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Attygalle AD, Chan JKC, Coupland SE, Du MQ, Ferry JA, Jong DD, Gratzinger D, Lim MS, Naresh KN, Nicolae A, Ott G, Rosenwald A, Schuh A, Siebert R. The 5th edition of the World Health Organization Classification of mature lymphoid and stromal tumors - an overview and update. Leuk Lymphoma 2024; 65:413-429. [PMID: 38189838 DOI: 10.1080/10428194.2023.2297939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 01/09/2024]
Abstract
The purpose of this review is to give an overview on the conceptual framework and major developments of the upcoming 5th edition of the World Health Organization (WHO) Classification of Haematolymphoid tumours (WHO-HAEM5) and to highlight the most significant changes made in WHO-HAEM5 compared with the revised 4th edition (WHO-HAEM4R) of lymphoid and stromal neoplasms. The changes from the revised 4th edition include the reorganization of entities by means of a hierarchical system that is realized throughout the 5th edition of the WHO classification of tumors of all organ systems, a modification of nomenclature for some entities, the refinement of diagnostic criteria or subtypes, deletion of certain entities, and introduction of new entities. For the first time, tumor-like lesions, mesenchymal lesions specific to lymph node and spleen, and germline predisposition syndromes associated with the lymphoid neoplasms are included in the classification.
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Affiliation(s)
- Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden Hospital, London, UK
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong, SAR China
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, ISMIB, University of Liverpool, Liverpool, UK
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Ming-Qing Du
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daphne de Jong
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Megan S Lim
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Kikkeri N Naresh
- Fred Hutchinson Cancer Center, University of Washington, Seattle, USA
| | - Alina Nicolae
- Department of Pathology, University Hospital of Strasbourg, Strasbourg, France
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Andreas Rosenwald
- Institute of Pathology, Julius-Maximilians-UniversitätWürzburg, and Cancer Center Mainfranken, Würzburg, Germany
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
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2
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Lin CW, Zheng JQ, Tzou KY, Fang YA, Kao WT, Lin HT, Liu JC, Huang YH, Lin YF, Lu KC, Dong SW, Zheng CM, Wu CC. Influenza vaccination is associated with lower risk of renal cell carcinoma among chronic kidney disease patients: a population-based cohort study. Clin Kidney J 2023; 16:1936-1946. [PMID: 37915887 PMCID: PMC10616448 DOI: 10.1093/ckj/sfad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Indexed: 11/03/2023] Open
Abstract
Background Chronic kidney disease (CKD) patients possess a higher risk for renal cell carcinoma (RCC) possibly because of related underlying inflammation and immune dysregulation. In the current population-based cohort study, we evaluate the effects of influenza vaccination on RCC among CKD patients. Methods We analysed the vaccinated and unvaccinated CKD patients (≥55 years of age) identified from the Taiwan National Health Insurance Database. Propensity score matching was used to reduce the selection bias. Subgroup analyses based on comorbid conditions, dialysis status and vaccinated dosages were also conducted. Results The incidence of RCC decreased significantly in the vaccinated compared with unvaccinated group {unadjusted hazard ratio [HR] 0.50 [95% confidence interval (CI) 0.31-0.81], P < .01; adjusted HR 0.46 [95% CI 0.28-0.75], P < .01}. Such protective effects of influenza vaccination were noted significantly among those ≥75 years of age [unadjusted HR 0.29 (95% CI 0.12-0.74), P < .01; adjusted HR 0.22 (95% CI 0.08-0.58), P < .01]. A reverse association was noted between the total number of vaccinations and RCC events in both unadjusted and adjusted models. The Kaplan-Meier estimates of the RCC events showed significantly higher free survival rates in the vaccinated as compared with the unvaccinated patients (logrank P = .005). Conclusion This population-based cohort study found a significant inverse relationship between influenza vaccination and the risk of RCC in CKD patients and the protective effects were more prominent in patients >75 years of age. A possible relation exists between the total number of vaccinations and RCC events. Future randomized clinical and basic studies will be needed to prove these findings and underlying pathophysiological mechanisms.
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Affiliation(s)
- Chia-Wei Lin
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jing-Quan Zheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kai-Yi Tzou
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Medical University Research Centre of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ann Fang
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wei-Tang Kao
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Medical University Research Centre of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Ting Lin
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ju-Chi Liu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Han Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuh-Feng Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Shao-Wei Dong
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cai-Mei Zheng
- Taipei Medical University Research Centre of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Medical University Research Centre of Urology and Kidney, Taipei Medical University, Taipei, Taiwan
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Bender ST, Zeremski V, Wiech T, Mertens PR, Gross C. Case report: Acute kidney injury as the initial manifestation of chronic lymphocytic leukemia/small lymphocytic lymphoma. Front Med (Lausanne) 2023; 10:1279005. [PMID: 37928472 PMCID: PMC10622965 DOI: 10.3389/fmed.2023.1279005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a lymphoproliferative disorder often diagnosed after incidental finding of leukocytosis. Renal involvement is usually clinically silent. Symptomatic renal impairment due to CLL/small lymphocytic lymphoma (SLL) cell infiltration in the kidney tissue is uncommon, and acute kidney injury (AKI) as a presenting feature is rare. In this case report, we describe the case of a patient with AKI caused by CLL/SLL infiltration as a presenting feature. Our report highlights the possibility of kidney injury as the first evident symptom of CLL/SLL. Kidney biopsy is the mainstay in these cases in order to establish a diagnosis. Treatment with zanubrutinib resulted in improved kidney function.
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Affiliation(s)
- Sascha T. Bender
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Vanja Zeremski
- University Hospital for Hematology and Oncology, Otto-von-Guericke University, Magdeburg, Germany
| | - Thorsten Wiech
- Institute for Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Peter R. Mertens
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
| | - Christian Gross
- University Clinic for Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University, Magdeburg, Germany
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Belizaire R, Wong WJ, Robinette ML, Ebert BL. Clonal haematopoiesis and dysregulation of the immune system. Nat Rev Immunol 2023; 23:595-610. [PMID: 36941354 PMCID: PMC11140722 DOI: 10.1038/s41577-023-00843-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/23/2023]
Abstract
Age-related diseases are frequently linked to pathological immune dysfunction, including excessive inflammation, autoreactivity and immunodeficiency. Recent analyses of human genetic data have revealed that somatic mutations and mosaic chromosomal alterations in blood cells - a condition known as clonal haematopoiesis (CH) - are associated with ageing and pathological immune dysfunction. Indeed, large-scale epidemiological studies and experimental mouse models have demonstrated that CH can promote cardiovascular disease, chronic obstructive pulmonary disease, chronic liver disease, osteoporosis and gout. The genes most frequently mutated in CH, the epigenetic regulators TET2 and DNMT3A, implicate increased chemokine expression and inflammasome hyperactivation in myeloid cells as a possible mechanistic connection between CH and age-related diseases. In addition, TET2 and DNMT3A mutations in lymphoid cells have been shown to drive methylation-dependent alterations in differentiation and function. Here we review the observational and mechanistic studies describing the connection between CH and pathological immune dysfunction, the effects of CH-associated genetic alterations on the function of myeloid and lymphoid cells, and the clinical and therapeutic implications of CH as a target for immunomodulation.
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Affiliation(s)
- Roger Belizaire
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Waihay J Wong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle L Robinette
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Benjamin L Ebert
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Howard Hughes Medical Institute, Dana-Farber Cancer Institute, Boston, MA, USA.
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5
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Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients—A Comparison between Different Immunomodulating Conditions. Cancers (Basel) 2023; 15:cancers15061764. [PMID: 36980651 PMCID: PMC10046308 DOI: 10.3390/cancers15061764] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background: Immunosuppression is strongly associated with an increased risk of developing cutaneous squamous cell carcinoma (cSCC). Studies on solid organ transplant recipients (SOTR) and chronic lymphocytic leukemia (CLL) patients have already demonstrated higher rates of aggressive cSCC tumors in these populations compared to immunocompetent controls. Studies on other immunosuppressed patient groups are scarce. This study was aimed at assessing the effects of different immunomodulating conditions on patients diagnosed with cSCC. We sought to compare the clinical features, treatments, and survival rates among the different study groups, as well as outcomes to those of immunocompetent controls with cSCC. Methods: A retrospective analysis of 465 cSCC patients, both immunosuppressed (IS) and immunocompetent controls. Etiologies for immunosuppression included SOTR, CLL, chronic kidney disease (CKD), psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematous (SLE). Results: Compared to the control group, IS patients demonstrated several significant differences. These include higher rates of positive resection margins, higher recurrence rates, and multiple SCC tumors. Patients in the IS group, who were also given immunomodulating agents, demonstrated even lower survival rates. Cox regression analysis demonstrated statistically significant decreased overall survival (OS) rates for IS patients compared to the controls (OR = 1.9, p = 0.031). SOTR patients tend to have multiple cSCC tumors (35%), with the highest number of primary tumors compared to controls (2.54 tumors per patient on average, p < 0.001), but also compared to all other IS groups. The average SCC lesion size in the SOTR group was the smallest, measuring at 13.5 mm, compared to the control group and all other IS groups. Decreased survival rates were seen on Cox regression analysis compared to controls (HR = 2.4, p = 0.001), but also to all other IS groups. CLL patients also had the highest rates of positive margins compared to controls (36% vs. 9%, p < 0.01) and to all other IS groups. They were also most likely to get adjuvant or definitive oncological treatments, either radiotherapy or chemotherapy, compared to controls (36% vs. 15%, p = 0.02) and to other IS groups. Patients in the CKD group demonstrated the highest rates for multiple cSCC (OR = 4.7, p = 0.001) and the worst rates of survival on Cox regression analysis (HR = 3.2, p = 0.001). Both rheumatoid arthritis and psoriasis patients demonstrated the shortest disease-free survival rates (2.9y ± 1.1, 2.3y ± 0.7, respectively), compared to controls (4.1y ± 2.8) and to all other IS groups. Conclusions: Among cSCC patients, immunosuppression due to SOTR, CLL, CKD, RA, and psoriasis is associated with worse outcomes compared to controls and other IS groups. These patients should be regarded as high-risk for developing aggressive cSCC tumors. This study is the first to assess and compare cSCC outcomes among multiple IS patient groups.
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6
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Tang C, Shen Y, Soosapilla A, Mulligan SP. Monoclonal B-cell Lymphocytosis - a review of diagnostic criteria, biology, natural history, and clinical management. Leuk Lymphoma 2022; 63:2795-2806. [PMID: 35767361 DOI: 10.1080/10428194.2022.2092857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since first described almost two decades ago, there has been significant evolution in our definition and understanding of the biology and implications of monoclonal B-cell lymphocytosis (MBL). This review provides an overview of the definition, classification, biology, and natural history of MBL, mainly focused on the dominant CLL-like phenotype form of MBL. The increasingly recognized implications of MBL with respect to immune dysfunction are discussed, particularly in view of the COVID-19 pandemic, along with management recommendations for MBL in the clinic.
