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Shen MX, Li FL, Luo XS, Wang ZM. An effective treatment and suspicious adverse reaction to Ibrutinib in a patient diagnosed with splenic B-cell lymphoma/leukaemia with prominent nucleoli: A first case report. Medicine (Baltimore) 2023; 102:e36022. [PMID: 38206706 PMCID: PMC10754594 DOI: 10.1097/md.0000000000036022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/16/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE Splenic B-cell lymphoma/leukemia with prominent nucleoli (SBLPN) is a new classification, which is so rare that it lacks clinical data. PATIENT CONCERNS An increased proportion of prolymphocytes (84%) in the bone marrow smear. Whole exon sequence analysis revealed a TP53 mutation. DIAGNOSES Combining the clinical features with laboratory test results led to a diagnosis of SBLPN which was made according to the 5th edition of the WHO classification of hematolymphoid tumors, although the patient was diagnosed with B-PLL when guided by the 4th edition of the WHO classification. INTERVENTIONS The use of Ibrutinib as an effective treatment. OUTCOMES The patient was in complete remission after 5 months of Ibrutinib and then died of sudden aortic dissection. LESSONS Ibrutinib was an effective regimen for SBLPN. Aortic dissection might be considered as a suspicious adverse reaction to Ibrutinib.
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Affiliation(s)
- Mei-Xiao Shen
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Fu-Ling Li
- Department of Pharmacy, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Xian-Sheng Luo
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Zhi-Ming Wang
- Department of Hematology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
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2
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Czader M, Amador C, Cook JR, Thakkar D, Parker C, Dave SS, Dogan A, Duffield AS, Nejati R, Ott G, Xiao W, Wasik M, Goodlad JR. Progression and transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma and B-cell prolymphocytic leukemia: Report from the 2021 SH/EAHP Workshop. Am J Clin Pathol 2023; 159:554-571. [PMID: 37052539 PMCID: PMC10233402 DOI: 10.1093/ajcp/aqad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/03/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVES Session 3 of the 2021 Workshop of the Society for Hematopathology/European Association for Haematopathology examined progression and transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and B-cell prolymphocytic leukemia (B-PLL). METHODS Thirty-one cases were reviewed by the panel. Additional studies such as immunohistochemistry and molecular genetic testing, including whole-exome sequencing and expression profiling, were performed in select cases. RESULTS Session 3 included 27 CLL/SLL cases and miscellaneous associated proliferations, 3 cases of B-PLL, and 1 case of small B-cell lymphoma. The criteria for -accelerated CLL/SLL are established for lymph nodes, but extranodal disease can be diagnostically challenging. Richter transformation (RT) is a broad term and includes true transformation from original CLL/SLL clone(s) and clonally unrelated neoplasms. The morphologic, immunophenotypic, and genetic spectrum is diverse with classical and highly unusual examples. T-cell proliferations can also be encountered in CLL/SLL. B-cell prolymphocytic leukemia is a rare, diagnostically challenging disease due to its overlaps with other lymphoid neoplasms. CONCLUSIONS The workshop highlighted complexity of progression and transformation in CLL/SLL and B-PLL, as well as diagnostic caveats accompanying heterogeneous presentations of RT and other manifestations of disease progression. Molecular genetic studies are pivotal for diagnosis and determination of clonal relationship, and to predict response to treatment and identify resistance to targeted therapy.
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MESH Headings
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Prolymphocytic, B-Cell
- Lymphoma, B-Cell
- Cell Transformation, Neoplastic/genetics
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Affiliation(s)
- Magdalena Czader
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, US
| | - Catalina Amador
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, US
| | - James R Cook
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, US
| | - Devang Thakkar
- Department of Medicine, Duke University School of Medicine, Durham, NC, US
| | | | - Sandeep S Dave
- Department of Medicine, Duke University School of Medicine, Durham, NC, US
| | - Ahmet Dogan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, US
| | - Amy S Duffield
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, US
| | - Reza Nejati
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, US
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology, Stuttgart, Germany
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, US
| | - Mariusz Wasik
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, US
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3
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Wang Y, Liu H, Wang H, Wu Y, Qiu H, Qiao C, Cao L, Zhang J, Li J, Fan L, Wang R. Enhancing morphological analysis of peripheral blood cells in chronic lymphocytic leukemia with an artificial intelligence-based tool. Leuk Res 2023; 130:107310. [PMID: 37244059 DOI: 10.1016/j.leukres.2023.107310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Real-time monitoring is essential for the management of chronic lymphocytic leukemia (CLL) patients. Utilizing peripheral blood is advantageous due to its affordability and convenience. Existing methods of assessing peripheral blood films have limitations that include lack of automation, dependence on personal experience, and low repeatability and reproducibility. To overcome these challenges, we have designed an artificial intelligence-driven system that provides a clinical perspective to objectively evaluate morphologic features in CLL patients' blood cells. METHODS Based on our center's CLL dataset, we developed an automated algorithm using a deep convolutional neural network to precisely identify regions of interest on blood films and used the well-established Visual Geometry Group-16 as the encoder to segment cells and extract morphological features. This tool enabled us to extract morphological features of all lymphocytes for subsequent analysis. RESULTS Our study's lymphocyte identification had a recall of 0.96 and an F1 score of 0.97. Cluster analysis identified three clear, morphological groups of lymphocytes that reflect distinct stages of disease development to some extent. To investigate the longitudinal evolution of lymphocyte, we extracted cellular morphology parameters at various time points from the same patient. The results showed some similar trends to those observed in the aforementioned cluster analysis. Correlation analysis further supports the prognostic potential of cell morphology-based parameters. CONCLUSION Our study provides valuable insights and potential avenues for further exploration of lymphocyte dynamics in CLL. Investigating morphological changes may help in determining the optimal timing for intervening with CLL patients, but further research is needed.
