon/GHS; Lyon France
- Cancer Research Center of Lyon; INSERM 1052-CNRS UMR5286 « Clinical and Experimental Models of Lymphomagenesis »; Lyon France
| | - G. Salles
- Cancer Research Center of Lyon; INSERM 1052-CNRS UMR5286 « Clinical and Experimental Models of Lymphomagenesis »; Lyon France
- Department of Clinic Hematology; Hospices Civils De Lyon/GHS; Lyon France
| | - L. Baseggio
- Department of Hematologic Laboratory; Hospices Civils De Lyon/GHS; Lyon France
- Cancer Research Center of Lyon; INSERM 1052-CNRS UMR5286 « Clinical and Experimental Models of Lymphomagenesis »; Lyon France
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30
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Cheng WY, Zhu YM, Cheng S, Chen YS, Shen Y. Development of B-cell prolymphocytic leukemia in a patient with splenic diffuse red pulp small B-cell lymphoma. Leuk Lymphoma 2017; 59:1990-1993. [PMID: 29199492 DOI: 10.1080/10428194.2017.1405397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Wen-Yan Cheng
- a Shanghai Institute of Hematology, Department of Hematology , Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yong-Mei Zhu
- a Shanghai Institute of Hematology, Department of Hematology , Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shu Cheng
- a Shanghai Institute of Hematology, Department of Hematology , Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yun-Shuo Chen
- a Shanghai Institute of Hematology, Department of Hematology , Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yang Shen
- a Shanghai Institute of Hematology, Department of Hematology , Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine , Shanghai , China
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31
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32
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Troussard X, Cornet E. Hairy cell leukemia 2018: Update on diagnosis, risk-stratification, and treatment. Am J Hematol 2017; 92:1382-1390. [PMID: 29110361 PMCID: PMC5698705 DOI: 10.1002/ajh.24936] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 01/15/2023]
Abstract
Disease overview Hairy cell leukemia (HCL) and HCL‐like disorders, including HCL variant (HCL‐V) and splenic diffuse red pulp lymphoma (SDRPL), are a very heterogeneous group of mature lymphoid B‐cell disorders, characterized by the identification of hairy cells, a specific genetic profile, a different clinical course and the need for appropriate treatment. Diagnosis Diagnosis of HCL is based on morphological evidence of hairy cells, an HCL immunologic score of 3 or 4 based on the CD11C, CD103, CD123, and CD25 expression, the trephine biopsy which makes it possible to specify the degree of tumoral medullary infiltration and the presence of BRAF V600E somatic mutation. Risk stratification Progression of patients with HCL is based on a large splenomegaly, leukocytosis, a high number of hairy cells in the peripheral blood and the immunoglobulin heavy chain variable region gene mutational status. VH4‐34 positive HCL cases are associated with poor prognosis Risk adapted therapy Purine analogs (PNA) are indicated in symptomatic first line HCL patients. The use of PNA followed by rituximab represents an alternative option. Management of progressive or refractory disease It is based on the use of BRAF inhibitors associated or not with MEK inhibitors, recombinant immunoconjugates targeting CD22 or BCR inhibitors.
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Affiliation(s)
| | - Edouard Cornet
- Laboratoire Hématologie, CHU Caen, 14 033; Caen Cedex France
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33
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A rare case of B-lymphoproliferative disorder with villous lymphocytes harboring t(8;14)(q24;q32) translocation. Front Med 2017; 12:324-329. [PMID: 29075958 DOI: 10.1007/s11684-017-0558-z] [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: 08/17/2016] [Accepted: 04/29/2017] [Indexed: 10/18/2022]
Abstract
Splenic lymphoma with villous lymphocytes (SLVL) or splenic marginal zone lymphoma with circulating villous lymphocytes is rare, and prolymphocytic transformation of SLVL is rarer. At present, only one case of SLVL with t(8;14)(q24;q32) translocation has been reported. In this study, we report a case of B-lymphoproliferative disorder with villous lymphocytes harboring t(8;14)(q24;q32) chromosome translocation that we inclined to SLVL with a prolymphocytic transformation. A 73-year-old female showed marked hepatosplenomegaly and high lymphocytosis (lymphocytes > 200 × 109/L). The abnormal lymphocytes had short coarse villi and round nuclei with prominent nucleoli. The immunophenotypes showed CD19+, CD20+, HLA-DR+, CD22+, CD5+, Kappa+, CD25dim, CD71dim, Lambda-, CD7-, CD10-, CD23-, CD34-, CD33-, CD13-, CD14-, CD117-, CD64-, CD103-, and CD11c-. The karyotype showed complex abnormality: 46XX,+ 3,-10, t(8;14)(q24; q32)[11]/46XX[9]. The cytoplasmic projection, immunological characteristics, and trisomy 3 chromosome abnormality supported the diagnosis of SLVL. However, the presence of prominent nucleoli and high lymphocytosis suggested prolymphocytic transformation, probably as a result of t(8,14) chromosome translocation. In this report, we described an unusual case of B-lymphoproliferative disorder with villous lymphocytes harboring t(8;14)(q24;q32) translocation, which could provide help in the diagnosis and differential diagnosis of B-lymphocytic proliferative diseases.