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Affiliation(s)
- Catherine Tang
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia.,Department of Haematology, Gosford Hospital, Gosford, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Yandong Shen
- Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Kolling Institute, University of Sydney, St Leonards, Sydney, Australia
| | - Asha Soosapilla
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia
| | - Stephen P Mulligan
- Department of Haematology and Flow Cytometry, Laverty Pathology, Sydney, Australia.,Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Kolling Institute, University of Sydney, St Leonards, Sydney, Australia
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7
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Andersen MA, Grand MK, Brieghel C, Siersma V, Andersen CL, Niemann CU. Pre-diagnostic trajectories of lymphocytosis predict time to treatment and death in patients with chronic lymphocytic leukemia. COMMUNICATIONS MEDICINE 2022; 2:50. [PMID: 35603299 PMCID: PMC9098503 DOI: 10.1038/s43856-022-00117-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background The dynamics of pre-diagnostic lymphocytosis in patients with ensuing chronic lymphocytic leukemia (CLL) need to be explored as a better understanding of disease progression may improve treatment options and even lead to disease avoidance approaches. Our aim was to investigate the development of lymphocytosis prior to diagnosis in a population-based cohort of patients with CLL and to assess the prognostic information in these pre-diagnostic measurements. Methods All patients diagnosed with CLL in the Greater Copenhagen area between 2008 and 2016 were included in the study. Pre-diagnostic blood test results were obtained from the Copenhagen Primary Care Laboratory Database encompassing all blood tests requested by Copenhagen general practitioners. Using pre-diagnostic measurements, we developed a model to assess the prognosis following diagnosis. Our model accounts for known prognostic factors and corresponds to lymphocyte dynamics after diagnosis. Results We explore trajectories of lymphocytosis, associated with known recurrent mutations. We show that the pre-diagnostic trajectories are an independent predictor of time to treatment. The implementation of pre-diagnostic lymphocytosis slope groups improved the model predictions (compared to CLL-IPI alone) for treatment throughout the period. The model can manage the heterogeneous data that are to be expected from the real-world setting and adds further prognostic information. Conclusions Our findings further knowledge of the development of CLL and may eventually make prophylactic measures possible. While clinicians largely agree that patients with chronic lymphocytic leukemia (CLL) have increased levels of white blood cells in the years preceding their diagnosis, there is less certainty as to how and when this increase occurs. A better understanding of how white blood cell levels change during this period might help us to predict who will become ill and require treatment. In this work, we explore patterns of white blood cell growth and develop a tool to predict the time to treatment for CLL based on these growth rates. Using our tool in the clinic might help clinicians to decide who needs treatment for CLL and when, potentially leading to better outcomes for patients. Andersen et al. evaluate lymphocyte dynamics in chronic lymphocytic leukemia (CLL) patients prior to diagnosis. The authors develop a model to predict risk of requiring CLL treatment or death based on pre-diagnostic lymphocyte growth rates.
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Akhtar OS, Groman A, Singh A, Ghione P, Lund I, Hernandez-Ilizaliturri FJ, Torka P. Frequency and timing of other primary cancers in patients with chronic lymphocytic leukemia (CLL): a 17-year longitudinal study. Leuk Lymphoma 2022; 63:1127-1136. [DOI: 10.1080/10428194.2021.2012662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Othman Salim Akhtar
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Adrienne Groman
- Department of Biostatistics and Statistical Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Paola Ghione
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ian Lund
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Mettler C, Petit C, Ernest V, Asli B, Daniel MT, Mathis S, Zini JM, Faucher B, Ebbo M, Legendre P, Malphettes M. Erythroblastic synartesis associated with lymphoproliferative disorder: There can be more than meets the eye. Clin Immunol 2022; 236:108951. [DOI: 10.1016/j.clim.2022.108951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
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Abstract
Patients with chronic lymphocytic leukemia can be divided into three categories: those who are minimally affected by the problem, often never requiring therapy; those that initially follow an indolent course but subsequently progress and require therapy; and those that from the point of diagnosis exhibit an aggressive disease necessitating treatment. Likewise, such patients pass through three phases: development of the disease, diagnosis, and need for therapy. Finally, the leukemic clones of all patients appear to require continuous input from the exterior, most often through membrane receptors, to allow them to survive and grow. This review is presented according to the temporal course that the disease follows, focusing on those external influences from the tissue microenvironment (TME) that support the time lines as well as those internal influences that are inherited or develop as genetic and epigenetic changes occurring over the time line. Regarding the former, special emphasis is placed on the input provided via the B-cell receptor for antigen and the C-X-C-motif chemokine receptor-4 and the therapeutic agents that block these inputs. Regarding the latter, prominence is laid upon inherited susceptibility genes and the genetic and epigenetic abnormalities that lead to the developmental and progression of the disease.
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Affiliation(s)
- Nicholas Chiorazzi
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York 11030, USA
| | - Shih-Shih Chen
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York 11030, USA
| | - Kanti R. Rai
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, USA
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11
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Blanco G, Puiggros A, Sherry B, Nonell L, Calvo X, Puigdecanet E, Chiu PY, Kieso Y, Ferrer G, Palacios F, Arnal M, Rodríguez-Rivera M, Gimeno E, Abella E, Rai KR, Abrisqueta P, Bosch F, Calon A, Ferrer A, Chiorazzi N, Espinet B. Chronic lymphocytic leukemia-like monoclonal B-cell lymphocytosis exhibits an increased inflammatory signature that is reduced in early-stage chronic lymphocytic leukemia. Exp Hematol 2021; 95:68-80. [PMID: 33421548 DOI: 10.1016/j.exphem.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022]
Abstract
Several studies in chronic lymphocytic leukemia (CLL) patients have reported impaired immune cell functions, which contribute to tumor evasion and disease progression. However, studies on CLL-like monoclonal B-cell lymphocytosis (MBL) are scarce. In the study described here, we characterized the immune environment in 62 individuals with clinical MBL, 56 patients with early-stage CLL, and 31 healthy controls. Gene expression arrays and quantitative reverse transcription polymerase chain reaction were performed on RNA from CD4+ peripheral blood cells; serum cytokines were measured with immunoassays; and HLA-DR expression on circulating monocytes, as well as the percentages of Th1, cytotoxic, exhausted, and effector CD4+ T cells, were evaluated by flow cytometry. In addition, cell cultures of clonal B cells and CD14-enriched or -depleted cell fractions were performed. Strikingly, MBL and early-stage CLL differed in pro-inflammatory signatures. An increased inflammatory drive orchestrated mainly by monocytes was identified in MBL, which exhibited enhanced phagocytosis, pattern recognition receptors, interleukin-8 (IL8), HMGB1, and acute response signaling pathways and increased pro-inflammatory cytokines (in particular IL8, interferon γ [IFNγ], and tumor necrosis factor α). This inflammatory signature was diminished in early-stage CLL (reduced IL8 and IFNγ levels, IL8 signaling pathway, and monocytic HLA-DR expression compared with MBL), especially in those patients with mutations in IGHV genes. Additionally, CD4+ T cells of MBL and early-stage CLL exhibited a similar upregulation of Th1 and cytotoxic genes and expanded CXCR3+ and perforin+ CD4+ T cells, as well as PD1+ CD4+ T cells, compared with controls. Cell culture assays disclosed tumor-supporting effects of monocytes similarly observed in MBL and early-stage CLL. These novel findings reveal differences in the inflammatory environment between MBL and CLL, highlighting an active role for antigen stimulation in the very early stages of the disease, potentially related to malignant B-cell transformation.
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Affiliation(s)
- Gonzalo Blanco
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Anna Puiggros
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Barbara Sherry
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, NY; Department of Medicine, Hofstra Northwell School of Medicine, Hempstead, NY; Department of Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY
| | | | - Xavier Calvo
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | | | - Pui Yan Chiu
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Yasmine Kieso
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Gerardo Ferrer
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Florencia Palacios
- Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | | | - María Rodríguez-Rivera
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Eva Gimeno
- Servei d'Hematologia, Hospital del Mar-IMIM, Barcelona, Spain; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Eugènia Abella
- Servei d'Hematologia, Hospital del Mar-IMIM, Barcelona, Spain; Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Cancer Research Program, IMIM-Hospital del Mar, Barcelona, Spain
| | - Kanti R Rai
- Department of Medicine, Hofstra Northwell School of Medicine, Hempstead, NY; Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Pau Abrisqueta
- Servei d'Hematologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francesc Bosch
- Servei d'Hematologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alexandre Calon
- Laboratori de Recerca Translacional en Microambient Tumoral, Cancer Research Program, IMIM, Barcelona, Spain
| | - Ana Ferrer
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Nicholas Chiorazzi
- Department of Medicine, Hofstra Northwell School of Medicine, Hempstead, NY; Department of Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY; Karches Center for Oncology Research, The Feinstein Institute for Medical Research, Manhasset, NY
| | - Blanca Espinet
- Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, Barcelona, Spain; Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research Program, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
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12
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Yokus O, Saglam EN, Goze H, Sametoglu F, Serin I. Prognostic Role of Lymphocyte/Monocyte Ratio in Chronic Lymphocytic Leukemia. J Hematol 2020; 9:116-122. [PMID: 33224391 PMCID: PMC7665864 DOI: 10.14740/jh730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background Chronic lymphocytic leukemia (CLL) is a B-lymphoproliferative disease with varying clinical characteristics, which occurs mostly in older ages. In studies from literature, we see that different parameters are examined to determine the prognosis of CLL. The main purpose of our study is to determine the relationship of lymphocyte/monocyte ratio (LMR) value in CLL, which has been previously shown to be a prognostic factor in various solid organ tumors and some hematological malignancies. Methods A total of 173 patients who were followed up between 2005 and 2019 were retrospectively analyzed. The diagnostic age, gender, laboratory, absolute lymphocyte and monocyte count, LMR and overall survival (OS), treatment and responses, recurrence, cytogenetic subtype and mortality rates were examined. Results The median LMR was 26.7 and it was considered as cut-off value of 26. A positive correlation was found between LMR and Rai Stage. LMR was significantly higher in patients who have an indication for treatment or who died. Conclusions In our study, in CLL, LMR has been shown to be over 26 in advanced stages, in relapse or with indication of a treatment. With the increase of LMR, it was found that survival and disease-free gap decreased.
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Affiliation(s)
- Osman Yokus
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Esma Nur Saglam
- Department of Internal Medicine, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Hasan Goze
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Fettah Sametoglu
- Department of Internal Medicine, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
| | - Istemi Serin
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Fatih, Istanbul, Turkey
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13
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Singh N, Mott SL, Sutamtewagul G, McCarthy A, Slager SL, Cerhan JR, Ballas Z, Link BK. Prevalence and the impact of hypogammaglobulinemia in newly diagnosed chronic lymphocytic lymphoma patients. EJHAEM 2020; 1:537-544. [PMID: 35845010 PMCID: PMC9176078 DOI: 10.1002/jha2.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 11/08/2022]
Abstract
Objective To examine the prevalence of hypogammaglobulinemia in chronic lymphocytic lymphoma (CLL) patients and to test the hypothesis that patients with hypogammaglobulinemia have a distinct clinical profile and outcome. Methods Immunoglobulin levels (IgA, IgG, IgM, IgE) were measured in newly diagnosed, treatment naïve banked samples of 150 patients with CLL followed prospectively for outcomes. Cox regression models were used to assess the effects of clinical variables on overall survival (OS). Results The median age of the selected CLL cohort was 64 years with a male predominance; 96.2% of the patients were white. Fifty-nine deaths occurred during a median follow up of 6.8 years. Hypogammaglobulinemia in CLL was common in our cohort with 88 (58.7%, 95% CI: 50.4-66.6%) patients having a measurable isotype deficiency. The most common Ig deficiency was IgM (44.0%). IgA deficiency or low IgE was associated with higher Rai stages as well as with higher white blood cell counts at presentation. Any immunoglobulin deficiency was not associated with overall survival. Conclusion A significant proportion of treatment-naïve CLL patients had underlying Ig deficiencies - both in isolation and in isotype combinations. Although a deficiency of IgA or IgE was associated with more severe disease at presentation, the impact of this association was mild.