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Affiliation(s)
- Yan Wang
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hailing Liu
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China
| | - Hui Wang
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yujie Wu
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hairong Qiu
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chun Qiao
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Lei Cao
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China
| | - Jianfu Zhang
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jianyong Li
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China
| | - Lei Fan
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China.
| | - Rong Wang
- Department of Hematology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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4
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Menakuru SR, Roepke J, Siddiqui S. De-Novo B-Cell Prolymphocytic Leukemia. J Hematol 2023; 12:82-86. [PMID: 37187496 PMCID: PMC10181324 DOI: 10.14740/jh1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
B-cell prolymphocytic leukemia (B-PLL) is a rare B-cell neoplasm that typically presents with splenomegaly, a rising white blood cell count, and may or may not have B symptoms. The diagnosis usually requires a bone marrow biopsy and aspirate with flow cytometry and cytogenetic studies. At least 55% of the lymphocytes in the peripheral blood must be prolymphocytes to be defined as B-PLL. A thorough differential diagnosis would include mantle cell lymphoma, chronic lymphocytic leukemia (CLL) with prolymphocytes, hairy cell leukemia, and splenic marginal zone lymphoma. B-PLL is managed with regimens utilized for CLL, such as ibrutinib and rituximab but is tailored for each individual. The authors report a rare case of B-PLL in a patient with no known history of CLL. The authors discuss this entity in context of the 2017 and 2022 World Health Organization (WHO) classifications, the latter of which no longer recognizes B-PLL as a distinct entity. The authors hope that this article helps practitioners with the diagnosis and treatment of B-PLL. Perhaps with better recognition, and better documentation of histopathologic features of these rare cases going forward, it may prove to be a distinct entity again in future classifications.
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Affiliation(s)
- Sasmith R. Menakuru
- Department of Internal Medicine, Indiana University School of Medicine-Muncie, Muncie, IN, USA
- Corresponding Author: Sasmith R. Menakuru, Department of Internal Medicine, Indiana University School of Medicine-Muncie, Muncie, IN, USA.
| | - Janet Roepke
- Department of Pathology, Indiana University Health-Ball Memorial Hospital, Muncie, IN, USA
| | - Salahuddin Siddiqui
- Department of Hematology/Oncology, Indiana University Health-Ball Memorial Hospital, Muncie, IN, USA
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5
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Sander B, Campo E, Hsi ED. Chronic lymphocytic leukaemia/small lymphocytic lymphoma and mantle cell lymphoma: from early lesions to transformation. Virchows Arch 2023; 482:131-145. [PMID: 36454275 PMCID: PMC9852142 DOI: 10.1007/s00428-022-03460-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/06/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
Abstract
The International Clinical Advisory Committee reviewed advances in our understanding of the clinicopathologic and biologic features of chronic lymphocytic leukaemia/small lymphocytic lymphoma, B-cell prolymphocytic leukaemia, and mantle cell lymphoma since the revised 4th edition of the WHO Classification of Tumours of the Haematopoietic and Lymphoid Tissues. Discussions amongst pathologists, clinicians, and molecular geneticists around these diseases focussed on incorporating new knowledge into the next classification system. In this manuscript, we review these disease entities and incorporate results of these deliberations, including advances in our understanding of early lesions and transformation.