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34
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Jallades L, Baseggio L, Sujobert P, Huet S, Chabane K, Callet-Bauchu E, Verney A, Hayette S, Desvignes JP, Salgado D, Levy N, Béroud C, Felman P, Berger F, Magaud JP, Genestier L, Salles G, Traverse-Glehen A. Exome sequencing identifies recurrent BCOR alterations and the absence of KLF2, TNFAIP3 and MYD88 mutations in splenic diffuse red pulp small B-cell lymphoma. Haematologica 2017; 102:1758-1766. [PMID: 28751561 PMCID: PMC5622860 DOI: 10.3324/haematol.2016.160192] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/12/2017] [Indexed: 01/04/2023] Open
Abstract
Splenic diffuse red pulp lymphoma is an indolent small B-cell lymphoma recognized as a provisional entity in the World Health Organization 2008 classification. Its precise relationship to other related splenic B-cell lymphomas with frequent leukemic involvement or other lymphoproliferative disorders remains undetermined. We performed whole-exome sequencing to explore the genetic landscape of ten cases of splenic diffuse red pulp lymphoma using paired tumor and normal samples. A selection of 109 somatic mutations was then evaluated in a cohort including 42 samples of splenic diffuse red pulp lymphoma and compared to those identified in 46 samples of splenic marginal zone lymphoma and eight samples of hairy-cell leukemia. Recurrent mutations or losses in BCOR (the gene encoding the BCL6 corepressor) – frameshift (n=3), nonsense (n=2), splicing site (n=1), and copy number loss (n=4) – were identified in 10/42 samples of splenic diffuse red pulp lymphoma (24%), whereas only one frameshift mutation was identified in 46 cases of splenic marginal zone lymphoma (2%). Inversely, KLF2, TNFAIP3 and MYD88, common mutations in splenic marginal zone lymphoma, were rare (one KLF2 mutant in 42 samples; 2%) or absent (TNFAIP3 and MYD88) in splenic diffuse red pulp lymphoma. These findings define an original genetic profile of splenic diffuse red pulp lymphoma and suggest that the mechanisms of pathogenesis of this lymphoma are distinct from those of splenic marginal zone lymphoma and hairy-cell leukemia.
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Affiliation(s)
- Laurent Jallades
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Hématologie, Pierre-Bénite, France.,Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France
| | - Lucile Baseggio
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Hématologie, Pierre-Bénite, France.,Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France
| | - Pierre Sujobert
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Hématologie, Pierre-Bénite, France.,Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France.,Université Claude Bernard Lyon-1, Marseillee, France
| | - Sarah Huet
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Hématologie, Pierre-Bénite, France.,Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France.,Université Claude Bernard Lyon-1, Marseillee, France
| | - Kaddour Chabane
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Hématologie, Pierre-Bénite, France.,Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France
| | - Evelyne Callet-Bauchu
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Hématologie, Pierre-Bénite, France.,Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France.,Université Claude Bernard Lyon-1, Marseillee, France
| | - Aurélie Verney
- Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France.,Université Claude Bernard Lyon-1, Marseillee, France
| | - Sandrine Hayette
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Hématologie, Pierre-Bénite, France.,Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France
| | - Jean-Pierre Desvignes
- Aix-Marseille Université, GMGF, 13385, Marseillee, France.,INSERM, UMR_S 910, 13385, Marseille, France
| | - David Salgado
- Aix-Marseille Université, GMGF, 13385, Marseillee, France.,INSERM, UMR_S 910, 13385, Marseille, France
| | - Nicolas Levy
- Aix-Marseille Université, GMGF, 13385, Marseillee, France.,INSERM, UMR_S 910, 13385, Marseille, France.,APHM, Hôpital TIMONE Enfants, Laboratoire de Génétique Moléculaire, 13385, Marseille, France
| | - Christophe Béroud
- Aix-Marseille Université, GMGF, 13385, Marseillee, France.,INSERM, UMR_S 910, 13385, Marseille, France.,APHM, Hôpital TIMONE Enfants, Laboratoire de Génétique Moléculaire, 13385, Marseille, France
| | - Pascale Felman
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Hématologie, Pierre-Bénite, France.,Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France
| | - Françoise Berger
- Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France.,Université Claude Bernard Lyon-1, Marseillee, France.,Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Anatomie Pathologique, Pierre-Bénite, France
| | - Jean-Pierre Magaud
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Hématologie, Pierre-Bénite, France.,Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France.,Université Claude Bernard Lyon-1, Marseillee, France
| | - Laurent Genestier
- Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France
| | - Gilles Salles
- Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France .,Université Claude Bernard Lyon-1, Marseillee, France.,Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Hématologie, Pierre-Bénite, France
| | - Alexandra Traverse-Glehen
- Cancer Research Center of Lyon, INSERM 1052 CNRS 5286, Team "Clinical and Experimental Models of Lymphomagenesis", Faculté de Médecine et de Maïeutique Lyon-Sud Charles Mérieux, Oulins, France.,Université Claude Bernard Lyon-1, Marseillee, France.,Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Laboratoire d'Anatomie Pathologique, Pierre-Bénite, France
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35
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Xochelli A, Oscier D, Stamatopoulos K. Clonal B-cell lymphocytosis of marginal zone origin. Best Pract Res Clin Haematol 2017; 30:77-83. [DOI: 10.1016/j.beha.2016.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 12/25/2022]
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36
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Merdin A, Yıldız J, Dal Mehmet S, Çakar MK, Batgi H, Tekgündüz E, Onursever A, Altuntaş F. A 80-Year-Old Woman with B-Cell Prolymphocytic Leukemia. Hematol Rep 2017; 9:6995. [PMID: 28435655 PMCID: PMC5379215 DOI: 10.4081/hr.2017.6995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/30/2022] Open
Abstract
Prolymhocytic leukemia (PLL) is a rare subtype of lymphocytic leukemias and its cells are immature lymphocytes. It is divided into 2 subgroups: T-PLL and B-PLL according to the lymphocytic origin of the cells. Discriminating B-PLL from other diseases with clinically-similar features is important because of the different treatment approaches and follow-up programs. Hereby, we report a 80-year-old woman presenting with fatigue, leucocytosis and mild anemia. Her peripheral blood smear evaluation revealed 85% prolymphocytes with moderately condensed nuclear chromatin, prominent nucleoli, and a faintly basophilic cytoplasm. Positron emission tomography-computed tomography showed mediastinal lymph nodes with cervical lymph nodes. There was no pathological FDG involvement in the spleen. Bone marrow aspiration smear exhibit atypical wide lymphocytes with prominent nucleoli and abundant agranular cytoplasm. Flow cytometry analysis revealed positive CD5+, CD19+, CD20+, CD22+, CD11c+, CD25+, CD79a+ and CD79b+. Fluorescence in situ hybridization technique analysis reveals no t(11;14). Bone marrow biopsy revealed interstitially distributed atypical cells with wide nucleus and prominent nucleolus.
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Affiliation(s)
- Alparslan Merdin
- Hematology Clinic and Bone Marrow Transplantation Unit, and Research Hospital, Ankara, Turkey
| | - Jale Yıldız
- Hematology Clinic and Bone Marrow Transplantation Unit, and Research Hospital, Ankara, Turkey
| | - Sinan Dal Mehmet
- Hematology Clinic and Bone Marrow Transplantation Unit, and Research Hospital, Ankara, Turkey
| | - Merih Kızıl Çakar
- Hematology Clinic and Bone Marrow Transplantation Unit, and Research Hospital, Ankara, Turkey
| | - Hikmetullah Batgi
- Hematology Clinic and Bone Marrow Transplantation Unit, and Research Hospital, Ankara, Turkey
| | - Emre Tekgündüz
- Hematology Clinic and Bone Marrow Transplantation Unit, and Research Hospital, Ankara, Turkey
| | - Aykut Onursever
- Pathology Clinic, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Fevzi Altuntaş
- Hematology Clinic and Bone Marrow Transplantation Unit, and Research Hospital, Ankara, Turkey
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37
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Splenic diffuse red pulp small B-cell lymphoma displays increased expression of cyclin D3 and recurrent CCND3 mutations. Blood 2017; 129:1042-1045. [PMID: 28069605 DOI: 10.1182/blood-2016-11-751024] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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38
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Piris MA, Onaindía A, Mollejo M. Splenic marginal zone lymphoma. Best Pract Res Clin Haematol 2016; 30:56-64. [PMID: 28288718 DOI: 10.1016/j.beha.2016.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 01/25/2023]
Abstract
Splenic marginal zone lymphoma (SMZL) is an indolent small B-cell lymphoma involving the spleen and bone marrow characterized by a micronodular tumoral infiltration that replaces the preexisting lymphoid follicles and shows marginal zone differentiation as a distinctive finding. SMZL cases are characterized by prominent splenomegaly and bone marrow and peripheral blood infiltration. Cells in peripheral blood show a villous cytology. Bone marrow and peripheral blood characteristic features usually allow a diagnosis of SMZL to be performed. Mutational spectrum of SMZL identifies specific findings, such as 7q loss and NOTCH2 and KLF2 mutations, both genes related with marginal zone differentiation. There is a striking clinical variability in SMZL cases, dependent of the tumoral load and performance status. Specific molecular markers such as 7q loss, p53 loss/mutation, NOTCH2 and KLF2 mutations have been found to be associated with the clinical variability. Distinction from Monoclonal B-cell lymphocytosis with marginal zone phenotype is still an open issue that requires identification of precise and specific thresholds with clinical meaning.