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Affiliation(s)
- Namrata Singh
- Division of RheumatologyUniversity of WashingtonSeattleWashingtonUSA
- Holden Comprehensive Cancer Center (HCCC)University of IowaIowa CityIowaUSA
| | - Sarah L. Mott
- Holden Comprehensive Cancer Center (HCCC)University of IowaIowa CityIowaUSA
| | - Grerk Sutamtewagul
- Holden Comprehensive Cancer Center (HCCC)University of IowaIowa CityIowaUSA
- Division of Allergy and ImmunologyUniversity of IowaIowa CityIowaUSA
| | - Ashley McCarthy
- Holden Comprehensive Cancer Center (HCCC)University of IowaIowa CityIowaUSA
| | - Susan L. Slager
- Mayo ClinicDivision of Biomedical Statistics and InformaticsRochesterMinnesotaUSA
| | | | - Zuhair Ballas
- Holden Comprehensive Cancer Center (HCCC)University of IowaIowa CityIowaUSA
- Division of Allergy and ImmunologyUniversity of IowaIowa CityIowaUSA
| | - Brian K. Link
- Holden Comprehensive Cancer Center (HCCC)University of IowaIowa CityIowaUSA
- Division of Hematology and OncologyUniversity of IowaIowa CityIowaUSA
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14
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Risk factors for hypogammaglobulinemia in chronic lymphocytic leukemia patients treated with anti-CD20 monoclonal antibody-based therapies. J Hematop 2020. [DOI: 10.1007/s12308-020-00417-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Corbingi A, Innocenti I, Tomasso A, Pasquale R, Visentin A, Varettoni M, Flospergher E, Autore F, Morelli F, Trentin L, Reda G, Efremov DG, Laurenti L. Monoclonal gammopathy and serum immunoglobulin levels as prognostic factors in chronic lymphocytic leukaemia. Br J Haematol 2020; 190:901-908. [PMID: 32712965 DOI: 10.1111/bjh.16975] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/31/2020] [Indexed: 12/17/2022]
Abstract
The relationship between chronic lymphocytic leukaemia (CLL) and qualitative/quantitative gammaglobulin abnormalities is well established. Nevertheless, in order to better understand this kind of connection, we examined 1505 patients with CLL and divided them into four subgroups on the basis of immunoglobulin (Ig) aberrations at diagnosis. A total of 73 (4·8%), 149 (10%), 200 (13·2%) and 1083 (72%) patients were identified with IgM monoclonal gammopathy (IgM/CLL), IgG monoclonal gammopathy (IgG/CLL), hypogammaglobulinaemia (hypo-γ) and normal Ig levels (γ-normal) respectively. IgM paraprotein was significantly associated with a more advanced Binet/Rai stage and del(17p)/TP53 mutation, while IgG abnormalities correlated with a higher occurrence of trisomy 12. Patients with any type of Ig abnormality had shorter treatment-free survival (TFS) but no significant impact affecting overall survival (OS) compared to those with normal Ig levels.
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Affiliation(s)
- Andrea Corbingi
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Idanna Innocenti
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annamaria Tomasso
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Raffaella Pasquale
- Department of Hematology, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Marzia Varettoni
- Department of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Flospergher
- Department of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Autore
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Morelli
- Department of Hematology, Università degli Studi di Firenze, Florence, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Gianluigi Reda
- Department of Hematology, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dimitar G Efremov
- Molecular Haematology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Luca Laurenti
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
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16
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Antimicrobial use before chronic lymphocytic leukemia: a retrospective cohort study. Leukemia 2020; 35:747-751. [PMID: 32684631 DOI: 10.1038/s41375-020-0980-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 11/08/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is accompanied by increased risk of potentially fatal infections. While this can mostly be attributed to disease-related immune dysfunction, it is not known if CLL patients are also constitutionally susceptible to infections. We linked nation-wide Danish registers to explore this possibility, approximating infection susceptibility by use of antimicrobials. We assessed the incidence of antimicrobials among CLL patients and matched controls from the general population for up to 22 years before index diagnosis, and among children and grandchildren of CLL patients and their matched controls. Our analyses showed that for CLL patients overall antimicrobial use began to increase gradually six years before leukemia diagnosis. Before this time point, CLL patients had used significantly more macrolides (relative risk = 1.15; 95% confidence interval 1.10-1.20), antimycotics (1.18; 1.08-1.30), and antivirals (1.62; 1.45-1.81) than controls for up to 22 years before diagnosis. The same pattern of increased use was found among CLL patients' children and grandchildren. Our study suggests that CLL diagnosis is preceded by decades of increased susceptibility to infections. The duration of this time window is compatible with causal roles of immune dysfunction and/or certain infections in CLL pathogenesis, possibly mediating the association between constitutional infection susceptibility and CLL risk.
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17
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IgA levels at diagnosis predict for infections, time to treatment, and survival in chronic lymphocytic leukemia. Blood Adv 2020; 3:2188-2198. [PMID: 31324639 DOI: 10.1182/bloodadvances.2018026591] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/01/2019] [Indexed: 01/29/2023] Open
Abstract
To better understand the relationship between baseline immunoglobulin measurements and subsequent clinical outcomes in chronic lymphocytic leukemia (CLL), we performed a retrospective analysis on 660 patients with CLL (72%), monoclonal B-cell lymphocytosis (MBL) (13%), and small lymphocytic lymphoma (SLL) (14%), diagnosed between 2005 and 2014 at CancerCare Manitoba. Of 511 patients who had their first immunoglobulin level determined within 3 months of diagnosis, abnormal (either increased or decreased) immunoglobulin M (IgM), IgG, and IgA values were observed in 58% of patients with CLL, 27% of patients with MBL, and 20% of patients with SLL. Immunoglobulin deviances were similar for MBL and CLL Rai stage 0 and for SLL and Rai stages I and II; for CLL, IgG and IgA abnormalities occurred with increasing frequency with advancing Rai stage. In contrast, the frequency of IgM abnormalities was similar in all patient groups. IgA abnormalities significantly correlated with high β2-microglobulin (B2M) expression, whereas abnormal IgG and IgA levels were associated with the use of IGHV1-69, 3-21, and 3-49 subtypes. Increases in IgG or IgM were commonly associated with the presence of a CLL-type M-band, whereas oligoclonal bands were frequently observed with increased IgA levels. Although abnormal levels of IgG and IgA at diagnosis were independent predictors for future immunoglobulin replacement, only abnormal IgA levels were associated with shorter time to first treatment and overall survival. These findings indicate that both reduced and elevated levels of IgG and IgA at diagnosis are important and independent prognostic markers for infection in CLL, with IgA being more relevant as a marker of disease progression and survival.
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18
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Inaida S, Matsuno S. Previous Infection Positively Correlates to the Tumor Incidence Rate of Patients with Cancer. Cancer Immunol Res 2020; 8:580-586. [DOI: 10.1158/2326-6066.cir-19-0510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/11/2019] [Accepted: 03/12/2020] [Indexed: 11/16/2022]
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19
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Maqbool MG, Tam CS, Morison IM, Simpson D, Mollee P, Schneider H, Chan H, Juneja S, Harvey Y, Nath L, Hissaria P, Prince HM, Wordsworth H, Opat S, Talaulikar D. A practical guide to laboratory investigations at diagnosis and follow up in Waldenström macroglobulinaemia: recommendations from the Medical and Scientific Advisory Group, Myeloma Australia, the Pathology Sub-committee of the Lymphoma and Related Diseases Registry and the Australasian Association of Clinical Biochemists Monoclonal Gammopathy Working Group. Pathology 2020; 52:167-178. [PMID: 31902622 DOI: 10.1016/j.pathol.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 01/30/2023]
Abstract
Waldenström macroglobulinaemia (WM) is an indolent non-Hodgkin lymphoma which usually presents with symptoms related to infiltration of bone marrow or other tissues like lymph nodes, liver or spleen and has certain unusual clinical manifestations, e.g., renal and central nervous system (CNS) involvement. It also has an array of laboratory features including hypersecretion of IgM, cryoglobulinaemia, increased plasma viscosity and identification of mutated MYD88L265P in more than 90% of cases. In this review, we aim to provide a guide to the laboratory investigations recommended for WM at initial diagnosis and at follow-up. A discussion on the nuances of diagnosis and differential diagnoses is followed by bone marrow (BM) assessment, measurement of paraprotein and other ancillary investigations. Recommendations are provided on laboratory work-up at diagnosis, in the asymptomatic follow-up phase, and during and post-treatment. Finally, we briefly discuss the implications of laboratory diagnosis in regard to recruitment and monitoring on clinical trials.
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Affiliation(s)
- M Gohar Maqbool
- Department of Haematology, ACT Pathology, Canberra Hospital, ACT, Australia; ANU Medical School, College of Medicine and Health, Australian National University, Canberra, ACT, Australia
| | - Constantine S Tam
- Peter MacCallum Cancer Center, St Vincent's Hospital and University of Melbourne, Melbourne, Vic, Australia
| | - Ian M Morison
- Southern Community Laboratories, Dunedin, New Zealand; Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia
| | - David Simpson
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Medical and Scientific Advisory Group, Myeloma Australia
| | - Peter Mollee
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Medical and Scientific Advisory Group, Myeloma Australia; Department of Haematology, Princess Alexandra Hospital and University of Queensland Medical School, Brisbane, Qld, Australia
| | - Hans Schneider
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Alfred Pathology Service and Monash University, Melbourne, Vic, Australia
| | - Henry Chan
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Medical and Scientific Advisory Group, Myeloma Australia
| | - Surender Juneja
- Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia
| | - Yasmin Harvey
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Lakshmi Nath
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Department of Haematology and Transfusion Medicine, Clinpath Pathology, Adelaide, SA, Australia
| | - Pravin Hissaria
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Royal Adelaide Hospital, University of Adelaide and SA Pathology, Adelaide, SA, Australia
| | - H Miles Prince
- Medical and Scientific Advisory Group, Myeloma Australia; Epworth Healthcare, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Vic, Australia
| | - Helen Wordsworth
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Stephen Opat
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Department of Haematology, Monash Health, Melbourne, Vic, Australia
| | - Dipti Talaulikar
- Department of Haematology, ACT Pathology, Canberra Hospital, ACT, Australia; ANU Medical School, College of Medicine and Health, Australian National University, Canberra, ACT, Australia; Medical and Scientific Advisory Group, Myeloma Australia; Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia.
