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Bibas M, Sarosiek S, Castillo JJ. Waldenström Macroglobulinemia - A State-of-the-Art Review: Part 1: Epidemiology, Pathogenesis, Clinicopathologic Characteristics, Differential Diagnosis, Risk Stratification, and Clinical Problems. Mediterr J Hematol Infect Dis 2024; 16:e2024061. [PMID: 38984103 PMCID: PMC11232678 DOI: 10.4084/mjhid.2024.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/19/2024] [Indexed: 07/11/2024] Open
Abstract
Waldenström macroglobulinemia (WM) is an infrequent variant of lymphoma, classified as a B-cell malignancy identified by the presence of IgM paraprotein, infiltration of clonal, small lymphoplasmacytic B cells in the bone marrow, and the MYD88 L265P mutation, which is observed in over 90% of cases. The direct invasion of the malignant cells into tissues like lymph nodes and spleen, along with the immune response related to IgM, can also lead to various health complications, such as cytopenias, hyperviscosity, peripheral neuropathy, amyloidosis, and Bing-Neel syndrome. Chemoimmunotherapy has historically been considered the preferred treatment for WM, wherein the combination of rituximab and nucleoside analogs, alkylating drugs, or proteasome inhibitors has exhibited notable efficacy in inhibiting tumor growth. Recent studies have provided evidence that Bruton Tyrosine Kinase inhibitors (BTKI), either used independently or in conjunction with other drugs, have been shown to be effective and safe in the treatment of WM. The disease is considered to be non-curable, with a median life expectancy of 10 to 12 years.
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Affiliation(s)
- Michele Bibas
- Department of Clinical Research, Hematology. National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCSS Rome Italy
| | - Shayna Sarosiek
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Jorge J Castillo
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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2
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Rezvani H, Salari S, Borhani H, Mataji M, Azhdari Tehrani H. Bing-Neel syndrome, a rare manifestation of WM; a case report and review of literature. Clin Case Rep 2024; 12:e9034. [PMID: 38840755 PMCID: PMC11150130 DOI: 10.1002/ccr3.9034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 06/07/2024] Open
Abstract
Bing-Neel syndrome (BNS) is a rare manifestation in individuals suffering from Waldenström macroglobulinemia (WM). Neurological signs and symptoms in this syndrome are almost difficult to be differentiated from other common neurological manifestations of hyper-viscosity or Waldenström-associated polyneuropathy. In this paper, we report a new case of WM with concurrent BNS, then review the clinical picture and treatment of this syndrome.
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Affiliation(s)
- Hamid Rezvani
- Department of Hematology‐Medical OncologyShahid Beheshti University of Medical SciencesTehranIran
| | - Sina Salari
- Department of Hematology‐Medical OncologyShahid Beheshti University of Medical SciencesTehranIran
| | - Hamed Borhani
- Department of Hematology‐Medical OncologyShahid Beheshti University of Medical SciencesTehranIran
| | - Maedeh Mataji
- Department of Hematology‐Medical OncologyShahid Beheshti University of Medical SciencesTehranIran
| | - Hamed Azhdari Tehrani
- Department of Hematology‐Medical OncologyShahid Beheshti University of Medical SciencesTehranIran
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3
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Gonçalves TAP, Donadel CD, Frezatti RSS, Garibaldi PMM, Calado RT, Marques Junior W, Tomaselli PJ. Monoclonal gammopathy-associated peripheral neuropathies: Uncovering pearls and challenges. J Peripher Nerv Syst 2024; 29:161-172. [PMID: 38873841 DOI: 10.1111/jns.12638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024]
Abstract
Monoclonal gammopathy-related peripheral neuropathies encompass a spectrum of clinical presentations in which the monoclonal protein directly damages the tissues, including the peripheral nervous system. Given the prevalence of both peripheral neuropathy and monoclonal gammopathy in the general population, these conditions may overlap in clinical practice, posing a challenge for clinicians in determining causality. Therefore, a comprehensive understanding of primary clinical syndromes and their neurophysiological patterns is of great importance for accurate differential diagnoses and effective treatment strategies. In this article, we examine the main forms of monoclonal gammopathies that affect the peripheral nerve. We explore the clinical and electrophysiological aspects and their correlation with each syndrome's corresponding monoclonal protein type. This knowledge is essential for healthcare professionals to diagnose better and manage patients presenting with monoclonal gammopathy-related peripheral nervous system involvement.
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Affiliation(s)
- Trajano Aguiar Pires Gonçalves
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Camila Derminio Donadel
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Pedro Manoel Marques Garibaldi
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Rodrigo T Calado
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Wilson Marques Junior
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Pedro José Tomaselli
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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4
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Alzghoul H, Haider A, Mukhtar F, Khuddus N. Bing-Neel syndrome: a rare neurological complication of Waldenström macroglobulinaemia. BMJ Case Rep 2024; 17:e255268. [PMID: 38182164 PMCID: PMC10773308 DOI: 10.1136/bcr-2023-255268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Bing-Neel syndrome (BNS) is a very rare manifestation of Waldenström macroglobulinaemia (WM), in which lymphoplasmacytic cells invade the central nervous system. The clinical presentation includes symptoms of headaches, visual floaters, neuropathy, seizures and gait abnormalities. Here, we describe an elderly woman, who presented with complaints of visual floaters, progressive neuropathy and cognitive changes. Workup including a bone marrow biopsy confirmed the diagnosis of WM. Shortly afterwards, the patient experienced a seizure leading to hospitalisation, which revealed a right frontal lobe lesion on brain MRI. A biopsy of the lesion showed a small B cell lymphoma positive for an MYD88 mutation, confirming BNS. The patient was initially treated with ibrutinib, before transitioning to zanubrutinib. However, she developed disease progression necessitating radiotherapy with lenalidomide and rituximab maintenance therapy, which achieved remission. This case sheds light on the diagnosis and management of a very rare complication of a rare disease.
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Affiliation(s)
- Hamza Alzghoul
- Internal Medicine, University of Central Florida College of Medicine, Gainesville, Florida, USA
- Internal Medicine, North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Asad Haider
- Internal Medicine, University of Central Florida College of Medicine, Gainesville, Florida, USA
- Internal Medicine, North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Faisal Mukhtar
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
| | - Nausheen Khuddus
- Ophthalmology, North Florida Regional Medical Center, Gainesville, Florida, USA
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5
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Hatasa M, Imoto N, Komori S, Nosaki Y, Kurahashi S. Waldenström Macroglobulinemia-Associated Peripheral Neuropathy in the Brachial Plexus With Bing-Neel Syndrome Diagnosed Through Repeated Cerebrospinal Tests. Cureus 2024; 16:e52400. [PMID: 38361676 PMCID: PMC10869174 DOI: 10.7759/cureus.52400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
In Waldenström macroglobulinemia (WM), confirming the presence of Bing-Neel syndrome (BNS) is important because drugs that penetrate the central nervous system (CNS) must be selected. We report the case of a 75-year-old man for whom tirabrutinib, a second-generation Bruton's tyrosine kinase inhibitor (BTKi), was useful in treating WM-associated peripheral neuropathy (PN) with BNS. Numbness and muscle weakness in the fingers occurred three years after the initial treatment of WM. WM-associated PN due to demyelinating disease was diagnosed based on the results of a nerve conduction study and magnetic resonance imaging showing bilateral symmetric swelling of the brachial plexus. The cerebrospinal fluid (CSF) cytology results were initially negative; however, the CSF test was repeated because of extremely high protein levels (984 mg/dL) and slightly elevated leukocyte counts (14/µL). The second test revealed abnormal lymphoplasmacytic cells (189/µL), indicating BNS. Rituximab and high-dose methotrexate-containing chemotherapy were administered. Despite the subsequent negative CSF cytology results, his neurological symptoms persisted but subsided soon after the initiation of tirabrutinib. The therapeutic effects of tirabrutinib persisted for 25 months. This case suggested that a careful search for concurrent BNS is important when lesions are close to the CNS or when atypical CSF findings are obtained in patients with WM-associated PN, especially when BTKi options are available.
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Affiliation(s)
- Misaki Hatasa
- Department of Postgraduate Clinical Training Center, Toyohashi Municipal Hospital, Toyohashi, JPN
| | - Naoto Imoto
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, JPN
| | - Shota Komori
- Department of Neurology, Toyohashi Municipal Hospital, Toyohashi, JPN
| | - Yasunobu Nosaki
- Department of Neurology, Toyohashi Municipal Hospital, Toyohashi, JPN
| | - Shingo Kurahashi
- Department of Hematology and Oncology, Toyohashi Municipal Hospital, Toyohashi, JPN
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6
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Sonato C, Colangelo L, Cecchetti V, Gianni W, Minisola S. Brain lesions: is there a role for internist? Intern Emerg Med 2024; 19:237-239. [PMID: 37430069 DOI: 10.1007/s11739-023-03363-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Affiliation(s)
- Chiara Sonato
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Luciano Colangelo
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Veronica Cecchetti
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Walter Gianni
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Salvatore Minisola
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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7
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Chen H, Zhao D, Wang Z, Zhang W, Wang W. Clonally related transformation from Waldenström macroglobulinemia to diffuse large B-cell lymphoma with central nervous system involvement at diagnosis: a case report and literature review. Clin Exp Med 2023; 23:5473-5476. [PMID: 37921873 DOI: 10.1007/s10238-023-01245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 10/26/2023] [Indexed: 11/05/2023]
Abstract
Histological transformation to diffuse large B-cell lymphoma (DLBCL) rarely occurs in patients with Waldenström macroglobulinemia (WM). The median time from WM diagnosis to DLBCL is 4-5 years. Extranodal involvement is common in transformed WM. However, central nervous system (CNS) involvement is relatively uncommon. Here, we report a case of a simultaneous diagnosis of WM and clonally related DLBCL, with the involvement of CNS demonstrated by dual enhancement in MRI. Nevertheless, it is unclear if CNS infiltration is caused by DLBCL or WM for the inaccessibility of brain biopsy. Intensified chemotherapy and Bruton tyrosine kinase inhibitor were administrated, and a good response was achieved.Please check the edit made in the article title.we have checked it.
