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Mauro FR, Frustaci AM, Visentin A, Vitale C, Bartoletti M, Oltolini C, Zappulo E, Mikulska M. Severe infections in patients with chronic lymphocytic leukemia included in trials investigating BTK and BCL2 inhibitors. Crit Rev Oncol Hematol 2024; 201:104408. [PMID: 38880368 DOI: 10.1016/j.critrevonc.2024.104408] [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: 02/28/2024] [Revised: 04/30/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024] Open
Abstract
Bruton tyrosine kinase inhibitors (BTKi) and the BCL-2 inhibitor venetoclax have significantly improved the prognosis of patients with chronic lymphocytic leukemia (CLL). However, the incidence of severe infections in patients receiving these agents needs to be better understood. Our review aimed to provide an overview of grade ≥3 infections in patients with CLL who received BTKi and venetoclax-based therapy in prospective trials. Infection rates were influenced by the age of patients and the duration of follow-up. For treatment-naive (TN) patients receiving BTKi, infection rates ranged between 11.4 % and 27.4 % and were close to 30 % in relapsed/refractory (R/R) patients. TN and R/R patients receiving fixed-duration venetoclax-based treatments showed variable rates, with maximum values around 20 %. Opportunistic and fatal infections were uncommon. In conclusion, infections remain a concern in patients with CLL receiving targeted agents. A better definition of factors increasing infection vulnerability could help identify those patients who require infection prophylaxis.
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Affiliation(s)
- Francesca R Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele Milan 20090, Italy; Infectious Disease Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - Chiara Oltolini
- Clinic of Infectious Diseases, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery University of Naples Federico II, Napoli, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL) University of Genoa, Italy; Infectious Diseases Unit IRCCS Ospedale Policlinico San Martino Genoa, Italy
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Dasanu CA, Mann SK, Baidya M, Mdluli XP, Stapleton AE, Codreanu I. Evaluation of infectious morbidity due to BTK inhibitors in indolent B-cell lymphomas: latest research findings and systematic analysis. Expert Opin Pharmacother 2024; 25:1525-1540. [PMID: 39109526 DOI: 10.1080/14656566.2024.2390121] [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: 05/22/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Randomized clinical trials (RCTs) have suggested that BTK inhibitors (BTKis) might increase infectious disease (ID) risk. Systematic analysis of this topic as derived from RCTs and clinical practice is needed. AREAS COVERED An extensive Medline, Embase, and Cochrane search of peer-reviewed sources reporting on ID morbidity in patients on BTKis was performed (1 January 2014 - 31 December 2013). Contribution of intrinsic immune defects in indolent B-cell lymphomas to this morbidity was carefully considered. EXPERT OPINION Patients with indolent B-cell lymphomas display a wide range of innate and adaptive immune defects. In addition, BTKi use is linked with an increased signal of upper respiratory tract infections (URTIs) and pneumonias, mainly grade 1-2. These agents also increase the risk of rare invasive fungal infections (IFIs), mainly due to Cryptococcus and Aspergillus spp. with a peak within several months after the start of therapy. More than half of these IFIs are fatal. Research suggests a similar ID risk across 1st, 2nd and 3rd generations of BTKis, all causing B-cell dysfunction due to BTK inhibition, along with off-target functional neutrophil/macrophage alterations. Expanding the knowledge base on ID morbidity in patients on BTKis would facilitate timely diagnosis and treatment, and improve clinical outcomes.
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Affiliation(s)
- Constantin A Dasanu
- Lucy Curci Cancer Center, Eisenhower Health, Rancho Mirage, CA, USA
- Department of Medical Oncology and Hematology, UC San Diego Health System, San Diego, CA, USA
| | - Samar K Mann
- Department of Graduate Medical Education, Oakland William Beaumont School of Medicine, Rochester, MI, USA
| | - Melvin Baidya
- Lucy Curci Cancer Center, Eisenhower Health, Rancho Mirage, CA, USA
| | - Xolani P Mdluli
- Department of Infectious Diseases, Eisenhower Health, Rancho Mirage, CA, USA
| | - Ann E Stapleton
- Department of Infectious Diseases, Eisenhower Health, Rancho Mirage, CA, USA
| | - Ion Codreanu
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
- Department of Radiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
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Zhu K, Jamroz A, Huang S, Villa D, Freeman CL, Scott DW, Slack G, Sehn LH, Connors JM, Toze CL, Savage KJ, Gerrie AS. Outcomes of Hodgkin variant Richter transformation in chronic lymphocytic leukaemia and small lymphocytic lymphoma in British Columbia. Br J Haematol 2022; 198:684-692. [PMID: 35567407 DOI: 10.1111/bjh.18241] [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: 02/12/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022]
Abstract
Hodgkin variant Richter transformation (HvRT) is a rare and challenging complication of chronic lymphocytic leukaemia (CLL) for which information on prognostic factors and treatment approaches remain limited. We analysed characteristics and survival outcomes of a population-based cohort of 32 patients with HvRT identified in British Columbia over a 40-year period. Median interval from CLL diagnosis to HvRT was 5.6 years (range, 0-33.6), with five cases diagnosed concurrently. Most patients (80%) had treatment for CLL prior to HvRT. Median age at HvRT was 71 years (range, 51-86) and the majority of patients had high-risk disease, including stage 3-4 in 87% and International Prognostic Score (IPS) ≥ 4 in 65%. Two-year progression-free (PFS) and overall survival (OS) from HvRT were 47% (95% CI: 29%-64%) and 57% (95% CI: 38%-72%), respectively. OS from HvRT was significantly worse in those with anaemia (p = 0.02), elevated lactate dehydrogenase (p = 0.04), high IPS (p = 0.04), and worse performance status (p = 0.001). For those treated with curative-intent ABVD/ABVD-like therapy, 2-year PFS and OS were 70% (95% CI: 45%-85%) and 74% (95% CI: 49%-89%), respectively. In this real-world population-based cohort, HvRT was associated with poor clinical outcomes overall; however, those able to tolerate curative-intent therapy had similar survival to older patients with de novo HL.
