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Flospergher E, Marino F, Calimeri T, Cangi MG, Ferreri AJM, Ponzoni M, Bongiovanni L. Primary central nervous system marginal zone lymphoma. Br J Haematol 2024; 204:31-44. [PMID: 38054330 DOI: 10.1111/bjh.19238] [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: 07/20/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
Marginal zone lymphoma (MZL) is the most common indolent lymphoma primarily arising in the central nervous system (CNS). To date, 207 cases of primary CNS MZL (PCNSMZL) were published, mostly as single case reports or small case series. It most commonly presents as extra-axial dural-based masses, more frequently in middle-aged women, displaying an insidious onset, with a long history of symptoms preceding the diagnosis. PCNSMZL can be radiographically mistaken for meningioma. PCNSMZL consists of CD20+ , CD3- small B lymphocytes with varying degrees of plasmacytic differentiation and low proliferation index. Trisomy 3, but not MALT1 or IgH translocation, is a common genetic abnormality. Other recurrent genetic abnormalities involve TNFAIP3 and NOTCH2. Ethiopathogenesis was poorly investigated. Due to its rarity, standard of care remains to be defined; it exhibits an excellent prognosis after varied treatments, such as surgery, radiotherapy, chemotherapy or their combinations. Nevertheless, each treatment should be considered after an accurate analysis of overtreatment risk. Short follow-up is a major limitation in reported PCNSMZL cases, which restrains our knowledge on long-term results and iatrogenic sequels. This review was focussed on presentation, differential diagnoses, pathological findings, treatment options and clinical outcomes of PCNSMZL; recommendations for best clinical practice are provided.
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Affiliation(s)
- Elena Flospergher
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Marino
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Teresa Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrés José María Ferreri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
| | - Maurilio Ponzoni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Bongiovanni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
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Angelopoulou MK, Vassilakopoulos TP, Konstantinou E, Boutsikas G, Asimakopoulos JV, Triantafyllou E, Petevi K, Kanellopoulos A, Moschogiannis M, Pangalis GA, Siakantaris MP, Konstantopoulos K. Central nervous system involvement in primary bone marrow or splenic marginal zone lymphoma: Report of two cases and review of the literature. Hematol Oncol 2019; 37:219-222. [DOI: 10.1002/hon.2571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Maria K. Angelopoulou
- Department of HematologyAthens University Medical School, Laikon Hospital Athens Greece
| | | | - Eliana Konstantinou
- Department of HematologyAthens University Medical School, Laikon Hospital Athens Greece
| | - George Boutsikas
- Department of HematologyAthens University Medical School, Laikon Hospital Athens Greece
| | - John V. Asimakopoulos
- Department of HematologyAthens University Medical School, Laikon Hospital Athens Greece
| | | | - Kyriaki Petevi
- Department of HematologyAthens University Medical School, Laikon Hospital Athens Greece
| | | | | | | | - Marina P. Siakantaris
- Department of HematologyAthens University Medical School, Laikon Hospital Athens Greece
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Dholaria BR, Hammond WA, Roy V, Sher T, Vishnu P, Soyano A, Finn LE, Tun H. Allogeneic hematopoietic cell transplant for relapsed-refractory, marginal zone lymphoma: a single-center experience. Leuk Lymphoma 2018; 59:2727-2730. [PMID: 29566563 DOI: 10.1080/10428194.2018.1452220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Bhagirathbhai R Dholaria
- a Department of Blood and Marrow Transplant and Cellular Immunotherapy , Moffitt Cancer Center , Tampa , FL , USA
| | - William A Hammond
- b Department of Malignant Hematology , Baptist M.D. Anderson Cancer Center , Jacksonville , FL , USA
| | - Vivek Roy
- c Department of Hematology and Oncology , Mayo Clinic , Jacksonville , FL , USA
| | - Taimur Sher
- c Department of Hematology and Oncology , Mayo Clinic , Jacksonville , FL , USA
| | - Prakash Vishnu
- c Department of Hematology and Oncology , Mayo Clinic , Jacksonville , FL , USA
| | - Aixa Soyano
- c Department of Hematology and Oncology , Mayo Clinic , Jacksonville , FL , USA
| | - Laura E Finn
- d Division of Hematology and Oncology , Ochsner Medical Center , New Orleans , LA , USA
| | - Han Tun
- c Department of Hematology and Oncology , Mayo Clinic , Jacksonville , FL , USA
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Busemann C, Klein S, Schmidt CA, Evert M, Dölken G, Krüger WH. Treatment of High-Risk T-NHL with Stem Cell Transplantation: A Single Center Experience. Indian J Hematol Blood Transfus 2014; 31:14-20. [PMID: 25548439 DOI: 10.1007/s12288-014-0398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 04/22/2014] [Indexed: 11/25/2022] Open
Abstract
Prognosis of peripheral and other advanced T cell lymphomas is poor. 20 patients with a median age of 46.4 (range 20.5-64.1) years were treated with autoSCT (n = 6) or alloSCT (n = 14) from 1996 to 2013. All patients were at high risk either due to the IPI-score or to the fact that SCT was part of a salvage therapy. Conditioning prior to alloSCT was myeloablative in seven cases (50 %). The patients were pretreated with 8.5 (median, range 2-38) cycles of chemotherapy. Ten patients are alive in CR after a median follow-up of 1.3 years (range 0.1-13.3). OS was 53 % after one and 40 % after 10 years. Best survival was reached after related alloSCT (80 % at 10 years) compared to other modalities. GvHD did not influence survival. AlloSCT from related donors can cure patients from T-cell lymphomas. Unrelated alloSCT or high-dose therapy and autoSCT are an option for patients without a familiar donor.