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Affiliation(s)
- Hongyun Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Danqing Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zi Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wei Wang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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8
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Suzuki D, Sato D, Kikuchi K, Suzuki T, Sugasawa K, Saito S, Uchimura F, Suzuki Y. Bing-Neel syndrome with a paravertebral mass. Am J Med Sci 2023; 366:316-320. [PMID: 37473959 DOI: 10.1016/j.amjms.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/10/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
Bing-Neel syndrome, a rare neurological complication of Waldenström macroglobulinemia, is caused by the direct infiltration of malignant lymphoplasmacytic cells into the central nervous system. We report a patient who presented with back pain, weakness, lower extremity numbness, and gait disturbance accompanied by immunoglobulin M paraproteinemia and lymphoplasmacytic lymphoma in the bone marrow. Thoracic and lumbar magnetic resonance imaging revealed a long paravertebral mass around the spinal column, but the direct infiltration could not be proven. The patient was diagnosed with possible Bing-Neel syndrome and managed with bendamustine and rituximab. After chemotherapy, the patient's neurological and radiological findings improved. Magnetic resonance imaging should be considered when the Bing-Neel syndrome diagnosis is unclear.
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Affiliation(s)
- Daisuke Suzuki
- Department of Neurology, Nihonkai General Hospital, Sakata, Yamagata, Japan.
| | - Daisuke Sato
- Department of Neurology, Nihonkai General Hospital, Sakata, Yamagata, Japan
| | - Kenji Kikuchi
- Department of Neurology, Nihonkai General Hospital, Sakata, Yamagata, Japan
| | - Takuma Suzuki
- Department of Hematology, Nihonkai General Hospital, Sakata, Yamagata, Japan
| | - Kunie Sugasawa
- Department of Hematology, Nihonkai General Hospital, Sakata, Yamagata, Japan
| | - Soichi Saito
- Department of Hematology, Nihonkai General Hospital, Sakata, Yamagata, Japan
| | - Fumiaki Uchimura
- Department of Radiology, Nihonkai General Hospital, Sakata, Yamagata, Japan
| | - Yoshihiro Suzuki
- Department of Neurology, Nihonkai General Hospital, Sakata, Yamagata, Japan
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9
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Lakhotia R, Roschewski M. Clinical applications of circulating tumor DNA in indolent B-cell lymphomas. Semin Hematol 2023; 60:164-172. [PMID: 37419716 PMCID: PMC10527907 DOI: 10.1053/j.seminhematol.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/15/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023]
Abstract
Indolent B-cell lymphomas are generally incurable with standard therapy and most patients have a prolonged disease course that includes multiple treatments and periods of time in which they do not require therapy. Currently available tools to monitor disease burden and define response to treatment rely heavily on imaging scans that lack tumor specificity are unable to detect disease at the molecular level. Circulating tumor DNA (ctDNA) is a versatile and promising biomarker being developed across multiple lymphoma subtypes. Advantages of ctDNA include high tumor specificity and limits of detection that are significantly lower than imaging scans. Potential clinical applications of ctDNA in indolent B-cell lymphomas include baseline prognostication, early signs of treatment resistance, measurements of minimal residual disease, and a noninvasive method to directly monitor disease burden and clonal evolution after therapy. Clinical applications of ctDNA have not yet proven clinical utility but are increasingly used as translational endpoints in clinical trials testing novel approaches and the analytic techniques used for ctDNA continue to evolve. Advances in therapy for indolent B-cell lymphomas include novel targeted agents and combinations that achieve very high rates complete response which amplifies the need to improve our current methods to monitor disease.
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Affiliation(s)
- Rahul Lakhotia
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Mark Roschewski
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
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10
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Zanwar S, Abeykoon JP, Ansell SM, Gertz MA, Mauermann M, Witzig TE, Johnston P, Kyle RA, King RL, Habermann TM, Kumar S, Kapoor P. Central nervous system involvement (Bing-Neel Syndrome) in patients with Waldenström macroglobulinemia. Leuk Lymphoma 2023; 64:1490-1493. [PMID: 37300306 DOI: 10.1080/10428194.2023.2214026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Saurabh Zanwar
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Jithma P Abeykoon
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Stephen M Ansell
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | | | - Thomas E Witzig
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Patrick Johnston
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Thomas M Habermann
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Shaji Kumar
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Internal Medicine, Rochester, MN, USA
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11
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Mauermann ML, Southerland AM. Hematologic Disorders and the Nervous System. Continuum (Minneap Minn) 2023; 29:826-847. [PMID: 37341332 DOI: 10.1212/con.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE This article discusses the epidemiology, diagnosis, treatment, and prevention of neurologic complications of red blood cell, platelet, and plasma cell disorders. LATEST DEVELOPMENTS Cerebrovascular complications can occur in patients with blood cell and platelet disorders. Treatment strategies to prevent stroke are available for patients with sickle cell disease, polycythemia vera, and essential thrombocythemia. A diagnosis of thrombotic thrombocytopenic purpura should be considered in patients with neurologic symptoms, hemolytic anemia, thrombocytopenia, mild renal insufficiency, and fever. Plasma cell disorders can be associated with peripheral neuropathy, and classification of the monoclonal protein type and neuropathy aid in diagnosis. Patients with POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes) syndrome can present with arterial and venous neurologic events. ESSENTIAL POINTS This article discusses the neurologic complications of blood cell disorders and the most recent advances in prevention and treatment.
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12
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Ashruf OS, Mirzai S, George LL, Anwer F. Beyond monoclonal gammopathy of undetermined significance, clinical spectrum of immunoglobulin M gammopathy: a case series with focus on the diagnostic and management challenges. Int J Hematol Oncol 2023; 12:IJH44. [PMID: 37304326 PMCID: PMC10248588 DOI: 10.2217/ijh-2022-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/30/2023] [Indexed: 06/13/2023] Open
Abstract
Immunoglobulin M monoclonal gammopathy is detected in Waldenström macroglobulinemia (WM), a rare lymphoplasmacytic lymphoma with serum immunoglobulin M. We report three rare presentations with focus on diagnostic and management challenges of type I cryoglobulinemia, type II cryoglobulinemia, and Bing-Neel syndrome. In approximately 10% of WM cases, macroglobulins can precipitate to cryoglobulins. Type I and II cryoglobulinemia, representing 10-15% and 50-60% of WM cases, respectively, present with vasculitis and renal failure. Bing-Neel syndrome, representing 1% of WM patients, is a rare neurological complication with lymphoplasmacytic infiltration in the brain. WM diagnosis includes bone marrow biopsy, immunophenotypic analysis, and MYD88 L265P mutation. We initiated management of cryoglobulinemia with dexamethasone, rituximab, and cyclophosphamide; in Bing-Neel, bortezomib and dexamethasone, followed by a Bruton tyrosine kinase inhibitor.
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Affiliation(s)
- Omer S Ashruf
- Northeast Ohio Medical University, Rootstown, OH 44139, USA
| | - Saeid Mirzai
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Laeth L George
- Division of Hematology & Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Faiz Anwer
- Division of Hematology & Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
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13
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Schep SJ, Vos JMI, Minnema MC. Evaluation and Management of Bing-Neel Syndrome. Hematol Oncol Clin North Am 2023:S0889-8588(23)00042-4. [PMID: 37258354 DOI: 10.1016/j.hoc.2023.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Bing-Neel syndrome is a rare manifestation of Waldenström macroglobulinemia (WM), which is caused by infiltration of the malignant lymphoplasmacytic cells in the central nervous system. Patients can present with a diverse range of neurologic symptoms, and differentiation with other comorbidities seen in WM, such as immunoglobulin M-related polyneuropathy, can be challenging. Both the rarity of this disorder and the heterogeneity of the clinical presentation often cause a significant diagnostic delay with the risk of permanent neurologic damage. This review summarizes current knowledge regarding diagnosis, treatment and prognosis of Bing-Neel syndrome.