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Affiliation(s)
- Birgitta Sander
- grid.24381.3c0000 0000 9241 5705Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Elias Campo
- grid.5841.80000 0004 1937 0247Laboratory of Pathology Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain ,grid.10403.360000000091771775Institute of Biomedical Research August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Eric D. Hsi
- grid.241167.70000 0001 2185 3318Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC USA
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6
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Kunnumbrath A, Singh N, Gupta AK, Chowdhury N, Nath UK, Chandra H. Flow Cytometric Expression of CD49d in Newly Diagnosed Chronic Lymphocytic Leukemia and Its Correlation with Established Prognostic Markers. J Lab Physicians 2022; 14:435-442. [DOI: 10.1055/s-0042-1748828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction Chronic lymphocytic leukemia (CLL) is the commonest hematological malignancy in the West but is relatively uncommon in India. The prognosis of CLL is determined by well-established prognostic markers. CD49d has been emerging as a promising prognostic marker in CLL. CD49d expression in CLL has been found to have an aggressive clinical course, shorter time to first treatment, and poorer prognosis. The aim of this study was to analyze the flow cytometric expression of CD49d in newly diagnosed CLL and to correlate its expression with clinico-hematological parameters.
Materials and Methods Twenty-five consecutive patients of CLL, diagnosed on flow cytometry, were included in the study. Patients on treatment or those with relapse were excluded. The panel for flow cytometry included the routine markers used for CLL diagnosis along with CD49d. The expression of CD49d was correlated with clinico-hematological parameters in all patients. “R” software was used for the statistical analysis. Fisher's exact test and Wilcox test were used to assess the correlation of CD49d to categorical and continuous data, respectively.
Results The mean age of the patients was 62.6 ± 12.5 years, and 80% were symptomatic at diagnosis. CD49d expression was found in 44% cases, with a higher proportion being male patients. CD49d and prolymphocyte percentage showed a statistically significant correlation (p = 0.0007). We found a statistically significant correlation between CD49d expression and lymphadenopathy and splenomegaly with p-values of 0.033 and 0.0472, respectively. CD49d positivity correlated significantly with a higher Rai stage (p = 0.0196) and intermediate and high-risk cases according to Binet staging (p = 0.033).
Conclusion CD49d expression in the present study correlated with a higher prolymphocyte percentage, lymphadenopathy, splenomegaly, and higher Rai and Binet stages. CD49d expression on flow cytometry was reproducible and easy to interpret.
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Affiliation(s)
- Arathi Kunnumbrath
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Neha Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Arvind Kumar Gupta
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nilotpal Chowdhury
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Uttam Kumar Nath
- Department of Medical Oncology and Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Harish Chandra
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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7
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B-prolymphocytic leukemia: Is it time to retire this entity? Ann Diagn Pathol 2021; 54:151790. [PMID: 34293709 DOI: 10.1016/j.anndiagpath.2021.151790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/11/2021] [Indexed: 11/23/2022]
Abstract
B-prolymphocytic leukemia (B-PLL) is included as a distinct entity in the current World Health Organization classification of hematolymphoid neoplasms. However, the diagnosis of B-PLL has presented several challenges since its conception, and over the past decades investigations of B-PLL have revealed substantial biologic and molecular heterogeneity. These data have shown that many B-PLL cases present many similarities with other types of small B-cell lymphomas, and that small B-cell lymphomas can undergo prolymphocytoid transformation. As a result, the frequency of B-PLL has markedly decreased, and currently B-PLL is a very rare entity. Most recent studies focused on B-PLL cases have been conducted on limited cohorts, precluding robust conclusions. In this article, we provide a concise historical review of B-PLL and describe the diagnostic and clinical challenges associated with establishing this diagnosis. We also argue that cases currently classified as B-PLL are unlikely to be a unique biologic entity, but rather represent a state of morphologic transformation characterized by many prolymphocytes that is shared by various types of small B-cell lymphoma.
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8
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Jiang P, Desai A, Ye H. Progress in molecular feature of smoldering mantle cell lymphoma. Exp Hematol Oncol 2021; 10:41. [PMID: 34256839 PMCID: PMC8278675 DOI: 10.1186/s40164-021-00232-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/02/2021] [Indexed: 12/30/2022] Open
Abstract
Mantle cell lymphoma (MCL) is considered one of the most aggressive lymphoid tumors. However, it sometimes displays indolent behavior in patients and might not necessitate treatment at diagnosis; this has been described as "smoldering MCL" (SMCL). There are significant differences in the diagnosis, prognosis, molecular mechanisms and treatments of indolent MCL and classical MCL. In this review, we discuss the progress in understanding the molecular mechanism of indolent MCL to provide insights into the genomic nature of this entity. Reported findings of molecular features of indolent MCL include a low Ki-67 index, CD200 positivity, a low frequency of mutations in TP53, a lack of SOX11, normal arrangement and expression of MYC, IGHV mutations, differences from classical MCL by L-MCL16 assays and MCL35 assays, an unmutated P16 status, few defects in ATM, no NOTCH1/2 mutation, Amp 11q gene mutation, no chr9 deletion, microRNA upregulation/downregulation, and low expression of several genes that have been valued in recent years (SPEN, SMARCA4, RANBP2, KMT2C, NSD2, CARD11, FBXW7, BIRC3, KMT2D, CELSR3, TRAF2, MAP3K14, HNRNPH1, Del 9p and/or Del 9q, SP140 and PCDH10). Based on the above molecular characteristics, we may distinguish indolent MCL from classical MCL. If so, indolent MCL will not be overtreated, whereas the treatment of classical MCL will not be delayed.
