1
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Zhang S, Ma M, Liu Y, Bu Y, Zhang Z, Zhang Y. Circulating Monocytes Phagocytosing Lymphocytes in the Small-Cell Variant of T-Cell Prolymphocytic Leukemia. Turk J Haematol 2024; 41:53-54. [PMID: 38153214 PMCID: PMC10918400 DOI: 10.4274/tjh.galenos.2023.2023.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/28/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Shuai Zhang
- The District People’s Hospital of Zhangqiu, Department of Emergency, Jinan, China
| | - Meng Ma
- The District People’s Hospital of Zhangqiu, Department of Emergency, Jinan, China
| | - Yanping Liu
- The District People’s Hospital of Zhangqiu, Department of Emergency, Jinan, China
| | - Ying Bu
- The District People’s Hospital of Zhangqiu, Department of Emergency, Jinan, China
| | - Zhe Zhang
- The District People’s Hospital of Zhangqiu, Department of Emergency, Jinan, China
| | - Yun Zhang
- The District People’s Hospital of Zhangqiu, Department of Clinical Laboratory, Jinan, China
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2
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Momose H, Kurita N, Nishikii H, Yusa N, Yokoyama K, Shimizu E, Imoto S, Nanmoku T, Maruyama Y, Sakamoto T, Yokoyama Y, Kato T, Matsuoka R, Obara N, Sakata-Yanagimoto M, Chiba S. [Durable remission of T-cell prolymphocytic leukemia with CLEC16A::IL2 after allogeneic hematopoietic stem cell transplantation]. Rinsho Ketsueki 2024; 65:35-40. [PMID: 38311387 DOI: 10.11406/rinketsu.65.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
A 64-year-old woman presented with fine motor impairment in both hands. MRI revealed a contrast-enhanced lesion in the medulla oblongata. Lymphoid cells with abnormal blebs were observed and a CD4+/CD8+ double positive (DP) T cell population was detected by flow cytometry (FCM) in the bone marrow (BM) and the peripheral blood (PB). CLEC16A::IL2 fusion gene was identified by whole exome sequencing with DNA prepared from DP T cells. Clonal rearrangement of the T-cell receptor gene and expression of TCL1A protein were detected. This led to a diagnosis of T-cell prolymphocytic leukemia (T-PLL) with central nervous system (CNS) infiltration. Abnormal cells in BM and PB became undetectable on microscopy and FCM, and the CNS lesion disappeared on MRI after second-line therapy with alemtuzumab. Meanwhile, the CLEC16A::IL2 fusion mRNA remained detectable in PB. Allogeneic hematopoietic stem-cell transplantation was performed, and the fusion mRNA has now been undetectable for more than 5 years since transplantation. This is the first report of a T-PLL case with a CLEC16A::IL2 fusion gene.
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Affiliation(s)
- Haruka Momose
- Department of Hematology, University of Tsukuba Hospital
| | - Naoki Kurita
- Department of Hematology, University of Tsukuba Hospital
- Department of Hematology, Institute of Medicine, University of Tsukuba
| | - Hidekazu Nishikii
- Department of Hematology, University of Tsukuba Hospital
- Department of Hematology, Institute of Medicine, University of Tsukuba
| | - Nozomi Yusa
- Department of Applied Genomics, Research Hospital, The Institute of Medical Science, The University of Tokyo
| | - Kazuaki Yokoyama
- Department of Hematology & Oncology, The Institute of Medical Science, The University of Tokyo
| | - Eigo Shimizu
- Division of Health Medical Intelligence, Human Genome Center, The Institute of Medical Science, The University of Tokyo
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, The Institute of Medical Science, The University of Tokyo
| | - Toru Nanmoku
- Department of Laboratory Medicine, University of Tsukuba Hospital
| | | | - Tatsuhiro Sakamoto
- Department of Hematology, University of Tsukuba Hospital
- Department of Hematology, Institute of Medicine, University of Tsukuba
| | - Yasuhisa Yokoyama
- Department of Hematology, University of Tsukuba Hospital
- Department of Hematology, Institute of Medicine, University of Tsukuba
| | - Takayasu Kato
- Department of Hematology, University of Tsukuba Hospital
- Department of Hematology, Institute of Medicine, University of Tsukuba
| | - Ryota Matsuoka
- Department of Diagnostic Pathology, Institute of Medicine, University of Tsukuba
| | - Naoshi Obara
- Department of Hematology, University of Tsukuba Hospital
- Department of Hematology, Institute of Medicine, University of Tsukuba