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Affiliation(s)
- Kai Zhu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Jamroz
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steven Huang
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diego Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciara L Freeman
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Centre, Tampa, Florida, USA
| | - David W Scott
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham Slack
- Department of Pathology and Laboratory Medicine, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia L Toze
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
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4
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Patel D, Sidana M, Mdluli X, Patel V, Stapleton A, Dasanu CA. A fatal disseminated cryptococcal infection in a patient treated with zanubrutinib for Waldenström's macroglobulinemia. J Oncol Pharm Pract 2022; 28:1917-1921. [PMID: 35306909 DOI: 10.1177/10781552221087730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Zanubrutinib is a second generation, irreversible small-molecule Bruton tyrosine kinase inhibitor (BTK) approved for the treatment of Waldenström's macroglobulinemia, mantle cell lymphoma, and marginal zone lymphoma. As a class, BTKs have been linked with an increased risk of respiratory infections in clinical trials. CASE REPORT We describe a 75-year-old patient who presented with generalized weakness, fevers, dyspnea, and dry cough four months after starting zanubrutinib therapy for Waldenström's macroglobulinemia. He was subsequently diagnosed with pneumonia. Septic work-up led to diagnosis of disseminated cryptococcal infection, complicated by fungal pneumonia and meningitis. MANAGEMENT AND OUTCOME Zanubrutinib was held on admission, and the patient was started on combination oral and intravenous antifungal therapy. Despite clearance of fungemia, aggressive resuscitation, and appropriate antimicrobial therapy, respiratory status deteriorated requiring intubation. His condition progressed to septic shock, multiorgan failure, and demise. DISCUSSION/CONCLUSION We report herein a case of fatal disseminated cryptococcosis in the setting of zanubrutinib use for Waldenström's macroglobulinemia. At the time of diagnosis, his Waldenström's macroglobulinemia was in a partial response. The mechanism by which Bruton tyrosine kinase inhibitors (BTKs) lead to invasive fungal infections in these patients remains to be explored. T- and B-cell immune defects accompanying low-grade B-cell lymphomas may contribute to the severity of these infections.
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Affiliation(s)
- Dave Patel
- Department of Medicine, 541618Eisenhower Health, Rancho Mirage, CA, USA.,Department of Infectious Disease, 541618Eisenhower Health, Rancho Mirage, CA, USA
| | - Megan Sidana
- Department of Medicine, 541618Eisenhower Health, Rancho Mirage, CA, USA.,Department of Infectious Disease, 541618Eisenhower Health, Rancho Mirage, CA, USA
| | - Xolani Mdluli
- Department of Medicine, 541618Eisenhower Health, Rancho Mirage, CA, USA.,Department of Infectious Disease, 541618Eisenhower Health, Rancho Mirage, CA, USA
| | - Vallari Patel
- Department of Medicine, 541618Eisenhower Health, Rancho Mirage, CA, USA.,Department of Infectious Disease, 541618Eisenhower Health, Rancho Mirage, CA, USA
| | - Ann Stapleton
- Department of Medicine, 541618Eisenhower Health, Rancho Mirage, CA, USA.,Department of Infectious Disease, 541618Eisenhower Health, Rancho Mirage, CA, USA
| | - Constantin A Dasanu
- Lucy Curci Cancer Center, 541618Eisenhower Health, Rancho Mirage, CA, USA.,UC San Diego Health, San Diego, CA, USA
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5
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Liu L, Deng J, Cibull T, Pesce CE. Invasive breast cancer found in a patient with new-onset pemphigus foliaceus. JAAD Case Rep 2021; 18:67-70. [PMID: 34841027 PMCID: PMC8606302 DOI: 10.1016/j.jdcr.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Luzheng Liu
- Dermatology Division, Department of Internal Medicine, NorthShore University HealthSystem, Chicago, Illinois.,University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Jennifer Deng
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois
| | - Thomas Cibull
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois.,Department of Pathology, NorthShore University HealthSystem, Chicago, Illinois
| | - Catherine E Pesce
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois.,Department of Surgical Oncology, NorthShore University HealthSystem, Chicago, Illinois
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6
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Koster MJ, Warrington KJ. VEXAS within the spectrum of rheumatologic disease. Semin Hematol 2021; 58:218-225. [PMID: 34802543 DOI: 10.1053/j.seminhematol.2021.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/15/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022]
Abstract
The identification of the VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome as a myeloid-driven inflammatory disease resulting from somatic mutations in the UBA1 gene further exposes the increasingly recognized overlap between hematologic disturbances and auto-immunity and/or auto-inflammatory presentations. Although single or multi-lineage cytopenias are a unifying aspect of VEXAS, patients with this condition can present with a wide array of inflammatory findings affecting the skin, lung, joints, eye, vascular system, and cartilaginous structures. As such, it is paramount that generalists, and subspecialty providers familiarize themselves with the clinical characteristics of this condition. This review summarizes the reported clinical symptoms of VEXAS syndrome with a particular focus on its non-hematologic inflammatory features.
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Affiliation(s)
- Matthew J Koster
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN.
| | - Kenneth J Warrington
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN
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Kondapi DS, Ramani S, Estes MK, Atmar RL, Okhuysen PC. Norovirus in Cancer Patients: A Review. Open Forum Infect Dis 2021; 8:ofab126. [PMID: 34189156 PMCID: PMC8232388 DOI: 10.1093/ofid/ofab126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022] Open
Abstract
Norovirus (NoV) is the leading cause of viral-related diarrhea in cancer patients, in whom it can be chronic, contributing to decreased quality of life, interruption of cancer care, malnutrition, and altered mucosal barrier function. Immunosuppressed cancer patients shed NoV for longer periods of time than immunocompetent hosts, favoring quasispecies development and emergence of novel NoV variants. While nucleic acid amplification tests (NAATs) for NoV diagnosis have revolutionized our understanding of NoV burden of disease, not all NAATs provide information on viral load or infecting genotype. There is currently no effective antiviral or vaccine for chronic NoV infections. Screening for inhibitors of NoV replication in intestinal organoid culture models and creation of NoV-specific adoptive T cells are promising new strategies to develop treatments for chronic NoV in immunosuppressed patients. Herein we summarize data on the epidemiology, clinical manifestations, diagnostic challenges, and treatment of NoV infection in patients with cancer.