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Affiliation(s)
- Panruo Jiang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University - Zhejiang, Wenzhou, China
| | - Aakash Desai
- Division of Hematology, Department of Medicine, Mayo Clinic-MN, Rochester, US
| | - Haige Ye
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University - Zhejiang, Wenzhou, China.
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9
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Chowdhury Z, Khonglah Y, Sarma S, Kalita P. De novo chronic lymphocytic leukemia/prolymphocytic leukemia or B-cell prolymphocytic leukemia? The importance of integrating clinico-morphological and immunophenotypic findings in distinguishing chronic lymphoproliferative diseases with circulating phase. AUTOPSY AND CASE REPORTS 2020; 11:e2020196. [PMID: 34277479 PMCID: PMC8101659 DOI: 10.4322/acr.2020.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/15/2020] [Indexed: 11/23/2022] Open
Abstract
B-cell prolymphocytic leukemia (B-PLL) is an extremely rare disease, accounting for approximately 1% of the lymphocytic leukemias. B-PLL generally occurs in older people. It is characterized by the presence of more than 55% prolymphocytes in the peripheral blood (PB), no or minimal lymphadenopathy, massive splenomegaly, and very high white blood cell counts. The prognosis of B-PLL patients is generally poor, with a median survival of 3 years, although a subset of patients may show a prolonged survival. Herein, we report a case of a 70-year-old male with weakness, generalized lymphadenopathy, and moderate splenomegaly at the initial presentation. Hematologic examination revealed lymphocytic leukocytosis, favoring a chronic lymphoproliferative disorder (CLPD). The key to decoding the precise CLPD was a combination of the clinical profile, morphologic findings on the peripheral blood and the bone marrow, immunophenotypic analysis, and cytogenetic study. The best diagnosis proffered was a de novo chronic lymphocytic leukemia/prolymphocytic leukemia. There was no prior history of lymphoproliferative disorder or lymphocytic leukocytosis. Discriminating this entity from other lymphoproliferative disorders is crucial as the treatment and prognosis are varied compared to the other lymphoproliferative disorders. The diagnostic conundrum encountered and the incredible utility of ancillary studies in such a scenario are highlighted in this study.
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Affiliation(s)
- Zachariah Chowdhury
- Homi Bhabha Cancer Hospital/MPMMCC (Tata Memorial Hospital), Department of Pathology, Varanasi, Uttar Pradesh, India
| | - Yookarin Khonglah
- North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Department of Pathology, Shillong, Meghalaya, India
| | - Susmita Sarma
- North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Department of Pathology, Shillong, Meghalaya, India
| | - Pranjal Kalita
- North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Department of Pathology, Shillong, Meghalaya, India
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10
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Magnano L, Navarro A, López-Guerra M, Clot G, Beà S, Bastidas G, Costa D, Rivero A, Garrote M, Giné E, Rozman M, Aymerich M, Colomer D, López-Guillermo A, Campo E, Villamor N, Matutes E. Chronic lymphocytic leukaemia and prolymphocytic leukaemia. Two coins or two sides of the same coin? Haematologica 2020; 105:e484. [PMID: 33054069 PMCID: PMC7556621 DOI: 10.3324/haematol.2020.253062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Alba Navarro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Guillem Clot
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | | | | | | | - Eva Giné
- Hospital Clínic of Barcelona, Spain
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11
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Zhao M, Mallesh N, Höllein A, Schabath R, Haferlach C, Haferlach T, Elsner F, Lüling H, Krawitz P, Kern W. Hematologist-Level Classification of Mature B-Cell Neoplasm Using Deep Learning on Multiparameter Flow Cytometry Data. Cytometry A 2020; 97:1073-1080. [PMID: 32519455 DOI: 10.1002/cyto.a.24159] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/07/2023]
Abstract
The wealth of information captured by multiparameter flow cytometry (MFC) can be analyzed by recent methods of computer vision when represented as a single image file. We therefore transformed MFC raw data into a multicolor 2D image by a self-organizing map and classified this representation using a convolutional neural network. By this means, we built an artificial intelligence that is not only able to distinguish diseased from healthy samples, but it can also differentiate seven subtypes of mature B-cell neoplasm. We trained our model with 18,274 cases including chronic lymphocytic leukemia and its precursor monoclonal B-cell lymphocytosis, marginal zone lymphoma, mantle cell lymphoma, prolymphocytic leukemia, follicular lymphoma, hairy cell leukemia, lymphoplasmacytic lymphoma and achieved a weighted F1 score of 0.94 on a separate test set of 2,348 cases. Furthermore, we estimated the trustworthiness of a classification and could classify 70% of all cases with a confidence of 0.95 and higher. Our performance analyses indicate that particularly for rare subtypes further improvement can be expected when even more samples are available for training. © 2020 The Authors. Cytometry Part A published by Wiley Periodicals LLC. on behalf of International Society for Advancement of Cytometry.
