1
|
Wurm-Kuczera RI, Buentzel J, Koenig JFL, Legler T, Valk JJ, Hasenkamp J, Jung W, Rademacher JG, Korsten P, Wulf GG. Sarcoidosis Following Hematopoietic Stem Cell Transplantation: Clinical Characteristics and HLA Associations. Front Immunol 2021; 12:746996. [PMID: 34691055 PMCID: PMC8529157 DOI: 10.3389/fimmu.2021.746996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Extrinsic factors and genetic predisposition contribute to the etiology of sarcoidosis, converging in a phenotype of altered immune response associated with multisystemic inflammatory granulomatous tissue infiltration. Immunological reconstitution after hematopoietic stem cell transplantation (HSCT) may represent a unique window for the pathogenesis of the disease. We describe the incidence, clinicopathological features, and HLA associations of sarcoidosis after HSCT in a single-center cohort of patients, together with data from previously published cases. Methods We retrospectively analyzed clinical characteristics and HLA haplotypes from allogeneic (allo) or autologous (auto) HSCT patients from January 2001 through May 2021 at the University Medicine Goettingen (UMG), and data from previously published cases. Results A total number of 19 patients was identified. These included 4 patients from our center (3 allo HSCT and 1 auto HSCT) and 15 patients from the literature review. Thirteen patients had received an allo HSCT, and six patients had received an auto HSCT. Sarcoidosis occurred after a median interval of 20 (after allo HSCT) and 7 (after auto HSCT) months, respectively. The predominant HLA allele associated with sarcoidosis was HLA DRB1*03:01. Sarcoidosis involved the respiratory tract in 15 patients (three unknown, one without pulmonary involvement), and it was associated with graft-versus-host disease in 7 of 13 patients receiving allo HSCT. None of the donors or patients had a history of sarcoidosis before transplantation. Disease manifestations resolved with standard glucocorticoid treatment without long-term sequelae. Conclusion Sarcoidosis may occur at low frequency during reconstitution of the immune system after HSCT. HLA allele associations reflect the associations observed in the general population, particularly with DRB1*03:01. Further insights into the interplay between Tcell reconstitution and the development of sarcoidosis could also provide novel approaches to an improved understanding of the pathogenesis in sarcoidosis.
Collapse
Affiliation(s)
| | - Judith Buentzel
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Tobias Legler
- Department of Transfusion Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Jan-Jakob Valk
- Department of Transfusion Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Justin Hasenkamp
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Wolfram Jung
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Gerald Georg Wulf
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| |
Collapse
|
2
|
Obi ON, Lower EE, Baughman RP. Biologic and advanced immunomodulating therapeutic options for sarcoidosis: a clinical update. Expert Rev Clin Pharmacol 2021; 14:179-210. [PMID: 33487042 DOI: 10.1080/17512433.2021.1878024] [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] [Indexed: 12/15/2022]
Abstract
Introduction: Sarcoidosis is a multi-organ disease with a wide range of clinical manifestations and outcomes. A quarter of sarcoidosis patients require long-term treatment for chronic disease. In this group, corticosteroids and cytotoxic agents be insufficient to control diseaseAreas covered: Several biologic agents have been studied for treatment of chronic pulmonary and extra-pulmonary disease. A review of the available literature was performed searching PubMed and an expert opinion regarding specific therapy was developed.Expert opinion: These agents have the potential of treating patients who have progressive disease. Many of these agents have different mechanisms of action, response rates, and toxicity profiles.