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Affiliation(s)
- Divya Samantha Kondapi
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Sasirekha Ramani
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Mary K Estes
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Robert L Atmar
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Pablo C Okhuysen
- Infection Control and Employee Health, Division of Internal Medicine, Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Htut TW, Han MM, Thein KZ. Acalabrutinib‐related second primary malignancies and nonmelanoma skin cancers in patients with chronic lymphocytic leukaemia (CLL): A systematic review and meta‐analysis of randomised controlled trials (RCTs). EJHAEM 2021; 2:112-117. [PMID: 35846092 PMCID: PMC9175848 DOI: 10.1002/jha2.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/11/2022]
Abstract
Acalabrutinib is a second generation Bruton's tyrosine kinase inhibitor and was recently approved in the treatment of chronic lymphocytic leukaemia. We undertook a systematic review and meta‐analysis of randomised controlled trials to determine the risks of acalabrutinib‐related second primary malignancies (SPM) and nonmelanoma skin cancers (NMSC). The incidence of SPM was 4.7% higher in the acalabrutinib arm compared to control arm with risk ratio (RR) of 1.76 (5.32 vs 3.2 per 100 person‐years). Notably, NMSC was the most common SPM, and the incidence was 2.56 per 100 person‐years in the acalabrutinib group versus 1.12 per 100 person‐years in the control group (RR 2.43). Long‐term follow‐up and future studies are necessary to define the actual relationship and their risk factors.
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Affiliation(s)
- Thura W. Htut
- Department of Haematology Aberdeen Royal Infirmary Foresterhill Health Campus Aberdeen United Kingdom
| | - Myat M. Han
- Division of Hematology and Medical Oncology Oregon Health and Science University/ Knight Cancer Institute Portland Oregon United States
| | - Kyaw Z. Thein
- Division of Hematology and Medical Oncology Oregon Health and Science University/ Knight Cancer Institute Portland Oregon United States
- Department of Investigational Cancer Therapeutics The University of Texas MD Anderson Cancer Center Houston Texas United States
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9
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Bond DA, Huang Y, Fisher JL, Ruppert AS, Owen DH, Bertino EM, Rogers KA, Bhat SA, Grever MR, Jaglowski SM, Maddocks KJ, Byrd JC, Woyach JA. Second cancer incidence in CLL patients receiving BTK inhibitors. Leukemia 2020; 34:3197-3205. [PMID: 32704159 PMCID: PMC7688551 DOI: 10.1038/s41375-020-0987-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 01/20/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is associated with perturbed immune function and increased risk for second primary malignancies (SPM). Ibrutinib and acalabrutinib (BTKi) are effective therapies for CLL resulting in partial restoration of immune function. The incidence of and risk factors for SPM in CLL patients receiving BTKi are not yet characterized. We retrospectively determined the incidence of SPM in CLL patients treated with ibrutinib or acalabrutinib at our institution between 2009 and 2017, assessed for association between baseline characteristics and SPM incidence, and compared the observed to expected cancer incidence among age, sex, and year matched controls without CLL. After a median of 44 months follow-up, 64/691 patients (9%) were diagnosed with SPM (excluding non-melanoma skin cancer [NMSC]). The three-year cumulative incidence rate was 16% for NMSC and 7% for other SPM. On multivariable analysis, smoking was associated with increased SPM risk (HR 2.8 [95% CI: 1.6–4.8]) and higher baseline CD8 count was associated with lower SPM risk (HR 0.9 for 2-fold increase [95% CI: 0.8–0.9]). The observed over expected rate of SPM was 2.2 [95% CI: 1.7–2.9]. CLL patients treated with BTKi remain at increased risk for SPM, and secondary cancer detection is an important consideration in this population.
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Affiliation(s)
- David A Bond
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Ying Huang
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James L Fisher
- Arthur G James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Amy S Ruppert
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dwight H Owen
- Department of Internal Medicine, Division of Medical Oncology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erin M Bertino
- Department of Internal Medicine, Division of Medical Oncology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kerry A Rogers
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Seema A Bhat
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael R Grever
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samantha M Jaglowski
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kami J Maddocks
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John C Byrd
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer A Woyach
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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10
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Morton LM. Novel Insights Into the Long-Term Immune Health of Diffuse Large B-Cell Lymphoma Survivors. J Clin Oncol 2020; 38:1648-1650. [PMID: 32228357 PMCID: PMC7238492 DOI: 10.1200/jco.20.00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lindsay M. Morton
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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11
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Amebic Encephalitis in a Patient with Chronic Lymphocytic Leukemia on Ibrutinib Therapy. Case Rep Hematol 2018; 2018:6514604. [PMID: 30155323 PMCID: PMC6092972 DOI: 10.1155/2018/6514604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/08/2018] [Indexed: 02/07/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in Western countries. A common first-line therapy offered to qualifying patients includes ibrutinib, an oral covalent inhibitor of Bruton's tyrosine kinase. Treatment of CLL with ibrutinib therapy is generally well tolerated; however, serious opportunistic infections are being reported in patients treated with ibrutinib. In this report, we present a patient with CLL on ibrutinib therapy who developed rapidly declining neurological status concerning for the central nervous system (CNS) process related to his immunocompromised status. Despite multiple testing modalities, no evidence was found to explain the acute changes the patient was experiencing, and he had no improvement with common antimicrobial coverage. The patient ultimately expired, and autopsy of the brain revealed granulomatous amebic encephalitis due to opportunistic infection by Acanthamoeba species. As evidenced by this case, ibrutinib therapy, despite being generally well tolerated, has the potential to predispose patients to opportunistic infections like amebic encephalitis. Amebic encephalitis is a highly lethal CNS infection, and it is important for clinicians to recognize early on the potential for infection in patients on ibrutinib therapy presenting with CNS symptoms.
