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Özyörük D, Güzelküçük Z, Metin A, Emir S, Yazal Erdem A, Kacar D, Koca Yozgat A, Aker CB, Çakmakçı S, Özdemir SI, Sari N, Cihan MK, Özbek NY, İlhan İE. Clinical Profile and Outcomes of Primary Immunodeficiency and Malignancy in Childhood at a Tertiary Oncology Center in Developing Country. Pediatr Hematol Oncol 2022; 39:600-612. [PMID: 35282762 DOI: 10.1080/08880018.2022.2045408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Primary immune deficiencies are a group of heterogenous genetic disorders characterized by frequent infections, autoimmunity and malignancy. In this study, we aimed to evaluate clinical characteristics, outcomes of children with malignancy developed on background of primary immunodeficiency and compare survival rates of patients between malignant lymphoma with primary immunodeficiency and without immunodeficiency from tertiary oncology center in a developing country. A total 23 patients with primary immunodeficiency and malignancy were evaluated retrospectively. A total of 26 malignancies (first or second) in 23 patients were determined. The median age at the time of the first malignancy was 8 years (ranges 2-18 years) with increased male ratio (M/F:14/9). Non-Hodgkin lymphoma (n = 17; 65%) was the most common malignancy, followed by Hodgkin lymphoma (n = 5), anaplastic ependymoma (n = 1), spinal glioblastoma multiforme (n = 1), retinoblastoma (n = 1) and intracranial hemangiopericytoma (n = 1). The median follow-up time of patients was 25 months (ranges between 1 and 189 months). The 5-year overall survival rate of patients with malignant lymphoma associated with primary immunodeficiency (41%) were lower than immunocompetent patients with malignant lymphoma (80%) (p = 0.000). The 5-year overall survival of patients was diagnosed between 2021 and 2013 years (62%) was higher than previous years (22%) (p = 0.03). In conclusion, non-Hodgkin lymphomas were the most common histopathologic type in patients with malignancy associated with primary immunodeficiency in the present study. The survival of patients with malignant lymphoma associated with primary immunodeficiency has improved in recent years, yet it is still lower than immunocompetent patients with lymphoma and new targeted drugs are required for better survival rates.
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Affiliation(s)
- Derya Özyörük
- Division of Pediatric Hematology and Oncology, Health Science University, Ankara City Hospital, Ankara, Turkey
| | - Zeliha Güzelküçük
- Division of Pediatric Hematology and Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Ayse Metin
- Division of Pediatric Immunology, Health Science University, Ankara City Hospital, Ankara, Turkey
| | - Suna Emir
- Division of Pediatric Hematology and Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Arzu Yazal Erdem
- Division of Pediatric Hematology and Oncology, Health Science University, Ankara City Hospital, Ankara, Turkey
| | - Dilek Kacar
- Division of Pediatric Hematology and Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Ayca Koca Yozgat
- Division of Pediatric Hematology and Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Can Baris Aker
- Division of Pediatric Hematology and Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Selma Çakmakçı
- Division of Pediatric Hematology and Oncology, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Sonay Incesoy Özdemir
- Division of Pediatric Hematology and Oncology, Yıldırım Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Neriman Sari
- Division of Pediatric Hematology and Oncology, Health Science University, Ankara City Hospital, Ankara, Turkey
| | - Meriç Kaymak Cihan
- Division of Pediatric Hematology and Oncology, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Namık Yasar Özbek
- Division of Pediatric Hematology and Oncology, Health Science University, Ankara City Hospital, Ankara, Turkey
| | - İnci Ergürhan İlhan
- Division of Pediatric Hematology and Oncology, Health Science University, Ankara City Hospital, Ankara, Turkey