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Affiliation(s)
- Miguel A Piris
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Arantza Onaindía
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuela Mollejo
- Servicio de Anatomía Patológica, Hospital Virgen de la Salud, Toledo, Spain
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BRAF V600E mutation in hairy cell leukemia: from bench to bedside. Blood 2016; 128:1918-1927. [DOI: 10.1182/blood-2016-07-418434] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/15/2016] [Indexed: 12/13/2022] Open
Abstract
AbstractHairy cell leukemia (HCL) is a distinct clinicopathological entity whose underlying genetic lesion has remained a mystery for over half a century. The BRAF V600E mutation is now recognized as the causal genetic event of HCL because it is somatic, present in the entire tumor clone, detectable in almost all cases at diagnosis (encompassing the whole disease spectrum), and stable at relapse. BRAF V600E leads to the constitutive activation of the RAF-MEK-extracellular signal-regulated kinase (ERK) signaling pathway which represents the key event in the molecular pathogenesis of HCL. KLF2 and CDNK1B (p27) mutations may cooperate with BRAF V600E in promoting leukemic transformation. Sensitive molecular assays for detecting BRAF V600E allow HCL (highly responsive to purine analogs) to be better distinguished from HCL-like disorders, which are treated differently. In vitro preclinical studies on purified HCL cells proved that BRAF and MEK inhibitors can induce marked dephosphorylation of MEK/ERK, silencing of RAF-MEK-ERK pathway transcriptional output, loss of the HCL-specific gene expression profile signature, change of morphology from “hairy” to “smooth,” and eventually apoptosis. The overall response rate of refractory/relapsed HCL patients to the BRAF inhibitor vemurafenib approached 100%, with 35% to 40% complete remissions (CRs). The median relapse free-survival was about 19 months in patients who had achieved CR and 6 months in those who had obtained a partial response. Future therapeutic perspectives include: (1) combining BRAF inhibitors with MEK inhibitors or immunotherapy (anti-CD20 monoclonal antibody) to increase the percentage of CRs and (2) better understanding of the molecular mechanisms underlying resistance of HCL cells to BRAF inhibitors.
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Sales MM, Ferreira SIACP, Ikoma MRV, Sandes AF, Beltrame MP, Bacal NS, Silva MCA, Malvezzi M, Lorand-Metze IGH, Orfao A, Yamamoto M. Diagnosis of chronic lymphoproliferative disorders by flow cytometry using four-color combinations for immunophenotyping: A proposal of the brazilian group of flow cytometry (GBCFLUX). CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 92:398-410. [PMID: 27362793 DOI: 10.1002/cyto.b.21396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiparametric flow cytometry (MFC) is a powerful tool for the diagnosis of hematological malignancies and has been useful for the classification of chronic lymphoproliferative disorders (CLPD) according to the WHO criteria. Following the purposes of the Brazilian Group of Flow Cytometry (GBCFLUX), the aim of this report was to standardize the minimum requirements to achieve an accurate diagnosis in CLPDs, considering the different economic possibilities of the laboratories in our country. Most laboratories in Brazil work with 4-fluorescence flow cytometers, which is why the GBCFLUX CLPD Committee has proposed 4-color monoclonal antibody (MoAb) panels. METHODS/RESULTS Panels for screening and diagnosis in B, T and NK lymphoproliferative disorders were developed based on the normal differentiation pathways of these cells and the most frequent phenotypic aberrations. Important markers for prognosis and for minimal residual disease (MRD) evaluation were also included. The MoAb panels presented here were designed based on the diagnostic expertise of the participating laboratories and an extensive literature review. CONCLUSION The 4-color panels presented to aid in the diagnosis of lymphoproliferative neoplasms by GBCFLUX aim to provide clinical laboratories with a systematic, step-wise, cost-effective, and reproducible approach to obtain an accurate immunophenotypic diagnosis of the most frequent of these disorders. © 2016 International Clinical Cytometry Society.
