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Takahara T, Nakamura S, Tsuzuki T, Satou A. The Immunology of DLBCL. Cancers (Basel) 2023; 15:cancers15030835. [PMID: 36765793 PMCID: PMC9913124 DOI: 10.3390/cancers15030835] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive malignancy and is the most common type of malignant lymphoid neoplasm. While some DLBCLs exhibit strong cell-autonomous survival and proliferation activity, others depend on interactions with non-malignant cells for their survival and proliferation. Recent next-generation sequencing studies have linked these interactions with the molecular classification of DLBCL. For example, germinal center B-cell-like DLBCL tends to show strong associations with follicular T cells and epigenetic regulation of immune recognition molecules, whereas activated B-cell-like DLBCL shows frequent genetic aberrations affecting the class I major histocompatibility complex. Single-cell technologies have also provided detailed information about cell-cell interactions and the cell composition of the microenvironment of DLBCL. Aging-related immunological deterioration, i.e., immunosenescence, also plays an important role in DLBCL pathogenesis, especially in Epstein-Barr virus-positive DLBCL. Moreover, DLBCL in "immune-privileged sites"-where multiple immune-modulating mechanisms exist-shows unique biological features, including frequent down-regulation of immune recognition molecules and an immune-tolerogenic tumor microenvironment. These advances in understanding the immunology of DLBCL may contribute to the development of novel therapies targeting immune systems.
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Affiliation(s)
- Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
- Correspondence:
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya 466-8550, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
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Kuhlman JJ, Moustafa MA, Jiang L, Iqbal M, Seegobin K, Wolcott Z, Ayala E, Ansell S, Rosenthal A, Paludo J, Micallef I, Johnston P, Inwards D, Habermann T, Kharfan-Dabaja M, Witzig TE, Nowakowski GS, Tun HW. Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e815-e825. [PMID: 35534379 DOI: 10.1016/j.clml.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Leukemic involvement in high grade B cell lymphoma (L-HGBL) is rare and has been sparsely described in the literature. We report our experience in a large single institution multicenter academic setting. MATERIALS AND METHODS Medical records of patients with HGBL who received care at Mayo Clinic between 2003 and 2020 were reviewed. L-HGBL was confirmed by peripheral blood smear and flow cytometry with corroboration from tissue and bone marrow biopsy findings. RESULTS Twenty patients met inclusion criteria. All patients had significant bone marrow involvement by HGBL. Leukemic involvement presented in 11 of 20 (55%) in the de novo and 9 of 20 (45%) in the relapsed setting. Seven of 20 patients had DLBCL, NOS, 6 of 20 had transformation (t-DLBCL), 3 of 20 had transformed double/triple hit lymphoma (t-DHL/THL), 2 of 20 had double hit lymphoma (DHL), and 2 of 20 had HGBL with intermediate features between DLBCL and Burkitt lymphoma. Nine of 15 patients had MYC translocation. Based on Hans criteria, 11 of 20 had germinal center B-cell (GCB) cell of origin (COO) and 9/20 had non-GCB COO. Five of 11 de novo patients experienced CNS relapse/progression. All de novo patients received anthracycline-based chemoimmunotherapy. Eighteen of 20 patients died of progressive disease. Median overall survival was significantly better in the de novo compared to relapsed group (8.9 months vs. 2.8 months, P = .01). COO, MYC status, DHL/THL status, HGBL subtype, or treatment group did not demonstrate a significant effect on overall survival. CONCLUSION L-HGBL carries a poor prognosis and is associated with MYC translocation, DHL/THL status, transformation, and high CNS risk. Novel therapeutic approaches are needed for L-HGBL.
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Affiliation(s)
| | | | - Liuyan Jiang
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, FL
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Karan Seegobin
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Zoe Wolcott
- Department of Neurology, Mayo Clinic, Jacksonville, FL
| | - Ernesto Ayala
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Steve Ansell
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Allison Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ
| | - Jonas Paludo
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Ivana Micallef
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Patrick Johnston
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - David Inwards
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Thomas Habermann
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Thomas E Witzig
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Han W Tun
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL.