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Affiliation(s)
- Sarah J Schep
- Department of Hematology, HAGA Ziekenhuis, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands.
| | - Josephine M I Vos
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam & Sanquin, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Monique C Minnema
- Department of Hematology, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Nehterlands. https://twitter.com/MinnemaMonique
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14
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Kerley RN, O'Donnell N, Lynott F, Mulcahy R, Hennessy B. Diagnosing, imaging, and successfully treating a debilitating case of Bing-Neel syndrome: A multidisciplinary feat. Clin Case Rep 2023; 11:e7296. [PMID: 37151950 PMCID: PMC10160417 DOI: 10.1002/ccr3.7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/18/2023] [Accepted: 04/19/2023] [Indexed: 05/09/2023] Open
Abstract
Key Clinical Message We present a case of Bing-Neel syndrome a rare central nervous system lymphoplasmocytic lymphoma associated with Waldenstrom macroglobulinemia. Diagnosis should be considered in the context of unexplained neurological symptoms in the presence of macroglobulinemia. Abstract Waldenstroms macroglobulinaemia (WM) is a rare B-cell lymphoma representing ~2% of all hematological malignancies. While most neurological complications of WM are secondary to the overproduction of immunoglobulin M (IgM), Bing-Neel syndrome (BNS) is an extremely rare direct central nervous system (CNS) infiltration by malignant lymphoplasmocytic lymphoma (LPL) cells. Limited information on BNS exists in the literature with sparse case reports and case series. Here, we present a diagnostically challenging BNS case successfully treated with systemic chemoimmunotherapy and ibrutinib, with remarkable clinical response.
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Affiliation(s)
- Robert N. Kerley
- Cork University HospitalCorkIreland
- University Hospital WaterfordWaterfordIreland
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15
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Pan Q, Luo Y, Cao X, Li J, Feng J. Bing–Neel Syndrome and Coexisting Pituitary Macroadenoma in a Patient with Waldenström Macroglobulinemia Revealed by 18F-FDG and 68Ga-Pentixafor PET/CT. Diagnostics (Basel) 2023; 13:diagnostics13071334. [PMID: 37046551 PMCID: PMC10093397 DOI: 10.3390/diagnostics13071334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
A 63-year-old man presenting with peripheral neuropathies was diagnosed of Waldenström’s macroglobulinemia, and Bing–Neel syndrome was subsequently confirmed via cerebrospinal fluid examinations. Besides involvement in bone marrow, lymph nodes, as well as the thoracic and sacral nerve root, 68Ga-Pentixafor PET/CT detected active tracer uptake in bilateral choroid plexus, which was negative in 18F-FDG PET/CT, possibly suggesting the involvement of Bing–Neel syndrome. The coexisting pituitary macroadenoma was FDG-avid but negative in 68Ga-Pentixafor PET/CT. After six cycles of chemotherapy, the follow-up PET/CT showed complete remission of the previous disease, including the high uptake of 68Ga-Pentixafor in choroid plexus. However, the hypermetabolic pituitary macroadenoma remained unchanged.
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Affiliation(s)
- Qingqing Pan
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Yaping Luo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Xinxin Cao
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Jian Li
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Jun Feng
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
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Pimentel Maldonado DA, Lisak R, Galetta S, Balcer L, Varkey T, Goodman A, Graves J, Racke M, Zamvil SS, Newsome S, Frohman EM, Frohman TC. Recurrent Optic Neuritis and Perineuritis Followed by an Unexpected Discovery. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2023; 10:10/1/e200051. [DOI: 10.1212/nxi.0000000000200051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
We describe a woman with a history of relapsing acute optic neuritis and perineuritis. Testing failed to confirm a specific diagnosis; hence, she was diagnosed with seronegative neuromyelitis optica spectrum disorder and treated with the immunotherapy rituximab, later in conjunction with mycophenolate mofetil. She achieved a durable remission for 9 years until she presented with paresthesia affecting her left fifth digit, right proximal thigh, and left foot, while also reporting a 25-pound weight loss over the prior 3 months. New imaging demonstrated a longitudinally extensive and enhancing optic nerve, in conjunction with multifocal enhancing lesions within the spinal cord, in a skip-like distribution. The differential diagnosis is discussed.
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Dogliotti I, Jiménez C, Varettoni M, Talaulikar D, Bagratuni T, Ferrante M, Pérez J, Drandi D, Puig N, Gilestro M, García-Álvarez M, Owen R, Jurczak W, Tedeschi A, Leblond V, Kastritis E, Kersten MJ, D’Sa S, Kaščák M, Willenbacher W, Roccaro AM, Poulain S, Morel P, Kyriakou C, Fend F, Vos JMI, Dimopoulos MA, Buske C, Ferrero S, García-Sanz R. Diagnostics in Waldenström's macroglobulinemia: a consensus statement of the European Consortium for Waldenström's Macroglobulinemia. Leukemia 2023; 37:388-395. [PMID: 36435884 PMCID: PMC9898035 DOI: 10.1038/s41375-022-01762-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/28/2022]
Abstract
The diagnosis of Waldenström's macroglobulinemia (WM), an IgM-associated lymphoplasmacytic lymphoma, can be challenging due to the different forms of disease presentation. Furthermore, in recent years, WM has witnessed remarkable progress on the diagnostic front, as well as a deeper understanding of the disease biology, which has affected clinical practice. This, together with the increasing variety of tools and techniques available, makes it necessary to have a practical guidance for clinicians to perform the initial evaluation of patients with WM. In this paper, we present the consensus recommendations and laboratory requirements for the diagnosis of WM developed by the European Consortium of Waldenström's Macroglobulinemia (ECWM), for both clinical practice as well as the research/academical setting. We provide the procedures for multiparametric flow cytometry, fluorescence in situ hybridization and molecular tests, and with this offer guidance for a standardized diagnostic work-up and methodological workflow of patients with IgM monoclonal gammopathy of uncertain significance, asymptomatic and symptomatic WM.
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Affiliation(s)
- Irene Dogliotti
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Cristina Jiménez
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain.
| | - Marzia Varettoni
- grid.419425.f0000 0004 1760 3027Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Dipti Talaulikar
- grid.1001.00000 0001 2180 7477Canberra Health Services, College of Medicine, Biology and Environment Australian National University, Canberra ACT, Australia
| | - Tina Bagratuni
- grid.5216.00000 0001 2155 0800Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Martina Ferrante
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - José Pérez
- grid.411258.bHematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - Daniela Drandi
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Noemí Puig
- grid.411258.bHematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - Milena Gilestro
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - María García-Álvarez
- grid.411258.bHematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - Roger Owen
- grid.415967.80000 0000 9965 1030The Leeds Teaching Hospitals National Health Service Trust, Leeds, UK
| | - Wojciech Jurczak
- grid.418165.f0000 0004 0540 2543Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Alessandra Tedeschi
- grid.416200.1ASST Grande Ospedale Metropolitano Niguarda Hospital, Milan, Italy
| | - Veronique Leblond
- grid.462844.80000 0001 2308 1657Département d’Hématologie Hôpital Pitié-Salpêtrière APHP, UPMC Université Paris, Paris, France
| | - Efstathios Kastritis
- grid.5216.00000 0001 2155 0800Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece ,grid.5216.00000 0001 2155 0800National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Marie José Kersten
- grid.509540.d0000 0004 6880 3010Department of Hematology, Amsterdam UMC, Location University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Shirley D’Sa
- grid.439749.40000 0004 0612 2754Centre for Waldenströms Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Michal Kaščák
- grid.412684.d0000 0001 2155 4545Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Wolfgang Willenbacher
- grid.410706.4Department of Haematology and Oncology, Internal Medicine V, Innsbruck University Hospital & Syndena GmbH, Connect to Cure, Innsbruck, Austria
| | - Aldo M. Roccaro
- grid.412725.7Clinical Research Development and Phase I Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stephanie Poulain
- grid.410463.40000 0004 0471 8845Laboratory of Hematology, Biology and Pathology Center, CHU of Lille, INSERM UMR-S 1277, Team 4, Oncolille, Lille, France
| | - Pierre Morel
- grid.134996.00000 0004 0593 702XService d’Hematologie Clinique et Therapie Cellulaire, Centre Hospitalier Universitaire d’Amiens-Picardie, Amiens, France
| | - Charalampia Kyriakou
- grid.439749.40000 0004 0612 2754Centre for Waldenströms Macroglobulinaemia and Related Conditions, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Falko Fend
- grid.411544.10000 0001 0196 8249Institute of Pathology and Comprehensive Cancer Centre, Eberhard-Karls-University, University Hospital Tübingen, Tübingen, Germany
| | - Josephine M. I. Vos
- grid.509540.d0000 0004 6880 3010Department of Hematology, Amsterdam UMC, Location University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Meletios A. Dimopoulos
- grid.5216.00000 0001 2155 0800Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece ,grid.5216.00000 0001 2155 0800National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christian Buske
- grid.410712.10000 0004 0473 882XInstitute of Experimental Cancer Research, Comprehensive Cancer Center Ulm, University Hospital of Ulm, Ulm, Germany
| | - Simone Ferrero
- grid.7605.40000 0001 2336 6580Unit of Hematology, Department of Biotechnology and Health Sciences, University of Torino, Torino, Italy ,Hematology Division 1U, “AOU Città della Salute e della Scienza di Torino”, Torino, Italy
| | - Ramón García-Sanz
- grid.411258.bHematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
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Naveed Ahmad JA, Schroeder BA, Yun JPT, Aboulafia DM. Mixed Diffuse and Tumoral Form of Bing-Neel Syndrome Successfully Treated with Ibrutinib. Case Rep Oncol 2023; 16:1353-1361. [PMID: 37946745 PMCID: PMC10631778 DOI: 10.1159/000534528] [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: 04/20/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023] Open
Abstract
Introduction Bing-Neel syndrome (BNS) is a rare and heterogenous manifestation of Waldenström macroglobulinemia (WM) involving central nervous system (CNS) infiltration by malignant lymphoplasmacytic cells. Efforts to standardize diagnostic criteria have improved in recent years, as have treatment options including the use of the Bruton tyrosine kinase inhibitor (BTKI) ibrutinib. Case Presentation Here, we present the case of a 70-year-old male with a remote history of WM previously treated with bendamustine and rituximab, who presented to medical attention with several months of left-sided weakness, headache, and ataxia. Brain magnetic resonance imaging revealed numerous enhancing masses in the bilateral cerebral hemispheres, inferior medulla, and upper cervical spine. Laboratory studies showed serum IgM lambda monoclonal gammopathy and elevated free serum kappa and lambda light chains, while cerebrospinal fluid flow cytometry revealed CD19+ B cells. Stereotactic brain biopsy of a right frontal brain lesion was consistent with lymphoplasmacytic lymphoma, confirmed by a positive MYD88 L265P mutation. He received ibrutinib 420 mg orally daily, and this resulted in appreciable clinical and radiologic responses, which have persisted over a 31-month period. Conclusion The advent of molecularly targeted agents and novel therapies for WM has provided patients and clinicians with additional therapeutic options. The use of BTK inhibitors with their high-level CNS penetrance, in particular, offers a novel way to treat BNS and improve patient overall survival while maintaining a high level of quality of life. We discuss the importance of MYD88 L265P testing in the context of BNS as well as the expanding role of BTKIs in treating this disease.