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Affiliation(s)
- M M Sales
- Hospital Das Clínicas Da Faculdade De Medicina Da Universidade De São Paulo, SP, Brazil
| | | | | | - A F Sandes
- Division of Hematology and Flow Cytometry, Fleury Group, São Paulo, SP, Brazil
| | - M P Beltrame
- Unidade De Apoio Diagnóstico, Hospital De Clínicas - UFPR, Brazil
| | - N S Bacal
- Hospital Albert Einstein, São Paulo, SP, Brazil
| | - M C A Silva
- Hospital Das Clínicas Da Faculdade De Medicina Da Universidade De São Paulo, SP, Brazil
| | - M Malvezzi
- Disciplina De Hematologia Do Departamento De Clínica Médica Da Universidade Federal Do Paraná, PR, Brazil
| | | | - A Orfao
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), Cytometry Service and Department of Medicine, University of Salamanca, Spain
| | - M Yamamoto
- Escola Paulista De Medicina, Universidade Federal De São Paulo (EPM-UNIFESP), SP, Brazil
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Kerbauy MN, Fernandes CM, Bezerra ED, Lage LADPC, Siqueira SAC, Pereira J. Splenic diffuse red-pulp small B-cell lymphoma associated with hepatitis B virus: a report of two cases. SAO PAULO MED J 2016; 134:359-65. [PMID: 27581334 PMCID: PMC10876336 DOI: 10.1590/1516-3180.2016.0035130416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 02/07/2016] [Accepted: 04/13/2016] [Indexed: 01/15/2023] Open
Abstract
CONTEXT Splenic diffuse red-pulp small B-cell lymphoma is a rare disease, representing less than 1% of all non-Hodgkin lymphomas (NHL). This entity is characterized by involvement of bone marrow sinusoids and peripheral blood. The majority of cases are at an advanced stage when diagnosed. Its pathogenesis is still poorly understood. CASE REPORTS We report on two patients with chronic non-replicating hepatitis B virus (HBV) who developed splenic diffuse red-pulp small B-cell lymphoma. Both of them were in stage IV at diagnosis and evolved with aggressive disease. Both of them achieved a complete response through chemotherapy, but one of them died due to infectious complications during bone marrow transplantation. The other decided not to undergo transplantation and continues not to show any evidence of disease today (three years after treatment). Some studies have shown a possible association between B-cell NHL and HBV. Nonetheless, the mechanism through which this oncogenic virus interacts with B-cell NHL is still poorly understood. HBV is lymphotropic and may insert into the host's genome, thus causing overexpression of oncogenes and downregulation of tumor suppressor genes. Therefore, chronic stimulation by HBV can increase B-cell proliferation, which promotes monoclonal expansion of these cells and results in malignancy. CONCLUSION HBV may be implicated in the pathogenesis of this lymphoma, although no direct association between these two entities could be proved in the present study. Further investigations are necessary.
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Affiliation(s)
- Mariana Nassif Kerbauy
- MD. Resident Physician, Department of Hematology and Hemotherapy, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Carolina Melo Fernandes
- MD. Hematologist, Department of Hematology and Hemotherapy, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Evandro Dantas Bezerra
- MD. Hematologist, Department of Hematology and Hemotherapy, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Luis Alberto de Padua Covas Lage
- MD. Hematologist, Department of Hematology and Hemotherapy, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Sheila Aparecida Coelho Siqueira
- MD, PhD. Professor in the Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Juliana Pereira
- MD, PhD. Professor in the Department of Hematology and Hemotherapy, Faculdade de Medicina da Universidade de São Paulo (FMUSP - University of São Paulo), São Paulo, SP, Brazil.
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Traverse-Glehen A, Verney A, Gazzo S, Jallades L, Chabane K, Hayette S, Coiffier B, Callet-Bauchu E, Ffrench M, Felman P, Berger F, Baseggio L, Salles G. Splenic diffuse red pulp lymphoma has a distinct pattern of somatic mutations amongst B-cell malignancies. Leuk Lymphoma 2016; 58:666-675. [PMID: 27347751 DOI: 10.1080/10428194.2016.1196813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Splenic Diffuse Red Pulp Lymphoma (SDRPL) has been recently introduced as a provisional entity but differential diagnosis with other splenic lymphomas is needed to be clarified since the therapeutic approaches are distinct. Recently described recurrent mutations or CD180 expression appear useful for differential diagnosis. We completed our previous description in a larger cohort including 53 patients selected on the presence of characteristic villous cells in peripheral blood (PB) and a specific immunophenotype. Immunoglobulin heavy variable (IGHV), BRAF, MYD88, and NOTCH2 mutations were determined and CD180 and BRAF expressions were assessed. Most cases (79%) were IGHV mutated with an overrepresentation of IGHV3-23 (19%) and IGHV4-34 (21%). MYD88 L265P and NOTCH2 mutations were observed in one case each, whereas no BRAF V600E mutation or expression was found. All cases demonstrated a high CD180 expression. Those results strengthen the concept that SDRPL does emerge as a new lymphoma entity distinct from the other splenic lymphomas with circulating lymphocytes.
