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Kolberg C, Doman E, Mignano S, Mullikin D, Vasta L, Wadzinski W, Foster B. Recognizing a Mediastinal Mass: A Case of Primary Mediastinal Large B-Cell Lymphoma With Pruritus in a 23-Year-Old Adult Male Sailor. Mil Med 2023; 188:3687-3691. [PMID: 35932188 DOI: 10.1093/milmed/usac238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/21/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
Primary mediastinal large B-cell lymphoma (PMBCL) is a rare, non-Hodgkin, B-cell lymphoma thought to originate from thymic B cells, which occurs primarily in young adults such as in the active duty population. Primary mediastinal large B-cell lymphoma (PMBCL) presents as a large mediastinal mass, posing risks to the cardiopulmonary safety of patients and challenging the routine approach to diagnosis. We describe a case of a 23-year-old male sailor who presented to sick call on his ship while in port with shortness of breath, night sweats, 50-pound weight loss, and pruritic punched-out lesions on all extremities. An initial chest X-ray showed a large consolidation. After being seen in the pulmonary medicine clinic 5 weeks after his initial presentation, the patient was admitted to the intensive care unit after computed tomography of his chest revealed a mediastinal mass, causing compression of both the right bronchus and superior vena cava with a large pericardial effusion. Empiric high-dose dexamethasone was initiated before a formal diagnosis due to his significant risk for cardiopulmonary compromise. Following diagnosis and two cycles of chemotherapy, the patient was transferred to a medical oncology facility in the continental USA. This case demonstrates the need to educate all military providers to recognize the presentation of mediastinal masses in active duty service members and the importance of urgently escalating these patients to higher levels of care in order to avoid life-threatening complications.
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Affiliation(s)
- Courtney Kolberg
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Elizabeth Doman
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Salvatore Mignano
- Department of Pathology, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Dolores Mullikin
- Department of Pediatric Hematology and Oncology, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Lauren Vasta
- Department of Pediatric Hematology and Oncology, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - William Wadzinski
- Department of Pulmonology and Critical Care, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Brian Foster
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI 96859, USA
- Department of Pulmonology and Critical Care, Tripler Army Medical Center, Honolulu, HI 96859, USA
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Ondrejka SL, Ott G. How I Diagnose Primary Mediastinal (Thymic) Large B-Cell Lymphoma. Am J Clin Pathol 2021; 156:497-512. [PMID: 34398178 DOI: 10.1093/ajcp/aqab122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/28/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Primary mediastinal (thymic) large B-cell lymphoma (PMBL) is an uncommon large B-cell neoplasm recognized by the World Health Organization as a distinct entity on the basis of its unique clinical features, histogenesis, phenotype, and pathogenetic mechanisms. The diagnosis of PMBL can be challenging because of features that may overlap with other (Hodgkin and non-Hodgkin) lymphoma types. This review describes our approach to the diagnosis of PMBL. METHODS Two cases are presented to illustrate how we diagnose PMBL and separate PMBL from related histologic and biological mimickers, such as Hodgkin lymphoma and gray zone lymphoma. RESULTS A diagnosis of PMBL requires correlation of morphology and immunophenotype with clinical and staging data. Gene expression analysis is not typically performed in clinical labs but has expanded our understanding of the functional pathways underlying this disease and helped identify biomarkers that can be translated to diagnostic practice and possibly to future therapeutic options. CONCLUSIONS PMBL and closely related entities can pose diagnostic challenges. It is important to understand the borders between PMBL and other closely related lymphoma types so that patients receive successful primary treatment with curative intent.
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Affiliation(s)
- Sarah L Ondrejka
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
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3
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Bubik RJ, Dierkhising RA, Mara KC, Daly RC, Kushwaha SS, Clavell AL, Bernard SA. Malignancy among adult heart transplant recipients following patient-tailored dosing of anti-thymocyte globulin: a retrospective, nested case-control study of individualized dosing. Transpl Int 2021; 34:2175-2183. [PMID: 34411345 DOI: 10.1111/tri.14012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/22/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
Post-transplant malignancy is diagnosed in approximately 18% of heart transplant patients and is a leading cause of death post-transplant. One modifiable risk factor is the type and amount of immunosuppression received. Contemporary rabbit anti-thymocyte globulin (rATG) dosing strategy using T-cell-guided dosing, and its effect on malignancy in heart transplant patients is unclear. This was a single-center, retrospective chart review of heart transplant recipients receiving rATG for induction. Patients diagnosed with malignancy post-transplant were matched 1:2 to controls using a nested case-control design. The primary endpoint was to determine the relative risk of rATG exposure with the actual incidence of malignancy post-transplant. The secondary endpoint was the impact of maintenance immunosuppression on malignancy risk. Of the 126 patients included in the study, 25 developed malignancy and were matched to 50 control patients. The median cumulative rATG dose in milligrams (mg) between groups was 365 mg in malignancy cases and 480 mg in controls (OR 0.90, 95% CI 0.75-1.08, P = 0.28). In both the univariate and multivariable analysis, there was no statistically significant difference in malignancy risk found with any maintenance immunosuppressant. The results of this study showed that patient-tailored rATG dosing strategies may not be associated with malignancy development as previously thought.
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Affiliation(s)
| | - Ross A Dierkhising
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Richard C Daly
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.,Divison of Transplantation Surgery, Mayo Clinic, Rochester, MN, USA
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Two distinct prognostic groups in advanced-stage Hodgkin lymphoma revealed by the presence and site of bulky disease. Blood Adv 2021; 4:2064-2072. [PMID: 32396621 DOI: 10.1182/bloodadvances.2019001265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/12/2020] [Indexed: 01/30/2023] Open
Abstract
Controversy exists regarding the definition and prognostic significance of bulk in advanced-stage (stage III/IV) Hodgkin lymphoma (ASHL), and bulk location (mediastinum vs other sites) further complicated the setting. This retrospective, multi-institutional study comprised 814 ASHL patients between 2000 and 2010 and aimed to evaluate the significance of bulk in ASHL. End points of interest included progression-free survival (PFS) and overall survival (OS). Covariates included maximum diameter and the site of bulky disease. SmoothHR and Kaplan-Meier analyses were used to assess for an association of PFS and OS with covariates. In the exploratory cohort (n = 683), maximum diameter had no association with PFS and a complex, U-shaped association with all-cause mortality on smoothHR analysis. Using 5 cm as a cutoff for bulk, Kaplan-Meier analyses confirmed the smoothHR results. The site of bulk was incorporated to divide patients into 2 groups. The mediastinal bulk (MB) type had more favorable characteristics than the nonbulky/non-MB (NB/NMB) type on age, histology, and bone marrow involvement (P < .001). The MB type was associated with better OS than the NB/NMB-type on univariable analysis (5-year OS, 92% vs 86%; HR, 0.53; 95% confidence interval, 0.34-0.84; P = .007). These findings persisted in the subgroup treated with chemotherapy alone and were confirmed in an independent validation cohort (n = 131). Our findings indicate that mediastinal bulk was associated with more favorable disease characteristics and improved OS in ASHL, and may be a surrogate of a more favorable biology.
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Jain H, Kapoor A, Sengar M, Chanana R, Menon H, Sridhar E, Laskar S, Agarwal A, Shastri J, Khanna N, Rangarajan V, Bagal B, Thorat J, Shet T, Gujral S. Outcomes of Patients with Primary Mediastinal B-Cell Lymphoma Treated with Dose Adjusted R-EPOCH Regimen: A Single Centre Experience. Indian J Hematol Blood Transfus 2021; 37:379-385. [PMID: 34267455 DOI: 10.1007/s12288-020-01372-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Primary Mediastinal B cell lymphoma (PMBCL) is a biologically and clinically distinct subset of diffuse large B cell lymphoma. We analysed the outcomes of our cohort of PMBCL patients treated with Dose adjusted (DA)-R-EPOCH regimen. Patients and Methods This is a retrospective analysis of consecutive PMBCL patients who received chemotherapy consisting of DA-R-EPOCH with filgrastim support. Survival analysis was done using Kaplan-Meier method. All calculations were performed using SPSS version 20 for windows. Results A total of 43 consecutive suspected PMBCL patients were reviewed for this study, 6 patients were excluded as diagnosis of PMBCL could not be established. All patients except one (97.3%) received 6 cycles of R-DA-EPOCH regimen. Median age of the patients was 27 years (range 15-58). Bulky disease (> 7 cm) was present in 97% patients and 54% patients had extranodal disease. With a median follow up of 40 months, 3-year overall survival was 80.6% (95% CI: 74.0-87.2). The 3-year event free survival was 78.4% (95% CI: 71.6-85.2). There were 6 (16.2%) relapses, 1 (2.7%) primary progression and 7 (23%) deaths. Mediastinal radiotherapy was administered to 17 (45.9%) patients. All the deaths were due to disease progression. Grade III/IV toxicities were seen in 28 (75.7%) patients, febrile neutropenia being the most common one. Conclusions DA-R-EPOCH regimen is an effective and tolerable regimen in PMBCL patients even with adverse features.