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Biopsy remains indispensable for evaluating bone marrow involvement in DLBCL patients despite the use of positron emission tomography. Int J Hematol 2021; 113:675-681. [PMID: 33515158 DOI: 10.1007/s12185-021-03080-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
Initial staging by positron emission tomography/computed tomography (PET/CT) scanning is recommended for patients with diffuse large B-cell lymphoma (DLBCL). Whether both PET/CT and bone marrow biopsy (BMB) are required remains unclear. This study examined whether staging by PET/CT is sufficient. Participants with untreated DLBCL assessed using both PET/CT and BMB were included. Patients received independent diagnostic assessments from a radiologist and a hematopathologist. Both hematoxylin-eosin staining and CD20 immunostaining were performed to determine the bone marrow involvement in BMB. A total of 84 patients were included. The number of patients with positive bone marrow involvement identified by PET/CT and BMB was 16 (19%) and 22 (26%), respectively. Eight (10%) patients showed positive results in both tests. When considering BMB as a reference, PET/CT showed 36% sensitivity and 87% specificity, with positive and negative predictive values of 50% and 79%, respectively. BMB-positive patients had shorter progression-free (PFS) and overall (OS) survival than their BMB-negative counterparts. Compared to PET/CT-negative patients, patients with positive results did not show any significant differences in PFS and OS. However, among 16 PET/CT-positive patients, poor PFS and OS were observed among patients who were also BMB positive. BMB remains a mandatory step in staging of untreated DLBCL patients.
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Vick EJ, Richardson N, Patel K, Delgado Ramos GM, Altahan A, Alloway T, Martin MG. Age-Related Chromosomal Aberrations in Patients with Diffuse Large B-Cell Lymphoma: An In Silico Approach. World J Oncol 2018; 9:97-103. [PMID: 30220946 PMCID: PMC6134989 DOI: 10.14740/wjon1136w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/27/2018] [Indexed: 02/05/2023] Open
Abstract
Background In diffuse large B-cell lymphoma (DLBCL), chromosomal aberrations are known to increase with advancing age. Our study aims to determine if there are other genetic aberrations associated with DLBCL based on age. Methods Using the Mitelman Database of Genetic Aberrations, we were able to find 749 cases of DLBCL with genomic aberrations with a median age of 62 years. Patients with DLBCL chromosomal aberration analysis results were divided into four groups based on age (0 - 30, 31 - 50, 51 - 70, > 71 years) and examined by chi-square analysis and Mantel-Cox for survival analysis. Results Ten aberrations were found to be significant with a particular age range: t(2;3), trisomy 19p13, trisomy 18q21, trisomy 3, trisomy 7, trisomy 14, trisomy 16, trisomy 18, monosomy 3 and monosomy 11, and survival ranged from 7 to 25 months. Conclusion This suggests that patients with DLBCL are likely to accumulate specific translocations depending on their age at the onset of DLBCL.
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Affiliation(s)
- Eric J. Vick
- Department of Internal Medicine, University of Cincinnati, Cincinnati OH, USA
| | - Noah Richardson
- College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kruti Patel
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Glenda M. Delgado Ramos
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alaa Altahan
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Taylor Alloway
- Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael G. Martin
- Department of Hematology and Oncology, The West Cancer Center, Memphis, TN, USA
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Waheed S, Hassan J, Naz M, Maqsood S, Abid M, Shan S, Nadeem M, Shamsi TS. Complex Karyotype in Hematological Diseases: A 6-Year Single Centre Study from Pakistan. JOURNAL OF ONCOLOGY 2018; 2018:2019239. [PMID: 29971104 PMCID: PMC6008829 DOI: 10.1155/2018/2019239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/30/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most of the hematological disorders are heterogenous with regard to morphology, immunophenotype, and genetic rearrangements. Multiple recurrent chromosomal aberrations have been identified by conventional cytogenetic analysis, which is now widely recognized as one of the most important diagnostic and prognostic determinants in these patients. Though rarer, complex karyotype has been associated with worst prognosis. MATERIALS AND METHODS A total of 1185 bone marrow or peripheral blood cytogenetics samples were taken with different hematological diseases. They included both benign and malignant disease entities. In each case, cells were cultured and conventional cytogenetic analysis was performed. RESULTS Among 1185 subjects, 41 (3.4%) patients possessed complex cytogenetic abnormalities. Out of these 41, 33 (80%) were males. The mean age was 37 years (median age 39 years). Myelodysplastic syndromes had the most numbers of complex karyotypes (8%), followed by acute myeloid leukemia (7%) and acute lymphoblastic leukemia (4%). Also we found few patients with acute promyelocytic leukemia, aplastic anemia , chronic myeloid leukemia, and diffuse large B cell Lymphoma possessing complex karyotype. Frequencies of different cytogenetic abnormalities were assessed with respect to disease as well as independently. Trisomy 21 was the most common chromosomal abnormality found in 28% of patients. CONCLUSION Complex karyotype was most frequently associated with myelodysplastic syndromes and acute myeloid leukemia. Trisomy 21 and deletion 5q were the commonest cytogenetic abnormalities found. We also assessed complex karyotype in benign diseases and detected one patient of aplastic anemia with complex karyotype. This is the first study highlighting the presence of complex karyotypes in hematological disorders in our region.