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Affiliation(s)
- Alexandra Traverse-Glehen
- a Service d'Anatomie Pathologique, Hospices Civils de Lyon , Lyon , France.,b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France
| | - Aurélie Verney
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France
| | - Sophie Gazzo
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France.,c Laboratoire de Cytogénétique , Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Laurent Jallades
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France.,d Laboratoire d'Hématologie cellulaire , Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Kaddour Chabane
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France.,d Laboratoire d'Hématologie cellulaire , Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Sandrine Hayette
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France.,d Laboratoire d'Hématologie cellulaire , Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Bertrand Coiffier
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France.,e Service d'Hématologie, Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Evelyne Callet-Bauchu
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France.,c Laboratoire de Cytogénétique , Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Martine Ffrench
- d Laboratoire d'Hématologie cellulaire , Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Pascale Felman
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France.,d Laboratoire d'Hématologie cellulaire , Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Françoise Berger
- a Service d'Anatomie Pathologique, Hospices Civils de Lyon , Lyon , France.,b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France
| | - Lucile Baseggio
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France.,d Laboratoire d'Hématologie cellulaire , Centre Hospitalier Lyon Sud , Pierre Bénite , France
| | - Gilles Salles
- b UMR CNRS 5239 Equipe Pathologie des Cellules Lymphoïdes, Université Lyon 1 , Lyon , France.,e Service d'Hématologie, Centre Hospitalier Lyon Sud , Pierre Bénite , France
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Porwit A, Fend F, Kremer M, Orazi A, Safali M, van der Walt J. Issues in diagnosis of small B cell lymphoid neoplasms involving the bone marrow and peripheral blood. Report on the Bone Marrow Workshop of the XVIIth meeting of the European Association for Haematopathology and the Society for Hematopathology. Histopathology 2016; 69:349-73. [PMID: 27208429 DOI: 10.1111/his.12999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 01/01/2023]
Abstract
Small B cell lymphoid neoplasms are the most common lymphoproliferative disorders involving peripheral blood (PB) and bone marrow (BM). The Bone Marrow Workshop (BMW) organized by the European Bone Marrow Working Group (EBMWG) of the European Association for Haematopathology (EAHP) during the XVIIth EAHP Meeting in Istanbul, October 2014, was dedicated to discussion of cases illustrating how the recent advances in immunophenotyping, molecular techniques and cytogenetics provide better understanding and classification of these entities. Submitted cases were grouped into following categories: (i) cases illustrating diagnostic difficulties in chronic lymphocytic leukaemia (CLL); (ii) cases of BM manifestations of small B cell lymphoid neoplasms other than CLL; (iii) transformation of small B cell lymphoid neoplasms in the BM; and (iv) multiclonality and composite lymphomas in the BM. This report summarizes presented cases and conclusions of the BMW and provides practical recommendations for classification of the BM manifestations of small B cell lymphoid neoplasms based on the current state of knowledge.
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences, Division of Oncology and Pathology, Faculty of Medicine, Lund University, Lund, Sweden.,Previous address: Department of Pathobiology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Marcus Kremer
- Institute of Pathology, Staedtisches Klinikum, München, Germany
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - Jon van der Walt
- Department of Histopathology, Guy's and St Thomas' Hospitals, London, UK
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A Single-center Experience in Splenic Diffuse Red Pulp Lymphoma Diagnosis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16 Suppl:S166-9. [PMID: 27131623 DOI: 10.1016/j.clml.2016.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 11/22/2022]
Abstract
The World Health Organization 2008 classification highlighted a new nosology-splenic diffuse red pulp lymphoma (SDRPL) with clinical and laboratory features similar to both splenic marginal zone lymphoma and hairy cell leukemia (HCL) and variant form of HCL. Experience of hematologists on the diagnosis and differential diagnosis of SDRPL is extremely limited. The aim of our report was to characterize the clinical and immunomorphologic features of SDRPL on our own observations. During 2013-2014, in National Research Center for Hematology, 87 spleen specimens removed from various B-cell lymphomas were analyzed. In four (4.6%) cases, the diagnosis SDRPL was made based on morphologic, immunohistochemical, immunophenotypic, molecular examination of spleen biopsies, blood and bone marrow samples. In all cases of SDRPL were observed significant splenomegaly, lymphocytosis from 56% to 94% (in two cases with leukocytosis 55.000 and 75.000 109/l). The circulating "villous" lymphocytes phenotype was CD20+ (bright), CD11c+/±, CD103 (weakly)+/±, LAIR-1+, CD25-, CD5-, CD10-, and CD23-. Mutation BRAFV600E was not detected. Bone marrow with minor lymphoid CD20+, CD25-, Annexin1-, Cyclin D1- cell infiltration. The average weight of the spleen was 3900 g (1450-9500 g), and morphologically, there was revealed lymphoid infiltration of red pulp with phenotype CD20+, DBA.44+, CD25-, Annexin1-, Cyclin D1-, CD103-, CD123-, CD27-, focal SD11c± and TRAP±. Now patients are observed in remission: two patients after splenectomy, two after splenectomy and cladribine+rituximab chemotherapy. SRDPL-a rare lymphoma that is suspected in the cases with significant splenomegaly and lymphocytosis with villous lymphocytes forms that have only a part of the classic markers HCL, with minor bone marrow infiltration. The standard diagnosis and treatment is splenectomy. Differential diagnosis of SMZL and HCL has clear criteria, but criteria of differentiation with variant HCL are still unknown.