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Affiliation(s)
- Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Raajit Chanana
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Hari Menon
- Medical Oncologist, Cytecare hospital, Bengaluru, India
| | - Epari Sridhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Archi Agarwal
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India
| | - Jayant Shastri
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Jayashree Thorat
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National University, E. Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
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6
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Vassilakopoulos TP, Papageorgiou SG, Angelopoulou MK, Chatziioannou S, Prassopoulos V, Karakatsanis S, Arapaki M, Mellios Z, Sachanas S, Kalpadakis C, Katodritou E, Leonidopoulou T, Kotsianidis I, Hatzimichael E, Kotsopoulou M, Dimou M, Variamis E, Boutsis D, Terpos E, Michali E, Karianakis G, Tsirkinidis P, Vadikolia C, Poziopoulos C, Pigaditou A, Vrakidou E, Siakantaris MP, Kyrtsonis MC, Symeonidis A, Anargyrou K, Papaioannou M, Chatziharissi E, Vervessou E, Tsirogianni M, Palassopoulou M, Gainaru G, Mainta C, Tsirigotis P, Assimakopoulou T, Konstantinidou P, Papadaki H, Dimopoulos MA, Pappa V, Karmiris T, Roussou P, Datseris I, Panayiotidis P, Konstantopoulos K, Pangalis GA, Rondogianni P. Positron emission tomography after response to rituximab-CHOP in primary mediastinal large B-cell lymphoma: impact on outcomes and radiotherapy strategies. Ann Hematol 2021; 100:2279-2292. [PMID: 33523289 DOI: 10.1007/s00277-021-04421-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/11/2021] [Indexed: 01/22/2023]
Abstract
End-of-treatment (EoT) PET/CT is used as a guide to omit radiotherapy (RT) patients with primary mediastinal large B-cell lymphoma (PMBCL). We present the mature and extended results of a retrospective study evaluating the prognostic significance of EoT-PET/CT after adequate response to R-CHOP. Among 231 consecutive PMLBCL patients, 182 underwent EoT-PET/CT and were evaluated according to the Deauville 5-point scale (D5PS) criteria. Freedom from progression (FFP) was measured from the time of PET/CT examination. Among 182 patients, 72 (40%) had D5PS score 1 (D5PSS-1), 33 (18%) had 2, 28 (15%) had 3, 29 (16%) had 4, and 20 (11%) had 5. The 5-year FFP was 97, 94, 92, 82, and 44% for D5PSS-1, D5PSS-2, D5PSS-3, D5PSS-4, and D5PSS-5, respectively. Among 105 patients with unequivocally negative PET/CT (D5PSS-1/D5PSS-2), 49 (47%) received RT (median dose 3420 cGy) and 56 (53%) did not with relapses in 0/49 vs. 4/56 patients (2 mediastinum and 2 isolated CNS relapses).The 5-year FFP for those who received RT or not was 100% versus 96%, when isolated CNS relapses were censored (p = 0.159). Among D5PSS-3 patients (27/28 irradiated-median dose 3600 cGy), the 5-year FFP was 92%. The 5-year FFP for D5PSS-4 and D5PSS-5 was 82 and 44%; 44/49 patients received RT (median dose 4000 and 4400 cGy for D5PSS-4 and D5PSS-5). Our study supports the omission of RT in a sizeable fraction of PET/CT-negative patients and definitely discourages salvage chemotherapy and ASCT in patients with PMLBCL who conventionally respond to R-CHOP, solely based on PET/CT positivity in the absence of documented progressive or multifocal disease. The persistence of positive PET/CT with D5PSS < 5 after consolidative RT should not trigger the initiation of further salvage chemotherapy in the absence of conventionally defined PD.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece.
| | - Sotirios G Papageorgiou
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Maria K Angelopoulou
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece
| | - Sophia Chatziioannou
- Department of Nuclear Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | | | - Stamatios Karakatsanis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Maria Arapaki
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece
| | - Zois Mellios
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Sotirios Sachanas
- Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | | | - Eirini Katodritou
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece
| | | | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Maria Kotsopoulou
- Department of Hematology, Metaxa Anticancer Hospital, Piraeus, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Variamis
- First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelos Terpos
- Department of Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Evridiki Michali
- Department of Clinical Hematology, "G.Gennimatas" Athens General Hospital, Athens, Greece
| | | | | | | | | | - Anna Pigaditou
- Department of Hematology, Athens Medical Center, Amaroussion Branch, Athens, Greece
| | | | - Marina P Siakantaris
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece
| | - Marie-Christine Kyrtsonis
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyris Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras, Patras, Greece
| | | | - Maria Papaioannou
- Hematology Unit, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdoxia Chatziharissi
- Department of Hematology, Theagenion Anticancer General Hospital, Thessaloniki, Greece.,Hematology Unit, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Maria Tsirogianni
- Department of Hematology, Aghios Savvas Anticancer Hospital, Athens, Greece
| | | | | | - Catherine Mainta
- Department of Nuclear Medicine and PET/CT, Athens Medical Center, Athens, Greece
| | - Panagiotis Tsirigotis
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Helen Papadaki
- Department of Hematology, University of Crete, Iraklion, Crete, Greece
| | | | - Vassiliki Pappa
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit, University General Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Themis Karmiris
- Department of Hematology and Lymphoma, Evangelismos General Hospital, Athens, Greece
| | - Paraskevi Roussou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
| | - Ioannis Datseris
- Department of Nuclear Medicine and PET/CT, Evangelismos General Hospital, Athens, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Konstantopoulos
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece
| | - Gerassimos A Pangalis
- Department of Haematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, 11527, Athens, Greece.,Department of Hematology, Athens Medical Center, Psychikon Branch, Athens, Greece
| | - Phivi Rondogianni
- Department of Nuclear Medicine and PET/CT, Evangelismos General Hospital, Athens, Greece
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Abstract
OBJECTIVE. The purpose of this article is to provide a primer for radiologists focused on integrating the radiologic, pathologic, and clinical features of primary mediastinal large B-cell lymphoma (PMLBCL). CONCLUSION. PMLBCL is a unique subtype of lymphoma that poses diagnostic and therapeutic challenges to the fields of radiology and oncology. Knowledge of this distinctive clinical-pathologic entity and its associated imaging and clinical features is critical for radiologists.
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8
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The Unsolved Puzzle of c-Rel in B Cell Lymphoma. Cancers (Basel) 2019; 11:cancers11070941. [PMID: 31277480 PMCID: PMC6678315 DOI: 10.3390/cancers11070941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 01/04/2023] Open
Abstract
Aberrant constitutive activation of Rel/NF-κB transcription factors is a hallmark of numerous cancers. Of the five Rel family members, c-Rel has the strongest direct links to tumorigenesis. c-Rel is the only member that can malignantly transform lymphoid cells in vitro. Furthermore, c-Rel is implicated in human B cell lymphoma through the frequent occurrence of REL gene locus gains and amplifications. In normal physiology, high c-Rel expression predominates in the hematopoietic lineage and a diverse range of stimuli can trigger enhanced expression and activation of c-Rel. Both expression and activation of c-Rel are tightly regulated on multiple levels, indicating the necessity to keep its functions under control. In this review we meta-analyze and integrate studies reporting gene locus aberrations to provide an overview on the frequency of REL gains in human B cell lymphoma subtypes, namely follicular lymphoma, diffuse large B cell lymphoma, primary mediastinal B cell lymphoma, and classical Hodgkin lymphoma. We also summarize current knowledge on c-Rel expression and protein localization in these human B cell lymphomas and discuss the co-amplification of BCL11A with REL. In addition, we highlight and illustrate key pathways of c-Rel activation and regulation with a specific focus on B cell biology.
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9
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Buchholtz ML, Bücklein V, Brendel M, Paal M. Superior vena cava syndrome related to mediastinal lymphoma in late pregnancy: A case report. Case Rep Womens Health 2018; 19:e00065. [PMID: 30094193 PMCID: PMC6071368 DOI: 10.1016/j.crwh.2018.e00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 11/26/2022] Open
Abstract
We report the initial diagnosis in a 28-year-old nulliparous woman of a primary mediastinal B-cell lymphoma in late pregnancy. For several weeks the patient had had symptoms of mediastinal obstruction, such as dyspnea, cough, swelling of the face and upper limbs. However, these symptoms had been misattributed to the pregnancy and a common cold. Due to a rapid decline in the patient's cardiovascular performance, she was transferred to the closest perinatal center in the 34th week of pregnancy, whereupon a cesarean section was performed. The diagnosis of a primary mediastinal B-cell lymphoma was made postpartum from a biopsy. This case emphasizes the importance of timely antenatal investigation in pregnant women with symptoms consistent with mediastinal obstruction. Thoracic ultrasonography can be a valuable tool for the detection of tumor-associated pleural and pericardial effusions. The incidence of primary mediastinal B-cell lymphoma (PMBCL) is disproportionately high in women of reproductive age. The diagnosis is made at a median age of 35 years. Physiological changes during pregnancy can mask mediastinal malignancies since both conditions share similar clinical signs. Symptoms of mediastinal obstruction during pregnancy should therefore lead to immediate diagnostic workup. Thoracic ultrasound examination can aid in the diagnosis of lymphoma-associated pleural and pericardial effusions.