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Affiliation(s)
- Samra Waheed
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - Jawad Hassan
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - Maliha Naz
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - Sidra Maqsood
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - Madiha Abid
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - Saira Shan
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - Muhammad Nadeem
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
| | - Tahir S. Shamsi
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi, Pakistan
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Klairmont MM, Cheng J, Martin MG, Gradowski JF. Recurrent Cytogenetic Abnormalities in Intravascular Large B-Cell Lymphoma. Am J Clin Pathol 2018; 150:18-26. [PMID: 29767679 DOI: 10.1093/ajcp/aqy023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Data characterizing the cytogenetic landscape of intravascular large B-cell lymphoma (ILBCL) are limited. Here, we developed a comprehensive karyotypic data set to identify recurrent cytogenetic abnormalities in ILBCL. METHODS Cases of ILBCL with complete cytogenetic analysis were identified from an institutional database and the literature. The combined data were systematically reviewed for the presence of recurrent abnormalities. RESULTS Four new cases were identified and combined with 25 karyotypes previously published in the literature. Karyotypes were uniformly complex with a median of 10 aberrations. In total, 72.4% had abnormalities involving chromosome 1, with 31.0% involving rearrangements of 1p13 or 1q21; 58.6% had abnormalities involving chromosome 6, which in almost all cases involved 6q; 34.5% had abnormalities involving chromosome 14, with 27.6% involving rearrangements of 14q32; and 55.2% had abnormalities of chromosome 18, with 37.9% harboring trisomy 18. CONCLUSIONS Recurrent cytogenetic abnormalities involving chromosomes 1, 6q, and 18 are present in greater than 50% of ILBCL.
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Affiliation(s)
- Matthew M Klairmont
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
| | - Jinjun Cheng
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
| | - Mike G Martin
- Department of Hematology/Oncology, West Cancer Center/University of Tennessee Health Science Center, Memphis
| | - Joel F Gradowski
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
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Lymphoma epidemiology in Korea and the real clinical field including the Consortium for Improving Survival of Lymphoma (CISL) trial. Int J Hematol 2018; 107:395-404. [DOI: 10.1007/s12185-018-2403-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/12/2018] [Indexed: 12/18/2022]
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Kim MS, Cho YU, Jang S, Seo EJ, Lee JH, Park CJ. A Case of Primary Bone Marrow Diffuse Large B-cell Lymphoma Presenting With Fibrillar Projections and Hemophagocytic Lymphohistiocytosis. Ann Lab Med 2017; 37:544-546. [PMID: 28840996 PMCID: PMC5587831 DOI: 10.3343/alm.2017.37.6.544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/03/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- Min Sun Kim
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Young Uk Cho
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea.
| | - Seongsoo Jang
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Eul Ju Seo
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jung Hee Lee
- Department of Internal Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chan Jeoung Park
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
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Suh C, Park BB, Kim WS. The Consortium for Improving Survival of Lymphoma (CISL): recent achievements and future perspective. Blood Res 2017; 52:3-6. [PMID: 28401092 PMCID: PMC5383584 DOI: 10.5045/br.2017.52.1.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/07/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byeong-Bae Park
- Division of Hematology/Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Moraveji S, Tonk V, Gaur S, Torabi A. Langerhans cell histiocytosis and diffuse large B-cell lymphoma with tetrasomy of PBX1 gene and t(14;19): two entities in one lymph node. Pathology 2016; 48:728-731. [PMID: 27788921 DOI: 10.1016/j.pathol.2016.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/31/2016] [Indexed: 11/15/2022]
MESH Headings
- Abnormal Karyotype
- Biomarkers, Tumor/analysis
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 19
- DNA-Binding Proteins/genetics
- Histiocytosis, Langerhans-Cell/complications
- Histiocytosis, Langerhans-Cell/pathology
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymph Nodes/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Pre-B-Cell Leukemia Transcription Factor 1
- Proto-Oncogene Proteins/genetics
- Tetrasomy
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Affiliation(s)
- Sharareh Moraveji
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, United States
| | - Vijay Tonk
- Department of Pediatrics, Texas Tech University Health Science Center, Lubbock, TX, United States
| | - Sumit Gaur
- Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, United States
| | - Alireza Torabi
- Department of Pathology, Texas Tech University Health Science Center, El Paso, TX, United States.