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20
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Clay-Gilmour AI, Rishi AR, Goldin LR, Greenberg-Worisek AJ, Achenbach SJ, Rabe KG, Maurer MJ, Kay NE, Shanafelt TD, Call TG, Brice Weinberg J, Camp NJ, Cerhan JR, Leis J, Norman A, Murray DL, Vincent Rajkumar S, Caporaso NE, Landgren O, McMaster ML, Slager SL, Vachon CM. Association of elevated serumfree light chains with chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis. Blood Cancer J 2019; 9:59. [PMID: 31383849 PMCID: PMC6683199 DOI: 10.1038/s41408-019-0220-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/06/2019] [Indexed: 02/08/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) and its precursor, monoclonal B-cell lymphocytosis (MBL), are heritable. Serumfree light-chain (sFLC) measures are a prognostic factor for CLL, but their role in susceptibility to CLL is not clear. We investigated differences between sFLC measurements in pre-treatment serum from five groups to inform the association of sFLC with familial and sporadic CLL: (1) familial CLL (n = 154), (2) sporadic CLL (n = 302), (3) familial MBL (n = 87), (4) unaffected first-degree relatives from CLL/MBL families (n = 263), and (5) reference population (n = 15,396). The percent of individuals having elevated monoclonal and polyclonal sFLCs was compared using age-stratified and age- and sex-adjusted logistic regression models. In age groups >50 years, monoclonal sFLC elevations were increased in sporadic and familial CLL cases compared to the reference population (p's < 0.05). However, there were no statistically significant differences in sFLC monoclonal or polyclonal elevations between familial and sporadic CLL cases (p's > 0.05). Unaffected relatives and MBL cases from CLL/MBL families, ages >60 years, showed elevated monoclonal sFLC, compared to the reference population (p's < 0.05). This is the first study to demonstrate monoclonal sFLC elevations in CLL cases compared to controls. Monoclonal sFLC levels may provide additional risk information in relatives of CLL probands.
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Affiliation(s)
- Alyssa I Clay-Gilmour
- Division of Epidemiology, Department of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Abdul R Rishi
- Department of Internal Medicine, Mercy Hospital, St. Louis, MO, USA
| | - Lynn R Goldin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Sara J Achenbach
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kari G Rabe
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Matthew J Maurer
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Neil E Kay
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Tait D Shanafelt
- Stanford University Medical Center, Department of Medicine/Hematology, Stanford, CA, USA
| | - Timothy G Call
- Division of Hematology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Nicola J Camp
- Department of Medicine, University of Utah and Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - James R Cerhan
- Division of Epidemiology, Department of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jose Leis
- Division of Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Aaron Norman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - David L Murray
- Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Ola Landgren
- Myeloma Service, Division of Hematologic Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Mary L McMaster
- Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Susan L Slager
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Celine M Vachon
- Division of Epidemiology, Department of Health Sciences, Mayo Clinic, Rochester, MN, USA.
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21
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Tadmor T, Braester A, Najib D, Aviv A, Herishanu Y, Yuklea M, Shvidel L, Rahimi-Levene N, Ruchlemer R, Arad A, Fogl C, Henig C, Barak M, Magal L, Polliack A, Townsend K. A new risk model to predict time to first treatment in chronic lymphocytic leukemia based on heavy chain immunoparesis and summated free light chain. Eur J Haematol 2019; 103:335-341. [PMID: 31278876 DOI: 10.1111/ejh.13288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic lymphocytic leukemia (CLL) is frequently accompanied by immune dysregulation. AIMS In this multicenter prospective study, we investigated whether heavy + light chains (HLC: IgGκ, IgGλ, IgAκ, IgAκ, IgMκ, IgMλ) and IgG subclasses (IgG1, IgG2, IgG3, and IgG4) could be used as novel prognostic markers of immunoparesis in 105 treatment-naïve patients with CLL. RESULTS Heavy + light chains immunoparesis of ≥1, ≥2, and ≥3 isotypes was evident in 74 (70%), 58 (55%), and 36 (34%) patients, respectively. Severe HLC immunoparesis was identified in 40 (38%) patients. Of the IgG subclasses, IgG1 and IgG2 were most frequently suppressed, affecting 46 (44%) and 36 (34%) patients, respectively; 63 (60%) patients had low levels of at least one IgG subclass. In multivariate analysis, severe HLC immunoparesis (hazard ratio [HR]: 36.5; P = .010) and ΣFLC ≥ 70 mg/L (HR: 13.2; P = .004) were the only factors independently associated with time to first treatment (TTFT). A risk model including these variables identified patients with 0, 1, and 2 risk factors and significantly different TTFT (P < .001). Patients with two factors represented an ultra-high-risk group with a median TTFT of only 1.3 months. CONCLUSION The above findings demonstrate the potential for the use of HLC immunoparesis, together with sFLC measurements, as future prognostic biomarkers in CLL.
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Affiliation(s)
- Tamar Tadmor
- Bnai Zion Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Andrei Braester
- Western Galilee Hospital, Nahariya, Israel.,Bar Ilan University, Ramat Gan, Israel
| | | | | | - Yair Herishanu
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Tel-Aviv University, Tel Aviv, Israel
| | | | | | | | | | - Ariela Arad
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Clara Henig
- Haifa and Western Galilee Laboratory, Nesher, Israel
| | - Mira Barak
- Haifa and Western Galilee Laboratory, Nesher, Israel
| | - Lee Magal
- Almog Diagnostic, Park Shoham, Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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22
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Ishdorj G, Beiggi S, Nugent Z, Streu E, Banerji V, Dhaliwal D, Mahmud SM, Marshall AJ, Gibson SB, Wiseman MC, Johnston JB. Risk factors for skin cancer and solid tumors in newly diagnosed patients with chronic lymphocytic leukemia and the impact of skin surveillance on survival. Leuk Lymphoma 2019; 60:3204-3213. [DOI: 10.1080/10428194.2019.1620941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ganchimeg Ishdorj
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
| | - Sara Beiggi
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
| | - Zoann Nugent
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Erin Streu
- Department of Nursing, CancerCare Manitoba, Winnipeg, Canada
| | - Versha Banerji
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Dhali Dhaliwal
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Salah M. Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Spencer B. Gibson
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Canada
| | - Marni C. Wiseman
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - James B. Johnston
- CancerCare Manitoba Research Institute (formerly, Manitoba Institute of Cell Biology), University of Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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23
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Glenn MJ, Madsen MJ, Davis E, Garner CD, Curtin K, Jones B, Williams JA, Tomasson MH, Camp NJ. Elevated IgM and abnormal free light chain ratio are increased in relatives from high-risk chronic lymphocytic leukemia pedigrees. Blood Cancer J 2019; 9:25. [PMID: 30808891 PMCID: PMC6391432 DOI: 10.1038/s41408-019-0186-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 02/07/2023] Open
Abstract
Abnormal serum immunoglobulin (Ig) free light chains (FLC) are established biomarkers of early disease in multiple B-cell lymphoid malignancies, including chronic lymphocytic leukemia (CLL). Heavy chains have also been shown to be biomarkers in plasma cell disorders. An unanswered question is whether these Ig biomarkers are heritable, i.e., influenced by germline factors. CLL is heritable but highly heterogeneous. Heritable biomarkers could elucidate steps of disease pathogenesis that are affected by germline factors, and may help partition heterogeneity and identify genetic pleiotropies across malignancies. Relatives in CLL pedigrees present an opportunity to identify heritable biomarkers. We compared FLCs and heavy chains between relatives in 23 high-risk CLL pedigrees and population controls. Elevated IgM (eIgM) and abnormal FLC (aFLC) ratio was significantly increased in relatives, suggesting that these Ig biomarkers are heritable and could offer risk stratification in pedigree relatives. Within high-risk CLL pedigrees, B-cell lymphoid malignancies were five times more prevalent in close relatives of individuals with eIgM, prostate cancer was three times more prevalent in relatives of individuals with aFLC, and monoclonal B-cell lymphocytosis increased surrounding individuals with normal Ig levels. These different clustering patterns suggest Ig biomarkers have the potential to partition genetic heterogeneity in CLL and provide insight into distinct heritable pleiotropies associated with CLL.
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Affiliation(s)
- Martha J Glenn
- University of Utah School of Medicine, Salt Lake City, UT, 84112, USA
| | - Michael J Madsen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA
| | - Ethan Davis
- University of Utah School of Medicine, Salt Lake City, UT, 84112, USA
| | | | - Karen Curtin
- University of Utah School of Medicine, Salt Lake City, UT, 84112, USA
| | - Brandt Jones
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA
| | - Justin A Williams
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA
| | - Michael H Tomasson
- Carver College of Medicine, University ofIowa, Iowa City, IA, 52242, USA
| | - Nicola J Camp
- University of Utah School of Medicine, Salt Lake City, UT, 84112, USA. .,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, 84112, USA.
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Atrash S, Zhang Q, Papanikolaou X, Stein C, Abdallah AO, Barlogie B. Clinical Presentation and Gene Expression Profiling of Immunoglobulin M Multiple Myeloma Compared With Other Myeloma Subtypes and Waldenström Macroglobulinemia. J Glob Oncol 2018; 4:1-8. [PMID: 30241189 PMCID: PMC6180798 DOI: 10.1200/jgo.2016.008003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Multiple myeloma (MM) is a clonal bone marrow disease characterized by the neoplastic transformation of differentiated postgerminal B cells. It is a heterogeneous disease both at the genetic level and in terms of clinical outcome. Immunoglobulin M (IgM) MM is a rare subtype of myeloma. Similar to Waldenström macroglobulinemia (WM), patients with MM experience IgM monoclonal gammopathy; however, both diseases are distinct in terms of treatment and clinical behavior. MATERIALS AND METHODS To shed light on the presentation of IgM MM, its prognosis, and its gene expression profiling, we identified and characterized 21 patients with IgM MM from our database. RESULTS One of these patients presented with a rare IgM monoclonal gammopathy of undetermined significance that progressed to smoldering myeloma. The median survival of the 21 patients was 4.9 years, which was comparable to a matched group of patients with non-IgM MM with similar myeloma prognostic factors (age, gender, albumin, creatinine, anemia, lactate dehydrogenase, β2-microglobulin, cytogenetics abnormalities), but much less than the median survival reported for patients with WM (9 years). We identified a cluster of genes that differ in their expression profile between MM and WM and found that the patients with IgM MM displayed a gene expression profile most similar to patients with non-IgM MM, confirming that IgM MM is a subtype of MM that should be differentiated from WM. CONCLUSION Because the prognosis of IgM MM and WM differ significantly, an accurate diagnosis is essential. Our gene expression model can assist with the differential diagnosis in controversial cases.