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Petley E, Yule A, Alexander S, Ojha S, Whitehouse WP. The natural history of ataxia-telangiectasia (A-T): A systematic review. PLoS One 2022; 17:e0264177. [PMID: 35290391 PMCID: PMC9049793 DOI: 10.1371/journal.pone.0264177] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ataxia-telangiectasia is an autosomal recessive, multi-system, and life-shortening disease caused by mutations in the ataxia-telangiectasia mutated gene. Although widely reported, there are no studies that give a comprehensive picture of this intriguing condition. OBJECTIVES Understand the natural history of ataxia-telangiectasia (A-T), as reported in scientific literature. SEARCH METHODS 107 search terms were identified and divided into 17 searches. Each search was performed in PubMed, Ovid SP (MEDLINE) 1946-present, OVID EMBASE 1980 -present, Web of Science core collection, Elsevier Scopus, and Cochrane Library. SELECTION CRITERIA All human studies that report any aspect of A-T. DATA COLLECTION AND ANALYSIS Search results were de-duplicated, data extracted (including author, publication year, country of origin, study design, population, participant characteristics, and clinical features). Quality of case-control and cohort studies was assessed by the Newcastle-Ottawa tool. Findings are reported descriptively and where possible data collated to report median (interquartile range, range) of outcomes of interest. MAIN RESULTS 1314 cases reported 2134 presenting symptoms. The most common presenting symptom was abnormal gait (1160 cases; 188 studies) followed by recurrent infections in classical ataxia-telangiectasia and movement disorders in variant ataxia-telangiectasia. 687 cases reported 752 causes of death among which malignancy was the most frequently reported cause. Median (IQR, range) age of death (n = 294) was 14 years 0 months (10 years 0 months to 23 years 3 months, 1 year 3 months to 76 years 0 months). CONCLUSIONS This review demonstrates the multi-system involvement in A-T, confirms that neurological symptoms are the most frequent presenting features in classical A-T but variants have diverse manifestations. We found that most individuals with A-T have life limited to teenage or early adulthood. Predominance of case reports, and case series demonstrate the lack of robust evidence to determine the natural history of A-T. We recommend population-based studies to fill this evidence gap.
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Affiliation(s)
- Emily Petley
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
| | - Alexander Yule
- United Lincolnshire Hospitals NHS Trust, Lincoln, United
Kingdom
| | - Shaun Alexander
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
| | - Shalini Ojha
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
- Children’s Hospital, University Hospitals of Derby and Burton, NHS
Foundation Trust, Derby, United Kingdom
| | - William P. Whitehouse
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
- Nottingham Children’s Hospital, Nottingham University Hospital NHS Trust,
Nottingham, United Kingdom
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Schoenaker MHD, Takada S, van Deuren M, Dommering CJ, Henriët SSV, Pico I, Vogel WV, Weemaes CMR, Willemsen MAAP, van der Burg M, Kaanders JHAM. Considerations for radiotherapy in Bloom Syndrome: A case series. Eur J Med Genet 2021; 64:104293. [PMID: 34352413 DOI: 10.1016/j.ejmg.2021.104293] [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: 09/08/2020] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 01/17/2023]
Abstract
Bloom Syndrome (BS) is a genetic DNA repair disorder, caused by mutations in the BLM gene. The clinical phenotype includes growth retardation, immunodeficiency and a strong predisposition to different types of malignancies. Treatment of malignancies in BS patients with radiotherapy or chemotherapy is believed to be associated with increased toxicity, but clinical and laboratory data are lacking. We collected clinical data of two Dutch BS patients with solid tumors. Both were treated with radiotherapy before the diagnosis BS was made and tolerated this treatment well. In addition, we collected fibroblasts from BS patients to perform in vitro clonogenic survival assays to determine radiosensitivity. BS fibroblasts showed less radiosensitivity than the severely radiosensitive Artemis fibroblasts. Moreover, studies of double strand break kinetics by counting 53BP1 foci after irradiation showed similar patterns compared to healthy controls. In combination, the clinical cases and laboratory experiments are valuable information in the discussion whether radiotherapy is absolutely contraindicated in BS, which is the Case in other DNA repair syndromes like Ataxia Telangiectasia and Artemis.