| | - Mamiko Sakata-Yanagimoto
- Department of Hematology, University of Tsukuba Hospital
- Department of Hematology, Institute of Medicine, University of Tsukuba
| | - Shigeru Chiba
- Department of Hematology, University of Tsukuba Hospital
- Department of Hematology, Institute of Medicine, University of Tsukuba
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3
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Hu Z, Medeiros LJ, Xu M, Yuan J, Peker D, Shao L, Tang Z, Mai B, Thakral B, Rios A, Hu S, Wang W. T-Cell Prolymphocytic Leukemia With t(X;14)(q28;q11.2): A Clinicopathologic Study of 15 Cases. Am J Clin Pathol 2023; 159:325-336. [PMID: 36883805 DOI: 10.1093/ajcp/aqac166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/08/2022] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVES T-cell prolymphocytic leukemia (T-PLL) is a rare mature T-cell leukemia usually characterized by inv(14)(q11.2q32)/t(14;14)(q11.2;q32). In this study, we aimed to investigate the clinicopathologic features and molecular profile of T-PLL associated with t(X;14)(q28;q11.2). METHODS The study group included 10 women and 5 men with a median age of 64 years. All 15 patients had a diagnosis of T-PLL with t(X;14)(q28;q11.2). RESULTS All 15 patients had lymphocytosis at initial diagnosis. Morphologically, the leukemic cells had features of prolymphocytes in 11 patients, small cell variant in 3, and cerebriform variant in 1. All 15 patients had hypercellular bone marrow with an interstitial infiltrate in 12 (80%) cases. By flow cytometry, the leukemic cells were surface CD3+/CD5+/CD7+/CD26+/CD52+/TCR α/β+ in 15 (100%) cases, CD2+ in 14 (93%) cases, CD4+/CD8+ in 8 (53%) cases, CD4+/CD8- in 6 (40%) cases, and CD4-/CD8 + in 1 (7%) case. At the cytogenetic level, complex karyotypes with t(X;14)(q28;q11.2) were seen in all 15 patients assessed. Mutational analysis showed mutations of JAK3 in 5 of 6 and STAT5B p.N642H in 2 of 6 patients. Patients received variable treatments, including 12 with alemtuzumab. After a median follow-up of 17.2 months, 8 of 15 (53%) patients died. CONCLUSIONS T-PLL with t(X;14)(q28;q11.2) frequently shows a complex karyotype and mutations involving JAK/STAT pathway, and it is an aggressive disease with a poor outcome.
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Affiliation(s)
- Zhihong Hu
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mina Xu
- Department of Pathology, Yale University Medical Center, New Haven, CT, USA
| | - Ji Yuan
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Minneapolis, MN, USA
| | - Deniz Peker
- Department of Pathology, Emory University, Atlanta, GA, USA
| | - Lina Shao
- Department of Pathology, The University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Zhenya Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brenda Mai
- Department of Pathology, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Beenu Thakral
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adan Rios
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shimin Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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4
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Huang-Xu L, Bertret C, Bodaghi B, Maestri F, Touhami S. Anterior Chamber Cytology Confirms the Diagnosis of T-cell Prolymphocytic Leukemia Masquerading as Viral Retinal Necrosis. Ocul Immunol Inflamm 2023:1-4. [PMID: 36821712 DOI: 10.1080/09273948.2023.2180648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE To describe a case of T-cell prolymphocytic leukemia (T-PLL) masquerading as viral retinal necrosis (VRN). CASE PRESENTATION A 75-year-old-man with a history of T-PLL in complete remission complained of an acute vision loss in his right and only eye. Ophthalmic examination demonstrated the presence of anterior chamber cells, mild vitritis, and peripheral retinal whitening with intraretinal hemorrhages evocative of VRN. While the anterior chamber tap came back negative for HSV, VZV, and CMV, cytology performed on the aqueous humor described the presence of leukemic cells. CONCLUSION T-PLL can rarely masquerade as a viral retinal necrosis. Diagnostic work-up should therefore always rule out the infectious causes of retinitis. Anterior chamber tap can sometimes prove useful in the diagnosis of T-PLL even in the absence of a hypopyon, avoiding the need for vitrectomy.