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Affiliation(s)
- Christoph Busemann
- Department of Internal Medicine C (Haematology and Oncology, Marrow Transplantation), Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Susanne Klein
- Department of Internal Medicine C (Haematology and Oncology, Marrow Transplantation), Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Christian Andreas Schmidt
- Department of Internal Medicine C (Haematology and Oncology, Marrow Transplantation), Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Matthias Evert
- Institute for Pathology, Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - Gottfried Dölken
- Department of Internal Medicine C (Haematology and Oncology, Marrow Transplantation), Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
| | - William H Krüger
- Department of Internal Medicine C (Haematology and Oncology, Marrow Transplantation), Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str., 17475 Greifswald, Germany
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Qi S, Li Z, Yue Y, van Triest HJW, Kang Y. Computational fluid dynamics simulation of airflow in the trachea and main bronchi for the subjects with left pulmonary artery sling. Biomed Eng Online 2014; 13:85. [PMID: 24957947 PMCID: PMC4079174 DOI: 10.1186/1475-925x-13-85] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/16/2014] [Indexed: 11/16/2022] Open
Abstract
Background Left pulmonary artery sling (LPAS) is a rare but severe congenital anomaly, in which the stenoses are formed in the trachea and/or main bronchi. Multi-detector computed tomography (MDCT) provides useful anatomical images, but does not offer functional information. The objective of the present study is to quantitatively analyze the airflow in the trachea and main bronchi of LPAS subjects through computational fluid dynamics (CFD) simulation. Methods Five subjects (four LPAS patients, one normal control) aging 6-19 months are analyzed. The geometric model of the trachea and the two main bronchi is extracted from the MDCT images. The inlet velocity is determined based on the body weight and the inlet area. Both the geometric model and personalized inflow conditions are imported into CFD software, ANSYS. The pressure drop, mass flow ratio through two bronchi, wall pressure, flow velocity and wall shear stress (WSS) are obtained, and compared to the normal control. Results Due to the tracheal and/or bronchial stenosis, the pressure drop for the LPAS patients ranges 78.9 - 914.5 Pa, much higher than for the normal control (0.7 Pa). The mass flow ratio through the two bronchi does not correlate with the sectional area ratio if the anomalous left pulmonary artery compresses the trachea or bronchi. It is suggested that the C-shaped trachea plays an important role on facilitating the air flow into the left bronchus with the inertia force. For LPAS subjects, the distributions of velocities, wall pressure and WSS are less regular than for the normal control. At the stenotic site, high velocity, low wall pressure and high WSS are observed. Conclusions Using geometric models extracted from CT images and the patient-specified inlet boundary conditions, CFD simulation can provide vital quantitative flow information for LPAS. Due to the stenosis, high pressure drops, inconsistent distributions of velocities, wall pressure and WSS are observed. The C-shaped trachea may facilitate a larger flow of air into the left bronchus under the inertial force, and decrease the ventilation of the right lung. Quantitative and personalized information may help understand the mechanism of LPAS and the correlations between stenosis and dyspnea, and facilitate the structural and functional assessment of LPAS.
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Affiliation(s)
- Shouliang Qi
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China.
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Abstract
OPINION STATEMENT Therapeutic options are limited in primary central nervous system lymphoma (PCNSL) with no uniform consensus on optimal management and few published, randomized trials. High-dose methotrexate in combination with other chemotherapeutic agents forms the mainstay of treatment. There hasn't been much progress beyond high-dose methotrexate in this disease, and although results from trials using high-dose chemotherapy and autologous stem-cell transplant seem promising, these need to be further validated. Moreover, the role of whole brain radiation in the upfront setting remains to be determined. However, international efforts in this direction are underway, with ongoing randomized trials in newly diagnosed PCNSL, more research on the molecular pathogenesis and biomarkers, and the use of novel agents in salvage therapy. There also is emphasis on quality of life parameters and neurocognitive status. Future treatment options should optimize high-efficacy rates while minimizing the risk of neurotoxicity.
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Affiliation(s)
- Lakshmi Nayak
- Dana-Farber Cancer Institute, Center for Neuro-Oncology, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215 USA
| | - Tracy T. Batchelor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology and Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA
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