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Affiliation(s)
- M H D Schoenaker
- Department of Pediatric Neurology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Laboratory for Immunology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
| | - S Takada
- Laboratory for Immunology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - M van Deuren
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C J Dommering
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, the Netherlands
| | - S S V Henriët
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I Pico
- Laboratory for Immunology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - W V Vogel
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Nuclear Medicine, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - C M R Weemaes
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M A A P Willemsen
- Department of Pediatric Neurology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M van der Burg
- Laboratory for Immunology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - J H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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Pediatric Lymphoma and Solid Tumors Associated With Cancer Susceptibility Syndromes. J Pediatr Hematol Oncol 2020; 42:438-445. [PMID: 32282651 DOI: 10.1097/mph.0000000000001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to determine cancer susceptibility syndromes (CSSs) in children with lymphoma and solid tumors and to evaluate their effects on overall survival rates. Between 2006 and 2019, the oncologic charts of 672 patients who were followed-up with a diagnosis of lymphoma and solid tumor in our clinic were retrospectively reviewed. CSSs were detected in 42 children (6.25%). The most common CSS was DNA damage repair defects/genetic instability (in 18 of 42 patients with CSSs, 42.8%). In the patients with CSSs, 48 different cancers developed. The most common types of cancer were lymphoma (n: 10, 21%) and high-grade glial tumor (n: 9, 19%). The lymphoma subgroups were very rare childhood lymphomas, such as gray zone lymphoma and marginal zone lymphoma. The overall survival rates for patients with DNA damage repair defects/genetic instability; with CSSs other than DNA damage repair defects/patients with genetic instability syndrome; and without any CSS, were 9.7%, 65.1%, and 68.7%, respectively. The overall survival rate for patients with DNA damage repair defects/patients with genetic instability syndrome was lower than both patients with CSSs other than DNA damage repair defects/genetic instability syndrome (P=0.002) and those without any CSS (P<0.0001). CSSs should be kept in mind in children with cafe au lait spots; syndromic features; a family history of cancer, especially in siblings; and rare childhood cancers.
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Cekic S, Metin A, Aytekin C, Edeer Karaca N, Baris S, Karali Y, Kiykim A, Karakoc Aydıner E, Ozen A, Aslan T, Sevinir B, Aksu G, Kutukculer N, Kilic SS. The evaluation of malignancies in Turkish primary immunodeficiency patients; a multicenter study. Pediatr Allergy Immunol 2020; 31:528-536. [PMID: 32060950 DOI: 10.1111/pai.13231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are no data regarding the prevalence of malignancies in patients with primary immunodeficiency (PID) in Turkey. Along with the prevalence of malignancy, we aimed to present the types of malignancy and define the underlying immune deficiency of the patients. METHOD Between the years 1992 and 2018, from five tertiary immunology clinics, fifty-nine patients with PID who developed malignancy were included. All patients were evaluated for demographics, clinical features, and prognosis. RESULTS The prevalence of malignancy in our cohort was detected as 0.9% (59/6392). The male-to-female ratio was 1.8 (38/21), and the median age of patients was 14 years (range: 1.5-51). The median age at diagnosis of malignancy was 10 years (range: 1.5-51). Ataxia-telangiectasia was the most frequent PID in patients with malignancy (n = 19, 32.2%), and non-Hodgkin lymphoma was the most common malignancy (n = 32, 51.6%). The rate of malignancy in DOCK8 deficiency (n = 7/43, 16.3%) was higher than AT (n = 19/193, 9.8%), Wiskott-Aldrich syndrome (n = 2/22, 9.1%), and common variable immunodeficiency (n = 11/205, 5.4%). EBV quantitative PCR was positive in 16 out of 53 patients (30.2%). Three patients had secondary malignancies. Remission was achieved in 26 patients (44.1%). However, 31 patients (52.5%) died. Two patients (3.4%) are still on chemotherapy. CONCLUSION This study is the largest cohort investigating the association of malignancy in patients with PID in Turkey. While lymphoid malignancies were the most common malignancy and observed more frequently in AT patients, the risk for malignancy was higher in patients with DOCK8 deficiency compared to AT.