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Affiliation(s)
- M L Buchholtz
- Institute of Laboratory Medicine, University Hospital, LMU, Munich, Germany
| | - V Bücklein
- Department of Internal Medicine III, University Hospital, LMU, Munich, Germany
| | - M Brendel
- Department of Nuclear Medicine, University Hospital, LMU, Munich, Germany
| | - M Paal
- Institute of Laboratory Medicine, University Hospital, LMU, Munich, Germany
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10
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Yönal-Hindilerden İ, Hindilerden F, Arslan S, Doğan İÖ, Nalçacı M. Primary Mediastinal Large B-Cell Lymphoma As an Incidental Finding: Report of a Case. Turk J Haematol 2018; 35:141-142. [PMID: 27094863 PMCID: PMC5972341 DOI: 10.4274/tjh.2016.0057] [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: 12/01/2022] Open
Affiliation(s)
- İpek Yönal-Hindilerden
- İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
| | - Fehmi Hindilerden
- Dr. Sadi Konuk Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Serkan Arslan
- Dr. Sadi Konuk Training and Research Hospital, Clinic of Radiology, İstanbul, Turkey
| | - İbrahim Öner Doğan
- İstanbul University İstanbul Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Meliha Nalçacı
- İstanbul University İstanbul Faculty of Medicine, Department of Internal Medicine, Division of Hematology, İstanbul, Turkey
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11
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Utpat K, Desai UD, Amonkar G, Joshi JM. A perplexing primary novel hilar lesion: Remember the pneumonic PPNHL! INDIAN J PATHOL MICR 2018; 61:85-89. [PMID: 29567890 DOI: 10.4103/ijpm.ijpm_71_17] [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: 11/04/2022] Open
Abstract
A 60-year-old female presented with dyspnea, cough, and chest pain with a left hilar mass lesion. In our case, clinicoradiological correlation, bronchoscopy, and computed tomography-guided biopsy revealed the diagnosis of primary pulmonary non-Hodgkin's lymphoma (PPNHL) on histopathology and immunohistochemistry. We discuss the approach to hilar masses. PPNHL is a rare malignant lymphoma most common being mucosa-associated lymphoid tissue lymphoma. Various therapeutic options are available. The chemotherapy regimen consisting of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) is preferred.
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Affiliation(s)
- Ketaki Utpat
- Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Unnati D Desai
- Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Gayathri Amonkar
- Department of Pathology, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Jyotsna M Joshi
- Department of Pulmonary Medicine, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India
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Shah NN, Szabo A, Huntington SF, Epperla N, Reddy N, Ganguly S, Vose J, Obiozor C, Faruqi F, Kovach AE, Costa LJ, Xavier AC, Okal R, Kanate AS, Ghosh N, Kharfan-Dabaja MA, Strelec L, Hamadani M, Fenske TS, Calzada O, Cohen JB, Chavez J, Svoboda J. R-CHOP versus dose-adjusted R-EPOCH in frontline management of primary mediastinal B-cell lymphoma: a multi-centre analysis. Br J Haematol 2017; 180:534-544. [PMID: 29265182 DOI: 10.1111/bjh.15051] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/09/2017] [Indexed: 01/09/2023]
Abstract
Primary mediastinal (thymic) large B-cell lymphoma (PMBCL) is an uncommon subtype of non-Hodgkin lymphoma (NHL) that presents with a mediastinal mass and has unique clinicopathological features. Historically, patients with PMBCL were treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy ± involved field radiation. Since a phase II trial, published in April 2013, demonstrated excellent results using dose-adjusted (DA) R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin), this treatment has gained popularity. We performed a retrospective, multicentre analysis of patients aged ≥18 years with PMBCL since January 2011. Patients were stratified by frontline regimen, R-CHOP versus DA-R-EPOCH. 132 patients were identified from 11 contributing centres (56 R-CHOP and 76 DA-R-EPOCH). The primary outcome was overall survival. Secondary outcomes included progression-free survival, complete response (CR) rate, and rates of treatment-related complications. Demographic characteristics were similar in both groups. DA-R-EPOCH use increased after April 2013 (79% vs. 45%, P < 0·001), and there was less radiation use after DA-R-EPOCH (13% vs. 59%, P < 0·001). While CR rates were higher with DA-R-EPOCH (84% vs. 70%, P = 0·046), these patients were more likely to experience treatment-related toxicities. At 2 years, 89% of R-CHOP patients and 91% of DA-R-EPOCH patients were alive. To our knowledge, this represents the largest series comparing outcomes of R-CHOP to DA-R-EPOCH for PMBCL.
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Affiliation(s)
- Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Narendranath Epperla
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nishitha Reddy
- Vanderbilt University Ingram Cancer Center, Nashville, TN, USA
| | | | - Julie Vose
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | | | | | - Ana C Xavier
- Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ryan Okal
- West Virginia University, Morgantown, WV, USA
| | | | - Nilanjan Ghosh
- Levine Cancer Institute/Carolinas HealthCare System, Charlotte, North Carolina, USA
| | | | | | - Mehdi Hamadani
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.,Center of International Bone Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | - Timothy S Fenske
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Oscar Calzada
- Emory University-Winship Cancer Institute, Atlanta, GA, USA
| | | | - Julio Chavez
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Tzankov A, Went P, Dirnhofer S. Prognostic Significance of in situ Phenotypic Marker Expression in Diffuse Large B-cell Lymphomas. Biomark Insights 2017. [DOI: 10.1177/117727190700200009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Diffuse large B-cell lymphomas (DLBCL) are the most common lymphoid malignancies, and encompass all malignant lymphomas characterized by large neoplastic cells and B-cell derivation. In the last decade, DLBCL has been subjected to intense clinical, phenotypic and molecular studies, and were found to represent a heterogeneous group of tumors. These studies suggested new disease subtypes and variants with distinct clinical characteristics, morphologies, immunophenotypes, genotypes or gene expression profiles, associated with distinct prognoses or unique sensitivities to particular therapy regimens. Unfortunately, the reliability and reproducibility of the molecular results remains unclear due to contradictory reports in the literature resulting from small sample sizes, referral and selection biases, and variable methodologies and cut-off levels used to determine positivity. Here, we review phenotypic studies on the prognostic significance of protein expression profiles in DLBCL and reconsider our own retrospective data on 301 primary DLBCL cases obtained on a previously validated tissue microarray in light of powerful statistical methods of determining optimal cut-off values of phenotypic factors for prediction of outcome.
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Affiliation(s)
| | - Philip Went
- Department of Pathology, University Hospital Basel, Switzerland
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Sturgis CD, Monaco SE, Sakr H, Pantanowitz L. Cytologic perspectives on neoteric B-cell lymphoproliferative disorders. Diagn Cytopathol 2017; 45:1005-1019. [PMID: 28594112 DOI: 10.1002/dc.23766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/09/2017] [Accepted: 05/17/2017] [Indexed: 12/16/2022]
Abstract
The 2008 World Health Organization (WHO) classification of hematopoietic and lymphoid tissues has been recently revised, and publication of the updated 2016 version is expected soon. Given that cytopathologists are often involved in the diagnosis of primary, recurrent, and transformed lymphoproliferative disorders, knowledge of updates to the WHO lymphoma classification, including terminology, pathogenesis, ancillary techniques, and targeted therapies is necessary. Herein, we reference the last decade of cytology specific literature for seven newer B-cell disorders and provide illustrative examples of each entity from our files.
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Affiliation(s)
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Hany Sakr
- Department of Pathology, Cleveland Clinic, Cleveland, OH
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The Pathobiology and Treatment of Hodgkin Lymphoma. Where do We go from Gianni Bonadonna's Lesson? TUMORI JOURNAL 2017; 103:101-113. [DOI: 10.5301/tj.5000608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/18/2023]
Abstract
This article reviews the evolution of the diagnosis and treatment of Hodgkin lymphoma (HL) since its discovery in 1832. The morphological, phenotypic and molecular characteristics of both nodular lymphocyte-predominant HL and classical HL are revised in the light of recent molecular information and possible impact on the identification of risk groups as well as the use of targeted therapies. The seminal contribution of Gianni Bonadonna to developing new treatment strategies for both advanced and early-stage HL is highlighted.