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Affiliation(s)
| | - Brett A. Schroeder
- Virginia Mason Medical Center, Cancer Institute, Seattle, WA, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - John Paul T. Yun
- National University of Ireland School of Medicine, Galway, Ireland
| | - David M. Aboulafia
- Virginia Mason Medical Center, Cancer Institute, Seattle, WA, USA
- Division of Hematology, University of Washington, Seattle, WA, USA
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Abstract
Bing-Neel syndrome (BNS) is a rare central nervous system manifestation of lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM). We herein report a 62-year-old man with LPL/WM after multiple chemotherapies. He had weakness of lower extremities and elevated serum IgM levels. A bone marrow examination showed lymphoplasmacytic cells infiltration. Contrast-enhanced magnetic resonance imaging suggested enhancing lesions in the cauda equina roots. He was diagnosed with BNS and started on treatment with tirabrutinib 480 mg daily. Within three months, he showed clinical and radiologic improvement. Tirabrutinib may have utility as an effective treatment for BNS.
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Affiliation(s)
- Takashi Oyama
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kazuki Taoka
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akira Chiba
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kensuke Matsuda
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroaki Maki
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yosuke Masamoto
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
- Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Japan
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20
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Sekiguchi N. The Impact of Tirabrutinib Monotherapy for Bing-Neel Syndrome in Waldenström's Macroglobulinemia. Intern Med 2022; 61:3473-3474. [PMID: 35569973 PMCID: PMC9790778 DOI: 10.2169/internalmedicine.0041-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Naohiro Sekiguchi
- Department of Hematology, National Hospital Organization Disaster Medical Center, Japan
- Department of Clinical Research, National Hospital Organization Disaster Medical Center, Japan
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21
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Bing–Neel Syndrome: Update on Diagnosis and Treatment. HEMATO 2022. [DOI: 10.3390/hemato3040051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bing–Neel syndrome (BNS) is a rare neurological complication of Waldenström macroglobulinaemia. We highlight key issues in clinical presentation, diagnosis, and treatment while focusing on new and emerging therapies available for patients diagnosed with BNS. It is anticipated that further development of Bruton Tyrosine Kinase (BTK) inhibitors and less toxic chemoimmunotherapies will improve treatment delivery and response.
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22
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Unique Presentation of Bing-Neel Syndrome With Co-existing Chronic Lymphocytic Leukemia. Hemasphere 2022; 6:e805. [PMID: 36407090 PMCID: PMC9668544 DOI: 10.1097/hs9.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/14/2022] [Indexed: 01/25/2023] Open
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23
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Guemara R, Pieren A, Brulhart L. Angioinvasive aspergillosis mimicking giant cell arteritis in an 81-year-old man with jaw pain and vision loss. RMD Open 2022; 8:rmdopen-2022-002489. [DOI: 10.1136/rmdopen-2022-002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
The present case report focuses on an immunocompromised 81-year-old patient initially diagnosed with Waldenström’s disease. The patient experienced a gradual vision loss and jaw pain with high erythrocyte sedimentation rate. We first suspected giant cell arteritis, despite inconclusive assessment, including a negative temporal artery biopsy. We rapidly started a corticosteroid pulse therapy followed by high-dose corticosteroid therapy that was followed even after discharge from the hospital. The patient was readmitted 20 days later with severe left retro-orbital pain and progressive left vision loss. Clinical examination revealed complete left eyelid ptosis and unilateral blindness with fixed mydriasis and no eye movement. MRI showed signs of ischaemic optic neuropathy with lysis of the left ethmoid sinus wall; thus, indicating ischaemic optic neuropathy related to lymphoplasmacytic infiltration of Waldenström’s disease (Bing-Neel syndrome). Oncological treatment of ibrutinib, a tyrosine kinase inhibitor, was then administered. Despite a favourable prognosis, no improvement was seen. An infectious aetiology was finally confirmed. The left sphenoid sinus biopsy highlighted an angioinvasive aspergillosis with rhino-orbital infiltration observed as ischaemic optic neuropathy. Oncologic treatment was discontinued and antifungal therapy with voriconazole was introduced, leading to a favourable radiological development and analgesic control, without ophtalmological improvement.
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24
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First-Line Treatment of Waldenström’s Macroglobulinaemia: Considerations Based on the Dutch National Guideline. HEMATO 2022. [DOI: 10.3390/hemato3040047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Waldenström macroglobulinemia (WM) is a rare B-cell Non-Hodgkin Lymphoma. There are only few prospective randomized clinical trials to guide treatment recommendations and there is no international consensus on a preferred first line treatment approach. In the recently revised Dutch guideline for WM, we describe recommendations for practice based as much as possible on the known data. Here, we summarize the considerations for first-line treatment based on these Dutch guidelines. Available evidence is summarized, including efficacy and toxicity data. Combinations of Rituximab with chemotherapy, proteasome inhibition or BTK-inhibition are all valid first line treatment options. The Dutch WM working group considers Dexamethasone/Rituximab/Cylofosfamide (DRC) a suitable first-line treatment for many WM patients, given the efficacy, the relatively mild toxicity profile and the extensive experience with this regimen. However, the long-term toxicities of DRC are unclear and need further clarification. Other regimens such as R-bendamustine, R-Bortezomib-dexamethason are also effective options, however with specific toxicities. BTK-inhibitors are not a preferred option in first line for most patients in the Dutch WM guidelines because of the need for longterm treatment and toxicities. Based on patient preferences research, future clinical trials should focus on effective fixed-duration regimens with non-cytotoxic therapies that have a favorable toxicity profile. Further development of (combinations with) BCL-2 inhibititors, novel proteasome inhibitors and BTK-inhibition could be interesting. In addition T-cell-directed treatments including bispecific antibodies as a monotherapy or combined with other novel agents deserve further study in WM.
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Saburi M, Sakata M, Okuhiro K, Kawano K, Uesugi S, Wada J, Urabe S, Saburi Y, Ohtsuka E. Successful treatment with tirabrutinib for relapsed Bing-Neel syndrome following high-dose methotrexate and craniospinal irradiation. J Clin Exp Hematop 2022; 62:181-186. [PMID: 36171098 PMCID: PMC9635027 DOI: 10.3960/jslrt.22018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A 63-year-old man was diagnosed with Waldenström's macroglobulinemia (WM). Six courses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) resulted in complete remission, but WM relapsed three years after R-CHOP. After six courses of BR (bendamustine, rituximab), the serum IgM level and CRP normalized. Four years after BR, the patient presented with muscle weakness, sensory disturbance, and myoclonus of lower limbs. T2-weighted magnetic resonance imaging (MRI) showed areas of signal hyperintensity with contrast enhancement in the right temporal and parietal lobes in brain parenchyma, medulla, bilateral basal ganglia, white matter of occipital lobe, and thoracic spinal cord at the Th2-11 levels. Open brain biopsy revealed diffuse proliferation of small lymphocytes and plasmacytoid lymphocytes on the brain surface and around cerebral blood vessels, resulting in a diagnosis of Bing-Neel syndrome (BNS). Two courses of R-MPV (rituximab, methotrexate, procarbazine, and vincristine) resulted in progressive disease, but the neurological symptoms and MRI findings improved following craniospinal irradiation of 30.6 Gy. Three years after craniospinal irradiation, T2-weighted MRI showed recurrence of BNS with progression of myoclonus of lower limbs and IgM elevation. Tirabrutinib was started for the second recurrence of WM and progression of BNS. Two months after the initiation of treatment with tirabrutinib, the myoclonus of lower limbs disappeared and the MRI findings showed improvement. Serum IgM levels decreased and no adverse events were observed. Tirabrutinib shows promise as a therapeutic option for relapsed BNS.