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12
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Kridin K, Zelber-Sagi S, Comaneshter D, Batat E, Cohen AD. Pemphigus and hematologic malignancies: A population-based study of 11,859 patients. J Am Acad Dermatol 2018; 78:1084-1089.e1. [DOI: 10.1016/j.jaad.2017.11.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/10/2017] [Accepted: 11/15/2017] [Indexed: 12/17/2022]
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13
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Williams AM, Baran AM, Meacham PJ, Feldman MM, Valencia HE, Newsom-Stewart C, Gupta N, Janelsins MC, Barr PM, Zent CS. Analysis of the risk of infection in patients with chronic lymphocytic leukemia in the era of novel therapies. Leuk Lymphoma 2017; 59:625-632. [PMID: 28696801 DOI: 10.1080/10428194.2017.1347931] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We studied the risk of infections in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL). Major infections were defined as requiring hospital admission or intravenous antimicrobial treatment. Incidence rate (IR) ratios (IRR) were used to compare infection rates. Of 263 CLL patients followed for 936.9 person-years, 60% required treatment for progressive CLL (66 received ibrutinib). Infections occurred in 71.9% patients (IR 92.4/100 person-years) with 31.9% having major infections (IR 20.3/100 person-years) and infections causing 37.5% of deaths. CLL treatment was associated with significantly higher risk of major (IRR 3.31, 95% CI 2.10, 5.21) and minor (IRR 1.78, 95% CI 1.43, 2.22) infections. Compared to their previous chemoimmunotherapy patients receiving salvage ibrutinib therapy (n = 47) had a significantly increased risk of a major infection (IRR 2.35 95% CI 1.27, 4.34). The risk of infection in CLL patients remains high even with use of less immunosuppressive therapies.
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Affiliation(s)
| | - Andrea M Baran
- a Wilmot Cancer Institute, University of Rochester , Rochester , NY , USA
| | - Philip J Meacham
- a Wilmot Cancer Institute, University of Rochester , Rochester , NY , USA
| | - Megan M Feldman
- a Wilmot Cancer Institute, University of Rochester , Rochester , NY , USA
| | - Hugo E Valencia
- b Department of Internal Medicine , University of Rochester , Rochester , NY , USA
| | | | - Nealansh Gupta
- a Wilmot Cancer Institute, University of Rochester , Rochester , NY , USA
| | - Michelle C Janelsins
- a Wilmot Cancer Institute, University of Rochester , Rochester , NY , USA.,c Department of Surgery , University of Rochester , Rochester , NY , USA
| | - Paul M Barr
- a Wilmot Cancer Institute, University of Rochester , Rochester , NY , USA
| | - Clive S Zent
- a Wilmot Cancer Institute, University of Rochester , Rochester , NY , USA
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14
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Chen H, Liu S, Liu J, Chai C, Mao H, Yu Z, Tang Y, Zhu G, Chen HX, Zhu C, Shao H, Tan S, Wang Q, Bi Y, Zou Z, Liu G, Jin T, Jiang C, Gao GF, Peiris M, Yu H, Chen E. Nosocomial Co-Transmission of Avian Influenza A(H7N9) and A(H1N1)pdm09 Viruses between 2 Patients with Hematologic Disorders. Emerg Infect Dis 2016; 22:598-607. [PMID: 26982379 PMCID: PMC4806937 DOI: 10.3201/eid2204.151561] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Transmission of these viruses was limited to 2 immunocompromised patients in the same ward. A nosocomial cluster induced by co-infections with avian influenza A(H7N9) and A(H1N1)pdm09 (pH1N1) viruses occurred in 2 patients at a hospital in Zhejiang Province, China, in January 2014. The index case-patient was a 57-year-old man with chronic lymphocytic leukemia who had been occupationally exposed to poultry. He had co-infection with H7N9 and pH1N1 viruses. A 71-year-old man with polycythemia vera who was in the same ward as the index case-patient for 6 days acquired infection with H7N9 and pH1N1 viruses. The incubation period for the second case-patient was estimated to be <4 days. Both case-patients died of multiple organ failure. Virus genetic sequences from the 2 case-patients were identical. Of 103 close contacts, none had acute respiratory symptoms; all were negative for H7N9 virus. Serum samples from both case-patients demonstrated strong proinflammatory cytokine secretion but incompetent protective immune responses. These findings strongly suggest limited nosocomial co-transmission of H7N9 and pH1N1 viruses from 1 immunocompromised patient to another.
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MESH Headings
- Aged
- Animals
- China
- Cross Infection/diagnosis
- Cross Infection/pathology
- Cross Infection/transmission
- Cross Infection/virology
- Cytokines/biosynthesis
- Cytokines/immunology
- Fatal Outcome
- Humans
- Immunocompromised Host
- Influenza A Virus, H1N1 Subtype/genetics
- Influenza A Virus, H1N1 Subtype/isolation & purification
- Influenza A Virus, H1N1 Subtype/physiology
- Influenza A Virus, H7N9 Subtype/genetics
- Influenza A Virus, H7N9 Subtype/isolation & purification
- Influenza A Virus, H7N9 Subtype/physiology
- Influenza in Birds/transmission
- Influenza in Birds/virology
- Influenza, Human/complications
- Influenza, Human/immunology
- Influenza, Human/transmission
- Influenza, Human/virology
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/virology
- Male
- Middle Aged
- Occupational Exposure
- Polycythemia Vera/complications
- Polycythemia Vera/immunology
- Polycythemia Vera/virology
- Poultry
- Poultry Diseases/transmission
- Poultry Diseases/virology
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Senatore FJ, Dasanu CA. Synchronous gastric and ampullary adenocarcinomas in a hairy cell leukemia patient treated with pentostatin eight years prior. J Oncol Pharm Pract 2016; 22:543-7. [PMID: 25712625 DOI: 10.1177/1078155215574140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hairy cell leukemia patients are at increased risk for second malignancies, including both solid and lymphoid neoplasms. Along with other factors, multiple immune defects present in hairy cell leukemia likely contribute to subsequent carcinogenesis. We report herein a case of synchronous high-grade gastric and ampullary adenocarcinomas in a patient with a history of hairy cell leukemia treated eight years prior with pentostatin. We include a review of immune alterations induced by both hairy cell leukemia and its therapies, and link them with the occurrence of second cancers in these patients.