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Affiliation(s)
- Shebli Atrash
- Shebli Atrash, Qing Zhang, Xenofon Papanikolaou, Caleb Stein, Al-Ola Abdallah, and Bart Barlogie, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Qing Zhang, Levine Cancer Institute, Charlotte, NC
| | - Qing Zhang
- Shebli Atrash, Qing Zhang, Xenofon Papanikolaou, Caleb Stein, Al-Ola Abdallah, and Bart Barlogie, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Qing Zhang, Levine Cancer Institute, Charlotte, NC
| | - Xenofon Papanikolaou
- Shebli Atrash, Qing Zhang, Xenofon Papanikolaou, Caleb Stein, Al-Ola Abdallah, and Bart Barlogie, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Qing Zhang, Levine Cancer Institute, Charlotte, NC
| | - Caleb Stein
- Shebli Atrash, Qing Zhang, Xenofon Papanikolaou, Caleb Stein, Al-Ola Abdallah, and Bart Barlogie, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Qing Zhang, Levine Cancer Institute, Charlotte, NC
| | - Al-Ola Abdallah
- Shebli Atrash, Qing Zhang, Xenofon Papanikolaou, Caleb Stein, Al-Ola Abdallah, and Bart Barlogie, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Qing Zhang, Levine Cancer Institute, Charlotte, NC
| | - Bart Barlogie
- Shebli Atrash, Qing Zhang, Xenofon Papanikolaou, Caleb Stein, Al-Ola Abdallah, and Bart Barlogie, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and Qing Zhang, Levine Cancer Institute, Charlotte, NC
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25
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Abnormal Plasma Cell Disorders in Refinery Waste Workers. J Clin Med 2018; 7:jcm7080221. [PMID: 30126157 PMCID: PMC6111622 DOI: 10.3390/jcm7080221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 01/19/2023] Open
Abstract
A monoclonal gammopathy of undetermined significance (MGUS) may develop into a multiple myeloma or a correlated lymphoproliferative malignancy with a progress rate of 1% per year. The immune status, occupational-environmental risk factors, and hereditary factors may influence the risk of developing MGUS. We investigated the prevalence of MGUS in 77 refinery waste workers. They were all males, averagely aged 36, with a mean working history of 18.5 years and working in the dump for about 4.2 years. After analyzing the results of standard serum electrophoresis migrations, 16% of cases (n = 12) showed levels beyond the normal ranges. In all 12 samples we observed an increase of gamma component: 67%, IgG; 17%, IgM; 8%, IgA; 8%, oligoclonal. Workers were exposed to hazardous refinery waste. After the biological monitoring of urine samples for metals and t,t-muconic acid, no extra-range values were observed. The multivariate analysis shows, however, that cigarette smoking and residence near industrial sites are significantly (p < 0.001) associated with a high risk of MGUS development; while no association was found with occupational exposure. Additional attention might be paid in particular to these conditions in epidemiological studies and further larger, prospective, population-based researches appear warranted to evaluate the strength of any positive association.
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26
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Yu X, Li W, Deng Q, Li L, Hsi ED, Young KH, Zhang M, Li Y. MYD88 L265P Mutation in Lymphoid Malignancies. Cancer Res 2018; 78:2457-2462. [PMID: 29703722 DOI: 10.1158/0008-5472.can-18-0215] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/13/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022]
Abstract
Next-generation sequencing has revealed cancer genomic landscapes, in which over 100 driver genes that, when altered by intragenic mutations, can promote oncogenesis. MYD88 is a driver gene found in hematologic B-cell malignancies. A missense mutation (L265P) changing leucine at position 265 to proline in MYD88 is found in ∼90% of Waldenström macroglobulinemia (WM) cases and in significant portions of activated B-cell diffuse large B-cell lymphomas and IgM monoclonal gammopathy of undetermined significance. Few cancers such as WM have a single amino acid substitution in one gene like MYD88 L265P that occurs in ∼90% of cases, making WM paradigmatic for study of a single causative mutation in oncogenesis. In this review, we summarize the frequency and cancer spectrum of MYD88 L265P and its downstream effects in lymphoid cancers. Malignant B cells with MYD88 L265P are likely transformed from IgM-producing B cells either in response to T-cell-independent antigens or in response to protein antigens before class switching. We also discuss therapeutic strategies that include targeting Bruton tyrosine kinase and other kinases, interfering with the assembly of MYD88 and its interacting partners, and MYD88 L265P-specific peptide-based immunotherapy. Cancer Res; 78(10); 2457-62. ©2018 AACR.
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Affiliation(s)
- Xinfang Yu
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan Province, China
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wei Li
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Qipan Deng
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ling Li
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan Province, China
| | - Eric D Hsi
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mingzhi Zhang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan Province, China.
| | - Yong Li
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
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Willrich MA, Murray DL, Kyle RA. Laboratory testing for monoclonal gammopathies: Focus on monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Clin Biochem 2018; 51:38-47. [DOI: 10.1016/j.clinbiochem.2017.05.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 02/07/2023]
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Singh G. Serum Free Light Chain Assay and κ/λ Ratio Performance in Patients Without Monoclonal Gammopathies: High False-Positive Rate. Am J Clin Pathol 2016; 146:207-14. [PMID: 27473738 DOI: 10.1093/ajcp/aqw099] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Serum free light chain assay is a recommended screening test for monoclonal gammopathies. Anecdotal observations indicated a high rate of false-positive abnormal κ/λ ratios. This study was undertaken to ascertain the magnitude of the false-positive rate and factors contributing to the error rate. METHODS Results of serum protein electrophoresis, serum free light chains, and related tests, usually done for investigation of suspected monoclonal gammopathy, were reviewed retrospectively for 270 patients and 297 observations. RESULTS Using the conventional κ/λ ratio, 36.4% of the ratios were abnormal, in the absence of monoclonal gammopathy. When the renal κ/λ ratio was used, the rate of abnormal κ/λ ratios was 30.1%. In patients with a γ-globulin concentration of 1.6 g/dL or more, the usual κ/λ ratio was abnormal in 54.8% of the patients. Urine protein electrophoresis was used in 53 (19.6%) instances, whereas bone marrow examination was done in 65 (24.1%) cases. CONCLUSIONS Usual κ/λ ratio was abnormal in 36.4% of the observations in patients without evidence of monoclonal gammopathy, and an abnormal κ/λ ratio should not be used as the sole indicator for diagnosis of neoplastic proliferation of the lympho-plasmacytic system. Hypergammaglobulinemia is associated with a higher rate of false-positive abnormal κ/λ ratios. Examination of urine for monoclonal immunoglobulins may be underused, and recommendations by some to use serum free light chain assay in place of, rather than as an adjunct to, urine electrophoresis are not warranted.
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Affiliation(s)
- Gurmukh Singh
- From the Department of Pathology, Division of Clinical Pathology, Augusta University, Medical College of Georgia, Augusta.
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29
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Landgren O, Shim YK, Michalek J, Costello R, Burton D, Ketchum N, Calvo KR, Caporaso N, Raveche E, Middleton D, Marti G, Vogt RF. Agent Orange Exposure and Monoclonal Gammopathy of Undetermined Significance: An Operation Ranch Hand Veteran Cohort Study. JAMA Oncol 2016; 1:1061-8. [PMID: 26335650 DOI: 10.1001/jamaoncol.2015.2938] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Multiple myeloma has been classified as exhibiting "limited or suggestive evidence" of an association with exposure to herbicides in Vietnam War veterans. Occupational studies have shown that other pesticides (ie, insecticides, herbicides, fungicides) are associated with excess risk of multiple myeloma and its precursor state, monoclonal gammopathy of undetermined significance (MGUS); however, to our knowledge, no studies have uncovered such an association in Vietnam War veterans. OBJECTIVE To examine the relationship between MGUS and exposure to Agent Orange, including its contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), in Vietnam War veterans. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cohort study conducted in 2013 to 2014, testing for MGUS in serum specimens collected and stored in 2002 by the Air Force Health Study (AFHS). The relevant exposure data collected by the AFHS was also used. We tested all specimens in 2013 without knowledge of the exposure status. The AFHS included former US Air Force personnel who participated in Operation Ranch Hand (Ranch Hand veterans) and other US Air Force personnel who had similar duties in Southeast Asia during the same time period (1962 to 1971) but were not involved in herbicide spray missions (comparison veterans). Agent Orange was used by the US Air Force personnel who conducted aerial spray missions of herbicides (Operation Ranch Hand) in Vietnam from 1962 to 1971. We included 479 Ranch Hand veterans and 479 comparison veterans who participated in the 2002 follow-up examination of AFHS. EXPOSURES Agent Orange and TCDD. Serum TCDD levels were measured in 1987, 1992, 1997, and 2002. MAIN OUTCOMES AND MEASURES Risk of MGUS measured by prevalence, odds ratios (ORs), and 95% CIs. RESULTS The 479 Ranch Hand veterans and 479 comparison veterans had similar demographic and lifestyle characteristics and medical histories. The crude prevalence of overall MGUS was 7.1% (34 of 479) in Ranch Hand veterans and 3.1% (15 of 479) in comparison veterans. This translated into a 2.4-fold increased risk for MGUS in Ranch Hand veterans than comparison veterans after adjusting for age, race, BMI in 2002, and the change in BMI between 2002 and the time of blood draw for TCDD measurement (adjusted OR, 2.37; 95% CI, 1.27-4.44; P=.007). CONCLUSIONS AND RELEVANCE Operation Ranch Hand veterans have a significantly increased risk of MGUS, supporting an association between Agent Orange exposure and multiple myeloma.
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Affiliation(s)
- Ola Landgren
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland2Memorial Sloan Kettering Cancer Center, New York, New York
| | - Youn K Shim
- Agency for Toxic Substances and Disease Registry, Atlanta, Georgia
| | - Joel Michalek
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio
| | - Rene Costello
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Debra Burton
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Norma Ketchum
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio
| | | | - Neil Caporaso
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Elizabeth Raveche
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark
| | - Dan Middleton
- Agency for Toxic Substances and Disease Registry, Atlanta, Georgia
| | - Gerald Marti
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Robert F Vogt
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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30
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Laboratory testing requirements for diagnosis and follow-up of multiple myeloma and related plasma cell dyscrasias. ACTA ACUST UNITED AC 2016; 54:907-19. [DOI: 10.1515/cclm-2015-0580] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023]
Abstract
AbstractMonoclonal immunoglobulins are markers of plasma cell proliferative diseases and have been described as the first (and perhaps best) serological tumor marker. The unique structure of each monoclonal protein makes them highly specific for each plasma cell clone. The difficulties of using monoclonal proteins for diagnosing and monitoring multiple myeloma, however, stem from the diverse disease presentations and broad range of serum protein concentrations and molecular weights. Because of these challenges, no single test can confidently diagnose or monitor all patients. Panels of tests have been recommended for sensitivity and efficiency. In this review we discuss the various disease presentations and the use of various tests such as protein electrophoresis and immunofixation electrophoresis as well as immunoglobulin quantitation, free light chain quantitation, and heavy-light chain quantitation by immuno-nephelometry. The choice of tests for inclusion in diagnostic and monitoring panels may need to be tailored to each patient, and examples are provided. The panel currently recommended for diagnostic screening is serum protein electrophoresis, immunofixation electrophoresis, and free light chain quantitation.
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31
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Frazer-Abel A, Sepiashvili L, Mbughuni MM, Willrich MAV. Overview of Laboratory Testing and Clinical Presentations of Complement Deficiencies and Dysregulation. Adv Clin Chem 2016; 77:1-75. [PMID: 27717414 DOI: 10.1016/bs.acc.2016.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Historically, complement disorders have been attributed to immunodeficiency associated with severe or frequent infection. More recently, however, complement has been recognized for its role in inflammation, autoimmune disorders, and vision loss. This paradigm shift requires a fundamental change in how complement testing is performed and interpreted. Here, we provide an overview of the complement pathways and summarize recent literature related to hereditary and acquired angioedema, infectious diseases, autoimmunity, and age-related macular degeneration. The impact of complement dysregulation in atypical hemolytic uremic syndrome, paroxysmal nocturnal hemoglobinuria, and C3 glomerulopathies is also described. The advent of therapeutics such as eculizumab and other complement inhibitors has driven the need to more fully understand complement to facilitate diagnosis and monitoring. In this report, we review analytical methods and discuss challenges for the clinical laboratory in measuring this complex biochemical system.