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Affiliation(s)
- Masuho Saburi
- Department of Hematology, Oita Prefectural Hospital, Oita, Japan
| | - Masanori Sakata
- Department of Hematology, Oita Prefectural Hospital, Oita, Japan
| | - Kazuki Okuhiro
- Department of Medical Oncology and Hematology, Faculty of Medicine, Oita University, Oita, Japan
| | - Katsuya Kawano
- Department of Clinical Laboratory Technology, Oita Prefectural Hospital, Oita, Japan
| | - Souhei Uesugi
- Department of Neurology, Oita Prefectural Hospital, Oita, Japan
| | - Junpei Wada
- Department of Pathology, Oita Prefectural Hospital, Oita, Japan
| | - Shogo Urabe
- Department of Pathology, Oita Prefectural Hospital, Oita, Japan
| | - Yoshio Saburi
- Department of Hematology, Oita Prefectural Hospital, Oita, Japan
| | - Eiichi Ohtsuka
- Department of Hematology, Oita Prefectural Hospital, Oita, Japan
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26
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Parra Salinas I, Murillo Florez I, García Fernández L. Bing-Neel síndrome in a patient with Waldenström macroglobulinemia. Med Clin (Barc) 2022; 159:e75-e76. [PMID: 36123201 DOI: 10.1016/j.medcli.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 10/14/2022]
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27
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Brotis AG, Palassopoulou M, Kapsalaki EZ, Paschalis T, Papastergiou V, Fountas KN. Bing-Neel syndrome presenting with bilateral lumbar radiculopathy: A case report of a rare clinical entity. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:250-253. [PMID: 36084961 DOI: 10.1016/j.neucie.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/20/2021] [Indexed: 06/15/2023]
Abstract
The differential diagnosis of bilateral lower extremity weakness is broad. We present a very rare case of a 48-year old male patient, with walking difficulties due to Bing-Neel syndrome. On clinical examination, there was a significant loss of muscle power in all his lower extremities key-muscle groups. The lumbar spine magnetic resonance imaging (MRI) showed only mild degenerative changes, whereas the MRI of the head indicated a diffuse meningeal thickening at the right temporal region, characterized by significant enhancement after contrast administration. Serum protein electrophoresis detected an IgM-kappa monoclonal protein. The patient received intrathecal chemotherapy with methotrexate and cytarabine, and was started on oral ibrutinib 420mg daily. In conclusion, a past medical history of Waldenstrom macroglobulinemia in conjunction with neurological manifestations should alert the treating physician for Bing-Neel syndrome. A complete diagnostic imaging and serologic protocol helps in setting the final diagnosis. Steroids are part of the treatment, but should be given after the diagnosis is set. Neurosurgical intervention is indicated for histologic confirmation in the case of diagnostic uncertainty.
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Affiliation(s)
- Alexandros G Brotis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece.
| | - Maria Palassopoulou
- Department of Haematology, General University Hospital of Larissa, Larissa, Greece
| | - Eftychia Z Kapsalaki
- Department of Radiology, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
| | - Thanos Paschalis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece
| | | | - Konstantinos N Fountas
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
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28
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[Chinese guideline for diagnosis and treatment of lymphoplasmacytic lymphoma/Walderström macroglobulinemia (2022)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:624-630. [PMID: 36709145 PMCID: PMC9593020 DOI: 10.3760/cma.j.issn.0253-2727.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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29
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Drozd-Sokołowska J, Waszczuk-Gajda A, Witkowska M, Sienkiewicz E, Kopińska A, Kołkowska-Leśniak A, Barankiewicz J, Długosz-Danecka M, Smolewski P, Helbig G, Lech-Marańda E, Jurczak W, Biecek P, Giebel S, Wiktor-Jędrzejczak W, Basak G. Bing-Neel Syndrome, a Rare Presentation of Waldenström Macroglobulinemia—A Multicenter Report by the Polish Lymphoma Research Group. J Clin Med 2022; 11:jcm11154447. [PMID: 35956064 PMCID: PMC9369437 DOI: 10.3390/jcm11154447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/08/2022] [Accepted: 07/28/2022] [Indexed: 12/10/2022] Open
Abstract
Bing-Neel syndrome (BNS) is a rare presentation of Waldenström macroglobulinemia (WM). BNS is a consequence of the central nervous system (CNS) involvement by lymphoplasmacytic lymphoma (LPL) and, rarely, the peripheral nervous system. The data on BNS are extremely scarce. Therefore, we performed a multicenter retrospective analysis of BNS patients diagnosed and treated in centers aligned with the Polish Lymphoma Research Group. The analysis covers the years 2014–2021. Eleven patients were included, 55% females and the median age at BNS diagnosis was 61 years. The median time from WM to BNS was 3.5 years; 27% of patients did have a diagnosis of WM and BNS made simultaneously or within 30 days from each other. Isolated parenchymal involvement was the least frequent (20%). Patients were treated with different regimens, mostly able to cross the blood-brain barrier, including 18% treated with ibrutinib first line. The cumulative objective response to treatment was 73%. With the median follow-up of 20 months (95% CI, 2–32), the 36-month estimates were: overall survival (OS) 47%, progression-free survival (PFS) 33%, and cumulative incidence of BNS-associated death 41%. The performance status according to ECOG was significant for PFS (HR = 7.79) and the hemoglobin concentration below 11 g/dL was correlated with PFS. To conclude, BNS is a very rare manifestation of WM. It is associated with a poor outcome with most patients succumbing to BNS.
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Affiliation(s)
- Joanna Drozd-Sokołowska
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland; (A.W.-G.); (W.W.-J.); (G.B.)
- Correspondence: ; Tel.: +48-22-599-2818
| | - Anna Waszczuk-Gajda
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland; (A.W.-G.); (W.W.-J.); (G.B.)
| | - Magdalena Witkowska
- Department of Experimental Hematology, Medical University of Lodz, 93-510 Lodz, Poland; (M.W.); (P.S.)
| | - Elżbieta Sienkiewicz
- Department of Mathematics and Information Science, Warsaw University of Technology, 00-662 Warsaw, Poland; (E.S.); (P.B.)
| | - Anna Kopińska
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-032 Katowice, Poland; (A.K.); (G.H.)
| | - Agnieszka Kołkowska-Leśniak
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland; (A.K.-L.); (J.B.); (E.L.-M.)
| | - Joanna Barankiewicz
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland; (A.K.-L.); (J.B.); (E.L.-M.)
| | - Monika Długosz-Danecka
- Maria Sklodowska-Curie National Research Institute of Oncology, 31-115 Cracow, Poland; (M.D.-D.); (W.J.)
| | - Piotr Smolewski
- Department of Experimental Hematology, Medical University of Lodz, 93-510 Lodz, Poland; (M.W.); (P.S.)
| | - Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-032 Katowice, Poland; (A.K.); (G.H.)
| | - Ewa Lech-Marańda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland; (A.K.-L.); (J.B.); (E.L.-M.)
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, 31-115 Cracow, Poland; (M.D.-D.); (W.J.)
| | - Przemysław Biecek
- Department of Mathematics and Information Science, Warsaw University of Technology, 00-662 Warsaw, Poland; (E.S.); (P.B.)
| | - Sebastian Giebel
- Maria Sklodowska-Curie Institute-Cancer Center, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Wiesław Wiktor-Jędrzejczak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland; (A.W.-G.); (W.W.-J.); (G.B.)
| | - Grzegorz Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland; (A.W.-G.); (W.W.-J.); (G.B.)
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30
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Kotsos D, Chatzileontiadou S, Apsemidou A, Xanthopoulou A, Rapi A, Frouzaki C, Hatjiharissi E. Bing-Neel Syndrome: Real-Life Experience in Personalized Diagnostic Approach and Treatment. Front Oncol 2022; 12:891052. [PMID: 35847958 PMCID: PMC9278058 DOI: 10.3389/fonc.2022.891052] [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: 03/07/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
The involvement of the central nervous system (CNS) in Waldenström’s Macroglobulinemia (WM) is a rare extramedullary manifestation of the disease known as Bing-Neel syndrome (BNS). To expand our understanding of this disease manifestation, we conducted a retrospective analysis of the incidence of BNS in 86 consecutive patients with WM [70% male, median age 65 years (range 33-86)] seen in our center during a 30-year period. Six patients (7%) from this group were diagnosed with BNS. The median period of time between WM diagnosis and BNS diagnosis was 6.8 years (range 2.3-15). They demonstrated a range of neurological deficits, including transient expressive aphasia, impaired vision, resting hand tremor, foot drop, and headache. Between the onset of symptoms and the diagnosis of BNS, the median time interval was 12.5 months (range 1-30). The diagnosis was made not on the basis of neurological symptoms or radiological evidence, but on the basis of the presence of WM cells in cerebrospinal fluid (CSF). Intrathecal chemotherapy with methotrexate, cytarabine, and dexamethasone (IT MTX, ARA-C, DEX) was used as front-line treatment, followed by intensive immunochemotherapy with rituximab, high-dose MTX, and ARA-C (R-Hi MTX/ARA-C) in three patients who were fit enough to receive this type of cytotoxic regimen, and rituximab plus bendamustine (R-Benda) in two patients who simultaneously required treatment for WM. Ibrutinib was administered to five patients (three as consolidation and two for initial treatment). All patients responded to front-line treatment, with four (67%) achieving partial response (PR) and two (33%) achieving complete response (CR). This study provides insight into the clinical presentation, diagnostic and treatment options, as well as the outcome of patients who have BNS.