Collapse
Affiliation(s)
- Ogugua Ndili Obi
- Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
3
|
El Jammal T, Pavic M, Gerfaud-Valentin M, Jamilloux Y, Sève P. Sarcoidosis and Cancer: A Complex Relationship. Front Med (Lausanne) 2020; 7:594118. [PMID: 33330555 PMCID: PMC7732692 DOI: 10.3389/fmed.2020.594118] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is a systemic disease of unknown etiology, characterized by the presence of non-caseating granulomas in various organs, mainly the lungs, and the lymphatic system. Since the individualization of sarcoidosis-lymphoma association by Brincker et al., the relationship between sarcoidosis or granulomatous syndromes and malignancies has been clarified through observational studies worldwide. Two recent meta-analyses showed an increased risk of neoplasia in sarcoidosis. The granulomatosis can also reveal malignancy, either solid or hematological, defining paraneoplastic sarcoidosis. Recent cancer immunotherapies, including immune checkpoint inhibitors (targeting PD-1, PD-L1, or CTLA-4) and BRAF or MEK inhibitors were also reported as possible inducers of sarcoidosis-like reactions. Sarcoidosis and neoplasia, especially lymphoma, can show overlapping presentations, thus making the diagnosis and treatment harder to deal with. There are currently no formal recommendations to guide the differential diagnosis workup between the evolution of lymphoma or a solid cancer and a granulomatous reaction associated with neoplasia. Thus, in atypical presentations (e.g., deeply impaired condition, compressive lymphadenopathy, atypical localization, unexplained worsening lymphadenopathy, or splenomegaly), and treatment-resistant disease, targeted biopsies on suspect localizations with histological examination could help the clinician to differentiate neoplasia from sarcoidosis. Pathological diagnosis could sometimes be challenging since very few tumor cells may be surrounded by massive granulomatous reaction. The sensitization of currently available diagnostic tools should improve the diagnostic accuracy, such as the use of more “cancer-specific” radioactive tracers coupled with Positron Emission Tomography scan.
Collapse
Affiliation(s)
- Thomas El Jammal
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France
| | - Michel Pavic
- Medicine Department, Sherbrooke University, Sherbrooke, QC, Canada
| | | | - Yvan Jamilloux
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France.,INSERM U1111, Center International de Recherche en Infectiologie/International Research Center in Infectiology (CIRI), University Claude-Bernard Lyon 1, Villeurbanne, France
| | - Pascal Sève
- Internal Medicine Department, La Croix-Rousse Hospital, Lyon, France.,Pôle IMER, Hospices Civils de Lyon, Lyon, France.,HESPER EA 7425, Lyon University, University Claude-Bernard Lyon 1, Lyon, France
| |
Collapse
|
4
|
Sano Y, Fujiwara M, Yuasa T, Komai Y, Yamamoto T, Kohno A, Nakao M, Inamura K, Yonese J. Testicular seminoma with a progressing pulmonary nodule and mediastinal lymphadenopathy without retroperitoneal metastasis. IJU Case Rep 2020; 3:211-214. [PMID: 32914079 PMCID: PMC7469829 DOI: 10.1002/iju5.12191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Testicular germ cell cancer has a relatively good prognosis even if visceral and/or lymph node metastases are present thanks to chemotherapy. Yet chemotherapy can lead to various adverse events. Therefore, it is crucial to distinguish whether a suspected metastatic disease is metastasis or not. CASE PRESENTATION A 33-year-old male visited our hospital to receive subsequent therapy for suspected recurrent seminoma with a progressing pulmonary nodule and mediastinal lymphadenopathy after orchiectomy. The pathological diagnosis of needle aspiration and resected specimen of the several lesions was consistent with epithelioid cell granuloma without caseous necrosis. Based on these findings, the lung and mediastinal lymph node lesions were diagnosed as sarcoidosis. CONCLUSION In cases where the simultaneous occurrence of other benign or malignant diseases is suspected, pathological confirmation is necessary for appropriate decision-making.