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Affiliation(s)
- Max Zhao
- Institute for Genomic Statistics and Bioinformatics, University Bonn, Bonn, Germany.,Institute of Human Genetics and Medical Genetics, Charité University Hospital, Berlin, Germany
| | - Nanditha Mallesh
- Institute for Genomic Statistics and Bioinformatics, University Bonn, Bonn, Germany
| | - Alexander Höllein
- MLL Munich Leukemia Laboratory, Munich, Germany.,Red Cross Hospital Munich, Munich, Germany
| | - Richard Schabath
- MLL Munich Leukemia Laboratory, Munich, Germany.,Onkologische Praxis Berlin Mitte, Berlin, Germany
| | | | | | | | | | - Peter Krawitz
- Institute for Genomic Statistics and Bioinformatics, University Bonn, Bonn, Germany
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12
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Bisso A, Sabò A, Amati B. MYC in Germinal Center-derived lymphomas: Mechanisms and therapeutic opportunities. Immunol Rev 2019; 288:178-197. [PMID: 30874346 DOI: 10.1111/imr.12734] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/11/2018] [Indexed: 12/13/2022]
Abstract
The rearrangement of immunoglobulin loci during the germinal center reaction is associated with an increased risk of chromosomal translocations that activate oncogenes such as MYC, BCL2 or BCL6, thus contributing to the development of B-cell lymphomas. MYC and BCL2 activation are initiating events in Burkitt's (BL) and Follicular Lymphoma (FL), respectively, but can occur at later stages in other subtypes such as Diffuse Large-B Cell Lymphoma (DLBCL). MYC can also be activated during the progression of FL to the transformed stage. Thus, either DLBCL or FL can give rise to aggressive double-hit lymphomas (DHL) with concurrent activation of MYC and BCL2. Research over the last three decades has improved our understanding of the functions of these oncogenes and the basis for their cooperative action in lymphomagenesis. MYC, in particular, is a transcription factor that contributes to cell activation, growth and proliferation, while concomitantly sensitizing cells to apoptosis, the latter being blocked by BCL2. Here, we review our current knowledge about the role of MYC in germinal center B-cells and lymphomas, discuss MYC-induced dependencies that can sensitize cancer cells to select pharmacological inhibitors, and illustrate their therapeutic potential in aggressive lymphomas-and in particular in DHL, in combination with BCL2 inhibitors.
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Affiliation(s)
- Andrea Bisso
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Arianna Sabò
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Bruno Amati
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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13
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Bhola RK, Das PK, Pradhan S, Chakraborty K, Mohapatra D, Samal P, Patra PC, Panda SS, Mishra SK. Multiplexing 8 colors with 12 antibodies in a single lymphoid screening tube by flow cytometry for evaluating suspected chronic lymphoproliferative disorders (CLPD). J Hematop 2019. [DOI: 10.1007/s12308-019-00376-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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14
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15
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Prolymphocytic transformation of lymphoplasmacytic lymphoma: an extremely unusual event. Hum Pathol 2019; 90:106-110. [DOI: 10.1016/j.humpath.2018.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/13/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022]
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16
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Yeung CCS, Shadman M. How to Choose the Best Treatment and Testing for Chronic Lymphocytic Leukemia in the Tsunami of New Treatment Options. Curr Oncol Rep 2019; 21:74. [PMID: 31327069 DOI: 10.1007/s11912-019-0819-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Treatment of chronic lymphocytic leukemia (CLL) has undergone a major shift since introduction of multiple targeted agents. B cell receptor inhibitors that target either bruton tyrosine kinase (ibrutinib) or phosphatidylinositol 3-kinases (idelalisib and duvelisib) and BCL-2 inhibitor venetoclax have become the mainstay of treatment. RECENT FINDINGS Newer generations of monoclonal antibodies targeting CD20 (obinutuzumab and ofatumumab) are commonly used with novel drugs or chemotherapy agents and result in improved efficacy. At the same time, chemoimmunotherapy remains a reasonable option for selected patients. Therefore, with variety of reasonable options, choice of treatment in first-line or relapsed setting has become more challenging. Better understanding of the molecular and cytogenetics data for each patient is critical to improve management of patients with CLL. Herein, we review our approach to diagnosis and treatment of CLL in the era of novel therapeutic agents.