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Affiliation(s)
- Frank J Senatore
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Constantin A Dasanu
- Lucy Curci Cancer Center, Eisenhower Medical Center/University of Southern California, Rancho Mirage, CA, USA
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16
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Shimanovsky A, Alvarez Argote J, Murali S, Dasanu CA. Autoimmune manifestations in patients with multiple myeloma and monoclonal gammopathy of undetermined significance. BBA CLINICAL 2016; 6:12-8. [PMID: 27331023 PMCID: PMC4900299 DOI: 10.1016/j.bbacli.2016.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 12/20/2022]
Abstract
Background Multiple myeloma (MM) and its precursor, monoclonal gammopathy of undetermined significance (MGUS), have been linked with several autoimmune conditions in the medical literature. Yet, significance of these associations is not well understood. Methods Herein, we provide a comprehensive literature review on autoimmune disorders identified in patients with MM and MGUS. Most relevant papers were identified via searching the PubMed/Medline and EMBASE databases for articles published from inception until May 1, 2016. Findings Scientific literature on autoimmune conditions in patients with MM and MGUS consists of several case series and a multitude of case reports. Our analysis suggests an increased prevalence of autoimmune conditions in patients with MM and monoclonal gammopathy of undetermined significance (MGUS), including various autoimmune hematologic and rheumatologic conditions among other entities. Conversely, persons with various autoimmune conditions tend to have a higher prevalence of MGUS and MM than the general population. Conclusions Future research is required to explore further the link between MGUS/MM and autoimmune disorders. Inflammation in the setting of autoimmunity may serve as a trigger for MGUS and MM. In addition, a common genetic susceptibility for developing both an autoimmune disease and MM/MGUS might also exist. Autoimmune hematologic and rheumatologic diseases may pose important clinical problems for the MM patients. Therefore, a catalogue of these problems is important so that physicians are able to consider, identify and address them promptly. A comprehensive review linking MM and MGUS with autoimmune disorders There is increased prevalence of autoimmune conditions in patients with MM and MGUS Most autoimmune disorders precede the development of plasma cell dyscrasias
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Affiliation(s)
- Alexei Shimanovsky
- Department of Hematology and Oncology, University of Connecticut Health Science Center, Farmington, CT, USA
| | - Juliana Alvarez Argote
- Department of Medicine, University of Connecticut Health Science Center, Farmington, CT, USA
| | - Shruti Murali
- Department of Medicine, University of Connecticut Health Science Center, Farmington, CT, USA
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17
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Janjetovic S, Bernd HW, Bokemeyer C, Fiedler W. Hodgkin's lymphoma as a rare variant of Richter's transformation in chronic lymphocytic leukemia: A case report and review of the literature. Mol Clin Oncol 2016; 4:390-392. [PMID: 26998289 PMCID: PMC4774418 DOI: 10.3892/mco.2016.727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/29/2015] [Indexed: 12/01/2022] Open
Abstract
Richter's transformation induces an aggressive clinical course in chronic lymphocytic leukemia (CLL). In the majority of cases, Richter's transformation manifests itself as a high-grade B-cell non-Hodgkin's lymphoma (B-NHL). However, other histological types, such as classical Hodgkin lymphoma (cHL), lymphoblastic lymphoma, hairy cell leukemia and high-grade T-cell NHL have been described previously. The present study reports a rare case of CLL with transformation into classical Hodgkin's lymphoma (cHL). The common clonal origin of CLL and cHL was documented by immunoglobulin gene rearrangement analysis performed using multiplex polymerase chain reaction. Following a review of the literature, treatment of secondary Hodgkin's lymphoma is discussed, and prognosis is often poor.
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Affiliation(s)
- Snjezana Janjetovic
- Department of Oncology and Hematology, BMT with Section of Pneumology, Hubertus Wald Tumorzentrum, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Heinz-Wolfram Bernd
- Department of Pathology, University Hospital of Schleswig-Holstein, 23562 Campus Lübeck, Germany
| | - Carsten Bokemeyer
- Department of Oncology and Hematology, BMT with Section of Pneumology, Hubertus Wald Tumorzentrum, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Walter Fiedler
- Department of Oncology and Hematology, BMT with Section of Pneumology, Hubertus Wald Tumorzentrum, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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18
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Lam CJK, Curtis RE, Dores GM, Engels EA, Caporaso NE, Polliack A, Warren JL, Young HA, Levine PH, Elmi AF, Fraumeni JF, Tucker MA, Morton LM. Risk Factors for Melanoma Among Survivors of Non-Hodgkin Lymphoma. J Clin Oncol 2015; 33:3096-104. [PMID: 26240221 DOI: 10.1200/jco.2014.60.2094] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Previous studies have reported that survivors of non-Hodgkin lymphoma (NHL) have an increased risk of developing cutaneous melanoma; however, risks associated with specific treatments and immune-related risk factors have not been quantified. PATIENTS AND METHODS We evaluated second melanoma risk among 44,870 1-year survivors of first primary NHL diagnosed at age 66 to 83 years from 1992 to 2009 and included in the Surveillance, Epidemiology, and End Results-Medicare database. Information on NHL treatments, autoimmune diseases, and infections was derived from Medicare claims. RESULTS A total of 202 second melanoma cases occurred among survivors of NHL, including 91 after chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and 111 after other NHL subtypes (cumulative incidence by age 85 years: CLL/SLL, 1.37%; other NHL subtypes, 0.78%). Melanoma risk after CLL/SLL was significantly increased among patients who received infused fludarabine-containing chemotherapy with or without rituximab (n=18: hazard ratio [HR], 1.92; 95% CI, 1.09 to 3.40; n=10: HR, 2.92; 95% CI, 1.42 to 6.01, respectively). Significantly elevated risks also were associated with T-cell activating autoimmune diseases diagnosed before CLL/SLL (n=36: HR, 2.27; 95% CI, 1.34 to 3.84) or after CLL/SLL (n=49: HR, 2.92; 95% CI, 1.66 to 5.12). In contrast, among patients with other NHL subtypes, melanoma risk was not associated with specific treatments or with T-cell/B-cell immune conditions. Generally, infections were not associated with melanoma risk, except for urinary tract infections (CLL/SLL), localized scleroderma, pneumonia, and gastrohepatic infections (other NHLs). CONCLUSION Our findings suggest immune perturbation may contribute to the development of melanoma after CLL/SLL. Increased vigilance is warranted among survivors of NHL to maximize opportunities for early detection of melanoma.