Collapse
Affiliation(s)
- Yuta Sano
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Motohiro Fujiwara
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Takeshi Yuasa
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Yoshinobu Komai
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Tatsuya Yamamoto
- Department ofRadiologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Atsushi Kohno
- Department ofRadiologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Masayuki Nakao
- Department ofThoracic Surgical OncologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Kentaro Inamura
- Department ofPathologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Junji Yonese
- Department ofUrologyCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| |
Collapse
|
5
|
Spiekermann C, Kuhlencord M, Huss S, Rudack C, Weiss D. Coexistence of sarcoidosis and metastatic lesions: A diagnostic and therapeutic dilemma. Oncol Lett 2017; 14:7643-7652. [PMID: 29344212 PMCID: PMC5755156 DOI: 10.3892/ol.2017.7247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/27/2017] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis, a chronic, inflammatory disease that affects various different organs, is characterized by noncaseating epitheloid granulomas. This systemic inflammatory process is associated with an increased risk of cancer. Several cases of sarcoidosis that mimic metastatic tumor progression in radiological findings have been reported so far. However, there are also cases that have presented a coexistence of sarcoidosis and metastasis, which have caused a diagnostic and therapeutic dilemma. Due to inadequate current therapies, a reliable differentiation between benign and malignant lesions is crucial. This review focuses on the residual risk of the coexistence of metastases within radiological suspicious lesions in patients with a history of solid tumors and sarcoidosis, as well as immunological findings, in order to explain the potential associations. Sarcoidosis has the potential to promote metastasis as it includes tumor-promoting and immune-regulating cell subsets. Notably, myeloid derived suppressor cells may serve a pivotal role in metastatic progression in patients with sarcoidosis. In addition, the present review also evaluates the potential novel diagnostic approaches, which may be able to differentiate between metastatic lesions and sarcoidosis. The risk of coexistent metastasis in sarcoidosis lesions must be considered by clinical practitioners, and a multidisciplinary approach may be required to avoid misdiagnosis and the subsequent unnecessary surgery or insufficient treatments.
Collapse
Affiliation(s)
- Christoph Spiekermann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, D-48149 Münster, Germany.,Institute of Immunology, University Hospital Münster, D-48149 Münster, Germany
| | - Meike Kuhlencord
- Institute of Immunology, University Hospital Münster, D-48149 Münster, Germany
| | - Sebastian Huss
- Institute of Pathology, University Hospital Münster, D-48149 Münster, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, D-48149 Münster, Germany
| | - Daniel Weiss
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Münster, D-48149 Münster, Germany
| |
Collapse
|
6
|
Marchal A, Charlotte F, Maksud P, Haroche J, Lifferman F, Miyara M, Choquet S, Amoura Z, Cohen Aubart F. [Sarcoidosis flare after autologous stem cell transplantation: An immune paradox?]. Rev Med Interne 2017; 38:619-622. [PMID: 28196699 DOI: 10.1016/j.revmed.2017.01.001] [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: 05/07/2016] [Revised: 11/06/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disorder of unknown cause. Apparition or flare of previously diagnosed sarcoidosis following hematopoietic stem cell transplantation (HSCT) has rarely been reported. OBSERVATION We report a 62-year-old woman who presented a radiological flare of sarcoidosis post-autologous stem cell transplantation for a POEMS syndrome. Imaging findings and lymph node histology, which revealed non-caseating granuloma, were consistent with the sarcoidosis diagnosis. The patient was asymptomatic and was kept free of treatment. CONCLUSION Sarcoidosis must be considered ahead of compatible clinicoradiological presentation occurring after HSCT. Sarcoidosis can mimic metastatic cancer or lymphatic relapse. Tissue biopsies and exclusion of differential diagnosis of granuloma diseases are warranted to confirm sarcoidosis diagnosis.
Collapse
Affiliation(s)
- A Marchal
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - F Charlotte
- Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France; Service d'anatomopathologie, hôpital Pitié-Salpêtrière, AP-HP, Paris 75013, France
| | - P Maksud
- Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France; Service de médecine nucléaire, hôpital Pitié-Salpêtrière, AP-HP, Paris 75013, France
| | - J Haroche
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France
| | - F Lifferman
- Service de médecine interne, hôpital de Dax, Dax 40180, France
| | - M Miyara
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France; Département d'immunochimie, hôpital Pitié-Salpêtrière, AP-HP, Paris 75013, France
| | - S Choquet
- Service d'hématologie, hôpital Pitié-Salpêtrière, AP-HP, Paris 75013, France
| | - Z Amoura
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France
| | - F Cohen Aubart
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France.
| |
Collapse
|