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Affiliation(s)
- Cecilia C S Yeung
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, G71910, Seattle, WA, 98109, USA. .,Department of Pathology, University of Washington, Seattle, WA, USA. .,Seattle Cancer Care Alliance, Seattle, WA, USA.
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, G71910, Seattle, WA, 98109, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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17
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Cross M, Dearden C. B and T cell prolymphocytic leukaemia. Best Pract Res Clin Haematol 2019; 32:217-228. [PMID: 31585622 DOI: 10.1016/j.beha.2019.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
Prolymphocytic leukaemias B-PLL and T-PLL are rare disorders, typically with an aggressive clinical course and poor prognosis. Combining morphology, immunophenotyping, cytogenetic and molecular diagnostics reliably separates B-PLL and T-PLL from one another and other disorders. In T-PLL discovery of frequent mutations in the JAK-STAT pathway have increased understanding of disease pathogenesis. Alemtuzumab (anti-CD52) produces excellent response rates but long-term remissions are only achieved in a minority following consolidation with allogeneic stem cell transplant. Molecular abnormalities in B-PLL are less understood. Disruption of TP53 is a key finding, conveying chemotherapy resistance requiring novel therapies such as B-cell receptor inhibitors (BCRi). Both conditions require improved pathobiological knowledge to identify new treatment targets and guide therapy with novel pathway inhibitors.
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Affiliation(s)
- M Cross
- The Royal Marsden Hospital and the Institute of Cancer Research, UK
| | - C Dearden
- The Royal Marsden Hospital and the Institute of Cancer Research, UK.
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18
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Jain P, Wang M. Mantle cell lymphoma: 2019 update on the diagnosis, pathogenesis, prognostication, and management. Am J Hematol 2019; 94:710-725. [PMID: 30963600 DOI: 10.1002/ajh.25487] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 12/16/2022]
Abstract
Unprecedented advances in our understanding of the pathobiology, prognostication, and therapeutic options in mantle cell lymphoma (MCL) have taken place in the last few years. Heterogeneity in the clinical course of MCL-indolent vs aggressive-is further delineated by a correlation with the mutational status of the variable region of immunoglobulin heavy chain, methylation status, and SOX-11 expression. Cyclin-D1 negative MCL, in situ MCL neoplasia, and impact of the karyotype on prognosis are distinguished. Apart from Ki-67% and morphology pattern (classic vs blastoid/pleomorphic), the proliferation gene signature has helped to further refine prognostication. Studies focusing on mutational dynamics and clonal evolution on Bruton's tyrosine kinase (BTK) inhibitors (ibrutinib, acalabrutinib) and/or Bcl2 antagonists (venetoclax) have further clarified the prognostic impact of somatic mutations in TP53, BIRC3, CDKN2A, MAP3K14, NOTCH2, NSD2, and SMARCA4 genes. In therapy, long-term follow-up on chemo-immunotherapy studies has demonstrated durable remissions in some patients; however, long-term toxicities, especially from second cancers, are a serious concern with chemotherapy. The therapeutic options in MCL are constantly evolving, with dramatic responses from nonchemotherapeutic agents (ibrutinib, acalabrutinib, and venetoclax). Chimeric antigen receptor therapy and combinations of nonchemotherapeutic agents are actively being studied and our focus is shifting toward making the treatment of MCL chemotherapy-free. Still, MCL remains incurable. The following aspects of MCL continue to pose a challenge: disease transformation, role of the cytokine-microenvironmental milieu, incorporation of positron emission tomography-computerized tomography imaging, minimal residual disease in the prognosis, circulating tumor DNA testing for clonal evolution, predicting resistance to BTK inhibitors, and optimal management of patients who progress on BTK/Bcl2 inhibitors. Next-generation clinical trials should incorporate nonchemotherapeutic agents and personalize the treatment based upon the genomic profile of individual patient. Recent advances in the field of MCL are reviewed.