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Affiliation(s)
- Sukru Cekic
- Division of Pediatric Allergy and Clinical Immunology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ayse Metin
- Pediatric Allergy and Clinical Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Caner Aytekin
- Pediatric Allergy and Clinical Immunology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Neslihan Edeer Karaca
- Pediatric Allergy and Clinical Immunology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Safa Baris
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Yasin Karali
- Division of Pediatric Allergy and Clinical Immunology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ayca Kiykim
- Pediatric Allergy and Clinical Immunology, Istanbul Cerrahpasa University Faculty of Medicine, İstanbul, Turkey
| | - Elif Karakoc Aydıner
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Ahmet Ozen
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Torehan Aslan
- Department of Pediatrics, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Betul Sevinir
- Pediatric Oncology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Guzide Aksu
- Pediatric Allergy and Clinical Immunology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Necil Kutukculer
- Pediatric Allergy and Clinical Immunology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Sara Sebnem Kilic
- Division of Pediatric Allergy and Clinical Immunology, Uludag University Faculty of Medicine, Bursa, Turkey
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Hematological Malignancies Associated With Primary Immunodeficiency Disorders. Clin Immunol 2018; 194:46-59. [DOI: 10.1016/j.clim.2018.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 12/18/2022]
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Abstract
The genomic revolution in the past decade fuelled by breathtaking advances in sequencing technologies has defined several new genetic diseases of the immune system. Many of these newly characterized diseases are a result of defects in genes involved in immune regulation. The discovery of these diseases has opened a vista of new therapeutic possibilities. Immunomodulatory agents, a hitherto unexplored therapeutic option in primary immunodeficiency diseases have been tried in a host of these newly described maladies. These agents have been shown conclusively to favorably modulate immune responses, resulting in abatement of clinical manifestations both in experimental models and patients. While some of the treatment options have been approved for therapeutic use or have been shown to be of merit in open-label trials, others have been shown to be efficacious in a handful of clinical cases, animal models, and cell lines. Interferon γ is approved for use in chronic granulomatous disease (CGD) to reduce the burden of infection and and has a good long-term efficacy. Recombinant human IL7 therapy has been shown increase the peripheral CD4 and CD8 T cell counts in patients with idiopathic CD4. Anti-IL1 agents are approved for the management of cryopyrin-related autoinflammatory syndrome, and their therapeutic efficacy is being increasingly recognized in other autoinflammatory syndromes and CGD. Mammalian target of rapamycin (mTOR) inhibitors have been proven useful in autoimmune lymphoproliferative syndrome (ALPS) and in IPEX syndrome. Therapies reported to be potential use in case reports include abatacept in CTLA4 haploinsufficiency and LRBA deficiency, ruxolitinib in gain-of-function STAT1, tocilizumab in gain-of-function STAT3 defect, mTOR inhibitors in PIK3CD activation, magnesium in XMEN syndrome, and pioglitazone in CGD. Treatment options of merit in human cell lines include interferon α and interferon β in TLR3 and UNC-93B deficiencies, anti-interferon therapy in SAVI, and Rho-kinase inhibitors in TTC7A deficiency. Anti-IL17 agents have show efficacy in animal models of leukocyte adhesion defect (LAD) and ALPS. This topical review explores the use of various immunomodulators and other biological agents in the context of primary immunodeficiency and autoinflammatory diseases.