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Affiliation(s)
- Lydie Huang-Xu
- Department of Ophthalmology, Pitié Salpetrière University Hospital, Sorbonne Université, Paris, France
| | - Clara Bertret
- Department of Ophthalmology, Pitié Salpetrière University Hospital, Sorbonne Université, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié Salpetrière University Hospital, Sorbonne Université, Paris, France
| | - Federico Maestri
- Department of Ophthalmology, Pitié Salpetrière University Hospital, Sorbonne Université, Paris, France
| | - Sara Touhami
- Department of Ophthalmology, Pitié Salpetrière University Hospital, Sorbonne Université, Paris, France
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5
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Okada N, Yamamoto R, Maruoka H, Himeno M, Hiramoto N, Ishikawa T. Haploidentical Stem Cell Transplantation Using Post-Transplant Cyclophosphamide for T-Cell Prolymphocytic Leukemia after Alemtuzumab Induction Therapy: A Case Report. Case Rep Oncol 2023; 16:604-612. [PMID: 37900793 PMCID: PMC10601731 DOI: 10.1159/000531471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 10/31/2023] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a rare aggressive disease with a poor prognosis. Allogeneic stem cell transplantation (allo-SCT) followed by alemtuzumab administration is the most promising treatment for T-PLL but is associated with a high risk of infections as alemtuzumab strongly suppresses cellular immunity, leading to high transplant-related mortality and unsatisfactory survival rates. In addition, for patients without human leukocyte antigen-matched donors, haploidentical stem cell transplantation (haplo-SCT) using post-transplant cyclophosphamide (PTCy) has been used because of the ready availability of donors and achievement of results comparable to those of transplantation with human leukocyte antigen-matched donors. However, there are no reports on the efficacy and safety, including infectious complications, of haplo-SCT with PTCy after alemtuzumab therapy in patients with. Here, we describe a 66-year-old Japanese male patient with T-PLL treated successfully with haplo-SCT after induction therapy of alemtuzumab for T-PLL. Approximately 3 months after the achievement of complete remission with alemtuzumab for T-PLL, haplo-SCT with reduced-intensity conditioning and PTCy was performed. Infectious complications were improved by early therapeutic interventions, and peripheral T cell counts gradually recovered. The patient was alive for more than 16 months after allo-SCT with no signs of relapse. Thus, haplo-SCT using PTCy should be considered as an option after alemtuzumab treatment for T-PLL.
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Affiliation(s)
- Naoki Okada
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryusuke Yamamoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hayato Maruoka
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mayuko Himeno
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
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6
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Abstract
T-cell clones can frequently be identified in peripheral blood. It can be difficult to appreciate whether these are benign and transient or whether they signify a clonal disorder. We review factors that aid in understanding the relevance of T-cell clones. Conversely, obvious pathological T-cell clones can be detected in blood, but there is uncertainty in how to categorize this clonal T cell population, thus, we adopt a multidisciplinary review of the clinical features, diagnostic material and radiology before making the diagnosis. In this review we shall discuss some of these challenges faced when diagnosing mature T-cell leukemias.