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Splenic marginal zone lymphoma: from genetics to management. Blood 2016; 127:2072-81. [DOI: 10.1182/blood-2015-11-624312] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 03/07/2016] [Indexed: 12/16/2022] Open
Abstract
AbstractSplenic marginal zone lymphoma (SMZL) is a rare B-cell malignancy involving the spleen, bone marrow, and frequently the blood. SMZL lymphomagenesis involves antigen and/or superantigen stimulation and molecular deregulation of genes (NOTCH2 and KLF2) involved in the physiological differentiation of spleen marginal zone B cells. Diagnosis requires either spleen histology or, alternatively, the documentation of a typical cell morphology and immunophenotype on blood cells coupled with the detection of intrasinusoidal infiltration by CD20+ cells in the bone marrow. Among B-cell tumors, deletion of 7q and NOTCH2 mutations are almost specific lesions of SMZL, thus representing promising diagnostic biomarkers of this lymphoma. Although the majority of SMZLs show an indolent course with a median survival of approximately 10 years, nearly 30% of patients experience a poor outcome. No randomized trials are reported for SMZL, and few prospective trials are available. A watch-and-wait approach is advisable for asymptomatic patients. Treatment options for symptomatic patients ranges from splenectomy to rituximab alone or combined with chemotherapy. In some geographic areas, a subset of patients with SMZL associates with hepatitis C virus infection, prompting virus eradication as an effective lymphoma treatment. It would be worthwhile to explore deregulated cellular programs of SMZL as therapeutic targets in the future; improved clinical and biological prognostication will be essential for identifying patients who may benefit from novel approaches.
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Al-Radi LS, Moiseeva TN, Julhakyan HL, Ntanishyan KI, Kovrigina AM, Glebova SM, Lugovskaya SA, Dvirnyk VN, Khvastunova AN, Yakutik IA, Savchenko VG. [Experience in investigating splenic red pulp lymphoma]. TERAPEVT ARKH 2016; 88:53-60. [PMID: 27070164 DOI: 10.17116/terarkh201688453-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To generalize hematologists' experience of the diagnosis and differential diagnosis of splenic red pulp lymphoma (SRPL). MATERIAL AND METHODS Eighty-seven splenic biopsy specimens taken from patients with different B-cell lymphoproliferative diseases were examined in the Hematology Research Center in 2013-2014. The diagnosis of SRPL was based on the morphological, immunohistochemical, immunophenotypic, and molecular examinations of the splenic biopsy specimens, blood and bone marrow (BM) tests in 4 (4.6%) cases. RESULTS There was significant splenomegaly in all SRPL cases, lymphocytosis in 56 to 94% (leukocytes, 55 and 75·109/l in 2 cases), circulation of hairy lymphocytes with the phenotypes CD20+ (markedly), CD11c+/±, CD103+/± (weakly), LAIR-1+, CD25-, CD5-, CD10-, and CD23-, which did not contain tartate-resistant acid phosphatase, without BRAFV600E mutation, BM with insignificant lymphoid infiltration of CD20+, CD25-, Annexin 1-, and Cyclin D1-. The weight of the spleen averaged 3900 g (1450-9500 g); its tissue exhibited lymphoid infiltration of the red pulp with the phenotypes CD20+, DBA.44+, CD25-, Annexin1-, Cyclin D1-, CD103-, CD123-, CD27-, focal СD11c±, and TRAP±. Four patients (2 after splenectomy (SE) and 2 after SE and chemotherapy with cladribine and rituximab) are being followed up in remission. CONCLUSION SRPL is a rare disease that should be presumed to be in significant splenomegaly and lymphocytosis with hairy lymphocytes, which have only some markers for classical hairy cell leukemia (HCL), in minor BM lesion. SE is the standard for diagnosis and treatment. The differential diagnosis of SRPL with HCL has clear criteria and that with HCL-v is undetected.