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Parikh SA, Leis JF, Chaffee KG, Call TG, Hanson CA, Ding W, Chanan-Khan AA, Bowen D, Conte M, Schwager S, Slager SL, Van Dyke DL, Jelinek DF, Kay NE, Shanafelt TD. Hypogammaglobulinemia in newly diagnosed chronic lymphocytic leukemia: Natural history, clinical correlates, and outcomes. Cancer 2015; 121:2883-91. [PMID: 25931291 PMCID: PMC4545721 DOI: 10.1002/cncr.29438] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although hypogammaglobulinemia is a well recognized complication in patients with chronic lymphocytic leukemia (CLL), its prevalence at the time of CLL diagnosis, and association with novel prognostic markers and clinical outcome is not well understood. METHODS All patients at the Mayo Clinic between January 1999 and July 2013 who had newly diagnosed CLL and had a baseline assessment of serum immunoglobulin G (IgG) were included. The relation between hypogammaglobulinemia at diagnosis and the novel prognostic parameters time to first treatment (TFT) and overall survival (OS) were evaluated. RESULTS Of 1485 patients who met the eligibility criteria, 382 (26%) had hypogammaglobulinemia (median IgG, 624 mg/dL), whereas the remaining 1103 patients (74%) had normal serum IgG levels (median IgG, 1040 mg/dL). Patients who had hypogammaglobulinemia at diagnosis were more likely to have advanced Rai stage (III-IV; P = .001) and higher expression of CD49d (P < .001) compared with patients who had normal IgG levels. Although the median TFT for patients who had hypogammaglobulinemia was shorter compared with that for patients who had normal IgG levels (3.8 years vs 7.4 years; P < .001), on multivariable analysis, there was no difference in OS between these 2 groups (12.8 years vs 11.3 years, respectively; P = .73). Of 1103 patients who had CLL with normal IgG levels at diagnosis and who did not receive CLL therapy, the risk of acquired hypogammaglobulinemia was 11% at 5 years and 23% at 10 years. CONCLUSIONS Hypogammaglobulinemia is present in 25% of patients with newly diagnosed CLL. Approximately 25% of patients who have CLL with normal IgG levels at diagnosis will subsequently develop hypogammaglobulinemia on long-term follow-up. The presence of hypogammaglobulinemia does not appear to impact overall survival.
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MESH Headings
- Adult
- Agammaglobulinemia/diagnosis
- Agammaglobulinemia/mortality
- Agammaglobulinemia/therapy
- Aged
- Aged, 80 and over
- Female
- Humans
- Immunoglobulin G/blood
- Kaplan-Meier Estimate
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Middle Aged
- Multivariate Analysis
- Proportional Hazards Models
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Sameer A. Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jose F. Leis
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, AZ
| | - Kari G. Chaffee
- Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN
| | - Timothy G. Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Curtis A. Hanson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Wei Ding
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Deborah Bowen
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Michael Conte
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Susan Schwager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Susan L. Slager
- Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN
| | - Daniel L. Van Dyke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Neil E. Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Tait D. Shanafelt
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
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Glancy E, Siles R. Monoclonal B-cell lymphocytosis and hypogammaglobulinaemia. Br J Haematol 2015; 173:316-7. [DOI: 10.1111/bjh.13585] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Erica Glancy
- Department of Allergy and Clinical Immunology; Cleveland Clinic; Cleveland OH USA
| | - Roxana Siles
- Department of Allergy and Clinical Immunology; Cleveland Clinic; Cleveland OH USA
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Al-Riyami N, Al-Farsi K, Al-Amrani K, Al-Harrasi S, Al-Huneini M, Al-Kindi S. Biclonal Gammopathy in Chronic Lymphocytic Leukemia: Case Report and Review of the Literature. Oman Med J 2015; 30:216-8. [PMID: 26171130 DOI: 10.5001/omj.2015.45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/29/2014] [Indexed: 11/03/2022] Open
Abstract
Monoclonal gammopathies are frequently seen in B-cell malignancies. Monoclonal proteins are seen in a significant proportion of patients with chronic lymphocytic leukemia (CLL), which is a clonal disorder of mature B cells. The use of more sensitive laboratory methods has enabled the detection of monoclonal proteins or light chains in the serum and/or urine in the majority of these patients. The presence of some of these monoclonal proteins may explain the different autoimmune phenomena that are associated with this disease. Some reports indicate that the finding of monoclonal proteins has a negative impact on patients' survival. The presence of two different monoclonal proteins (i.e. biclonal gammopathy) is on the other hand rare. Most of the reported cases in the literature are of patients with plasma cell disorders. In this report, we describe a rare occurrence of biclonal gammopathy in a patient with CLL. Serum protein electrophoresis and immunofixation, which were negative at the time of initial diagnosis, showed biclonal immunoglobin A (IgA) kappa and IgA lambda during the course of the disease. The patient's disease showed steady progression, despite multiple treatments. Although this could just be the result of using more sensitive laboratory techniques, biclonal gammopathy in this patient likely reflects the evolution of another clone, which would explain the encountered resistance to therapy. Because of paucity of reports, the impact of biclonal gammopathies in such patients is not known and an effort to collectively report the presentation and outcome of these patients is needed to further understand the pathophysiology and clinical significance of such a finding.
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Affiliation(s)
- Nafila Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalil Al-Farsi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalfan Al-Amrani
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sameera Al-Harrasi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Salam Al-Kindi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
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Assi LK, McIntyre N, Fraser S, Harris S, Hutchison CA, McIntyre CW, Cockwell P, Taal MW. The Association between Polyclonal Combined Serum Free Light Chain Concentration and Mortality in Individuals with Early Chronic Kidney Disease. PLoS One 2015; 10:e0129980. [PMID: 26132658 PMCID: PMC4489104 DOI: 10.1371/journal.pone.0129980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/14/2015] [Indexed: 01/22/2023] Open
Abstract
A major component of increased mortality risk in people with chronic kidney disease (CKD) is associated with non-traditional cardiovascular risk factors including markers of inflammation. We studied whether a novel marker of systemic inflammation, elevated serum combined polyclonal immunoglobulin free light chains (cFLC), was an independent risk factor for increased all-cause mortality in people with CKD stage 3. In a prospective community based cohort study, 1695 participants with stage 3 CKD and no cases of monoclonal gammopathy had cFLC concentrations measured. cFLC levels were determined using the summation of Freelite kappa and lambda assays. All other bioclinical variables were collected at the time of sample collection. Kaplan-Meier plots and Cox proportional hazards analysis was used to assess the relationship between high cFLC levels (>43.3 mg/L) and mortality. There were 167 deaths (10%) after a median of 1375 days. cFLC levels at recruitment were higher in participants who died compared with those who were alive at the end of the study; median: 46.5 mg/L (IQR: 36.1-65.4 mg/L) and 35.4 mg/L (28.1-46.6 mg/L) respectively, P <0.001. Kaplan-Meier survival analysis demonstrated participants with cFLC >43.3 mg/L levels had an increased risk of mortality compared to people with normal cFLC levels (P <0.001). Elevated cFLC levels were independently associated with worse survival (Hazard ratio: 1.50; 95% confidence interval: 1.04-2.16; P=0.03). Other independent risk factors for worse survival were: older age, male gender, previous cardiovascular event, lower eGFR and higher high sensitivity C-reactive protein (hsCRP). To conclude, high cFLC levels predict increased mortality in people with stage 3 CKD, independent of established risk factors and other markers of inflammation.
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Affiliation(s)
- Lakhvir K. Assi
- The Binding Site Group Ltd, 8 Calthorpe Road, Edgbaston, Birmingham, United Kingdom
| | - Natasha McIntyre
- Division of Medical Sciences and Graduate-Entry Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Simon Fraser
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Scott Harris
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | | | - Chris W. McIntyre
- Division of Medical Sciences and Graduate-Entry Medicine, University of Nottingham, Nottingham, United Kingdom
- Renal Unit, Royal Derby Hospital, Derby, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Division of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maarten W. Taal
- Division of Medical Sciences and Graduate-Entry Medicine, University of Nottingham, Nottingham, United Kingdom
- Renal Unit, Royal Derby Hospital, Derby, United Kingdom
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Hospital population screening reveals overrepresentation of CD5− monoclonal B-cell lymphocytosis and monoclonal gammopathy of undetermined significance of IgM type. Ann Hematol 2015; 94:1559-65. [DOI: 10.1007/s00277-015-2409-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
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Rossi D. Role of MYD88 in lymphoplasmacytic lymphoma diagnosis and pathogenesis. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:113-118. [PMID: 25696843 DOI: 10.1182/asheducation-2014.1.113] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lymphoplasmacytic lymphoma (LPL) is a distinct B-cell lymphoproliferative disorder primarily characterized by bone marrow infiltration of lymphoplasmacytic cells. When LPL produces a serum monoclonal immunoglobulin of the IgM class, it is termed Waldenström macroglobulinemia (WM). The differential diagnosis between LPL and other types of morphologically similar B-cell tumors that may also have plasmacytic differentiation and/or secretion of IgM paraproteins is not always clear-cut based solely on the pathologic and phenotypic features of the tumor. Although the current treatments for LPL/WM are initially effective in inducing responses in most patients, they are not curative and show decreasing efficacy with repeated administrations, ultimately resulting in the selection of a chemoresistant clone. Next-generation sequencing studies have identified somatic mutations of MYD88, a key component of the Toll-like receptor signaling machinery, in ∼90% of LPL/WM. Deregulated MYD88 signaling promoted by mutations sustains tumor cell survival in LPL/WM, demonstrating that they are gain-of-function driver events in this lymphoma. This review discusses the molecular and biological mechanisms underlying MYD88 mutations in LPL/WM, the role of MYD88 mutations as molecular biomarker for the refinement of diagnosis and the improvement classification of LPL/WM, and novel targeted therapeutic strategies for LPL/WM based on the pharmacological manipulation of MYD88 signaling to which this lymphoma is addicted.
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Affiliation(s)
- Davide Rossi
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
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Nieters A, Łuczyńska A, Becker S, Becker N, Vermeulen R, Overvad K, Aleksandrova K, Boeing H, Lagiou P, Trichopoulos D, Trichopoulou A, Krogh V, Masala G, Panico S, Tumino R, Sacerdote C, Bueno-de-Mesquita B, Jeurnink SM, Weiderpass E, Ardanaz E, Chirlaque MD, Sánchez MJ, Sánchez S, Borgquist S, Butt S, Melin B, Späth F, Rinaldi S, Brennan P, Kelly RS, Riboli E, Vineis P, Kaaks R. Prediagnostic immunoglobulin E levels and risk of chronic lymphocytic leukemia, other lymphomas and multiple myeloma-results of the European Prospective Investigation into Cancer and Nutrition. Carcinogenesis 2014; 35:2716-22. [PMID: 25269801 PMCID: PMC4247516 DOI: 10.1093/carcin/bgu188] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 12/25/2022] Open
Abstract
Previous epidemiological studies suggest an inverse association between allergies, marked by elevated immunoglobulin (Ig) E levels, and non-Hodgkin lymphoma (NHL) risk. The evidence, however, is inconsistent and prospective data are sparse. We examined the association between prediagnostic total (low: <20; intermediate: 20-100; high >100 kU/l) and specific IgE (negative: <0.35; positive ≥0.35 kU/I) concentrations against inhalant antigens and lymphoma risk in a study nested within the European Prospective Investigation into Cancer and Nutrition cohort. A total of 1021 incident cases and matched controls of NHL, multiple myeloma (MM) and Hodgkin lymphoma with a mean follow-up time of 7 years were investigated. Multivariate-adjusted odds ratios (ORs) with 95% confidence intervals (CI) were calculated by conditional logistic regression. Specific IgE was not associated with the risk of MM, B-cell NHL and B-cell NHL subtypes. In contrast, total IgE levels were inversely associated with the risk of MM [high level: OR = 0.40 (95% CI = 0.21-0.79)] and B-cell NHL [intermediate level: OR = 0.68 (95% CI = 0.53-0.88); high level: OR = 0.62 (95% CI = 0.44-0.86)], largely on the basis of a strong inverse association with chronic lymphocytic leukemia [CLL; intermediate level: OR = 0.49 (95% CI = 0.30-0.80); high level: OR = 0.13 (95% CI = 0.05-0.35)] risk. The inverse relationship for CLL remained significant for those diagnosed 5 years after baseline. The findings of this large prospective study demonstrated significantly lower prediagnostic total IgE levels among CLL and MM cases compared with matched controls. This corresponds to the clinical immunodeficiency state often observed in CLL patients prior to diagnosis. No support for an inverse association between prediagnostic levels of specific IgE and NHL risk was found.