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Affiliation(s)
- Clara J K Lam
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel.
| | - Rochelle E Curtis
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Graça M Dores
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Eric A Engels
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Neil E Caporaso
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Aaron Polliack
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Joan L Warren
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Heather A Young
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Paul H Levine
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Angelo F Elmi
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Joseph F Fraumeni
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Margaret A Tucker
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
| | - Lindsay M Morton
- Clara J.K. Lam, Rochelle E. Curtis, Graça M. Dores, Eric A. Engels, Neil E. Caporaso, Joan L. Warren, Joseph F. Fraumeni Jr, Margaret A. Tucker, and Lindsay M. Morton, National Cancer Institute, Rockville, MD; Clara J.K. Lam, Heather A. Young, Paul H. Levine, and Angelo F. Elmi, The George Washington University Milken Institute School of Public Health, Washington, DC; Graça M. Dores, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma; and Aaron Polliack, Hadassah University Hospital, Jerusalem, Israel
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De Roos AJ, Martínez-Maza O, Jerome KR, Mirick DK, Kopecky KJ, Madeleine MM, Magpantay L, Edlefsen KL, Lacroix AZ. Investigation of epstein-barr virus as a potential cause of B-cell non-Hodgkin lymphoma in a prospective cohort. Cancer Epidemiol Biomarkers Prev 2013; 22:1747-55. [PMID: 23885038 PMCID: PMC4193346 DOI: 10.1158/1055-9965.epi-13-0240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We hypothesized that poor control of Epstein-Barr virus (EBV) infection, leading to reactivation of the virus, increases the risk of non-Hodgkin lymphoma (NHL) in the general population of primarily immunocompetent persons. METHODS We conducted a case-control study nested within the Women's Health Initiative Observational Study cohort in which we measured antibodies to EBV antigens [immunoglobulin G (IgG) to viral capsid antigen (VCA), nuclear antigen (EBNA1), and early antigen-diffuse (EA-D)] and EBV DNA load in prediagnostic samples of 491 B-cell NHL cases and 491 controls. RESULTS We found no association with established EBV infection, based on seropositivity for VCA. Seropositivity for EBNA1 was associated with decreased risk of B-cell NHL, overall [OR = 0.5; 95% confidence interval (CI), 0.3-0.8] and for each of the histologic subtypes examined. Increased risk of chronic lymphocytic leukemia (CLL) and related subtypes was observed with higher levels of EBV DNA and antibody to EA-D, both markers reflective of reactivation. These associations were strongest for cases with the shortest time interval between blood draw and diagnosis. CONCLUSIONS In balance, these results do not provide strong evidence of EBV playing a causal role in B-cell NHL in general population women. The associations we observed may reflect increased risk of NHL with underlying immune impairment or could be due to reverse causation. IMPACT Further characterization of the subtype-specific association with CLL is warranted. Exclusion of cases with preclinical disease markers (such as monoclonal B-lymphocytosis for CLL) may help rule out reverse causation in future studies.
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Affiliation(s)
- Anneclaire J De Roos
- Authors' Affiliations: Department of Environmental and Occupational Health, Drexel University School of Public Health, Philadelphia, Pennsylvania; Division of Public Health Sciences and Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Department of Epidemiology, School of Public Health and Department of Laboratory Medicine, University of Washington, Seattle, Washington; Departments of Obstetrics & Gynecology, and Microbiology, Immunology & Molecular Genetics, David Geffen School of Medicine at UCLA; Jonsson Comprehensive Cancer Center; UCLA AIDS Institute; and Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
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20
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Dasanu CA, Gopal S, Davis LK, Atienza JA. Subcutaneous panniculitis-like T-cell lymphoma in a patient with history of B-cell lymphoma treated successfully with chemotherapy 15 years prior. J Oncol Pharm Pract 2013; 20:233-5. [PMID: 23740379 DOI: 10.1177/1078155213489913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Constantin A Dasanu
- 1Department of Hematology-Oncology, Saint Francis Hospital and Medical Center, Hartford, CT, USA
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21
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Kontoyiannis DP, Georgiadou SP, Wierda WG, Wright S, Albert ND, Ferrajoli A, Keating M, Lewis RE. Impaired bactericidal but not fungicidal activity of polymorphonuclear neutrophils in patients with chronic lymphocytic leukemia. Leuk Lymphoma 2013; 54:1730-3. [PMID: 23163595 DOI: 10.3109/10428194.2012.750723] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We examined the qualitative polymorphonuclear neutrophil (PMN)-associated immune impairment in patients with chronic lymphocytic leukemia (CLL) by characterizing phagocytic killing of key non-opsonized bacterial (Staphylococcus aureus and Pseudomonas aeruginosa) and fungal (Candida albicans and Aspergillus fumigatus) pathogens. Neutrophils were collected from 47 non-neutropenic patients with CLL (PMN count > 1000/mm(3)) and age-matched and young healthy controls (five each). A subset of patients (13%) had prior or subsequent infections. We found that the patients with CLL had diminished PMN microbicidal response against bacteria but not against fungi compared with the controls. Compared to patients with effective PMN responses, we did not identify differences of basal PMN pathogen-associated molecular pattern receptor gene expression, soluble pathogen-associated molecular pattern gene expression or inflammatory cytokine signatures in patients with impaired PMN responses when PMNs were analyzed in multiplex real-time polymerase chain reaction assays. However, differences in PMN microbicidal response against A. fumigatus in patients with CLL were associated with the degree of hypogammaglobulinemia.