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Affiliation(s)
- Dimitrios Kotsos
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Sofia Chatzileontiadou
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Athanasia Apsemidou
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Anna Xanthopoulou
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Aikaterini Rapi
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Christina Frouzaki
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Evdoxia Hatjiharissi
- Hematology Unit, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
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31
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Thomas SK. SOHO State of the Art Updates and Next Questions: Waldenström Macroglobulinemia - 2021 Update on Management and Future Directions. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:347-355. [PMID: 34980578 DOI: 10.1016/j.clml.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/15/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
Waldenstrom macroglobulinemia (WM) is a low-grade B-cell lymphoproliferative disorder. It is defined by having ≥ 10% bone marrow infiltration with lymphoplasmacytic cells and/or an immunoglobulin M (IgM) monoclonal gammopathy of ≥3g/dL. Risk factors include a personal history of IgM MGUS, and a family history of WM or a related disorder. Race, sex, and chronic antigen stimulation also appear to influence risk. Between 93 to 97% of patients with WM have a somatic mutation of the MYD88 gene. Of these, approximately 30% also have a mutation of CXCR4. The presence of a MYD88 mutation is associated with higher 10-year overall survival (90% vs. 73%; P < .001), while CXCR4 mutation status does not appear to have a similar effect. Based on consensus guidelines, WM patients with a disease-related hemoglobin level of less than 10g/dL, a platelet count of less than 100×10 9/L, bulky adenopathy or organomegaly, symptomatic hyperviscosity, severe neuropathy, amyloidosis, cryoglobulinemia, cold agglutinin disease, or evidence of disease transformation, should be considered for immediate therapy. Patients not meeting these criteria may be observed, with monitoring at 3 to 6 month intervals. When treatment is warranted, combinations of rituximab with alkylating agents and proteasome inhibitors are often effective, as are Bruton's tyrosine kinase (BTK) inhibitors and BCL-2 inhibitors. Selection among available regimens should take patients' gene mutation profile, disease-related features, and co-morbid conditions into account. Promising novel therapies in development include non-covalent BTK inhibitors, CXCR4 antagonists, BCL 2 inhibitors, bi-specific antibodies, radioimmunoconjugates, and CD19- and CD20-Targeted Chimeric Antigen Receptor T cells.
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Affiliation(s)
- Sheeba K Thomas
- Department of Lymphoma & Myeloma, University of Texas M.D. Anderson Cancer Center, Houston, TX.
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32
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Ababneh O, Abushukair H, Qarqash A, Syaj S, Al Hadidi S. The Use of Bruton Tyrosine Kinase Inhibitors in Waldenström’s Macroglobulinemia. Clin Hematol Int 2022; 4:21-29. [PMID: 35950210 PMCID: PMC9358782 DOI: 10.1007/s44228-022-00007-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 01/04/2023] Open
Abstract
The use of Bruton Tyrosine Kinase (BTK) inhibitors in Waldenström’s Macroglobulinemia (WM) is evolving. Ibrutinib, a first-generation BTK inhibitor, is currently approved for use in frontline and relapsed/refractory disease. Second-generation BTK inhibitors are being used and studied to improve clinical outcomes and/or safety profile. Zanubrutinib, one such second-generation inhibitor, was recently approved in treatment-naive and refractory/relapsed patients. Here, we review the use of BTK inhibitors in WM in front-line and refractory or relapsed settings. We also highlight common adverse events, the emergence of BTK inhibitors resistance, and future directions of their use.
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Affiliation(s)
- Obada Ababneh
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Hassan Abushukair
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Aref Qarqash
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Sebawe Syaj
- Faculty of Medicine, Jordan University of Science and Technology, P.O. 22110, Irbid, Jordan
| | - Samer Al Hadidi
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR USA
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33
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Donzelli L, Minotti C, Torelli GF, Cartoni C, Luise C, Di Rocco A, Petrucci L, Di Napoli A, Martelli M. Bing-Neel syndrome coexisting with oligodendroglioma. Leuk Lymphoma 2022; 63:2511-2514. [DOI: 10.1080/10428194.2022.2076849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Livia Donzelli
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Clara Minotti
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Giovanni Fernando Torelli
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Claudio Cartoni
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Cristina Luise
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alice Di Rocco
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luigi Petrucci
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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34
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Pratt G, El-Sharkawi D, Kothari J, D'Sa S, Auer R, McCarthy H, Krishna R, Miles O, Kyriakou C, Owen R. Diagnosis and management of Waldenström macroglobulinaemia-A British Society for Haematology guideline. Br J Haematol 2022; 197:171-187. [PMID: 35020191 DOI: 10.1111/bjh.18036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022]
Abstract
SCOPE The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with Waldenström macroglobulinaemia. In individual patients, circumstances may dictate an alternative approach. METHODOLOGY This guideline was compiled according to the British Society for Haematology (BSH) process at http://www.b-s-h.org.uk/guidelines/proposing-and-writing-a-new-bsh-guideline/. Recommendations are based on a review of the literature using Medline, Pubmed, Embase, Central, Web of Science searches from beginning of 2013 (since the publication of the previous guidelines) up to November 2021. The following search terms were used: Waldenström('s) macroglobulin(a)emia OR lymphoplasmacytic lymphoma, IgM(-related) neuropathy OR cold h(a)emagglutinin disease OR cold agglutinin disease OR cryoglobulin(a)emia AND (for group a only) cytogenetic OR molecular OR mutation OR MYD88 OR CXCR4, management OR treatment OR transfusion OR supportive care OR plasma exchange OR plasmapheresis OR chemotherapy OR bendamustine OR bortezomib OR ibrutinib OR fludarabine OR dexamethasone OR cyclophosphamide OR rituximab OR everolimus, bone marrow transplantation OR stem cell transplantation. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org. Review of the manuscript was performed by the British Society for Haematology (BSH) Guidelines Committee Haemato-Oncology Task Force, the BSH Guidelines Committee and the Haemato-Oncology sounding board of BSH. It was also on the members section of the BSH website for comment. It has also been reviewed by UK Charity WMUK; these organisations do not necessarily approve or endorse the contents.
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Affiliation(s)
- Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jaimal Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shirley D'Sa
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Helen McCarthy
- University Hospitals Dorset NHS Foundation Trust, Dorset, UK
| | - Rajesh Krishna
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Oliver Miles
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Charalampia Kyriakou
- University College London Hospitals NHS Foundation Trust, London, UK
- London North West University Healthcare NHS Trust, London, UK
| | - Roger Owen
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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35
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Kaji FA, Martinez-Calle N, Sovani V, Fox CP. Rare central nervous system lymphomas. Br J Haematol 2022; 197:662-678. [PMID: 35292959 PMCID: PMC9310777 DOI: 10.1111/bjh.18128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Abstract
Central nervous system (CNS) lymphomas are rare malignancies characterised by lymphoid infiltration into the brain, spinal cord, cranial nerves, meninges and/or eyes in the presence or absence of previous or concurrent systemic disease. Most CNS lymphomas are of the diffuse large B-cell lymphoma (DLBCL) subtype for which treatment strategies, particularly the use of high-dose methotrexate-based protocols and consolidation with autologous stem cell transplantation, are well established. Other histopathological subtypes of CNS lymphoma are comparatively less common with published data on these rare lymphomas dominated by smaller case series and retrospective reports. Consequently, there exists little clinical consensus on the optimal methods to diagnose and manage these clinically and biologically heterogeneous CNS lymphomas. In this review article, we focus on rarer CNS lymphomas, summarising the available clinical data on incidence, context, diagnostic features, reported management strategies, and clinical outcomes.
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Affiliation(s)
- Furqaan Ahmed Kaji
- Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Vishakha Sovani
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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36
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Awad AK, Elbadawy MA, Boury M, Rivera A, Motawea K, Shah J, Parnia S, Varney J. Simple headache revealed a rare lymphoma: Waldenstrom macroglobulinemia with unique markers: a case report and review of the literature. J Egypt Natl Canc Inst 2022; 34:10. [PMID: 35253074 DOI: 10.1186/s43046-022-00107-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/28/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Waldenstrom macroglobulinemia (WM) is a rare lymphoma with an incidence rate of 3 per million people per year, with approximately 1000 to 1500 new cases diagnosed each year in the USA. It is primarily seen in Caucasian males with a median age of 70 years old. Patients are most often asymptomatic, but WM can manifest itself with constitutional symptoms such as lethargy, bleeding, organomegaly, and neurological or fundoscopic abnormalities. WM is characterized by immunoglobulin M (IgM) monoclonal gammopathy, lymphocytic infiltration of bone marrow, and normocytic anemia due to bone marrow replacement. CASE PRESENTATION Our patient is a Hispanic 67-year-old female that presents with one month of intermittent band-like bilateral headache accompanied by dizziness, light-headedness, nausea, and blurred vision. A thorough diagnostic workup was performed, including serum protein electrophoresis (SPEP) with serum immunofixation (SIFE) showing an M spike and IgM kappa. Bone marrow biopsy was significant for lymphoplasmacytic infiltration with nodular B cells (CD19+, CD20+, CD22+). Computerized Tomography (CT) imaging showed splenomegaly in the patient. Treatment was provided for hyperviscosity syndrome with plasmapheresis twice. The patient reported improvement of her symptoms and was then scheduled for chemotherapy. Throughout 7 months, our patient received multiple cycles of bortezomib, dexamethasone, and rituximab. While her symptoms improved her psychiatric status got progressively worse. CONCLUSION It is important not to neglect symptoms such as a headache, which may seem small, but could serve as a clue in the diagnosis of Waldenstrom's macroglobulinemia.