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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
| | - H L Julhakyan
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - K I Ntanishyan
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A M Kovrigina
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - S M Glebova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - S A Lugovskaya
- Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow, Russia
| | - V N Dvirnyk
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A N Khvastunova
- Dmitry Rogachev Federal Research-and-Clinical Center for Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - I A Yakutik
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V G Savchenko
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
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47
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CD27-positive hairy cell leukemia-Japanese variant. Virchows Arch 2016; 468:375-9. [DOI: 10.1007/s00428-015-1881-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/18/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
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Mestrallet F, Sujobert P, Sarkozy C, Traverse-Glehen A, Callet-Bauchu E, Magaud JP, Salles G, Baseggio L. CD180 overexpression in follicular lymphoma is restricted to the lymph node compartment. CYTOMETRY PART B-CLINICAL CYTOMETRY 2015; 90:433-9. [PMID: 26482097 DOI: 10.1002/cyto.b.21331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/01/2015] [Accepted: 10/14/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Altered Toll-like receptor (TLR) expression levels and/or mutations in its signaling pathway (such as MyD88 mutation) contribute to the pathogenesis of lymphoproliferative disorders (LPD). CD180 is an orphan member of the TLR family that modulates the signaling of several TLRs, but only limited studies have evaluated its expression by flow cytometry (FCM) in LPD. METHODS Using a multiparameter FCM approach, we have assessed CD180 mean fluorescence intensity (MFI) in lymph nodes (LNs) and peripheral blood (PB) samples obtained from patients with follicular lymphoma (FL; LN/PB, n = 44/n = 15), chronic lymphocytic leukemia (CLL, n = 26/n = 21), mantle cell lymphoma (MCL, n = 13/n = 17), and marginal zone lymphoma (MZL, n = 16/n = 12). Specimens from non-tumoral PB and LN (n = 8/n = 12) were used as controls. RESULTS In the LN specimens, FL and control B-cells showed similar CD180 expression (MFI = 1,049 vs. 1,381, P > 0.05; Mann-Whitney U-test). This level was markedly lower in the other LPDs, MCL (MFI = 396, P < 0.05), or CLL (MFI = 502 P < 0.05), and similar to MZL (MFI = 858, P > 0.05). However, the CD180 expression of FL B-cells assessed in PB was dim and/or negative, in the same range as MCL and CLL (FL MFI = 453, MCL MFI = 305, CLL MFI = 420, P > 0.05) but lower than in MZL (MFI = 895, P < 0.05). Therefore, these results suggest a modulation of CD180 expression by neoplastic FL B-cells based on the anatomical compartment. CONCLUSION These FCM data confirm the usefulness of CD180 in the accurate diagnosis of LPDs and emphasize the need to interpret this marker according to the origin of the sample. © 2015 Clinical Cytometry Society.
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Affiliation(s)
| | - Pierre Sujobert
- Laboratoire D'hématologie Cellulaire, Pierre-Bénite, France.,UMR5239 Pathologies Des Cellules Lymphoïdes, Université Claude Bernard, Lyon, France
| | - Clémentine Sarkozy
- UMR5239 Pathologies Des Cellules Lymphoïdes, Université Claude Bernard, Lyon, France.,Service D'hématologie Centre Hospitalier Lyon-Sud/Hospices Civils De Lyon, Pierre-Bénite, France
| | - Alexandra Traverse-Glehen
- UMR5239 Pathologies Des Cellules Lymphoïdes, Université Claude Bernard, Lyon, France.,Service d'Anatomie-Pathologique, Pierre-Bénite, France
| | - Evelyne Callet-Bauchu
- Laboratoire D'hématologie Cellulaire, Pierre-Bénite, France.,UMR5239 Pathologies Des Cellules Lymphoïdes, Université Claude Bernard, Lyon, France
| | - Jean-Pierre Magaud
- Laboratoire D'hématologie Cellulaire, Pierre-Bénite, France.,UMR5239 Pathologies Des Cellules Lymphoïdes, Université Claude Bernard, Lyon, France
| | - Gilles Salles
- UMR5239 Pathologies Des Cellules Lymphoïdes, Université Claude Bernard, Lyon, France.,Service D'hématologie Centre Hospitalier Lyon-Sud/Hospices Civils De Lyon, Pierre-Bénite, France
| | - Lucile Baseggio
- Laboratoire D'hématologie Cellulaire, Pierre-Bénite, France. .,UMR5239 Pathologies Des Cellules Lymphoïdes, Université Claude Bernard, Lyon, France.
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49
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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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Matutes E, Martínez-Trillos A, Campo E. Hairy cell leukaemia-variant: Disease features and treatment. Best Pract Res Clin Haematol 2015; 28:253-63. [PMID: 26614904 DOI: 10.1016/j.beha.2015.09.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
Hairy cell leukaemia-variant (HCL-V) is a rare B-cell malignancy that affects elderly males and manifests with splenomegaly, lymphocytosis and cytopenias without monocytopenia. The neoplastic cells have morphological features of prolymphocytes and hairy cells. The immunophenotype is that of a clonal B-cell CD11c and CD103 positive but, unlike classical HCL, CD25, CD123 and CD200 negative. The spleen histology is similar to classical HCL and the pattern of bone marrow infiltration is interstitial and/or intrasinusoidal. Mutations of the immunoglobulin heavy chain (IGVH) are seen in two thirds of cases with a preferential VH4-34 family usage. There is no distinct chromosomal abnormality but del17p13 and mutations of the TP53 gene are frequent. Mutations in the MAP2K1 gene have been documented in half of the cases. The course is chronic with median survivals of 7-9 years. Patients are refractory to purine analogues and the most effective therapy is the combination of 2-chlorodeoxyadenosine and Rituximab.
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Affiliation(s)
- Estella Matutes
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | | | - Elias Campo
- Hematopathology Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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