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Kim M, Ju YS, Lee EJ, Kang HJ, Kim HS, Cho HC, Kim HJ, Kim JA, Lee DS, Lee YK. Abnormalities in Chromosomes 1q and 13 Independently Correlate With Factors of Poor Prognosis in Multiple Myeloma. Ann Lab Med 2016; 36:573-82. [PMID: 27578511 PMCID: PMC5011111 DOI: 10.3343/alm.2016.36.6.573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/09/2016] [Accepted: 06/28/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We comprehensively profiled cytogenetic abnormalities in multiple myeloma (MM) and analyzed the relationship between cytogenetic abnormalities of undetermined prognostic significance and established prognostic factors. METHODS The karyotype of 333 newly diagnosed MM cases was analyzed in association with established prognostic factors. Survival analysis was also performed. RESULTS MM with abnormal karyotypes (41.1%) exhibited high international scoring system (ISS) stage, frequent IgA type, elevated IgG or IgA levels, elevated calcium levels, elevated creatine (Cr) levels, elevated β2-microglobulin levels, and decreased Hb levels. Structural abnormalities in chromosomes 1q, 4, and 13 were independently associated with elevated levels of IgG or IgA, calcium, and Cr, respectively. Chromosome 13 abnormalities were associated with poor prognosis and decreased overall survival. CONCLUSIONS This is the first study to demonstrate that abnormalities in chromosomes 1q, 4, and 13 are associated with established factors for poor prognosis, irrespective of the presence of other concurrent chromosomal abnormalities. Chromosome 13 abnormalities have a prognostic impact on overall survival in association with elevated Cr levels. Frequent centromeric breakpoints appear to be related to MM pathogenesis.
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Affiliation(s)
- Miyoung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Young Su Ju
- Department of Occupational and Environmental Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Eun Jin Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Han Sung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Hyoun Chan Cho
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Jung Ah Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Soon Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Kyung Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea.
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Gavrilina OA, Parovichnikova EN, Zvonkov EE, Troitskaya VV, Kravchenko SK, Savchenko VG. [Diffuse large B-cell lymphoma with monoclonal immunoglobulin secretion]. TERAPEVT ARKH 2016; 88:56-61. [PMID: 27459616 DOI: 10.17116/terarkh201688756-61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM to provide the clinical characteristics of patients with diffuse large B-cell lymphoma (DLBCL) with monoclonal immunoglobulin secretion and to evaluate the efficiency of intensified mNHL-BFM-90 or R-DA-EPOCH/R-HMA therapy programs in patients with Ig-secreting DLBCL. SUBJECTS AND METHODS A clinical trial was conducted in 93 patients with newly diagnosed DLBCL, among whom 21 (22.6%) were found to have monoclonal immunoglobulin secretion. RESULTS Ig-secreting DLBCL is shown to be characterized by bone marrow involvement (p<0.001), as well as generalized injury (Ann Arbor Stage 4) and a high risk in accordance with the international prognostic index (p=0.001 and p=0.026, respectively). Analysis of overall and event-free survival rates has indicated that the patients have a poor prognosis versus those with non-Ig-secreting DLBCL and poor prognostic factors even when implementing intensified therapy programs, such as mNHL-BFM-90 or R-DA-EPOCH/R-HMA ones. CONCLUSION The investigation has demonstrated that there is a high association of the secretion of monoclonal paraproteins with bone marrow involvement in DLBCL (p<0.001). The intensified therapy using the mNHL-BFM-90 and R-DA-EPOCH/R-HMA programs involving autologous hematopoietic stem cell transplantation also permits the patients with Ig-secreting DLBCL to achieve long-term sustained remissions in not all cases.