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Földeák D, Kalapos A, Domsik P, Sinkó M, Szeleczki N, Bagdi E, Krenács L, Forster T, Borbényi Z, Nemes A. Left ventricular rigid body rotation in a diffuse large B-cell lymphoma patient with cardiac involvement: A case from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Földeák D, Kalapos A, Domsik P, Sinkó M, Szeleczki N, Bagdi E, Krenács L, Forster T, Borbényi Z, Nemes A. Left ventricular rigid body rotation in a diffuse large B-cell lymphoma patient with cardiac involvement: A case from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study. Rev Port Cardiol 2017; 36:145.e1-145.e5. [PMID: 28159427 DOI: 10.1016/j.repc.2016.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/11/2016] [Accepted: 04/26/2016] [Indexed: 01/27/2023] Open
Abstract
Secondary myocardial involvement by diffuse large B-cell lymphoma is a rare occurrence. Left ventricular (LV) twist is considered an essential part of LV function. In normal circumstances LV twist results from the movement of two orthogonally oriented muscular bands of a helical myocardial structure with consequent clockwise rotation of the base and counterclockwise rotation of the apex. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) has been found to be feasible for non-invasive 3D quantification of LV wall motion and rotational mechanics. The present report aimed to assess LV twisting motion in a patient with diffuse large B-cell lymphoma with positron emission tomography/computer tomography-proven cardiac involvement by 3DSTE. During 3DSTE, reduction in some segmental radial, longitudinal, circumferential, area and 3D LV strains were found. Apical and basal LV rotations were found to be in the same counterclockwise direction, confirming near absence of LV twist - so-called rigid body rotation.
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Affiliation(s)
- Dóra Földeák
- Division of Haematology, 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Anita Kalapos
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Péter Domsik
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Mária Sinkó
- PET/CT Centre, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Nóra Szeleczki
- PET/CT Centre, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Enikő Bagdi
- Laboratory of Tumor Pathology and Molecular Diagnostics, Szeged, Hungary
| | - László Krenács
- Laboratory of Tumor Pathology and Molecular Diagnostics, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zita Borbényi
- Division of Haematology, 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
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Primary mediastinal B-cell lymphoma - metabolic and anatomical features in 18FDG-PET/CT and response to therapy. Contemp Oncol (Pozn) 2016; 20:297-301. [PMID: 27688726 PMCID: PMC5032157 DOI: 10.5114/wo.2016.61849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 06/22/2016] [Indexed: 11/17/2022] Open
Abstract
Aim of the study Determining the role of PET/CT imaging in the evaluation of treatment efficacy in primary mediastinal B-cell lymphoma (PMBCL). Material and methods Retrospective analysis of seven PMBCL patients, treated at the University Hospital in Krakow, with interim PET/CT after the third course of chemo-immunotherapy.The analysis was based on the calculation of exact tumour volume and metabolic activity, compared with initial values (directly after diagnosis). Results Patients (five females, two males, average age 26.2 years, range 18–40 years), in clinical stage IIBX at diagnosis, were treated with eight cycles of R-CHOP-14 regimen, with radiotherapy consolidation (7/7) and central nervous system prophylaxis (6/7). The observed decrease in tumour volume between the initial staging and the interim PET ranged 72–89%. The mean ΔSUVmax reduction between initial (when available) and interim PET was 87% (range 84–89%). In 3/7 cases in the interim PET/CT, the uptake of the tumour was higher than the liver (Deauville Criteria score 4–5), and in 4/7 it was lower than the liver but higher than mediastinal blood pool structures (score 3 according to Deauville Criteria). After a median follow-up of 58 months – OS and EFS is 100%. Conclusions The excellent clinical outcome in the study group corresponds with very good metabolic and volumetric response in the interim PET. The ΔSUVmax seems to be easier in implementation and has a more significant impact than other measurements.
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Abstract
Diffuse large B-cell lymphoma (DLBCL) is an aggressive disease with considerable heterogeneity reflected in the 2008 World Health Organization classification. In recent years, genome-wide assessment of genetic and epigenetic alterations has shed light upon distinct molecular subsets linked to dysregulation of specific genes or pathways. Besides fostering our knowledge regarding the molecular complexity of DLBCL types, these studies have unraveled previously unappreciated genetic lesions, which may be exploited for prognostic and therapeutic purposes. Following the last World Health Organization classification, we have witnessed the emergence of new variants of specific DLBCL entities, such as CD30 DLBCL, human immunodeficiency virus-related and age-related variants of plasmablastic lymphoma, and EBV DLBCL arising in young patients. In this review, we will present an update on the clinical, pathologic, and molecular features of DLBCL incorporating recently gained information with respect to their pathobiology and prognosis. We will emphasize the distinctive features of newly described or emerging variants and highlight advances in our understanding of entities presenting a diagnostic challenge, such as T-cell/histiocyte-rich large B-cell lmphoma and unclassifiable large B-cell lymphomas. Furthermore, we will discuss recent advances in the genomic characterization of DLBCL, as they may relate to prognostication and tailored therapeutic intervention. The information presented in this review derives from English language publications appearing in PubMed throughout December 2015. For a complete outline of this paper, please visit: http://links.lww.com/PAP/A12.
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Mangasarova YK, Magomedova AU, Nesterova ES, Volodicheva EM, Vorobyev VI, Kravchenko SK. Therapy for primary mediastinal large B-cell lymphoma in accordance with the R-DA-EPOCH-21 program: The first results. TERAPEVT ARKH 2016; 88:37-42. [DOI: 10.17116/terarkh201688737-42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Binkley MS, Hiniker SM, Wu S, Natkunam Y, Mittra ES, Advani RH, Hoppe RT. A single-institution retrospective analysis of outcomes for stage I-II primary mediastinal large B-cell lymphoma treated with immunochemotherapy with or without radiotherapy. Leuk Lymphoma 2015; 57:604-8. [PMID: 26159046 DOI: 10.3109/10428194.2015.1067700] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As the optimal treatment for primary mediastinal large B-cell lymphoma (PMBCL) remains undefined, we evaluated outcomes of patients treated with standard and dose-intense rituximab-chemotherapy (R-CT) with and without radiotherapy (RT). We retrospectively identified 28 patients with stage I-II PMBCL in our lymphoma database, re-reviewed pathology slides and scored interim or post-chemotherapy PET/CTs using the Deauville scale. Fourteen patients received RT (36-45 Gy) preceded by either six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or 12 weeks of rituximab, etoposide, doxorubicin, cyclophosphamide, vincristine, prednisone and bleomycin (R-VACOP-B) with median follow-up of 94 months. Fourteen patients received 4-8 cycles of dose-adjusted etoposide, vincristine, doxorubicin, cyclophosphamide and rituximab (DA-EPOCH-R) with median follow-up of 38 months; one of these received RT (36 Gy) due to post-chemotherapy PET/CT Deauville score 4. Following R-CT and RT or DA-EPOCH-R, 5-year and 3-year FFP and OS were both 100%. Both R-CHOP/R-VACOP-B with RT and DA-EPOCH-R demonstrate excellent outcomes.
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Affiliation(s)
- Michael S Binkley
- a Department of Radiation Oncology , Stanford University School of Medicine , Stanford , CA , USA
| | - Susan M Hiniker
- a Department of Radiation Oncology , Stanford University School of Medicine , Stanford , CA , USA
| | - Sharon Wu
- b Department of Pathology , Stanford University School of Medicine , Stanford , CA , USA
| | - Yasodha Natkunam
- b Department of Pathology , Stanford University School of Medicine , Stanford , CA , USA
| | - Erik S Mittra
- c Department of Radiology , Stanford University School of Medicine , Stanford , CA , USA
| | - Ranjana H Advani
- d Department of Medicine , Division of Medical Oncology, Stanford University School of Medicine , Stanford , CA , USA
| | - Richard T Hoppe
- a Department of Radiation Oncology , Stanford University School of Medicine , Stanford , CA , USA
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22
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Staton AD, Koff JL, Chen Q, Ayer T, Flowers CR. Next-generation prognostic assessment for diffuse large B-cell lymphoma. Future Oncol 2015; 11:2443-57. [PMID: 26289217 DOI: 10.2217/fon.15.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Current standard of care therapy for diffuse large B-cell lymphoma (DLBCL) cures a majority of patients with additional benefit in salvage therapy and autologous stem cell transplant for patients who relapse. The next generation of prognostic models for DLBCL aims to more accurately stratify patients for novel therapies and risk-adapted treatment strategies. This review discusses the significance of host genetic and tumor genomic alterations seen in DLBCL, clinical and epidemiologic factors, and how each can be integrated into risk stratification algorithms. In the future, treatment prediction and prognostic model development and subsequent validation will require data from a large number of DLBCL patients to establish sufficient statistical power to correctly predict outcome. Novel modeling approaches can augment these efforts.