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Affiliation(s)
- Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Bockorny B, Dasanu CA. Autoimmune manifestations in large granular lymphocyte leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 12:400-5. [PMID: 22999943 DOI: 10.1016/j.clml.2012.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/17/2012] [Accepted: 06/15/2012] [Indexed: 12/16/2022]
Abstract
Large granular lymphocyte (LGL) leukemia features a group of indolent lymphoproliferative diseases that display a strong association with various autoimmune conditions. Notwithstanding, these autoimmune conditions have not been comprehensively characterized or systematized to date. As a result, their clinical implications remain largely unknown. The authors offer a comprehensive review of the existing literature on various autoimmune conditions documented in the course of T-cell LGL (T-LGL) leukemia. Though some of them are thought be secondary to the LGL leukemia, others could be primary and might even play a role in its pathogenesis. A considerable clinico-laboratory overlap between T-LGL leukemia associated with rheumatoid arthritis and Felty's syndrome suggests that they are just different eponyms for the same clinical entity.
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Affiliation(s)
- Bruno Bockorny
- Department of Medicine, University of Connecticut Medical Center, Farmington, CT 06030-1235, USA.
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23
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Bockorny B, Dasanu CA. Poor prognosis of Hodgkin variant of Richter transformation in chronic lymphocytic leukaemia treated with cladribine - Response to Jamroziak et al. Br J Haematol 2012. [DOI: 10.1111/j.1365-2141.2012.09126.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bruno Bockorny
- Department of Internal Medicine; University of Connecticut Medical Center; Farmington CT
| | - Constantin A. Dasanu
- Department of Hematology-Oncology; St. Francis Hospital and Medical Center; Hartford CT USA
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24
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Afify A, Das S, Mingyi C. Two smalls in one: Coincident small cell carcinoma and small lymphocytic lymphoma in a lymph node diagnosed by fine-needle aspiration biopsy. Cytojournal 2012; 9:5. [PMID: 22438859 PMCID: PMC3307210 DOI: 10.4103/1742-6413.93280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 02/05/2012] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND B-cell chronic lymphocytic leukemia / small lymphocytic lymphoma (CLL / SLL) is one of the most common lymphoproliferative disorders in western countries. Patients with SLL / CLL are at increased risk of site-specific secondary cancers. We present a unique case of a 71-year-old male, with a history of SLL / CLL, who presented with pulmonary symptoms and a mediastinal mass. Fine needle aspiration (FNA) of the mediastinal lymph node revealed synchronous SLL / CLL and small cell carcinoma (SCC). MATERIALS AND METHODS The patient underwent a computed tomography (CT) scan of the chest and endobronchial ultrasound-guided transbronchial fine needle aspiration of the mediastinal lymph node (4R). The sample was submitted for cytopathology, immunohistochemical stains, and flow cytometry evaluation. RESULTS Fine needle aspiration of the mediastinal lymph node revealed neoplastic cells, in clusters and singly, with cytological features suggestive of small cell carcinoma. The immunohistochemistry results confirmed this diagnosis. Small-to-medium, mature-appearing lymphocytes were also present in the background. Flow cytometry analysis revealed that these lymphocytes possessed an immunophenotype consistent with CLL / SLL. CONCLUSIONS This case illustrates the importance of a pathologist's awareness of the possibility of concurrent lymphoma and metastatic carcinoma in a lymph node. When evaluating lymph nodes, pathologists must strive to identify both foreign cells and subtle lymphoid changes. As demonstrated by our case, ancillary techniques (such as immunohistochemistry and flow cytometry) can be critical to making a complete and accurate diagnosis. The diagnosis of small cell carcinoma in the enlarged lymph node, primarily harboring CLL / SLL, is of critical importance for decision-making and treatment purposes, in addition to having a significant adverse impact on the overall survival.
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Affiliation(s)
- Alaa Afify
- Address: Department of Medical Pathology and Laboratory Medicine, UC Davis Health System, 4400 V Street, PATH Building, Sacramento CA 95817
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Bockorny B, Codreanu I, Dasanu CA. Hodgkin lymphoma as Richter transformation in chronic lymphocytic leukaemia: a retrospective analysis of world literature. Br J Haematol 2011; 156:50-66. [DOI: 10.1111/j.1365-2141.2011.08907.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Grabska J, Dasanu CA. Autoimmune phenomena in untreated and treated marginal zone lymphoma. Expert Opin Pharmacother 2011; 12:2369-79. [PMID: 21679092 DOI: 10.1517/14656566.2011.591381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Current literature suggests an association between various autoimmune conditions and marginal zone lymphoma (MZL). However, these autoimmune conditions have not been comprehensively systematized to date. As a result, their clinical implications remain largely unknown. AREAS COVERED The authors provide a comprehensive review of the existing literature on various autoimmune abnormalities documented in the course of MZL, as well as on autoimmune alterations induced by certain MZL therapies. EXPERT OPINION The course of MZL is accompanied by a variety of hematologic and non-hematologic autoimmune disorders. Whereas some of them could be secondary and related to the course of the MZL, others may be primary and might even favor the development of MZL itself. In addition, authentic autoimmune conditions have been documented with the use of rituximab as a single agent and the nucleoside analogs. Therefore, we believe caution should be exerted with the use of these agents in MZL patients with evidence of autoimmune disorders, as exacerbation of autoimmune phenomena can be anticipated. While the heterogeneity of the MZL subtypes represents an inherent limitation, integration of emerging information from immunology research laboratories and clinical practice could translate into improved outcomes of this disease spectrum.
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Affiliation(s)
- Joanna Grabska
- University of Connecticut Medical Center, Department of Internal Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.