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Affiliation(s)
- Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | | | - Maty Boury
- American University of the Caribbean, School of Medicine, Philipsburg, St. Maarten, SXM
| | - Amanda Rivera
- American University of the Caribbean, School of Medicine, Philipsburg, St. Maarten, SXM
| | - Karam Motawea
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jaffer Shah
- Drexel University College of Medicine, Philadelphia, USA
| | - Shanli Parnia
- Morehouse School of Medicine, Atlanta, Georgia, United States
| | - Joseph Varney
- American University of the Caribbean, School of Medicine, Philipsburg, St. Maarten, SXM
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37
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Optic Perineuritis in Waldenström Macroglobulinemia–Related Cryoglobulinemic Vasculitis. J Neuroophthalmol 2022; 42:e306-e309. [DOI: 10.1097/wno.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Nanah A, Al Hadidi S. Bing-Neel Syndrome: Update on the Diagnosis and Treatment. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e213-e219. [PMID: 34674984 DOI: 10.1016/j.clml.2021.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
Bing-Neel syndrome (BNS) is a rare syndrome that occurs in patients with Waldenstrom macroglobulinemia and is characterized by lymphoplasmacytic infiltration into the leptomeningeal tissue and/or the central nervous system. It represents an extramedullary manifestation which may translate into various neurological symptoms. Accurate diagnosis of BNS can be established via histologic sampling and cerebrospinal fluid examination with molecular analysis of some genetic markers including immunoglobulin heavy locus rearrangements and MYD88 L265P mutation. The use of Bruton tyrosine kinase inhibitors such as ibrutinib resulted in promising outcomes. In this review, we discuss the pathophysiology, clinical manifestations, diagnostic characteristics, and an overview of the current treatment modalities of BNS.
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Affiliation(s)
| | - Samer Al Hadidi
- Myeloma Section, Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences, Little Rock, AR.
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39
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Tan J, Chandra V, Hall AJ. Bilateral Choroidal Infiltrates as the Initial Manifestation of Waldenström Macroglobulinemia Relapse. JOURNAL OF VITREORETINAL DISEASES 2022; 6:158-162. [PMID: 37008658 PMCID: PMC9976009 DOI: 10.1177/24741264211021238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work describes a case of Waldenström macroglobulinemia (WM) relapse presenting with unilateral blurred vision. Method: A case report is presented. Results: A 60-year-old woman with a history of WM in remission was referred for suspicious peripheral choroidal lesions and left optic disc swelling. Magnetic resonance imaging revealed optic nerve and cranial nerve infiltration consistent with central nervous system invasion from WM relapse, called Bing-Neel syndrome. Irradiation of the optic nerve and systemic targeted therapy were successful in addressing the ocular features as well as reducing immunoglobulin M paraprotein levels and lymphoproliferative disease burden. Conclusions: We described the first documented case to our knowledge of intraocular involvement as the earliest sign of relapse of WM. Ophthalmology assessment is warranted in patients with a history of WM who present with new ocular symptoms to aid early detection and treatment of this disease.
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Affiliation(s)
- Jason Tan
- Department of Ophthalmology, Alfred Health, Melbourne, VIC, Australia
| | - Varun Chandra
- Department of Ophthalmology, Alfred Health, Melbourne, VIC, Australia
| | - Anthony J. Hall
- Department of Ophthalmology, Alfred Health, Melbourne, VIC, Australia
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40
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Durable response of therapy-related MDS/AML with concomitant Waldenström's macroglobulinemia treated with venetoclax and azacitidine. Ann Hematol 2022; 101:1587-1589. [PMID: 35187605 PMCID: PMC9203379 DOI: 10.1007/s00277-022-04777-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/25/2022] [Indexed: 11/18/2022]
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41
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Bing-Neel syndrome hidden by multiple sclerosis, a challenging overlay of diseases. Acta Neurol Belg 2022; 122:227-229. [PMID: 34424495 DOI: 10.1007/s13760-021-01777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
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42
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Piazza F, Di Paolo V, Scapinello G, Manni S, Trentin L, Quintieri L. Determinants of Drug Resistance in B-Cell Non-Hodgkin Lymphomas: The Case of Lymphoplasmacytic Lymphoma/Waldenström Macroglobulinemia. Front Oncol 2022; 11:801124. [PMID: 35087759 PMCID: PMC8787211 DOI: 10.3389/fonc.2021.801124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
Lymphoplasmacytic lymphoma (LPL) is a rare subtype of B cell-derived non-Hodgkin lymphoma characterized by the abnormal growth of transformed clonal lymphoplasmacytes and plasma cells. This tumor almost always displays the capability of secreting large amounts of monoclonal immunoglobulins (Ig) of the M class (Waldenström Macroglobulinemia, WM). The clinical manifestations of WM/LPL may range from an asymptomatic condition to a lymphoma-type disease or may be dominated by IgM paraprotein-related symptoms. Despite the substantial progresses achieved over the last years in the therapy of LPL/WM, this lymphoma is still almost invariably incurable and exhibits a propensity towards development of refractoriness to therapy. Patients who have progressive disease are often of difficult clinical management and novel effective treatments are eagerly awaited. In this review, we will describe the essential clinical and pathobiological features of LPL/WM. We will also analyze some key aspects about the current knowledge on the mechanisms of drug resistance in this disease, by concisely focusing on conventional drugs, monoclonal antibodies and novel agents, chiefly Bruton’s Tyrosine Kinase (BTK) inhibitors. The implications of molecular lesions as predictors of response or as a warning for the development of therapy resistance will be highlighted.
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Affiliation(s)
- Francesco Piazza
- Laboratory of Myeloma and Lymphoma Pathobiology, Veneto Institute of Molecular Medicine (VIMM) and Foundation for Advanced Biomedical Research (FABR), Padua, Italy.,Hematology Division, Azienda Ospedaliera Universitaria and Department of Medicine, University of Padua, Padua, Italy
| | - Veronica Di Paolo
- Laboratory of Drug Metabolism, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Greta Scapinello
- Laboratory of Myeloma and Lymphoma Pathobiology, Veneto Institute of Molecular Medicine (VIMM) and Foundation for Advanced Biomedical Research (FABR), Padua, Italy.,Hematology Division, Azienda Ospedaliera Universitaria and Department of Medicine, University of Padua, Padua, Italy
| | - Sabrina Manni
- Laboratory of Myeloma and Lymphoma Pathobiology, Veneto Institute of Molecular Medicine (VIMM) and Foundation for Advanced Biomedical Research (FABR), Padua, Italy.,Hematology Division, Azienda Ospedaliera Universitaria and Department of Medicine, University of Padua, Padua, Italy
| | - Livio Trentin
- Hematology Division, Azienda Ospedaliera Universitaria and Department of Medicine, University of Padua, Padua, Italy
| | - Luigi Quintieri
- Laboratory of Drug Metabolism, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
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43
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Lee MS, Sathe S, Valasapalli S, Grosse Perdekamp M. Bing-Neel Syndrome: An Initial Manifestation of Waldenstrom Macroglobulinemia. Cureus 2021; 13:e19402. [PMID: 34926004 PMCID: PMC8657278 DOI: 10.7759/cureus.19402] [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] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Waldenstrom macroglobulinemia (WM) is a low-grade B-cell lymphoma characterized by bone marrow infiltration by monoclonal lymphoplasmacytic cells plus an IgM monoclonal gammopathy. Bing-Neel syndrome (BNS) is a rare manifestation of WM where malignant lymphoplasmacytic cells infiltrate the central nervous system (CNS). Though only present in 0.8% of WM cases, it is likely underdiagnosed and may present before or during WM treatment. Here, we present a case of BNS as an initial sign of WM. A 75-year-old male presented with confusion, gait instability, and expressive aphasia. MRI demonstrated a 5.5-cm mass in the right frontal lobe, crossing midline. Brain biopsy showed CNS lymphoma and later tested positive for the MYD88L265P mutation suggesting WM (as is a mutation in 90-95% WM patients). Indeed, quantitative serum immunoglobulins showed elevated IgM. Initial treatment for WM was started with rituximab, methylprednisolone, carfilzomib, and ibrutinib. MRI two months after initiation showed good response, and the patient was transitioned to ibrutinib monotherapy. Surveillance MRI one year later showed patchy right frontal lobe enhancement indicating disease progression, and therefore the patient was placed back on his initial treatment regimen. However, ibrutinib later had to be held due to thrombocytopenia. Two months after re-starting chemotherapy, he presented with bizarre behavior, and MRI showed extensive disease progression. He was then transitioned to palliative chemotherapy with high-dose methotrexate and rituximab. He has responded well to this regimen, and MRI two years after diagnosis showed no recurrent disease. BNS is a rare but easily missed manifestation of WM. As per the recent National Comprehensive Cancer Network (NCCN) guidelines and the 8th International Workshop on WM (IWWM-8), no standardized diagnostic or management guidelines for BNS is available. Direct brain biopsy is the gold standard for diagnosis. Due to its low incidence, rarity, and limited prospective trial, there is a lack of a clear standard of care therapy. Specific treatment regimen depends on the patient factors and treatment tolerability. IWWM-8 suggests the use of a variety of cytotoxic chemotherapies or ibrutinib. A high-quality meta-analysis of existing reports is critical to characterize the diagnostic features and optimal treatment for BNS. The prognosis of BNS remains unclear, with an estimated three- and five-year survival rate at 59% and 71%, respectively. BNS is an infrequent complication of WM. Clinicians should suspect BNS with persistent, unexplained neurologic symptoms in WM.