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MESH Headings
- Adult
- Aged
- B-Lymphocytes
- Biomarkers, Tumor/blood
- Case-Control Studies
- Female
- Follow-Up Studies
- Humans
- Immunoglobulin E/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Lymphoma/blood
- Lymphoma/diagnosis
- Lymphoma/epidemiology
- Lymphoma/immunology
- Male
- Middle Aged
- Multiple Myeloma/blood
- Multiple Myeloma/diagnosis
- Multiple Myeloma/epidemiology
- Multiple Myeloma/immunology
- Prognosis
- Prospective Studies
- Risk Factors
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Affiliation(s)
- Alexandra Nieters
- *To whom correspondence should be addressed. Tel: +49 761 270 78150; Fax: +49 761 270 7600;
| | - Anna Łuczyńska
- Center for Chronic Immunodeficiency, University Medical Center Freiburg, 79108 Freiburg, Germany
- Institute of Laboratory Medicine, Clinical Chemistry and Medical Diagnostics, University Hospital Leipzig 04103, Leipzig, Germany
- Division of Cancer Epidemiology, German Cancer Research Center Heidelberg, 69120 Heidelberg, Germany
- Julius Center, University Medical Center Utrecht, 3508 Utrecht, The Netherlands
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), 3508 Utrecht University, Utrecht, The Netherlands
- Department of Public Health, Section of Epidemiology, Aarhus University, 8000 Aarhus, Denmark
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
- Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, 115 27 Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, 02115 USA
- Bureau of Epidemiologic Research, Academy of Athens, 115 27 Athens, Greece
- Hellenic Health Foundation, Athens, Greece
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milano, Italy
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, 50141 Florence, Italy
- Dipartamento di Medicina Clinica e Chirurgia, Federico II University, 80138 Naples, Italy
- Cancer Registry and Histopathology Unit, ‘Civile M.P.Arezzo’ Hospital, ASP Ragusa, Italy
- Center for Cancer Prevention (CPO-Piemonte), Turin, Italy
- Human Genetics Foundation, 10126 Turin, Italy
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Center, 3508 GA Utrecht, The Netherlands
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, 9037 Tromsø, Norway
- Department of Etiological Cancer Research, Cancer Registry of Norway, 0304Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 171 77 Stockholm, Sweden
- Program on Genetic Research, Folkhälsan Research Center, Samfundet Folkhälsan, University of Helsinki, 00014, Helsinki, Finland
- CIBER Epidemiología y Salud Pública, 08003 Barcelona, Spain
- Navarre Public Health Institute, E-31003 Pamplona, Spain
- Department of Epidemiology, Murcia Regional Health Council, 30008 Murcia, Spain
- School of Public Health, 18011Granada, Spain
- Public Health Directorate, 33009 Asturias, Spain
- Department of Oncology, Skåne University Hospital
- and Department of Clinical Sciences, Lund University, 22100 Lund, Sweden
- Department of Surgery, Lund University, Skåne University Hospital, 20502 Malmö, Sweden
- Department of Radiation Sciences, Oncology Umeå University, 901 85 Umeå, Sweden
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
- Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health and
- School of Public Health, Imperial College London, London, W2 1PG UK
| | - Susen Becker
- Center for Chronic Immunodeficiency, University Medical Center Freiburg, 79108 Freiburg, Germany
| | - Nikolaus Becker
- Institute of Laboratory Medicine, Clinical Chemistry and Medical Diagnostics, University Hospital Leipzig 04103, Leipzig, Germany
| | - Roel Vermeulen
- Division of Cancer Epidemiology, German Cancer Research Center Heidelberg, 69120 Heidelberg, Germany
- Julius Center, University Medical Center Utrecht, 3508 Utrecht, The Netherlands
| | - Kim Overvad
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), 3508 Utrecht University, Utrecht, The Netherlands
| | - Krasimira Aleksandrova
- Department of Public Health, Section of Epidemiology, Aarhus University, 8000 Aarhus, Denmark
| | - Heiner Boeing
- Department of Public Health, Section of Epidemiology, Aarhus University, 8000 Aarhus, Denmark
| | | | | | - Antonia Trichopoulou
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
- Bureau of Epidemiologic Research, Academy of Athens, 115 27 Athens, Greece
| | | | - Giovanna Masala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milano, Italy
| | - Salvatore Panico
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, 50141 Florence, Italy
| | - Rosario Tumino
- Dipartamento di Medicina Clinica e Chirurgia, Federico II University, 80138 Naples, Italy
| | - Carlotta Sacerdote
- Cancer Registry and Histopathology Unit, ‘Civile M.P.Arezzo’ Hospital, ASP Ragusa, Italy
- Center for Cancer Prevention (CPO-Piemonte), Turin, Italy
| | - Bas. Bueno-de-Mesquita
- Human Genetics Foundation, 10126 Turin, Italy
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
| | - Suzanne M. Jeurnink
- Human Genetics Foundation, 10126 Turin, Italy
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
| | | | - Eva Ardanaz
- Program on Genetic Research, Folkhälsan Research Center, Samfundet Folkhälsan, University of Helsinki, 00014, Helsinki, Finland
- CIBER Epidemiología y Salud Pública, 08003 Barcelona, Spain
| | - Maria-Dolores Chirlaque
- Program on Genetic Research, Folkhälsan Research Center, Samfundet Folkhälsan, University of Helsinki, 00014, Helsinki, Finland
- Navarre Public Health Institute, E-31003 Pamplona, Spain
| | - María-José Sánchez
- Program on Genetic Research, Folkhälsan Research Center, Samfundet Folkhälsan, University of Helsinki, 00014, Helsinki, Finland
- Department of Epidemiology, Murcia Regional Health Council, 30008 Murcia, Spain
| | | | | | - Salma Butt
- Department of Oncology, Skåne University Hospital
| | - Beatrice Melin
- and Department of Clinical Sciences, Lund University, 22100 Lund, Sweden
| | - Florentin Späth
- and Department of Clinical Sciences, Lund University, 22100 Lund, Sweden
| | - Sabina Rinaldi
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - Paul Brennan
- Department of Surgery, Lund University, Skåne University Hospital, 20502 Malmö, Sweden
| | - Rachel S. Kelly
- Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, 115 27 Greece
- Department of Radiation Sciences, Oncology Umeå University, 901 85 Umeå, Sweden
| | - Elio Riboli
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - Paolo Vineis
- Center for Cancer Prevention (CPO-Piemonte), Turin, Italy
- Department of Radiation Sciences, Oncology Umeå University, 901 85 Umeå, Sweden
| | - Rudolf Kaaks
- Institute of Laboratory Medicine, Clinical Chemistry and Medical Diagnostics, University Hospital Leipzig 04103, Leipzig, Germany
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Blot M, Boyer P, Samson M, Audia S, Devilliers H, Leguy V, Berthier S, Besancenot JF, Lorcerie B, Lakomy D, Bonnotte B. Should mild hypogammaglobulinemia be managed as severe hypogammaglobulinemia? A study of 389 patients with secondary hypogammaglobulinemia. Eur J Intern Med 2014; 25:837-42. [PMID: 25307285 DOI: 10.1016/j.ejim.2014.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/21/2014] [Accepted: 09/15/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although secondary hypogammaglobulinemia is more frequent than primary hypogammaglobulinemia, its etiology and management are poorly described, particularly for mild hypogammaglobulinemia. METHODS This retrospective observational study included all adult patients with a gammaglobulin level <6.4g/L on serum electrophoresis identified at Dijon teaching hospital between April and September 2012. Clinico-biological features, etiologies and infectious complications were collected at inclusion and compared between group 1 (gammaglobulin <5g/L, severe hypogammaglobulinemia), and group 2 (gammaglobulin <6.4 and ≥5g/L, mild hypogammaglobulinemia). RESULTS Among the 4011 serum electrophoreses, 570 samples from 389 patients had gammaglobulin levels below 6.4g/L: 156 (40%) in group 1 and 233 (60%) in group 2. Mean age±SD was 67 (15) years, and sex ratio was 1.04 (M/F) with no difference between the two groups. An etiology was identified in 79% and 58% of patients in groups 1 and 2, respectively (p<0.0001). The main etiologies were similar in both groups and included malignant hemopathy treated with cytostatic agents (n=129, 33%), smoldering or newly-diagnosed hemopathy without treatment (n=49, 13%) and immunosuppressive treatment (n=91, 23%). The incidence of hypogammaglobulinemia-related infections was 22/100/year, with no significant difference between the two groups (p=0.17). Vaccination coverage against pneumococcus was 33%, and higher in group 1 (46% vs. 24%; p<0.0001). When no cause was known at inclusion, an etiology was discovered in 22/130 patients (17%), 11 in each group. CONCLUSIONS Though mild hypogammaglobulinemia does not meet the classical criteria for hypogammaglobulinemia (<5g/L), the etiology and infectious risk are similar. It therefore requires investigation and vaccination.
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Affiliation(s)
- Mathieu Blot
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France
| | - Pierre Boyer
- Laboratory of Immunology, Dijon University Hospital, 21079 Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France; INSERM, UMR1098, University of Franche-Comté, 25030 Besançon, France
| | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France; INSERM, UMR1098, University of Franche-Comté, 25030 Besançon, France
| | - Hervé Devilliers
- Faculty of Medicine, University of Burgundy, Dijon, France; Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, 21079 Dijon, France
| | - Vanessa Leguy
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France
| | - Sabine Berthier
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France
| | - Jean-François Besancenot
- Faculty of Medicine, University of Burgundy, Dijon, France; Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, 21079 Dijon, France
| | - Bernard Lorcerie
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France
| | - Daniela Lakomy
- Laboratory of Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, 21079 Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France; INSERM, UMR1098, University of Franche-Comté, 25030 Besançon, France.
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40
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von Keudell G, Sanchorawala V, O'Hara C, C Seldin D, Sloan JM. Simultaneous presentation of kappa-restricted chronic lymphocytic leukemia and lambda light chain AL amyloidosis. Amyloid 2014; 21:124-7. [PMID: 24471777 DOI: 10.3109/13506129.2013.854205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report on a 58-year-old man who presented with simultaneous kappa-restricted chronic lymphocytic leukemia (CLL) and a lambda-restricted plasma cell dyscrasia causing AL amyloidosis involving the kidney and GI tract. While monoclonal immunoglobulins occasionally produced by CLL has previously been implicated in AL amyloidosis, this is the first case of AL amyloidosis resulting from a distinct plasma cell dyscrasia that is not clonally related to the concurrent CLL. Appropriate treatment depended on detailed pathologic diagnosis of both disease processes.