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Affiliation(s)
- Dima El-Sharkawi
- Department of Haematology, The Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Ayoma Attygalle
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Claire Dearden
- Department of Haematology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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7
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Patil P, Hillebrecht S, Chteinberg E, López C, Toprak UH, Seufert J, Bernhart SH, Kretzmer H, Bergmann AK, Bens S, Högel J, Scheffold A, Chelliah Jebaraj BM, Schrader A, Johansson P, Costa D, Schlesner M, Dürig J, Herling M, Campo E, Stilgenbauer S, Wiehle L, Siebert R. T-cell prolymphocytic leukemia is associated with deregulation of oncogenic microRNAs on transcriptional and epigenetic level. Genes Chromosomes Cancer 2022; 61:432-436. [PMID: 35218115 DOI: 10.1002/gcc.23034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/09/2022] Open
Abstract
Deregulation of micro(mi)-RNAs is a common mechanism in tumorigenesis. We investigated the expression of 2083 miRNAs in T-cell prolymphocytic leukemia (T-PLL). Compared to physiologic CD4+ and CD8+ T-cell subsets, 111 miRNAs were differentially expressed in T-PLL. Of these, 33 belonged to miRNA gene clusters linked to cancer. Genomic variants affecting miRNAs were infrequent with the notable exception of copy number aberrations. Remarkably, we found strong upregulation of the miR-200c/-141 cluster in T-PLL to be associated with DNA hypomethylation and active promoter marks. Our findings suggest that copy number aberrations and epigenetic changes could contribute to miRNA deregulation in T-PLL. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Paurnima Patil
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Sina Hillebrecht
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Emil Chteinberg
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Cristina López
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany.,Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany.,Haematopathology Section, Hospital Clínic, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Umut H Toprak
- Bioinformatics and Omics Data Analytics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany.,Division Neuroblastoma Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Hopp-Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
| | - Julian Seufert
- Bioinformatics and Omics Data Analytics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Stephan H Bernhart
- Interdisciplinary Center for Bioinformatics, Transcriptome Bioinformatics, University of Leipzig, Germany
| | - Helene Kretzmer
- Interdisciplinary Center for Bioinformatics, Transcriptome Bioinformatics, University of Leipzig, Germany
| | - Anke K Bergmann
- Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany.,Institute for Human Genetics, Hannover Medical School, Hannover, Germany
| | - Susanne Bens
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany.,Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Josef Högel
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Annika Scheffold
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | | | - Alexandra Schrader
- Department of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Study Group (DCLLSG), University of Cologne, Cologne, Germany
| | - Patricia Johansson
- Institute for Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Dolors Costa
- Haematopathology Section, Hospital Clínic, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Matthias Schlesner
- Bioinformatics and Omics Data Analytics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Biomedical Informatics, Data Mining and Data Analytics, Faculty of Applied Informatics and Medical Faculty, Augsburg University, Augsburg, Germany
| | - Jan Dürig
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marco Herling
- Department of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Study Group (DCLLSG), University of Cologne, Cologne, Germany.,Clinic of Hematology, Cellular Therapy and Hemostaseology, University of Leipzig, Leipzig, Germany
| | - Elias Campo
- Haematopathology Section, Hospital Clínic, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Laura Wiehle
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany.,Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
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8
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Edmonds N, Guerra R, Noland MMB, Schenck O, Krasner B, Gru AA. An unusual case of T-cell prolymphocytic leukemia mimicking a cutaneous vasculitis. J Cutan Pathol 2021; 48:1311-1316. [PMID: 34089197 DOI: 10.1111/cup.14079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
T-cell prolymphocytic leukemia (T-PLL) is an aggressive post-thymic T-cell malignancy, which accounts for 2% of mature lymphocytic leukemias in adults. Though typically presenting with a brief history of B symptoms, hepatosplenomegaly, and marked lymphocytosis, erythematous or nodular skin rashes involving the trunk or limbs may be seen in 25% to 30% of patients, as well as a purpuric rash in a periorbital distribution. Cutaneous involvement typically presents in the context of patients with an established history of T-PLL, but it can less frequently present as an initial symptom heralding the diagnosis. An unusual case of T-PLL is described, presenting initially as palmoplantar ulcerated nodules with an initial biopsy suggestive of perniosis, followed by rapid progression of dark violaceous and bright red papules throughout the body after initiation of Obinutuzumab. The diagnosis of T-PLL was subsequently fully supported by the clinical, laboratory, cytologic, and immunophenotypic findings. This case highlights the importance of a multidisciplinary team approach to address such rare and atypical presentations.