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Affiliation(s)
- Ashley D Staton
- Department of Hematology & Medical Oncology, Emory University, Atlanta, GA 30322, USA
| | - Jean L Koff
- Department of Hematology & Medical Oncology, Emory University, Atlanta, GA 30322, USA
| | - Qiushi Chen
- H Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30318, USA
| | - Turgay Ayer
- H Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, GA 30318, USA
| | - Christopher R Flowers
- Department of Hematology & Medical Oncology, Emory University, Atlanta, GA 30322, USA
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Utility of baseline 18FDG-PET/CT functional parameters in defining prognosis of primary mediastinal (thymic) large B-cell lymphoma. Blood 2015; 126:950-6. [DOI: 10.1182/blood-2014-12-616474] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/24/2015] [Indexed: 12/11/2022] Open
Abstract
Key Points
18FDG PET/CT is a very important staging tool for patients with PMBCL. Metabolic activity defined by TLG on the baseline PET scan is a powerful predictor of PMBCL outcome.
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Xie L, Ritz O, Leithäuser F, Guan H, Färbinger J, Weitzer CD, Gehringer F, Bruederlein S, Holzmann K, Vogel MJ, Möller P, Wirth T, Ushmorov A. FOXO1 downregulation contributes to the oncogenic program of primary mediastinal B-cell lymphoma. Oncotarget 2015; 5:5392-402. [PMID: 24977668 PMCID: PMC4170625 DOI: 10.18632/oncotarget.2107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Recently we have shown that the transcription factor FOXO1, highly expressed in B cells, is downregulated in classical Hodgkin lymphoma (cHL). As primary mediastinal B cell lymphoma (PMBL) has similarities with the cHL transcription program we investigated FOXO1 expression in this entity. By using immunohistochemistry we found that FOXO1 was absent or expressed at low levels in 19 of 20 primary PMBL cases. PMBL cell lines reproduce the low FOXO1 expression observed in primary cases. By analyzing gene expression profiling data we found that FOXO1 expression inversely correlated with JAK2 in PMBL cases. Targeting JAK2 activity by the small molecular weight inhibitor TG101348 resulted in upregulation of FOXO1 mRNA and protein expression in MedB-1 and U2940 cell lines, and the MYC inhibitor 10058-F4 increased FOXO1 mRNA in MedB-1 cells. Moreover, in MedB-1 cells FOXO1 expression was strongly upregulated by the inhibitor of DNA methylation 5-aza-2-deoxycytidine and by the histone deacetylase inhibitor trichostatin A. Since FOXO1 promoter was unmethylated, this effect is most likely indirect. FOXO1 activation in the FOXO1-negative MedB-1 cell line led to growth arrest and apoptosis, which was accompanied by repression of MYC and BCL2L1/BCLxL. Thus, FOXO1 repression might contribute to the oncogenic program and phenotype of PMBL.
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Affiliation(s)
- Linka Xie
- Cancer Center of Union Hospital, Tongji Medical College, HuaZhong University of Science and Technology, Wuhan, China. Institute of Physiological Chemistry, University of Ulm, Germany
| | - Olga Ritz
- Institute of Pathology, University of Ulm, Germany
| | | | - Hanfeng Guan
- Institute of Physiological Chemistry, University of Ulm, Germany. Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Hua Zhong University of Science and Technology, Wuhan, China
| | | | | | | | | | | | - Marion J Vogel
- Institute of Physiological Chemistry, University of Ulm, Germany
| | - Peter Möller
- Institute of Pathology, University of Ulm, Germany
| | - Thomas Wirth
- Institute of Physiological Chemistry, University of Ulm, Germany
| | - Alexey Ushmorov
- Institute of Physiological Chemistry, University of Ulm, Germany
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Primary mediastinal large B-cell lymphoma. Cancer Treat Rev 2015; 41:476-85. [PMID: 25913715 DOI: 10.1016/j.ctrv.2015.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/09/2015] [Accepted: 04/12/2015] [Indexed: 11/24/2022]
Abstract
The management of primary mediastinal large B-cell lymphoma (PMBCL) requires a balance between optimizing chances of cure and reducing risk of long-term toxicities. The combination of rituximab to cyclophosphamide, doxorubicin, vincristine and prednisone (RCHOP) followed by mediastinal radiation results in a plateau in progression-free survival after first few years of follow-up. In rituximab era, a negative positron emission tomography (PET) scan performed after the completion of immunochemotherapy has a high predictive value for durable remission. Consequently, end-of-therapy PET may be utilizable to avoid radiation without compromising survival. Additionally, intensified chemotherapy alone has shown excellent survival. PMBCL is frequently associated with amplification of programmed death ligand (PDL) 1/2 and constitutive activation of JAK-STAT and NFKB pathways; these may serve as promising therapeutic targets. Clinical trials that integrate novel therapies into upfront immunochemotherapy and utilize end-of-therapy PET scan to guide mediastinal radiation have potential to further enhance survival and prevent long-term toxicities.
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26
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Drexler HG, Ehrentraut S, Nagel S, Eberth S, MacLeod RAF. Malignant hematopoietic cell lines: in vitro models for the study of primary mediastinal B-cell lymphomas. Leuk Res 2014; 39:18-29. [PMID: 25480038 DOI: 10.1016/j.leukres.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/30/2014] [Accepted: 11/05/2014] [Indexed: 11/27/2022]
Abstract
Primary mediastinal B-cell lymphoma (PMBL) is a highly aggressive disease with a unique set of biological, clinical, morphological, immunological and in particular genetic features that in the molecular era of defining lymphomas clearly distinguishes it as a separate entity from other diffuse large B-cell lymphomas (DLBCL). A precise molecular diagnosis of PMBL can be achieved by gene expression profiling. The signature gene expression profile of PMBL is more closely related to classic Hodgkin lymphoma (cHL) than to other DLBCL subgroups. A number of common genetic aberrations in PMBL and cHL further underscore their close relationship. To investigate the pathobiology of lymphomas in depth, many groups have turned to cell lines that are suitable models facilitating molecular studies and providing unique insights. For the purposes of the current perspective, we focus on four bona fide PMBL-derived cell lines (FARAGE, KARPAS-1106, MEDB-1, U-2940) that we identified and validated as such through hierarchical cluster analysis among a large collection of leukemia-lymphoma cell lines. These gene expression profiles showed that the four PMBL cell lines represent a distinct entity and are most similar to cHL cell lines, confirming derivation from a related cell type. A validated cell line resource for PMBL should assist those seeking druggable targets in this entity. This review aims to provide a comprehensive overview of the currently available cellular models for the study of PMBL.
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Affiliation(s)
- Hans G Drexler
- Leibniz-Institute DSMZ-German Collection of Microorganisms and Cell Cultures, Dept. Human and Animal Cell Lines, Braunschweig, Germany.
| | - Stefan Ehrentraut
- Leibniz-Institute DSMZ-German Collection of Microorganisms and Cell Cultures, Dept. Human and Animal Cell Lines, Braunschweig, Germany
| | - Stefan Nagel
- Leibniz-Institute DSMZ-German Collection of Microorganisms and Cell Cultures, Dept. Human and Animal Cell Lines, Braunschweig, Germany
| | - Sonja Eberth
- Leibniz-Institute DSMZ-German Collection of Microorganisms and Cell Cultures, Dept. Human and Animal Cell Lines, Braunschweig, Germany
| | - Roderick A F MacLeod
- Leibniz-Institute DSMZ-German Collection of Microorganisms and Cell Cultures, Dept. Human and Animal Cell Lines, Braunschweig, Germany
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Moustafa S, Patton DJ, Alvarez N, Prieur T, Connelly MS, Alnasser M, Mookadam F. Unusual cardiac infiltration in diffuse large B-cell lymphoma. J Cardiovasc Ultrasound 2014; 22:160-1. [PMID: 25309697 PMCID: PMC4192418 DOI: 10.4250/jcu.2014.22.3.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 06/30/2014] [Accepted: 08/20/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sherif Moustafa
- Department of Cardiovascular Diseases, Prince Salman Heart Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. ; Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - David J Patton
- Section of Pediatric Cardiology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Nanette Alvarez
- Adult Congenital Heart Disease Clinic, Peter Lougheed Hospital, Division of Cardiovascular Diseases, Calgary, AB, Canada
| | - Timothy Prieur
- Adult Congenital Heart Disease Clinic, Peter Lougheed Hospital, Division of Cardiovascular Diseases, Calgary, AB, Canada
| | - Michael S Connelly
- Adult Congenital Heart Disease Clinic, Peter Lougheed Hospital, Division of Cardiovascular Diseases, Calgary, AB, Canada
| | - Mohammed Alnasser
- Department of Radiology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Farouk Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ, USA
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30
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Santoro F, Tarantino N, Pellegrino PL, Caivano M, Lopizzo A, Di Biase M, Brunetti ND. Cardiovascular sequelae of radiation therapy. Clin Res Cardiol 2014; 103:955-67. [DOI: 10.1007/s00392-014-0718-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/15/2014] [Indexed: 01/13/2023]
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Recurrent somatic mutations of PTPN1 in primary mediastinal B cell lymphoma and Hodgkin lymphoma. Nat Genet 2014; 46:329-35. [PMID: 24531327 DOI: 10.1038/ng.2900] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 01/24/2014] [Indexed: 12/20/2022]
Abstract
Classical Hodgkin lymphoma and primary mediastinal B cell lymphoma (PMBCL) are related lymphomas sharing pathological, molecular and clinical characteristics. Here we discovered by whole-genome and whole-transcriptome sequencing recurrent somatic coding-sequence mutations in the PTPN1 gene. Mutations were found in 6 of 30 (20%) Hodgkin lymphoma cases, in 6 of 9 (67%) Hodgkin lymphoma-derived cell lines, in 17 of 77 (22%) PMBCL cases and in 1 of 3 (33%) PMBCL-derived cell lines, consisting of nonsense, missense and frameshift mutations. We demonstrate that PTPN1 mutations lead to reduced phosphatase activity and increased phosphorylation of JAK-STAT pathway members. Moreover, silencing of PTPN1 by RNA interference in Hodgkin lymphoma cell line KM-H2 resulted in hyperphosphorylation and overexpression of downstream oncogenic targets. Our data establish PTPN1 mutations as new drivers in lymphomagenesis.