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Capizzi T, Makari-Judson G, Steingart R, Mertens WC. Chronic diarrhea associated with persistent norovirus excretion in patients with chronic lymphocytic leukemia: report of two cases. BMC Infect Dis 2011; 11:131. [PMID: 21586142 PMCID: PMC3118142 DOI: 10.1186/1471-2334-11-131] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 05/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic diarrhea in patients treated with immunosuppressive agents or suffering from immunosuppressive disease can represent a diagnostic and therapeutic challenge to the clinician. Norovirus infection, a major cause of acute epidemic diarrhea, has been described as a cause of chronic diarrhea in patients who are immunosuppressed, including transplant recipients and the very young. CASE PRESENTATIONS We describe two patients, a 64 year-old man and a 59 year-old woman, both suffering from chronic lymphocytic leukemia and hypogammaglobulinemia, who developed chronic diarrhea resistant to therapy. In both cases, after months of symptoms, persistent norovirus infection--documented by repeatedly-positive high-sensitivity stool enzyme immunoassay--was found to be the cause. Both patients died with active diarrheal symptoms. CONCLUSIONS We describe the first cases of advanced chronic lymphocytic leukemia to suffer from chronic symptomatic norovirus infection. Clinicians caring for such patients, particularly those with concomitant hypogammaglobulinema, who have chronic unexplained diarrhea, should consider norovirus infection in the differential diagnosis.
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Affiliation(s)
- Todd Capizzi
- Baystate Regional Cancer Program/Tufts University School of Medicine, Springfield, MA 01107, USA
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Morton LM, Curtis RE, Linet MS, Bluhm EC, Tucker MA, Caporaso N, Ries LAG, Fraumeni JF. Second malignancy risks after non-Hodgkin's lymphoma and chronic lymphocytic leukemia: differences by lymphoma subtype. J Clin Oncol 2010; 28:4935-44. [PMID: 20940199 DOI: 10.1200/jco.2010.29.1112] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Previous studies have shown increased risks of second malignancies after non-Hodgkin's lymphoma (NHL) and chronic lymphocytic leukemia (CLL); however, no earlier investigation has quantified differences in risk of new malignancy by lymphoma subtype. PATIENTS AND METHODS We evaluated second cancer and leukemia risks among 43,145 1-year survivors of CLL/small lymphocytic lymphoma (SLL), diffuse large B-cell lymphoma (DLBCL), or follicular lymphoma (FL) from 11 Surveillance, Epidemiology, and End Results (SEER) population-based registries during 1992 to 2006. RESULTS Among patients without HIV/AIDS-related lymphoma, lung cancer risks were significantly elevated after CLL/SLL and FL but not after DLBCL (standardized incidence ratio [SIR], CLL/SLL = 1.42, FL = 1.28, DLBCL = 1.00; Poisson regression P for difference among subtypes, P(Diff) = .001). A similar pattern was observed for risk of cutaneous melanoma (SIR: CLL/SLL = 1.92, FL = 1.60, DLBCL = 1.06; P(Diff) = .004). Acute nonlymphocytic leukemia risks were significantly elevated after FL and DLBCL, particularly among patients receiving initial chemotherapy, but not after CLL/SLL (SIR: CLL/SLL = 1.13, FL = 5.96, DLBCL = 4.96; P(Diff) < .001). Patients with HIV/AIDS-related lymphoma (n = 932) were predominantly diagnosed with DLBCL and had significantly and substantially elevated risks for second anal cancer (SIR = 120.50) and Kaposi's sarcoma (SIR = 138.90). CONCLUSION Our findings suggest that differing immunologic alterations, treatments (eg, alkylating agent chemotherapy), genetic susceptibilities, and other risk factors (eg, viral infections, tobacco use) among lymphoma subtypes contribute to the patterns of second malignancy risk. Elucidating these patterns may provide etiologic clues to lymphoma as well as to the second malignancies.
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Affiliation(s)
- Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD 20892, USA.
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Dasanu CA, Alexandrescu DT. Risk of additional cancers in untreated and treated hairy cell leukemia patients. Expert Opin Pharmacother 2010; 11:41-50. [PMID: 20001428 DOI: 10.1517/14656560903405647] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD One of the feared events encountered in hairy cell leukemia (HCL) survivors is the subsequent development of a malignant neoplasm. The increased incidence of second cancers in HCL has been documented in large epidemiologic studies conducted in various locations on the globe. AREAS COVERED IN THIS REVIEW The authors explore the current clinico-epidemiologic evidence, as well as the immune alterations, that link HCL and its therapies to the development of second cancers. Most relevant publications have been identified through the PubMed/Medline database search. WHAT THE READER WILL GAIN Although HCL patients could develop both HCL and secondary malignancies because of a shared genetic predisposition, a common environmental carcinogen, or not yet identified infectious agents, multiple immune defects documented in HCL might play an important role in second carcinogenesis. Furthermore, the 'gold standards' of HCL therapy - cladribine and pentostatin - are associated with profound and prolonged suppression of the CD4(+) T-lymphocyte counts, often in excess of 2 - 3 years. And while there is no clear-cut evidence that pentostatin or interferon-alpha play an established role in generation of an excess of second cancers in HCL, the safety of cladribine, the preferred agent by a majority of clinicians worldwide, in this regard is a still largely unsettled issue. TAKE-HOME MESSAGE Therefore, it remains to be seen if the immune deficiencies induced by the HCL therapies and their consequences can be offset by the benefit conferred by controlling the leukemic process.
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Affiliation(s)
- Constantin A Dasanu
- St Francis Hospital and Medical Center, Department of Hematology-Oncology, Gothic Park, 43 Woodland Street, G-80, Hartford, CT 06105, USA.
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Dasanu CA, Ichim TE, Alexandrescu DT. Inherent and iatrogenic immune defects in hairy cell leukemia: revisited. Expert Opin Drug Saf 2009; 9:55-64. [DOI: 10.1517/14740330903427951] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Reuter S, Kern W, Zenz C, Kern P. Prognostic factors for invasive aspergillosis in patients with haematological malignancies. ACTA ACUST UNITED AC 2009; 41:483-90. [DOI: 10.1080/00365540902856529] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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