1
|
Dumbrava M, Galardy P, Feldman AL, Kuhn A, Khan S, Ferdjallah A, Kohorst MA. An Effective Combination Therapy for the Treatment of Pediatric Monomorphic Post-transplant Lymphoproliferative Disorder With Plasmacytic Differentiation. J Pediatr Hematol Oncol 2023; 45:e624-e627. [PMID: 36719134 DOI: 10.1097/mph.0000000000002629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/01/2022] [Indexed: 02/01/2023]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a complication of immunosuppressive therapy following solid organ or hematopoietic cell transplantation. Initial treatment typically includes a reduction of immunosuppression with or without rituximab. However, the optimal therapy for PTLD with plasmacytic differentiation is unclear. We present 3 cases of pediatric patients with plasmacytic PTLD. Two patients received a standard rituximab-based approach and relapsed, prompting additional chemotherapy. The third patient was treated with a novel regimen of bortezomib, dexamethasone, and daratumumab. This regimen was safe, well-tolerated, and resulted in a 2-year remission. Larger studies are needed to further explore this regimen.
Collapse
Affiliation(s)
| | - Paul Galardy
- Division of Pediatric Hematology/Oncology, Department of Pediatric and Adolescent Medicine
| | - Andrew L Feldman
- Division of Hematopathology, Department of Laboratory Medicine and Pathology
| | - Alexis Kuhn
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Shakila Khan
- Division of Pediatric Hematology/Oncology, Department of Pediatric and Adolescent Medicine
| | - Asmaa Ferdjallah
- Division of Pediatric Hematology/Oncology, Department of Pediatric and Adolescent Medicine
| | - Mira A Kohorst
- Division of Pediatric Hematology/Oncology, Department of Pediatric and Adolescent Medicine
| |
Collapse
|
2
|
Fraticelli S, Bonometti A, Lucioni M, Capuano F, Meloni F, Arcaini L, Baldanti F, Paulli M. Late-onset EBV-related post-transplant non-secreting plasma-cell neoplasms: Description of two cases. Leuk Res 2020; 100:106493. [PMID: 33401160 DOI: 10.1016/j.leukres.2020.106493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Sara Fraticelli
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Arturo Bonometti
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Marco Lucioni
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Capuano
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federica Meloni
- Department of Respiratory Diseases Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Policlinic IRCCS Foundation San Matteo, University of Pavia, Pavia, Italy
| | - Marco Paulli
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| |
Collapse
|
3
|
Rosenberg AS, Ruthazer R, Paulus JK, Kent DM, Evens AM, Klein AK. Survival Analyses and Prognosis of Plasma-Cell Myeloma and Plasmacytoma-Like Posttransplantation Lymphoproliferative Disorders. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2016; 16:684-692.e3. [PMID: 27771291 PMCID: PMC5402751 DOI: 10.1016/j.clml.2016.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/08/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Multiple myeloma/plasmacytoma-like posttransplantation lymphoproliferative disorder (PTLD-MM) is a rare complication of solid organ transplantation. Case series have shown variable outcomes, and survival data in the modern era are lacking. PATIENTS AND METHODS A cohort of 212 PTLD-MM patients was identified in the Scientific Registry of Transplant Recipients between 1999 and 2011. Overall survival (OS) was estimated by the Kaplan-Meier method, and the effects of treatment and patient characteristics on OS were evaluated by Cox proportional hazards models. OS in 185 PTLD-MM patients was compared to 4048 matched controls with multiple myeloma (SEER-MM) derived from Surveillance, Epidemiology, and End Results (SEER) data. RESULTS Men comprised 71% of patients; extramedullary disease was noted in 58%. Novel therapeutic agents were used in 19% of patients (more commonly during 2007-2011 vs. 1999-2006; P = .01), reduced immunosuppression in 55%, and chemotherapy in 32%. Median OS was 2.4 years and improved in the later time period (adjusted hazard ratio [aHR], 0.64, P = .05). Advanced age, creatinine > 2 g/dL, white race, and use of OKT3 were associated with inferior OS in multivariable analysis. OS of PTLD-MM patients is significantly inferior to SEER-MM patients (aHR, 1.6, P < .001). Improvements in OS over time differed between PTLD-MM and SEER-MM. Median OS of patients diagnosed from 2000 to 2005 was shorter for PTLD-MM than SEER-MM patients (18 vs. 47 months, P < .001). There was no difference among those diagnosed from 2006 to 2010 (44 months vs. median not reached, P = .5; interaction P = .08). CONCLUSION Age at diagnosis, elevated creatinine, white race, and OKT3 were associated with inferior survival in patients with PTLD-MM. Survival of PTLD-MM is inferior to SEER-MM, although significant improvements in survival have been documented.