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Affiliation(s)
- O A Gavrilina
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - E N Parovichnikova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - E E Zvonkov
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V V Troitskaya
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - S K Kravchenko
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V G Savchenko
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
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Song MK, Yang DH, Lee GW, Lim SN, Shin S, Pak KJ, Kwon SY, Shim HK, Choi BH, Kim IS, Shin DH, Kim SG, Oh SY. High total metabolic tumor volume in PET/CT predicts worse prognosis in diffuse large B cell lymphoma patients with bone marrow involvement in rituximab era. Leuk Res 2016; 42:1-6. [PMID: 26851438 DOI: 10.1016/j.leukres.2016.01.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/17/2015] [Accepted: 01/21/2016] [Indexed: 01/06/2023]
Abstract
Bone marrow involvement (BMI) in diffuse large B cell lymphoma (DLBCL) was naively regarded as an adverse clinical factor. However, it has been unknown which factor would separate clinical outcomes in DLBCL patients with BMI. Recently, metabolic tumor volume (MTV) on positron emission tomography/computed tomography (PET/CT) was suggested to predict prognosis in several lymphoma types. Therefore, we investigated whether MTV would separate the outcomes in DLBCL patients with BMI. MTV on PET/CT was defined as an initial tumor burden as target lesion ≥ standard uptake value, 2.5 in 107 patients with BMI. Intramedullary (IM) MTV was defined as extent of BMI and total MTV was as whole tumor burden. 260.5 cm(3) and 601.2 cm(3) were ideal cut-off values for dividing high and low MTV status in the IM and total lymphoma lesions in Receiver Operating Curve analysis. High risk NCCN-IPI (p<0.001, p<0.001), bulky disease (p=0.011, p=0.005), concordant subtype (p=0.025, p=0.029), high IM MTV status (p<0.001, p<0.001), high total MTV status (p<0.001, p<0.001), and ≥ 2CAs in BM (p=0.037, p=0.033) were significantly associated with progression-free survival (PFS) and overall survival (OS) than other groups. In multivariate analysis, high risk NCCN-IPI (PFS, p=0.006; OS, p=0.013), concordant subtype (PFS, p=0.005; OS, p=0.007), and high total MTV status (PFS, p<0.001; OS, p<0.001) had independent clinical impacts. MTV had prognostic significances for survivals in DLBCL with BMI.
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Affiliation(s)
- Moo-Kon Song
- Department of Hematology-Oncology, Pusan National University Yangsan Hospital Medical Research Institute, Yangsan, Republic of Korea
| | - Deok-Hwan Yang
- Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
| | - Gyeong-Won Lee
- Department of Hematology, Gyeong-Sang National University Hospital, school of medicine, Gyeong-Sang National University Jinju, Republic of Korea
| | - Sung-Nam Lim
- Department of Hematology, Busan Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seunghyeon Shin
- Department of Nuclear medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyoung June Pak
- Department of Nuclear medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Hye Kyung Shim
- Department of Nuclear Medicine, Busan Haeundae Paik Hospital, Busan, Republic of Korea
| | - Bong-Hoi Choi
- Department of Nuclear Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - In-Suk Kim
- Department of Laboratory medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong-Hoon Shin
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Seong-Geun Kim
- Department of Hematology-Oncology, Pusan National University Yangsan Hospital Medical Research Institute, Yangsan, Republic of Korea
| | - So-Yeon Oh
- Department of Hematology-Oncology, Pusan National University Yangsan Hospital Medical Research Institute, Yangsan, Republic of Korea
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Nardi V, Pulluqi O, Abramson JS, Dal Cin P, Hasserjian RP. Routine conventional karyotyping of lymphoma staging bone marrow samples does not contribute clinically relevant information. Am J Hematol 2015; 90:529-33. [PMID: 25776302 DOI: 10.1002/ajh.24008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 12/27/2022]
Abstract
Bone marrow (BM) evaluation is an important part of lymphoma staging, which guides patient management. Although positive staging marrow is defined as morphologically identifiable disease, such samples often also include flow cytometric analysis and conventional karyotyping. Cytogenetic analysis is a labor-intensive and costly procedure and its utility in this setting is uncertain. We retrospectively reviewed pathological reports of 526 staging marrow specimens in which conventional karyotyping had been performed. All samples originated from a single institution from patients with previously untreated Hodgkin and non-Hodgkin lymphomas presenting in an extramedullary site. Cytogenetic analysis revealed clonal abnormalities in only eight marrow samples (1.5%), all of which were positive for lymphoma by morphologic evaluation. Flow cytometry showed a small clonal lymphoid population in three of the 443 morphologically negative marrow samples (0.7%). Conventional karyotyping is rarely positive in lymphoma staging marrow samples and, in our cohort, the BM karyotype did not contribute clinically relevant information in the vast majority of cases. Our findings suggest that karyotyping should not be performed routinely on BM samples taken to stage previously diagnosed extramedullary lymphomas unless there is pathological evidence of BM involvement by lymphoma.
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Affiliation(s)
- Valentina Nardi
- Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
| | - Olja Pulluqi
- Department of Pathology; Brigham and Women's Hospital; Boston Massachusetts
| | - Jeremy S. Abramson
- Harvard Medical School; Boston Massachusetts
- Center for Lymphoma; Massachusetts General Hospital Cancer Center; Boston Massachusetts
| | - Paola Dal Cin
- Harvard Medical School; Boston Massachusetts
- Department of Pathology; Brigham and Women's Hospital; Boston Massachusetts
| | - Robert P. Hasserjian
- Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
- Harvard Medical School; Boston Massachusetts
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