1
|
Tran J, Gaulin C, Tallman MS. Advances in the Treatment of Hairy Cell Leukemia Variant. Curr Treat Options Oncol 2022; 23:99-116. [PMID: 35178674 DOI: 10.1007/s11864-021-00927-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Hairy cell leukemia variant (HCL-V) is a rare B cell lymphoproliferative disorder with a clinical-pathological distinction from the classic form of hairy cell leukemia (HCL-C). HCL-V is more aggressive in nature, has a higher tendency to be refractory to conventional purine analog pharmacotherapies, and leads to a poorer prognosis. Hence, these differing features bring paramount importance to the diagnosis and management of HCL-V. While there is no genetic mutation diagnostic of HCL-V, genetic profiling efforts have identified potential therapeutic targets (i.e., MAP2K1, KDM6A, CREBBP, ARID1A, CCND3, U2AF1, KMT2C) and yielded prognostic markers (i.e., IGHV4-34 rearrangements). To date, combination chemoimmunotherapies, such as cladribine and rituximab, have shown the best results in HCL-V. Future directions include targeted therapies such as moxetumomab pasudotox, ibrutinib, trametinib, and binimetinib and potentially anti-CD22 chimeric antigen receptor T cell therapy. The purpose of this review is to provide an outline of the diagnostic approach and an update on the therapeutic advancements in HCL-V.
Collapse
Affiliation(s)
- Julie Tran
- University of Arizona College of Medicine, 475 N 5th St, HSEB C536, Phoenix, AZ, 85004, USA.
| | - Charles Gaulin
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Martin S Tallman
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
2
|
Liu Q, Harris N, Epperla N, Andritsos LA. Current and Emerging Therapeutic Options for Hairy Cell Leukemia Variant. Onco Targets Ther 2021; 14:1797-1805. [PMID: 33727830 PMCID: PMC7955867 DOI: 10.2147/ott.s242247] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/06/2021] [Indexed: 12/11/2022] Open
Abstract
Hairy cell leukemia variant (HCL-v) is a rare B-cell lymphoproliferative disorder with distinct immunophenotypic and molecular characteristics when compared to classical hairy cell leukemia (HCL-c). In contrast to the enormous progress in therapeutic options for HCL-c, HCL-v remains a therapeutic challenge due to inferior outcomes with standard chemoimmunotherapy and BCR signaling pathway inhibitors, and due to the fact that HCL-v has limited molecular therapeutic targets. In addition, because of the rarity of the disease, there is a paucity of later phase studies or multicenter trials to guide treatment decisions. In this article, we briefly review the diagnostic criteria and clinical characteristics of HCL-v and present a comprehensive overview of current therapeutic options in HCL-v.
Collapse
Affiliation(s)
- Qiuying Liu
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Nicholas Harris
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Narendranath Epperla
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Leslie A Andritsos
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| |
Collapse
|
3
|
Dong H, Shen Y, Shen Y, Wu D. Severe Systemic Rash in the Treatment of Hairy Cell Leukemia with Cladribine: Case Report and Literature Review. Int J Gen Med 2020; 13:1187-1192. [PMID: 33239902 PMCID: PMC7682778 DOI: 10.2147/ijgm.s281476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/04/2020] [Indexed: 12/16/2022] Open
Abstract
A 49-year-old male patient who had been diagnosed with variable hairy cell leukemia (HCL-V) was treated with interferon for half a year but exert no obvious effect. After two courses of chemotherapy with cladribine, he achieved remission, and splenomegaly significantly improved (the length in craniocaudal dimension decreased from 15.8cm to 11.8cm). Four years later, the patient got disease relapse and was recommended for another cycle of cladribine (6mg for 7 days). On the last day of cladribine, the patient developed fever with needle-like red rashes on the face, limbs, and trunk. At the very beginning, the rash was lighter in color, sparsely distributed, and without obvious itching. Three days later, the rash gradually darkened, expanded and merged, with itching. With the application of high dose gamma globulin and corticosteroids (prednisolone combined with dexamethasone), the rash finally faded, and the patient was discharged. Rash caused by cladribine is not uncommon, such serious and widespread drug-induced rash is rare, and there are few reports. This article reviewed relevant studies and treatments.