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Affiliation(s)
- Matthew S Lee
- Medicine, Carle Illinois College of Medicine, Carle Foundation Hospital, Urbana, USA
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Delasos L, Phachu D, Shetty N, Sepulveda‐Ramos M, Vredenburgh J. Primary central nervous system diffuse large B-cell lymphoma masqueraded as Bing-Neel syndrome: Steps in management and review of future directions. Clin Case Rep 2021; 9:e05113. [PMID: 34925831 PMCID: PMC8647806 DOI: 10.1002/ccr3.5113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 12/22/2022] Open
Abstract
Bing-Neel syndrome (BNS) remains a rare complication of Waldenstrom Macroglobulinemia. Given the paucity of this disease, treatment guidelines are based on small clinical trials with limited participants. Here, we present a case of primary CNS diffuse large B-cell lymphoma masqueraded as BNS that developed while on ibrutinib therapy.
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Affiliation(s)
- Lukas Delasos
- Department of Internal MedicineUniversity of Connecticut Health CenterFarmingtonConnecticutUSA
| | - Deep Phachu
- Department of Internal MedicineUniversity of Connecticut Health CenterFarmingtonConnecticutUSA
| | - Nishka Shetty
- Department of Internal MedicineUniversity of Connecticut Health CenterFarmingtonConnecticutUSA
| | | | - James Vredenburgh
- Department of Hematology and OncologySmilow Cancer Hospital at St. FrancisHartfordConnecticutUSA
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Lequain H, Gerfaud‐Valentin M, Fontaine J, Ferrant E, Grumet P, Jamilloux Y, Traverse‐Glehen A, Sève P. Crystal-storing histiocytosis and Bing-Neel-like syndrome revealing a small B-cell lymphoma with plasmacytic differentiation, presumed to be a marginal zone lymphoma. Clin Case Rep 2021; 9:e05202. [PMID: 34934503 PMCID: PMC8650757 DOI: 10.1002/ccr3.5202] [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: 01/06/2021] [Revised: 09/20/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
Crystal-storing histiocytosis and Bing-Neel syndrome are two diseases induced by paraproteins. Herein, we report a rare case of crystal-storing histiocytosis associated with Bing-Neel-like neurological manifestations in the context of a small B-cell lymphoma with plasmacytic differentiation, presumed to be a marginal zone lymphoma.
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Affiliation(s)
- Hippolyte Lequain
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
| | - Mathieu Gerfaud‐Valentin
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
| | - Juliette Fontaine
- Department of PathologyCentre Hospitalier Lyon SudHospices Civils de LyonLyonFrance
| | | | - Pierre Grumet
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
| | - Yvan Jamilloux
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
| | | | - Pascal Sève
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
- Pôle IMERLyonFrance
- HESPER EALyonFrance
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46
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Ellenbogen Y, Al-Khotani A, Tang-Wai D, Fasano A, Agid R, Hodaie M. Bing-Neel Syndrome: A Rare Mimic of Secondary Normal Pressure Hydrocephalus. Neurology 2021; 97:1033-1034. [PMID: 34635562 DOI: 10.1212/wnl.0000000000012917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yosef Ellenbogen
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - Afnan Al-Khotani
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - David Tang-Wai
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - Alfonso Fasano
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - Ronit Agid
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada
| | - Mojgan Hodaie
- From the Divisions of Neurosurgery (Y.E., A.A.-K., M.H.) and Neurology (D.T.-W., A.F.), University of Toronto; Krembil Brain Institute (D.T.-W., A.F., M.H.); Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic (A.F.) and Division of Neuroradiology, Joint Department of Medical Imaging (R.A.), Toronto Western Hospital, UHN, Toronto, Canada.
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Carella M, Stefoni V, Broccoli A, Argnani L, Zinzani PL. A Case of Bing-Neel Syndrome Treated Successfully With Ibrutinib Monotherapy Following Intensive Chemoimmunotherapy. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2021; 21:e817-e819. [PMID: 34281758 DOI: 10.1016/j.clml.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/09/2021] [Accepted: 06/19/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Matteo Carella
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Vittorio Stefoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Lisa Argnani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy.
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Saburi M, Saburi Y, Kawano K, Sato R, Urabe S, Ohtsuka E. Successful treatment with tirabrutinib for relapsed lymphoplasmacytic lymphoma complicated by Bing-Neel syndrome. Int J Hematol 2021; 115:585-589. [PMID: 34699012 DOI: 10.1007/s12185-021-03246-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/28/2022]
Abstract
A 53-year-old woman was diagnosed with lymphoplasmacytic lymphoma (LPL)/Waldenström's macroglobulinemia (WM) in 2008. Six courses of R-COP (rituximab, cyclophosphamide, vincristine, and prednisolone) resulted in complete remission, but LPL/WM relapsed in 2015. After six courses of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone), the M-peak disappeared, but the patient presented with muscle weakness and sensory disturbance in the lower extremities. No lesions were apparent in the brain parenchyma, but T2-weighted magnetic resonance imaging (MRI) showed a signal-hyperintense area with contrast enhancement in the spinal cord at the C2-4 and Th2-3 levels, and cerebrospinal fluid (CSF) examination showed only a few mononuclear cells. In 2020, the patient started to require walking assistance, and MRI findings worsened. Neurologically, lower limb muscle strength was reduced (manual muscle test score 3), and sensations of touch and pain were about 30% of normal. Vibratory sensation was absent at the knees and medial malleoli, accompanied by dysuria due to neurogenic bladder. CSF cell count was 15/μl (all mononuclear cells). Bing-Neel syndrome (BNS) was diagnosed and tirabrutinib was started. Within 2 months of treatment, lower extremity muscle strength had normalized and MRI findings had improved. Tirabrutinib may offer a promising therapeutic option for BNS.
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Affiliation(s)
- Masuho Saburi
- Department of Hematology, Oita Prefectural Hospital, 8-1 Bunyo 2-chome, Oita, 870-8511, Japan.
| | - Yoshio Saburi
- Department of Hematology, Oita Prefectural Hospital, 8-1 Bunyo 2-chome, Oita, 870-8511, Japan
| | - Katsuya Kawano
- Department of Clinical Laboratory Technology, Oita Prefectural Hospital, Oita, Japan
| | - Ryuichi Sato
- Department of Neurology, Oita Prefectural Hospital, Oita, Japan
| | - Shogo Urabe
- Department of Pathology, Oita Prefectural Hospital, Oita, Japan
| | - Eiichi Ohtsuka
- Department of Hematology, Oita Prefectural Hospital, 8-1 Bunyo 2-chome, Oita, 870-8511, Japan
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Nguyen Van D, Duong Van N, Le Van Q, Ngo Thanh T, Ta Van T. External-Beam Radiotherapy Alone Management of Primary CNS Lymphoplasmacytic Lymphoma: A Vietnamese Case Report and Literature Review. J Blood Med 2021; 12:769-774. [PMID: 34456597 PMCID: PMC8387585 DOI: 10.2147/jbm.s326165] [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: 06/25/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background Primary central nervous system (CNS) lymphoma is an uncommon non-Hodgkin disease limited to the CNS, and most cases are diffuse large B-cell lymphomas. Other pathologies, including lymphoplasmacytic lymphoma (LPL), are exceedingly rare and poorly understood. The clinical presentation of primary CNS LPL is diverse. It depends on the original site and the tumor’s extension. There is currently no consensus on a treatment strategy for this uncommon manifestation. To our knowledge, no previously published case was successfully treated with radiation therapy alone. Case Presentation We present here a case of primary CNS LPL. A 46-year-old, previously healthy woman was presented with a worsening headache and lower extremity numbness. Multifocal enhanced masses were detected in an MRI with biopsy results consistent with LPL. A complete staging workup was performed with no evidence of systemic disease. The patient received external-beam radiotherapy alone and had a complete remission. After 2 years of follow-up, she remains disease-free. Conclusion Radiation alone is a promising treatment option for primary CNS lymphoplasmacytic lymphoma.
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Affiliation(s)
- Dang Nguyen Van
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam.,Department of Head and Neck Radiation Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Nghia Duong Van
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Quang Le Van
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Tung Ngo Thanh
- Department of Head and Neck Radiation Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - To Ta Van
- Center of Pathology and Molecular Biology, Vietnam National Cancer Hospital, Hanoi, Vietnam
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Abstract
Paraproteinaemic neuropathies comprise a heterogeneous group of neuro-haematological conditions with some distinct neurological, haematological and systemic phenotypes. The spectrum of disease varies from mild to severe, indolent to rapidly progressive and from small fibre sensory involvement to dramatic sensorimotor deficits. The haematological association may be overlooked, resulting in delayed treatment, disability, impaired quality of life and increased mortality. However, the presence of an irrelevant benign paraprotein can sometimes lead to inappropriate treatment. In this review, we outline our practical approach to paraproteinaemic disorders, discuss the utility and limitations of diagnostic tests and the distinctive clinical phenotypes and touch on the complex multidisciplinary management approaches.
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Affiliation(s)
- Antonia S Carroll
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,National Hospital for Neurology and Neurosurgery, London, UK
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