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Hutchison CA, Burmeister A, Harding SJ, Basnayake K, Church H, Jesky MD, White K, Green CE, Stringer SJ, Bassett P, Ferro CJ, Cockwell P. Serum polyclonal immunoglobulin free light chain levels predict mortality in people with chronic kidney disease. Mayo Clin Proc 2014; 89:615-22. [PMID: 24797643 DOI: 10.1016/j.mayocp.2014.01.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/09/2014] [Accepted: 01/28/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether elevated serum polyclonal free light chain (FLC) levels predict mortality in a population of individuals with chronic kidney disease (CKD). PATIENTS AND METHODS From January 2, 2006, through July 31, 2007, we recruited a cohort of 848 people with CKD who were not receiving renal replacement therapy and did not have monoclonal gammopathy. We measured serum kappa FLC and lambda FLC isotype levels to determine combined FLC (cFLC) levels. The cohort was prospectively followed up for a median of 63 months (interquartile range, 0-93 months). Cox regression analysis was performed to determine variables predictive of mortality. RESULTS High cFLC levels were an independent risk factor for death (hazard ratio [HR], 2.71; 95% CI, 1.98-3.70; P<.001). Other independent risk factors were age (HR, 1.79; 95% CI, 1.52-2.10; P<.001), South Asian ethnicity (HR, 0.33; 95% CI, 0.14-0.64; P=.02), preexisting cardiovascular disease (HR, 1.59; 95% CI, 1.09-2.31; P=.02), and high-sensitivity C-reactive protein (HR, 1.13; 95% CI, 1.00-1.28; P=.04). Neither estimated glomerular filtration rate nor albuminuria was an independent risk factor for death. CONCLUSION High cFLC levels independently predict mortality in people with CKD.
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Affiliation(s)
| | - Anne Burmeister
- The Binding Site Group Ltd, Birmingham, United Kingdom; Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, United Kingdom
| | - Stephen J Harding
- The Binding Site Group Ltd, Birmingham, United Kingdom; Division of Immunity and Infection, University of Birmingham, Medical School, Birmingham, United Kingdom
| | - Kolitha Basnayake
- Sussex Kidney Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Hannah Church
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, United Kingdom
| | - Mark D Jesky
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, United Kingdom
| | - Katie White
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, United Kingdom
| | - Clara E Green
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, United Kingdom
| | - Stephanie J Stringer
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, United Kingdom; Division of Immunity and Infection, University of Birmingham, Medical School, Birmingham, United Kingdom
| | - Paul Bassett
- Statsconsultancy, Ltd, Amersham, Bucks, United Kingdom
| | - Charles J Ferro
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, United Kingdom; Division of Immunity and Infection, University of Birmingham, Medical School, Birmingham, United Kingdom
| | - Paul Cockwell
- Department of Renal Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, United Kingdom; Division of Immunity and Infection, University of Birmingham, Medical School, Birmingham, United Kingdom.
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Burmeister A, Assi LK, Ferro CJ, Hughes RG, Barnett AH, Bellary S, Cockwell P, Pratt G, Hutchison CA. The relationship between high-sensitivity CRP and polyclonal Free Light Chains as markers of inflammation in chronic disease. Int J Lab Hematol 2013; 36:415-24. [DOI: 10.1111/ijlh.12159] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/16/2013] [Indexed: 11/27/2022]
Affiliation(s)
- A. Burmeister
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- The Binding Site Group Ltd; Birmingham UK
| | - L. K. Assi
- The Binding Site Group Ltd; Birmingham UK
| | - C. J. Ferro
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
| | | | - A. H. Barnett
- University of Birmingham; Birmingham UK
- Diabetes Centre; Heart of England NHS Trust; Birmingham UK
| | - S. Bellary
- Diabetes Centre; Heart of England NHS Trust; Birmingham UK
- Aston University; Birmingham UK
| | - P. Cockwell
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
| | - G. Pratt
- Department of Haematology; Heart of England NHS Trust; Birmingham UK
| | - C. A. Hutchison
- Renal Institute of Birmingham; University Hospital Birmingham; Birmingham UK
- University of Birmingham; Birmingham UK
- Hawke's Bay District Health Board; Hawke's Bay New Zealand
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Prognostic significance of serum free light chains in chronic lymphocytic leukemia. Adv Hematol 2013; 2013:359071. [PMID: 24288537 PMCID: PMC3830760 DOI: 10.1155/2013/359071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 09/10/2013] [Accepted: 09/11/2013] [Indexed: 12/04/2022] Open
Abstract
Background. Serum free light chains (sFLC), the most commonly detected paraprotein in CLL, were recently proposed as useful tools for the prognostication of CLL patients. Objective. To investigate the prognostic implication of sFLC and the summated FLC-kappa plus FLC-lambda in a CLL patients' series. Patients and Methods. We studied 143 CLL patients of which 18 were symptomatic and needed treatment, while 37 became symptomatic during follow-up. Seventy-two percent, 18%, and 10% were in Binet stage A, B and C, respectively. Median patients' followup was 32 months (range 4–228). Results. Increased involved (restricted) sFLC (iFLC) was found in 42% of patients, while the summated FLC-kappa plus FLC-lambda was above 60 mg/dL in 14%. Increased sFLC values as well as those of summated FLC above 60 were related to shorter time to treatment (P = 0.0005 and P = 0.000003, resp.) and overall survival (P = 0.05 and P = 0.003, resp.). They also correlated with β2-microglobulin (P = 0.009 and P = 0.03, resp.), serum albumin (P = 0.009 for summated sFLC), hemoglobin (P < 0.001), abnormal LDH (P = 0.037 and P = 0.001, resp.), Binet stage (P < 0.05) and with the presence of beta symptoms (P = 0.004 for summated sFLC). Conclusion. We confirmed the prognostic significance of sFLC in CLL regarding both time to treatment and survival and showed their relationship with other parameters.
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Beiggi S, Johnston JB, Seftel MD, Pitz MW, Kumar R, Banerji V, Griffith EJ, Gibson SB. Increased risk of second malignancies in chronic lymphocytic leukaemia patients as compared with follicular lymphoma patients: a Canadian population-based study. Br J Cancer 2013; 109:1287-90. [PMID: 23860531 PMCID: PMC3778273 DOI: 10.1038/bjc.2013.381] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/24/2013] [Accepted: 06/24/2013] [Indexed: 12/28/2022] Open
Abstract
Background: Chronic lymphocytic leukaemia (CLL) patients have an increased risk of other malignancies. This may be due to surveillance bias, treatment or immunosuppression. Methods: Cohort study of 612 consecutively diagnosed CLL patients in a Canadian province, with comparisons to follicular lymphoma (FL) patients. Results: Treated CLL patients had a 1.7-fold increased risk of second cancers compared with untreated CLL patients. As compared with untreated FL patients, untreated CLL patients had a two-fold increased incidence of second malignancies. Conclusion: Chronic lymphocytic leukaemia patients have an inherent predisposition to second cancers and the incidence is further increased by treatment.
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Affiliation(s)
- S Beiggi
- Department of Biochemistry and Medical Genetics, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, MB, Canada R3E 0V9
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Freeman JA, Crassini KR, Best OG, Forsyth CJ, Mackinlay NJ, Han P, Stevenson W, Mulligan SP. Immunoglobulin G subclass deficiency and infection risk in 150 patients with chronic lymphocytic leukemia. Leuk Lymphoma 2012; 54:99-104. [DOI: 10.3109/10428194.2012.706285] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Anandram S, Assi LK, Lovatt T, Parkes J, Taylor J, Macwhannell A, Jacob A, Handa S, Harding S, Basu S. Elevated, combined serum free light chain levels and increased mortality: a 5-year follow-up, UK study. J Clin Pathol 2012; 65:1036-42. [PMID: 22923765 DOI: 10.1136/jclinpath-2012-200910] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS Abnormal serum free light chain (FLC) ratios are diagnostically important in almost all plasma cell disorders. However, absolute increases in polyclonal FLC levels are often discarded as inconsequential. Here we report an association between increased combined polyclonal FLC (cFLC: FLCκ plus FLCλ) concentrations and mortality. METHODS 723 patients sent for 30 routine haematological assessments were enrolled. Patients with a confirmed monoclonal gammopathy were removed. The remaining 527 patients were followed up for up to 4.5 years. Statistical analysis was performed using SPSS (V.19). RESULTS During follow-up, there were 99 deaths (18.8%). Kaplan-Meier survival analysis revealed 29% of these deaths occurred within the first 100 days (N=29). Multivariate analysis identified only cFLC >65 mg/l, albumin <33 g/l and estimated glomerular filtration rate <30 ml/min/1.73 m(2) to be independently associated with mortality within 100 days and 4.5 years with, cFLC having the highest HR of 7.1. A simple risk stratification model based only on albumin and cFLC identified 86% mortality within 100 days and 62% over 4.5 years. CONCLUSIONS Elevated cFLC is significantly associated with increased mortality and with albumin can be used to identify patients at risk of mortality at 4.5 years with high-risk patients detected within 100 days.
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Affiliation(s)
- Seetharam Anandram
- The Department of Haematology. The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
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Bibas M. Polyclonal Serum Free Light Chains: A Biomarker of Disease Prognosis or of Immune Senescence? J Clin Oncol 2012; 30:3033-4; author reply 3034. [DOI: 10.1200/jco.2012.43.4043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michele Bibas
- National Institute for Infectious Diseases Lazzaro Spallanzani, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Moreira J, Rabe KG, Cerhan JR, Kay NE, Wilson JW, Call TG, Leis JF, Jelinek DF, Schwager SM, Bowen DA, Hanson CA, Slager SL, Shanafelt TD. Infectious complications among individuals with clinical monoclonal B-cell lymphocytosis (MBL): a cohort study of newly diagnosed cases compared to controls. Leukemia 2012; 27:136-41. [PMID: 22781591 DOI: 10.1038/leu.2012.187] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although the risk of progression from monoclonal B-cell lymphocytosis (MBL) to chronic lymphocytic leukemia (CLL) has been well characterized, it is unknown whether other common complications associated with CLL, such as increased risk of infection, occurs in individuals with MBL. We used the Mayo CLL database to identify cohorts of individuals with newly diagnosed MBL (n=154) or newly diagnosed CLL (n=174) who resided within 50 miles of Mayo Clinic. A cohort of 689 adult patients seen for a general medical examination who resided within 50 miles of Mayo clinic and who enrolled in a case-control study of non-Hodgkin lymphoma (NHL) was used as a comparison cohort. Hospitalization with infection was more common among individuals with MBL (25/154; 16.2%), and CLL (32/174; 18.4%) than controls (18/689; 2.6%). On pooled multivariable Cox proportional hazards analysis of all 1017 patients (controls, MBL and CLL), male sex (hazards ratio (HR)=2.3; P=0.002), major co-morbid health problems (HR=1.7, P=0.04), the presence of CLL (HR=3.2, P<0.001), treatment for progressive CLL (HR=2.4, P=0.001) and the presence of MBL (HR=3.0, P=0.001) were independently associated with risk of hospitalization for infection. These results suggest the risk of serious infection in clinical MBL is substantially greater than the risk of progression requiring treatment.
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Affiliation(s)
- J Moreira
- Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
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