Collapse
Affiliation(s)
- Huijie Dong
- First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, People's Republic of China
| | - Yingying Shen
- First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, People's Republic of China.,Department of Hematology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, People's Republic of China
| | - Yiping Shen
- First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, People's Republic of China.,Department of Hematology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, People's Republic of China
| | - Dijiong Wu
- First Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, People's Republic of China.,Department of Hematology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, People's Republic of China
| |
Collapse
|
4
|
Payandeh M, Sadeghi M, Sadeghi E, Iranshahi N. The prevalence of BRAF V600E mutation in hairy cell leukemia: A systematic review and meta-analysis study. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_145_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: BRAF V600E mutations were recently identified in the leukemic cells from patients with hairy cell leukemia (HCL) that this mutation in exon 15 is considered the disease-defining mutation in HCL. Objectives: This meta-analysis aimed to report the prevalence of BRAF V600E mutation in HCL patients. Methods: Three databases including PubMed, Scopus, and Web of Science up to 2017 were searched for the prevalence of BRAF mutation in HCL patients. A random effects meta-analysis was performed using the Comprehensive Meta-Analysis software version 2.0 with the event rate (ER) and 95% confidence interval (95% CI). Results: Out of 552 articles identified from the search, 11 were included included and were analyzed for meta-analysis study. The studies in meta-analysis included 437 patients with HCL, of which 353 (80.8%) patients had BRAF V600E mutation. The pooled ER of the studies was 81.5% (95% CI: 69.5%–89.5%). The Begg's test did not show publication bias, but the Egger's test showed publication bias. Conclusions: With regard to the mentioned limitations, the prevalence of BRAF mutation in HCL patients was >80%. In future studies, considering sex, age, and other variables can exactly show the correlation between these variables with the detection of BRAF mutation.
Collapse
Affiliation(s)
- Mehrdad Payandeh
- Department of Hematology and Medical Oncology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Sadeghi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Edris Sadeghi
- Department of Nursing, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrin Iranshahi
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
5
|
Andritsos LA, Grieselhuber NR, Anghelina M, Rogers KA, Roychowdhury S, Reeser JW, Timmers CD, Freud AG, Blachly JS, Lucas DM, Lozanski G, Jones JA, Williams K, Oakes C, Jones D, Grever MR. Trametinib for the treatment of IGHV4-34, MAP2K1-mutant variant hairy cell leukemia. Leuk Lymphoma 2017; 59:1008-1011. [PMID: 28918710 DOI: 10.1080/10428194.2017.1365853] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Leslie A Andritsos
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Nicole R Grieselhuber
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Mirela Anghelina
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Kerry A Rogers
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Sameek Roychowdhury
- b Division of Medical Oncology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Julie W Reeser
- b Division of Medical Oncology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Cynthia D Timmers
- b Division of Medical Oncology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Aharon G Freud
- c Department of Pathology , The Ohio State University , Columbus , OH , USA
| | - James S Blachly
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - David M Lucas
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Gerard Lozanski
- c Department of Pathology , The Ohio State University , Columbus , OH , USA
| | - Jeffrey A Jones
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Katie Williams
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Christopher Oakes
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| | - Dan Jones
- c Department of Pathology , The Ohio State University , Columbus , OH , USA
| | - Michael R Grever
- a Division of Hematology, Department of Internal Medicine , The Ohio State University , Columbus , OH , USA
| |
Collapse
|
6
|
Tian X, Pelton A, Shahsafaei A, Dorfman DM. Differential expression of enhancer of zeste homolog 2 (EZH2) protein in small cell and aggressive B-cell non-Hodgkin lymphomas and differential regulation of EZH2 expression by p-ERK1/2 and MYC in aggressive B-cell lymphomas. Mod Pathol 2016; 29:1050-7. [PMID: 27282353 DOI: 10.1038/modpathol.2016.114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 12/14/2022]
Abstract