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Genomic rearrangements involving programmed death ligands are recurrent in primary mediastinal large B-cell lymphoma. Blood 2014; 123:2062-5. [PMID: 24497532 DOI: 10.1182/blood-2013-10-535443] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The pathogenesis of primary mediastinal large B-cell lymphoma (PMBCL) is incompletely understood. Recently, specific genotypic and phenotypic features have been linked to tumor cell immune escape mechanisms in PMBCL. We studied 571 B-cell lymphomas with a focus on PMBCL. Using fluorescence in situ hybridization here, we report that the programmed death ligand (PDL) locus (9p24.1) is frequently and specifically rearranged in PMBCL (20%) as compared with diffuse large B-cell lymphoma, follicular lymphoma, and Hodgkin lymphoma. Rearrangement was significantly correlated with overexpression of PDL transcripts. Utilizing high-throughput sequencing techniques, we characterized novel translocations and chimeric fusion transcripts involving PDLs at base-pair resolution. Our data suggest that recurrent genomic rearrangement events underlie an immune privilege phenotype in a subset of B-cell lymphomas.
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Rogowitz E, Babiker HM, Krishnadasan R, Jokerst C, Miller TP, Bookman M. Heart of lymphoma: primary mediastinal large B-cell lymphoma with endomyocardial involvement. Case Rep Oncol Med 2013; 2013:814291. [PMID: 24194994 PMCID: PMC3806362 DOI: 10.1155/2013/814291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 09/17/2013] [Indexed: 11/17/2022] Open
Abstract
Primary mediastinal B-cell lymphoma (PMBCL) is an uncommon aggressive subset of diffuse large B-cell lymphomas. Although PMBCL frequently spreads locally from the thymus into the pleura or pericardium, it rarely invades directly through the heart. Herein, we report a case of a young Mexican female diagnosed with PMBCL with clear infiltration of lymphoma through the cardiac wall and into the right atrium and tricuspid valve leading to tricuspid regurgitation. This was demonstrated by cardiac MRI and transthoracic echocardiogram. In addition, cardiac MRI and CT scan of the chest revealed the large mediastinal mass completely surrounding and eroding into the superior vena cava (SVC) wall causing a collar of stokes. The cardiac and SVC infiltration created a significant therapeutic challenge as lymphomas are very responsive to chemotherapy, and treatment could potentially lead to vascular wall rupture and hemorrhage. Despite the lack of conclusive data on chemotherapy-induced hemodynamic compromise in such scenarios, her progressive severe SVC syndrome and respiratory distress necessitated urgent intervention. In addition to the unique presentation of this rare lymphoma, our case report highlights the safety of R-CHOP treatment.
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Affiliation(s)
- Elisa Rogowitz
- University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA
| | - Hani M. Babiker
- Division of Hematology-Oncology, University of Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ 85724, USA
| | - Ravitharan Krishnadasan
- Division of Hematology-Oncology, University of Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ 85724, USA
| | - Clint Jokerst
- Department of Radiology, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA
| | - Thomas P. Miller
- Division of Hematology-Oncology, University of Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ 85724, USA
| | - Michael Bookman
- Division of Hematology-Oncology, University of Arizona Cancer Center, 1515 N. Campbell Avenue, Tucson, AZ 85724, USA
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Nedomova R, Papajik T, Prochazka V, Indrak K, Jarosova M. Cytogenetics and molecular cytogenetics in diffuse large B-cell lymphoma (DLBCL). Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 157:239-47. [PMID: 23132512 DOI: 10.5507/bp.2012.085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) accounts for up to 40% of all non-Hodgkin's lymphomas diagnosed in the western hemisphere. Determination of the gene expression profile has confirmed the physiological heterogeneity of the disease and defined three molecular prognostic subgroups - germinal center B-cell-like (GCB), activated B-cell-like (ABC) and primary mediastinal B-cell lymphoma (PMBL) - with different gene expression and prognosis. METHODS AND RESULTS This review covers current knowledge on the most frequent recurrent cytogenetic and molecular cytogenetic aberrations in molecular DLBCL subgroups. CONCLUSIONS Cytogenetic and molecular cytogenetic techniques used to determine nonrandom chromosomal aberrations in patients with DLBCL have revealed the incidence of frequent cytogenetic aberrations in the subgroups reported, suggesting their potential use for more accurate prognostic stratification of DLBCL, contributing to personalized selection of the most effective therapy.
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Affiliation(s)
- Radka Nedomova
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Tirado CA, Chen W, García R, Kohlman KA, Rao N. Genomic profiling using array comparative genomic hybridization define distinct subtypes of diffuse large B-cell lymphoma: a review of the literature. J Hematol Oncol 2012; 5:54. [PMID: 22967872 PMCID: PMC3479011 DOI: 10.1186/1756-8722-5-54] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/31/2012] [Indexed: 11/13/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin Lymphoma comprising of greater than 30% of adult non-Hodgkin Lymphomas. DLBCL represents a diverse set of lymphomas, defined as diffuse proliferation of large B lymphoid cells. Numerous cytogenetic studies including karyotypes and fluorescent in situ hybridization (FISH), as well as morphological, biological, clinical, microarray and sequencing technologies have attempted to categorize DLBCL into morphological variants, molecular and immunophenotypic subgroups, as well as distinct disease entities. Despite such efforts, most lymphoma remains undistinguishable and falls into DLBCL, not otherwise specified (DLBCL-NOS). The advent of microarray-based studies (chromosome, RNA, gene expression, etc) has provided a plethora of high-resolution data that could potentially facilitate the finer classification of DLBCL. This review covers the microarray data currently published for DLBCL. We will focus on these types of data; 1) array based CGH; 2) classical CGH; and 3) gene expression profiling studies. The aims of this review were three-fold: (1) to catalog chromosome loci that are present in at least 20% or more of distinct DLBCL subtypes; a detailed list of gains and losses for different subtypes was generated in a table form to illustrate specific chromosome loci affected in selected subtypes; (2) to determine common and distinct copy number alterations among the different subtypes and based on this information, characteristic and similar chromosome loci for the different subtypes were depicted in two separate chromosome ideograms; and, (3) to list re-classified subtypes and those that remained indistinguishable after review of the microarray data. To the best of our knowledge, this is the first effort to compile and review available literatures on microarray analysis data and their practical utility in classifying DLBCL subtypes. Although conventional cytogenetic methods such as Karyotypes and FISH have played a major role in classification schemes of lymphomas, better classification models are clearly needed to further understanding the biology, disease outcome and therapeutic management of DLBCL. In summary, microarray data reviewed here can provide better subtype specific classifications models for DLBCL.
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Affiliation(s)
- Carlos A Tirado
- Department of Pathology & Laboratory Medicine UCLA - David Geffen UCLA, School of Medicine, Los Angeles, USA.