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Affiliation(s)
- Preetesh Jain
- Division of Cancer Medicine, Department of Lymphoma/MyelomaThe University of Texas MD Anderson Cancer Center Houston Texas
| | - Michael Wang
- Division of Cancer Medicine, Department of Lymphoma/MyelomaThe University of Texas MD Anderson Cancer Center Houston Texas
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19
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Li X, Wu N, Li B. A high mutation rate of immunoglobulin heavy chain variable region gene associates with a poor survival and chemotherapy response of mantle cell lymphoma patients. Medicine (Baltimore) 2019; 98:e15811. [PMID: 31145313 PMCID: PMC6708879 DOI: 10.1097/md.0000000000015811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Immunoglobulin heavy chain variable region (IGHV) gene mutation status is a biomarker for the prognosis of chronic lymphocytic leukemia, whether it is associated with the diagnosis, staging, and prognosis of patients with mantle cell lymphoma (MCL) remains to be determined.The IGHV gene mutations of 52 MCL patients were determined by DNA sequencing and compared with published IGHV germline sequences.DNA sequence alignment of IGHV variable regions with published IGHV germline sequences showed that the coincidence rate was 94% to 100%. Ten cases (21%) were significantly mutated with the rate of 96.9% to 94.0%. The overall survival time of patients was negatively correlated with the degree of IGHV gene mutation. Further survival analysis with log-rank test demonstrated that the patients with significant IGHV gene mutations showed a trend towards poor survival.The mutation rate of the IGHV variant region may be determined to assess the prognosis and overall survival time of MCL patients.
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Affiliation(s)
- Xianqian Li
- Clinical Laboratory, Shanghai Yangpu District Psychiatric Hospital
| | | | - Bin Li
- Department of Pathology, Shanghai Xuhui Central Hospital, Shanghai, China
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20
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[The consensus for differential diagnosis of B cell chronic lymphoproliferative diseases in China (2018 edition)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:359-365. [PMID: 29779341 PMCID: PMC7342900 DOI: 10.3760/cma.j.issn.0253-2727.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Indexed: 01/17/2023]
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21
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Schick M, Habringer S, Nilsson JA, Keller U. Pathogenesis and therapeutic targeting of aberrant MYC expression in haematological cancers. Br J Haematol 2017; 179:724-738. [DOI: 10.1111/bjh.14917] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Markus Schick
- Internal Medicine III; School of Medicine; Technische Universität München; Munich Germany
| | - Stefan Habringer
- Internal Medicine III; School of Medicine; Technische Universität München; Munich Germany
| | - Jonas A. Nilsson
- Department of Surgery; Sahlgrenska Cancer Center; Gothenburg University; Gothenburg Sweden
| | - Ulrich Keller
- Internal Medicine III; School of Medicine; Technische Universität München; Munich Germany
- German Cancer Consortium (DKTK); German Cancer Research Center (DKFZ); Heidelberg Germany
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22
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Abstract
PURPOSE OF REVIEW We aimed to produce a comprehensive update on clinical and biological data regarding two rare lymphoid neoplasms, B and T prolymphocytic leukemias, and assess therapeutic management in the light of new molecular insights and the advent of targeted therapies. RECENT FINDINGS B cell prolymphocytic leukemia (B-PLL) diagnosis remains challenging in the absence of clear immunophenotypic or cytogenetic signature and overlap with mantle cell lymphoma. New molecular defects have been identified in T cell prolymphocytic leukemia (T-PLL), especially in the JAK STAT pathway. Like in chronic lymphocytic leukemia (CLL), B-PLL treatment depends on the presence of TP53 dysfunction. In T-PLL, alemtuzumab still remains the standard of care. Allogeneic transplantation is the only curable option. Thanks to reduced intensity conditioning regimens, it has become accessible to a larger number of patients. PLL prognosis remains poor with conventional therapies. However, great advances in the understanding of both T- and B-PLL pathogenesis lead to promising new therapeutic agents.
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23
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El-Fattah MA. Risk of second cancers in survivors of prolymphocytic leukemia: a SEER data analysis. Acta Oncol 2017; 56:115-117. [PMID: 27924652 DOI: 10.1080/0284186x.2016.1265667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mohamed Abd El-Fattah
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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24
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Porwit A, Fend F, Kremer M, Orazi A, Safali M, van der Walt J. Issues in diagnosis of small B cell lymphoid neoplasms involving the bone marrow and peripheral blood. Report on the Bone Marrow Workshop of the XVIIth meeting of the European Association for Haematopathology and the Society for Hematopathology. Histopathology 2016; 69:349-73. [PMID: 27208429 DOI: 10.1111/his.12999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 01/01/2023]
Abstract
Small B cell lymphoid neoplasms are the most common lymphoproliferative disorders involving peripheral blood (PB) and bone marrow (BM). The Bone Marrow Workshop (BMW) organized by the European Bone Marrow Working Group (EBMWG) of the European Association for Haematopathology (EAHP) during the XVIIth EAHP Meeting in Istanbul, October 2014, was dedicated to discussion of cases illustrating how the recent advances in immunophenotyping, molecular techniques and cytogenetics provide better understanding and classification of these entities. Submitted cases were grouped into following categories: (i) cases illustrating diagnostic difficulties in chronic lymphocytic leukaemia (CLL); (ii) cases of BM manifestations of small B cell lymphoid neoplasms other than CLL; (iii) transformation of small B cell lymphoid neoplasms in the BM; and (iv) multiclonality and composite lymphomas in the BM. This report summarizes presented cases and conclusions of the BMW and provides practical recommendations for classification of the BM manifestations of small B cell lymphoid neoplasms based on the current state of knowledge.