Collapse
Affiliation(s)
- Aaron S Rosenberg
- Division of Hematology/Oncology, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA; Division of Hematology/Oncology, Department of Internal Medicine, Tufts Cancer Center, Boston, MA; Department of Internal Medicine, Tufts Medical Center, Boston, MA.
| | - Robin Ruthazer
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Sciences Institute, Tufts University, Boston, MA
| | - Jessica K Paulus
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Sciences Institute, Tufts University, Boston, MA
| | - David M Kent
- Division of Hematology/Oncology, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA; Department of Internal Medicine, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Sciences Institute, Tufts University, Boston, MA
| | - Andrew M Evens
- Division of Hematology/Oncology, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA; Division of Hematology/Oncology, Department of Internal Medicine, Tufts Cancer Center, Boston, MA; Department of Internal Medicine, Tufts Medical Center, Boston, MA
| | - Andreas K Klein
- Division of Hematology/Oncology, Department of Internal Medicine, Tufts University School of Medicine, Boston, MA; Division of Hematology/Oncology, Department of Internal Medicine, Tufts Cancer Center, Boston, MA; Department of Internal Medicine, Tufts Medical Center, Boston, MA
| |
Collapse
|
4
|
Bansal P, Osman D, Gan GN, Simon GR, Boumber Y. Recent Advances in Targetable Therapeutics in Metastatic Non-Squamous NSCLC. Front Oncol 2016; 6:112. [PMID: 27200298 PMCID: PMC4854869 DOI: 10.3389/fonc.2016.00112] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 04/19/2016] [Indexed: 11/13/2022] Open
Abstract
Lung adenocarcinoma is the most common subtype of non-small cell lung cancer (NSCLC). With the discovery of epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) rearrangements, and effective targeted therapies, therapeutic options are expanding for patients with lung adenocarcinoma. Here, we review novel therapies in non-squamous NSCLC, which are directed against oncogenic targets, including EGFR, ALK, ROS1, BRAF, MET, human epidermal growth factor receptor 2 (HER2), vascular endothelial growth factor receptor 2 (VEGFR2), RET, and NTRK. With the rapidly evolving molecular testing and development of new targeted agents, our ability to further personalize therapy in non-squamous NSCLC is rapidly expanding.
Collapse
Affiliation(s)
- Pranshu Bansal
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA; Hematology/Oncology Fellowship Program, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Diaa Osman
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA; Hematology/Oncology Fellowship Program, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Gregory N Gan
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA; Section of Radiation Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - George R Simon
- Department of Thoracic and Head/Neck Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Yanis Boumber
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico Comprehensive Cancer Center, University of New Mexico School of Medicine, Albuquerque, NM, USA; Cancer Genetics, Epigenetics, and Genomics Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| |
Collapse
|
5
|
Plant AS, Venick RS, Farmer DG, Upadhyay S, Said J, Kempert P. Plasmacytoma-like post-transplant lymphoproliferative disorder seen in pediatric combined liver and intestinal transplant recipients. Pediatr Blood Cancer 2013; 60:E137-9. [PMID: 23813867 DOI: 10.1002/pbc.24632] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 05/09/2013] [Indexed: 11/12/2022]
Abstract
Post-transplant lymphoproliferative disease (PTLD) is a lymphoproliferative disorder secondary to chronic immunosuppression and is the most common malignancy in transplanted patients [Kamdar et al. Curr Opin Organ Transplant, 2011; 16:274-280]. Although PTLD usually presents as B or T cell lymphoma, plasmacytomas have been reported, mostly in the adult population. Six cases of pediatric plasmacytoma-like PTLD have been reported, all of which were treated with vincristine, adriamycin, and dexamethasone (VAD), high dose dexamethasone alone, or dexamethasone + thalidomide [Tcheng et al. Pediatric Blood Cancer, 2006; 47:218-223; Perry et al. Blood, 2013; 8:1377-1383]. We present two cases of pediatric plasmacytoma-like PTLD in combined liver and small bowel transplant patients both successfully treated with bortezomib and dexamethasone based on multiple myeloma protocols [Kyle and Rajkumar, Clin Lymphoma Myeloma, 2009; 9:278-288; Adams and Kaufmann, Cancer Invest, 2004; 22:304-311].
Collapse
Affiliation(s)
- Ashley S Plant
- Department of Pediatrics, Division of Hematology/Oncology, Los Angeles, California
| | | | | | | | | | | |
Collapse
|
6
|
Bhandiwad AR, Cummings KW, Crowley M, Woodard PK. Cardiovascular magnetic resonance with an MR compatible pacemaker. J Cardiovasc Magn Reson 2013; 15:18. [PMID: 23409835 PMCID: PMC3579751 DOI: 10.1186/1532-429x-15-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 01/15/2013] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance imaging (MRI) within FDA guidelines for the MRI-conditional pacemaker precludes placing the heart at the center of the magnet's bore. This in effect appears to preclude cardiovascular MR. In this manuscript, we describe a protocol for cardiovascular MR of patients with a Revo pacemaker system while operating within FDA guidelines, and the first US case of cardiovascular MR in a patient with a Revo MRI-conditional pacing system despite position constraints.
Collapse
Affiliation(s)
- Anita R Bhandiwad
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, 1020 N. Mason Road, Suite 100, Saint Louis, MO, 63141, USA
| | - Kristopher W Cummings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Michael Crowley
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| |
Collapse
|