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Papageorgiou SG, Diamantopoulos P, Levidou G, Angelopoulou MK, Economopoulou P, Efthimiou A, Constantinou N, Katsigiannis A, Korkolopoulou P, Pappa V, Economopoulou C, Georgiou G, Dimou M, Tsirigotis P, Kyrtsonis MC, Kotsianidis I, Kalpadakis C, Dimopoulos MA, Beris P, Meletis J, Pangalis GA, Dervenoulas J, Panayiotidis P, Vassilakopoulos TP. Isolated central nervous system relapses in primary mediastinal large B-cell lymphoma after CHOP-like chemotherapy with or without Rituximab. Hematol Oncol 2012; 31:10-7. [DOI: 10.1002/hon.2012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 02/06/2012] [Accepted: 03/01/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sotirios G. Papageorgiou
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit; National and Kapodistrian University of Athens, Medical School, University General Hospital ‘Attikon’; Haidari; Greece
| | - Panayiotis Diamantopoulos
- Department of Haematology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | - Georgia Levidou
- Department of Pathology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | - Maria K. Angelopoulou
- Department of Haematology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | - Panagiota Economopoulou
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit; National and Kapodistrian University of Athens, Medical School, University General Hospital ‘Attikon’; Haidari; Greece
| | - Anna Efthimiou
- Department of Haematology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | | | - Andreas Katsigiannis
- Third Department of Internal Medicine; National and Kapodistrian University of Athens, Medical School, ‘Sotiria’ Hospital; Athens; Greece
| | - Penelope Korkolopoulou
- Department of Pathology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | - Vassiliki Pappa
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit; National and Kapodistrian University of Athens, Medical School, University General Hospital ‘Attikon’; Haidari; Greece
| | - Christina Economopoulou
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit; National and Kapodistrian University of Athens, Medical School, University General Hospital ‘Attikon’; Haidari; Greece
| | - George Georgiou
- Department of Haematology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | - Maria Dimou
- Department of Haematology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | - Panagiotis Tsirigotis
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit; National and Kapodistrian University of Athens, Medical School, University General Hospital ‘Attikon’; Haidari; Greece
| | - Marie-Christine Kyrtsonis
- Department of Haematology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | - Ioannis Kotsianidis
- Department of Haematology; Democritus University of Thrace; Alexandroupolis; Greece
| | | | - Meletios-Athanassios Dimopoulos
- Department of Therapeutics; National and Kapodistrian University of Athens, Medical School, ‘Alexandra’ Hospital; Athens; Greece
| | - Photis Beris
- Department of Haematology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | - John Meletis
- Department of Haematology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
| | | | - John Dervenoulas
- Second Department of Internal Medicine, Propaedeutic, Hematology Unit; National and Kapodistrian University of Athens, Medical School, University General Hospital ‘Attikon’; Haidari; Greece
| | - Panayiotis Panayiotidis
- Department of Haematology; University of Athens, Medical School, ‘Laikon’ General Hospital; Athens; Greece
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Vassilakopoulos TP, Pangalis GA, Katsigiannis A, Papageorgiou SG, Constantinou N, Terpos E, Zorbala A, Vrakidou E, Repoussis P, Poziopoulos C, Galani Z, Dimopoulou MN, Kokoris SI, Sachanas S, Kalpadakis C, Dimitriadou EM, Siakantaris MP, Kyrtsonis MC, Dervenoulas J, Dimopoulos MA, Meletis J, Roussou P, Panayiotidis P, Beris P, Angelopoulou MK. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone with or without radiotherapy in primary mediastinal large B-cell lymphoma: the emerging standard of care. Oncologist 2012; 17:239-49. [PMID: 22282906 PMCID: PMC3286173 DOI: 10.1634/theoncologist.2011-0275] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 11/02/2011] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED More aggressive treatment approaches (methotrexate, cytarabine, cyclophosphamide, vincristine, prednisone, and bleomycin [the MACOP-B regimen] or consolidation with high-dose therapy and autologous stem cell transplantation) have been considered to be superior to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in patients with primary mediastinal large B-cell lymphoma (PMLBCL). Rituximab-CHOP (R-CHOP) is the standard of care for diffuse large B-cell lymphoma, whereas efficacy in PMLBCL has not been adequately confirmed. PATIENT AND METHODS Seventy-six consecutive PMLBCL patients who received R-CHOP with or without radiotherapy (RT) were compared with 45 consecutive historical controls treated with CHOP with or without RT. Baseline characteristics of the two groups were balanced. RESULTS The rate of early treatment failure was much lower with R-CHOP with or without RT (9% versus 30%; p = .004). The 5-year freedom from progression rate after R-CHOP with or without RT was 81%, versus 48% for CHOP with or without RT (p < .0001). The 5-year event-free survival rates were 80% and 47% (p < .0001) and the 5-year overall and lymphoma-specific survival rates were 89% and 69% (p = .003) and 91% and 69% (p = .001), respectively, with only seven of 76 lymphoma-related deaths. Among R-CHOP responders, 52 of 68 received RT. CONCLUSIONS Based on these results, most patients with PMLBCL appear to be cured by R-CHOP in 21-day cycles with or without RT, which could be the current standard of care. Therefore, the need for more aggressive treatment strategies is questionable unless high-risk patients are adequately defined. Further studies are required to establish the precise role of RT.
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Affiliation(s)
- Theodoros P Vassilakopoulos
- Department of Haematology, National and Kapodistrian University of Athens, School of Medicine, Laikon General Hospital, Athens 11527, Greece.
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Spieler P, Rössle M. Respiratory Tract and Mediastinum. ESSENTIALS OF DIAGNOSTIC PATHOLOGY 2012. [PMCID: PMC7122295 DOI: 10.1007/978-3-642-24719-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Normal cytology, abnormal and atypical cells, non-cellular components, and infectious cell changes are largely described together with benign, malignant, and neuroendocrine lesions regarding exfoliative and aspiration cytology of the lung. A separate section broadly addresses diagnostic findings and differential diagnoses in bronchoalveolar washings. The section ‘Fine needle aspiration biopsy of mediastinal disorders’ covers in particular biopsy techniques, accuracy of liquid-based cytology, and the complex lesions of the thymus gland. Cytodiagnostic algorithms of the major benign and malignant pulmonary and mediastinal lesions and their respective differential diagnoses are additionally presented in synoptic setups.
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Affiliation(s)
- Peter Spieler
- Institut für Pathologie, Kantonsspital St. Gallen, Rorschacherstraße 95, 9007 St. Gallen, Switzerland
| | - Matthias Rössle
- Institut für Klinische Pathologie, UniversitätsSpital Zürich, Schmelzbergstraße 12, 8091 Zürich, Switzerland
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De Mello CAL, De Andrade VP, De Lima VCC, Carvalho AL, Soares FA. Prognostic impact of MUM1 expression by immunohistochemistry on primary mediastinal large B-cell lymphoma. Leuk Lymphoma 2011; 52:1495-503. [PMID: 21623692 DOI: 10.3109/10428194.2011.573032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diffuse large B-cell lymphoma can be classified into two prognostically distinct subgroups with germinal center B-cell-like (CG) and activated B-cell-like (post-CG) characteristics, based on CD10, BCL-6, and MUM1 expression. We performed a retrospective analysis of the clinical variables of 37 patients with primary mediastinal large B-cell lymphoma and the expression of BCL-6 and MUM1 in 22 patients with available tissue. The median age was 30 years, and 70% of the patients were female. BCL-6 and MUM1 were expressed in 64% and 45% of cases, respectively. Five-year overall survival (OS) and disease-free survival (DFS) were 47% and 81%, respectively. In univariate analysis, complete response (p = 0.0001), radiation therapy (p = 0.01), International Prognostic Index (p = 0.001), and MUM1 expression (p = 0.002) correlated with OS. For this group of patients with homogeneous clinical characteristics, response to initial chemotherapy and MUM1 expression were associated with prognosis.
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Affiliation(s)
- Celso A L De Mello
- Department of Medical Oncology, Hospital AC Camargo, Sao Paulo, SP, Brazil.
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40
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Hutchinson CB, Wang E. Primary mediastinal (thymic) large B-cell lymphoma: a short review with brief discussion of mediastinal gray zone lymphoma. Arch Pathol Lab Med 2011; 135:394-8. [PMID: 21366467 DOI: 10.5858/2009-0463-rsr.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary mediastinal (thymic) large B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma (DLBCL). It commonly presents as a bulky lesion in the anterior-superior mediastinum with symptoms related to local invasion or compression. Microscopic examination typically shows infiltration of medium-large cells surrounded by collagen fibrosis. The neoplastic cells express B-cell markers, and CD30 often shows heterogeneous staining. Comparative genomic hybridization has identified gains in loci of 9p24 and 2p15 as well as Xp11.4-21 and Xq24-26. Amplification of REL and BCL11A at 2p as well as elevated expression of JAK2, PDL1, and PDL2 at 9p has been demonstrated. Nodular sclerosis classic Hodgkin lymphoma needs to be differentiated from PMBCL and cases with overlapped features have been described as mediastinal gray zone lymphoma. Primary mediastinal (thymic) large B-cell lymphoma carries a favorable prognosis in comparison to conventional DLBCL.