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences, Division of Oncology and Pathology, Faculty of Medicine, Lund University, Lund, Sweden.,Previous address: Department of Pathobiology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Marcus Kremer
- Institute of Pathology, Staedtisches Klinikum, München, Germany
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - Jon van der Walt
- Department of Histopathology, Guy's and St Thomas' Hospitals, London, UK
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25
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Sato S, Ichihara K, Inaba T. A new self-partition clustering method for robust identification of subsets with heterogeneous size and density and its clinical application to leukocyte differential counting. Clin Chim Acta 2016; 455:118-27. [DOI: 10.1016/j.cca.2016.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/04/2016] [Accepted: 01/21/2016] [Indexed: 11/16/2022]
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26
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Abstract
B-cell (B-PLL) and T-cell (T-PLL) prolymphocytic leukemias are rare, poor-prognosis lymphoid neoplasms with similar presentation characterized by symptomatic splenomegaly and lymphocytosis. They can be distinguished from each other and from other T- and B-cell leukemias by careful evaluation of morphology, immunophenotyping, and molecular genetics. The clinical behavior is typically aggressive, although a subset of patients may have an indolent phase of variable length. First-line therapy for T-PLL is with intravenous alemtuzumab and for B-PLL is with combination purine analog-based chemo-immunotherapy. New B-cell receptor inhibitors, such as ibrutinib and idelalisib, may have a role in the management of B-PLL, especially for the patients harboring abnormalities of TP53. Allogenic stem cell transplantation should still be considered for eligible patients and may be the only current therapy capable of delivering a cure. In the past few years, many of the molecular mechanisms underlying disease pathogenesis and progression have been revealed and are likely to lead to the development of novel targeted approaches.
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27
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Doni E, Carli G, Di Rocco A, Sassone M, Gandolfi S, Patti C, Falisi E, Salemi C, Visco C. Autoimmune haemolytic anaemia in mantle cell lymphoma : an insidious complication associated with leukemic disease. Hematol Oncol 2015; 35:135-137. [PMID: 26078106 DOI: 10.1002/hon.2241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/23/2015] [Accepted: 05/02/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Elisa Doni
- Division of Hematology, San Gerardo Hospital, Monza, Milano-Bicocca University, Milan, Italy
| | - Giuseppe Carli
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Alice Di Rocco
- Division of Hematology, Sapienza University of Rome, Italy
| | - Marianna Sassone
- Division of Onco-Haematological Medicine, Department of Onco-Haematology, Unit of Lymphoid Malignancies, San Raffaele Scientific Institute, Milan, Italy
| | - Sara Gandolfi
- Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center, Milan, Italy
| | - Caterina Patti
- Division of Hematology, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Erika Falisi
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Claudia Salemi
- Division of Hematology, San Gerardo Hospital, Monza, Milano-Bicocca University, Milan, Italy
| | - Carlo Visco
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
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28
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Dearden C. Management of prolymphocytic leukemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:361-367. [PMID: 26637744 DOI: 10.1182/asheducation-2015.1.361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
B-cell (B-PLL) and T-cell (T-PLL) prolymphocytic leukemias are rare, poor-prognosis lymphoid neoplasms with similar presentation characterized by symptomatic splenomegaly and lymphocytosis. They can be distinguished from each other and from other T- and B-cell leukemias by careful evaluation of morphology, immunophenotyping, and molecular genetics. The clinical behavior is typically aggressive, although a subset of patients may have an indolent phase of variable length. First-line therapy for T-PLL is with intravenous alemtuzumab and for B-PLL is with combination purine analog-based chemo-immunotherapy. New B-cell receptor inhibitors, such as ibrutinib and idelalisib, may have a role in the management of B-PLL, especially for the patients harboring abnormalities of TP53. Allogenic stem cell transplantation should still be considered for eligible patients and may be the only current therapy capable of delivering a cure. In the past few years, many of the molecular mechanisms underlying disease pathogenesis and progression have been revealed and are likely to lead to the development of novel targeted approaches.
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Affiliation(s)
- Claire Dearden
- Department of Haemato-Oncology, Royal Marsden Biomedical Research Centre, London, UK
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29
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New developments in the pathology of malignant lymphoma. A review of the literature published from June–August 2014. J Hematop 2014. [DOI: 10.1007/s12308-014-0218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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