EZH2, a member of the polycomb protein group, is an important methyltransferase that is overexpressed in various neoplasms. We found that in small cell B-cell lymphomas, EZH2 is expressed in <40% of neoplastic cells, with heterogenous signal intensity. In aggressive B-cell lymphomas, 70-100% of tumor cells were positive for EZH2 expression with high signal intensity, which correlated with a high proliferation rate. We investigated the potential signaling molecules that regulate EZH2 overexpression in aggressive B-cell lymphomas and found that 80% of cases of EZH2-positive diffuse large B-cell lymphoma show high p-ERK1/2 expression (average ~57% tumor cell positivity). In contrast, only a small percentage of tumor cells (~10%) show p-ERK1/2 expression in Burkitt lymphoma and double hit lymphoma. On average, 91 and 76% of neoplastic cells were positive for MYC expression in Burkitt lymphoma and double hit lymphoma, respectively, while only 20% neoplastic cells were positive for MYC expression in diffuse large B-cell lymphoma. None of the aggressive B-cell lymphomas showed significant p-STAT3 expression in EZH2-overexpressed cases. The correlation of EZH2 expression with aggressive behavior and proliferation rate in B-cell neoplasms suggests that this molecule may function as an oncogenic protein in these neoplasms, with possible regulation by different signaling cascades in different types of aggressive B-cell lymphomas: p-ERK-related signaling in diffuse large B-cell lymphoma, and MYC-related signaling in Burkitt lymphoma and double hit lymphoma. Furthermore, EZH2 and associated signaling cascades may serve as therapeutic targets for the treatment of aggressive B-cell lymphomas.
Collapse
Affiliation(s)
- Xuejun Tian
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashley Pelton
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Shahsafaei
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David M Dorfman
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
7
|
Grever MR, Blachly JS, Andritsos LA. Hairy cell leukemia: Update on molecular profiling and therapeutic advances. Blood Rev 2014; 28:197-203. [PMID: 25110197 DOI: 10.1016/j.blre.2014.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 02/07/2023]
Abstract
Hairy cell leukemia was initially described as a clinicopathologic entity more than 50 years ago. We have subsequently discovered that HCL is really at least two diseases: classical HCL and the hairy cell leukemia variant. The former is among a small group of cancers exceptional for being (nearly) unified by a single genetic lesion, the BRAF V600E mutation. Over the past three decades, tremendous progress in both diagnostic and prognostic clarification has been accompanied by therapeutic advances in classical HCL. Consequently, this once uniformly fatal disease has been converted in most cases into a chronic illness enabling patients to live long and productive lives. In response to standard therapy, patients have high complete remission rates. Unfortunately, the long-term survival curves have not plateaued, revealing that this disease is controlled but not cured. Though rare and representing only about 10% of an already rare disease, those patients with the variant fare exceptionally poorly with standard therapy: complete response rates to purine nucleoside analogs are reported to be less than 50%, whereas the complete response rates in classical HCL are up to 90%. Novel small molecules targeting BRAF and the B-cell receptor signaling complex, and biologic agents like antibodies and immunotoxin conjugates are being explored for those patients who have relapsed. Substantial opportunities for continued research remain. This complex and multi-faceted disease incorporates challenges from altered immunity associated with the underlying disease and its treatments. Considering the rarity of this malignancy, optimization of patient management requires multi-institutional collaboration. The Hairy Cell Leukemia Foundation (www.hairycellleukemia.org) was formed to coordinate these efforts.
Collapse
Affiliation(s)
- Michael R Grever
- 395 W. 12th Ave, Room 392, Columbus, OH 43210, USA; Department of Internal Medicine, Division of Hematology at The Ohio State University, Columbus, OH, USA.
| | - James S Blachly
- 320 W. 10th Ave, 406C Starling Loving Hall, Columbus, OH 43210, USA; Department of Internal Medicine, Division of Hematology at The Ohio State University, Columbus, OH, USA.
| | - Leslie A Andritsos
- 320 W. 10th Ave, A352 Starling Loving Hall, Columbus, OH 43210, USA; Department of Internal Medicine, Division of Hematology at The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
8
|
LANGABEER SE, O’BRIEN D, LIPTROT S, FLYNN CM, HAYDEN PJ, CONNEALLY E, BROWNE PV, VANDENBERGHE E. Correlation of the BRAF V600E mutation in hairy cell leukaemia with morphology, cytochemistry and immunophenotype. Int J Lab Hematol 2012; 34:417-21. [DOI: 10.1111/j.1751-553x.2012.01402.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|