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41
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Banerjee D. Recent Advances in the Pathobiology of Hodgkin's Lymphoma: Potential Impact on Diagnostic, Predictive, and Therapeutic Strategies. Adv Hematol 2011; 2011:439456. [PMID: 21318045 PMCID: PMC3034907 DOI: 10.1155/2011/439456] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 10/04/2010] [Accepted: 11/12/2010] [Indexed: 12/20/2022] Open
Abstract
From its first description by Thomas Hodgkin in 1832, Hodgkin's disease, now called Hodgkin's lymphoma, has continued to be a fascinating neoplasm even to this day. In this review, historical aspects, epidemiology, diagnosis, tumor biology, new observations related to host-microenvironment interactions, gene copy number variation, and gene expression profiling in this complex neoplasm are described, with an exploration of chemoresistance mechanisms and potential novel therapies for refractory disease.
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Affiliation(s)
- Diponkar Banerjee
- Centre for Translational and Applied Genomics (CTAG), Department of Pathology, British Columbia Cancer Agency (BCCA), 600 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 4E6
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada V6T 2B5
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[An 80-year-old male with pleural effusion and mediastinal lymph nodes]. Med Clin (Barc) 2010; 135:700-6. [PMID: 20846696 DOI: 10.1016/j.medcli.2010.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 06/03/2010] [Indexed: 11/21/2022]
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43
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Primary mediastinal large B-cell lymphoma (thymic lymphoma) imaged with F-18 FDG PET-CT. Clin Nucl Med 2010; 35:421-4. [PMID: 20479590 DOI: 10.1097/rlu.0b013e3181db4d33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pervez S, Deedar Ali Khawaja R. Mediastinal lymphomas: Primary Mediastinal (Thymic) Large B-cell Lymphoma versus classical Hodgkin lymphoma, histopathologic dilemma solved? Pathol Res Pract 2010; 206:365-7. [DOI: 10.1016/j.prp.2010.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 01/05/2010] [Indexed: 11/24/2022]
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45
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Rehm A, Anagnostopoulos I, Gerlach K, Broemer M, Scheidereit C, Jöhrens K, Hübler M, Hetzer R, Stein H, Lipp M, Dörken B, Höpken UE. Identification of a chemokine receptor profile characteristic for mediastinal large B-cell lymphoma. Int J Cancer 2009; 125:2367-74. [PMID: 19536742 DOI: 10.1002/ijc.24652] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Mediastinal large B-cell lymphomas (MLBCLs) are considered as a subtype of diffuse large B-cell lymphoma; however, they exhibit completely different patterns of dissemination. Since they share a number of surface markers with thymic B cells, a close relationship was assumed. MLBCLs arise extranodally within the anterior mediastinum and have a low propensity to metastasize. To address the preferential positioning of MLBCL, we focused on homeostatic chemokines involved in B-cell compartmental homing in secondary lymphoid organs, which are also capable of shaping lymphoid niches in ectopic sites. Here, we applied immunohistochemistry to assess chemokine receptor and ligand expression in situ. Flow cytometry was used to identify the chemokine receptor profile on an MLBCL-derived cell line, Karpas1106 and on thymic B cells. Migration assays were performed to examine functionality of chemokine receptors. Electrophoretic mobility shift assay was applied to score for NF-kappaB activity. Using immunohistochemistry, we obtained an unexpectedly low-expression frequency for the chemokine receptors CXCR5 and CCR7 in primary lesions. Although the mature B-cell marker CCR6 was absent in most cases, the lineage aberrant marker CCR9 emerged in the majority of MLBCL cases. Given the role of NF-kappaB in the transcriptional activation of CCR7, we identified the involvement of the noncanonical activation pathway in MLBCLs. MLBCLs exhibit a diagnostic chemokine receptor profile that is instrumental in the discrimination from diffuse large B-cell lymphoma not otherwise specified and classical Hodgkin lymphoma. Furthermore, we suggest that low-abundance expression of CCR7 and CXCR5 may hinder lymphoma cells from nodal dissemination.
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Affiliation(s)
- Armin Rehm
- Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.
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46
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Attias D, Hodgson D, Weitzman S. Primary mediastinal B-cell lymphoma in the pediatric patient: Can a rational approach to therapy be based on adult studies? Pediatr Blood Cancer 2009; 52:566-70. [PMID: 19058208 DOI: 10.1002/pbc.21821] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The literature on adult and pediatric primary mediastinal B-cell lymphoma (PMBCL) was reviewed and compared. Biologically, adult PMBCL has more similarities to Hodgkin Lymphoma (HL) than diffuse large B-cell lymphoma (DLBCL). Pediatric studies suggest that the biology is similar to that in adults. Median age of children is 14.3 years and the overall survival (OS) is reported as 78.6% and event-free survival (EFS) as 67.4%. Adverse prognostic factors included LDH >500 and mass size over 10 cm, with a trend towards better survival in younger patients. Studies in adults show better survival with intensified chemotherapy and the addition of rituximab. Data on the use of radiation therapy show improved CR rates and survival with addition of involved field radiation therapy (IFRT). Positron emission tomography (PET) with computerized tomography (CT) imaging response-assessment after two courses and at therapy-end may allow for the rational use of IFRT in pediatric/adolescent patients who are more susceptible to development of adverse late effects.
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Affiliation(s)
- Dina Attias
- Division of Pediatric Hematology/Oncology, Bnai Zion, Medical Center, Bruce Rappoport Faculty of Medicine, Technion Institute, Haifa, Israel
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47
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CNS recurrence of primary mediastinal large b-cell lymphoma after complete remission. J Neurooncol 2009; 95:135-139. [PMID: 19381440 DOI: 10.1007/s11060-009-9898-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
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Wani AM, Hussain WM, Fatani MI, Qadmani A, Hemdi M, Hanif S, Akhtar M, Bafaraj MG. Chest wall swelling: unusual presentation of an aggressive mediastinal tumour. BMJ Case Rep 2009; 2009:bcr05.2009.1890. [PMID: 21954405 DOI: 10.1136/bcr.05.2009.1890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The majority of patients with primary mediastinal lymphoma are symptomatic at the time of diagnosis and commonly have fever, weight loss and/or night sweats. Symptoms due to compression of adjacent mediastinal structures are infrequent, but may include pain, dyspnoea, stridor, or superior vena cava syndrome. Local infiltration into the chest wall, pleura and pericardium is not uncommon.In the present report, two interesting cases of chest wall swellings that in fact were extensions of primary mediastinal lymphoma are given. Histopathology of the tumour was large B cell lymphoma (CD20+). The first case was in a 23-year-old woman, with dramatic onset but a good outcome. The second was in a 34-year-old Pakistani woman, with insidious onset and poor outcome due to extent and invasion by the tumour. Interesting CT images are presented showing chest wall and left supraclavicular swelling.
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Treatment of primary mediastinal large B cell lymphoma with an alternating chemotherapy regimen based on high-dose methotrexate. Ann Hematol 2008; 88:433-9. [PMID: 18853160 DOI: 10.1007/s00277-008-0625-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 12/21/2007] [Indexed: 10/21/2022]
Abstract
Primary mediastinal large B cell lymphomas (MLCL) differ from other diffuse large cell lymphomas, leading to a description as a separate entity in the current World Health Organization classification. Dose intensification improves long-term results, but no standard therapy has been established so far. We investigated the use of a high-dose methotrexate-based alternating chemotherapy regimen (B-ALL protocol of the German ALL study group) followed by consolidative mediastinal radiotherapy first as a single-center trial, then later as a prospective multicenter trial in 44 patients with a median age of 33 years. Response rates exceeded 90% with an overall survival rate of 80% in the single-center group (8.6 years median follow-up) and 82% in the multicenter group (2.5 years follow-up).Short-term toxicity was manageable, but required hospitalization: the rates of grade 3 or 4 toxicity were 20% (for mucositis), 42% (for neutropenia), 29% (for thrombocytopenia), and 9% (for neutropenic fever). No relapse occurred more than 2 years after diagnosis and initiation of treatment, but unfortunately, no patient with overt progression or relapse within these 2 years could be salvaged. Future directions in the treatment of MLCL will not focus on further dose intensification, but rather on the incorporation of (radio)immunotherapy as a therapeutic tool and gene expression profiling as well as positron emission tomography-computed tomography as stratifying tools.
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Reiter A, Klapper W. Recent advances in the understanding and management of diffuse large B-cell lymphoma in children. Br J Haematol 2008; 142:329-47. [PMID: 18537979 DOI: 10.1111/j.1365-2141.2008.06988.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
MESH Headings
- Adult
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Child
- Clinical Trials as Topic
- Cyclophosphamide/administration & dosage
- Diagnosis, Differential
- Doxorubicin/administration & dosage
- Humans
- Immunophenotyping
- Lymph Nodes/immunology
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/immunology
- Prednisone/administration & dosage
- Rituximab
- Treatment Outcome
- Vincristine/administration & dosage
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Affiliation(s)
- Alfred Reiter
- Department of Paediatric Haematology and Oncology, Justus-Liebig-University, Giessen, Germany.
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