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Lim JY, Jeon M, Kim HS, Han JW, Lyu CJ, Hahn SM. A Case of Hodgkin Lymphoma Developed in an Ataxia-telangiectasia Patient. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.2.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ju Yeon Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Mina Jeon
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Sun Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Chuhl Joo Lyu
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Hahn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Lymphoma Secondary to Congenital and Acquired Immunodeficiency Syndromes at a Turkish Pediatric Oncology Center. J Clin Immunol 2016; 36:667-76. [PMID: 27492260 DOI: 10.1007/s10875-016-0324-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022]
Abstract
The prevalence of lymphoma in primary immunodeficiency cases and autoimmune diseases, as well as on a background of immunodeficiency following organ transplants, is increasing. The lymphoma treatment success rate is known to be a low prognosis. Our study aimed to emphasize the low survival rates in immunodeficient vs. immunocompetent lymphoma patients and also to investigate the effect of rituximab in patients with ataxia telangiectasia and other immunodeficiencies. We summarized the clinical characteristics and treatment results of 17 cases with primary immunodeficiency that developed non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) retrospectively. Seven patients were diagnosed with ataxia-telangiectasia, two with common variable immunodeficiency, two with selective IgA deficiency, one with X-related lymphoproliferative syndrome, one with Wiskott-Aldrich syndrome, one with Epstein-Barr virus-related lymphoproliferative syndrome, one with interleukin-2-inducible T-cell kinase (ITK) deficiency, and one with lymphoma developing after autoimmune lymphoproliferative syndrome (ALPS). One patient underwent a renal transplant. Of the nine males and eight females (aged 3-12 years, median = 7) that developed lymphoma, seven were diagnosed with HL and ten with NHL (seven B-cell, three T-cell). The NHL patients were started on the Berlin-Frankfurt-Münster, POG9317, LMB-96, or R-CHOP treatment protocols with reduced chemotherapy dosages. HL cases were started on the doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and/or cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) protocol, also with modified dosages. Importantly, all seven cases of HL are alive and in remission, while six of the ten NHL patients have died. Primary immunodeficiency is a strong predisposing factor for developing lymphoma. Low treatment success rates relative to other lymphomas and difficulties encountered during treatment indicate that new treatment agents are needed. While some success has been achieved by combining rituximab with lymphoma treatment protocols in B-NHL cases with primary immunodeficiency, the need for new treatment approaches for these patients remains critical.
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Primary immunodeficiencies and B-cell lymphomas. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:18-25. [PMID: 29421227 DOI: 10.1016/j.bmhimx.2015.11.009] [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: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In primary immunodeficiencies there is a failure in the anti-tumor defense. Common variable immunodeficiency (CVID) is one of the most common primary immunodeficiencies characterized by an alteration in the differentiation of B lymphocytes (BL). Epstein-Barr virus (EBV) is an ubiquitous virus that selectively infects the BL. In patients with immunodeficiency, uncontrolled proliferation of infected BL and the action of viral proteins promote the development of lymphomas. CLINICAL CASES At the University Hospital Sant Joan de Deu, Barcelona, 28 patients were diagnosed with CVID from 2000 to 2013. This paper describes four patients who developed non-Hodgkin's lymphoma (NHL). The lymphoma was associated with EBV in two of the cases. Patients were<18 years old, diagnosed with lymphoma between 4 and 13 years old. Two patients were treated with rituximab as monotherapy and achieved complete remission. Two patients were treated with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) and radiotherapy or rituximab and achieved complete remission. CONCLUSIONS Early detection of EBV infections and NHL in all patients diagnosed with CVID is recommended, regardless of age at diagnosis.
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Malignancies in Primary Immunodeficiencies: A Single Center Experience. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2015. [DOI: 10.1089/ped.2014.0453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lymphoproliferative disease and cancer among patients with common variable immunodeficiency. Leuk Res 2015; 39:389-96. [PMID: 25711943 DOI: 10.1016/j.leukres.2015.02.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/01/2015] [Accepted: 02/02/2015] [Indexed: 01/08/2023]
Abstract
Innate immune deficiencies are a heterogeneous group of genetically inherited diseases affecting the innate and adaptive immune systems that confer susceptibility to infection, autoimmunity, and cancer. This review discusses the latest insights into the links between common variable immunodeficiency (CVI) and malignancies. Although Ig therapy greatly reduces the number of infections and enhances survival, it does not appear to address the development of cancer, especially lymphoma. The reasons for the increased susceptibility to lymphoid malignancies are unclear. These include genetics, immune dysregulation, radiosensitivity and chronic infections such as Helicobacter pylori, EBV, human herpes virus type 8 and cytomegalovirus. Further studies will allow us to better stratify the risk for cancer in these patients, and teach us to better prevent these complications and to better treat them.
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