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Affiliation(s)
- Nicole Edmonds
- Department of Dermatology, University of Virginia, Charlottesville, Virginia, USA
| | - Ricardo Guerra
- Department of Dermatology, University of Virginia, Charlottesville, Virginia, USA
| | - Mary-Margaret B Noland
- Department of Pathology and Dermatology, University of Virginia, Charlottesville, Virginia, USA
| | - Olivia Schenck
- Department of Dermatology, University of Virginia, Charlottesville, Virginia, USA
| | - Brett Krasner
- Department of Dermatology, Family Albemarle Dermatology, Charlottesville, Virginia, USA
| | - Alejandro A Gru
- Department of Pathology and Dermatology, University of Virginia, Charlottesville, Virginia, USA
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9
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Leckey BD, Kheterpal MK, Selim MA, Al-Rohil RN. Cutaneous involvement by T-cell prolymphocytic leukemia presenting as livedoid vasculopathy. J Cutan Pathol 2021; 48:975-979. [PMID: 33837964 DOI: 10.1111/cup.14023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/26/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a rare, aggressive neoplasm derived from post-thymic T-cells. Patients are typically middle aged with a slight male predominance who present with a high white blood cell count, hepatosplenomegaly, lymphadenopathy, and other symptoms typically associated with leukemia. Although cutaneous involvement has been reported in up to 30% of cases of T-PLL, to our knowledge, none have presented with a presentation resembling livedoid vasculopathy. In the correct clinical context, an underlying hematolymphoid neoplasm should be included in the differential diagnosis of a patient presenting with livedoid vasculopathy.
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Affiliation(s)
- Bruce D Leckey
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Meenal K Kheterpal
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - M Angelica Selim
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Rami N Al-Rohil
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
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10
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Johansson P, Dierichs L, Klein-Hitpass L, Bergmann AK, Möllmann M, Menninger S, Habenberger P, Klebl B, Siveke JT, Dührsen U, Choidas A, Dürig J. Anti-leukemic effect of CDK9 inhibition in T-cell prolymphocytic leukemia. Ther Adv Hematol 2020; 11:2040620720933761. [PMID: 33117517 PMCID: PMC7570784 DOI: 10.1177/2040620720933761] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 05/19/2020] [Indexed: 12/22/2022] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is an aggressive malignancy characterized by chemotherapy resistance and a median survival of less than 2 years. Here, we investigated the pharmacological effects of the novel highly specific cyclin-dependent kinase 9 (CDK9) inhibitor LDC526 and its clinically used derivate atuveciclib employing primary T-PLL cells in an ex vivo drug sensitivity testing platform. Importantly, all T-PLL samples were sensitive to CDK9 inhibition at submicromolar concentrations, while conventional cytotoxic drugs were found to be largely ineffective. At the cellular level LDC526 inhibited the phosphorylation at serine 2 of the RNA polymerase II C-terminal domain resulting in decreased de novo RNA transcription. LDC526 induced apoptotic leukemic cell death through down-regulating MYC and MCL1 both at the mRNA and protein level. Microarray-based transcriptomic profiling revealed that genes down-modulated in response to CDK9 inhibition were enriched for MYC and JAK-STAT targets. By contrast, CDK9 inhibition increased the expression of the tumor suppressor FBXW7, which may contribute to decreased MYC and MCL1 protein levels. Finally, the combination of atuvecliclib and the BCL2 inhibitor venetoclax exhibited synergistic anti-leukemic activity, providing the rationale for a novel targeted-agent-based treatment of T-PLL.
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Affiliation(s)
| | - Laura Dierichs
- Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Ludger Klein-Hitpass
- Institute of Cell Biology (Cancer Research), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anke K. Bergmann
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Michael Möllmann
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | | | - Bert Klebl
- Lead Discovery Center GmbH, Dortmund, Germany
| | - Jens T. Siveke
- Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Solid Tumor Translational Oncology, German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Ulrich Dührsen
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Jan Dürig
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK, partner site Essen) and German Cancer Research Center (DKFZ), Heidelberg, Germany
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11
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Johansson P, Klein-Hitpass L, Röth A, Möllmann M, Reinhardt HC, Dührsen U, Dürig J. Mutations in PIGA cause a CD52-/GPI-anchor-deficient phenotype complicating alemtuzumab treatment in T-cell prolymphocytic leukemia. Eur J Haematol 2020; 105:786-796. [PMID: 32875608 DOI: 10.1111/ejh.13511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Infusional alemtuzumab followed by consolidating allogeneic hematopoietic stem cell transplantation in eligible patients is considered a standard of care in T-cell prolymphocytic leukemia (T-PLL). Antibody selection against CD52 has been associated with the development of CD52-negative leukemic T cells at time of relapse. Clinical implications and molecular mechanisms underlying this phenotypic switch are unknown. METHODS We performed flow cytometry and real-time-PCR for CD52-expression and next generation sequencing for PIGA mutational analyses. RESULTS We identified loss of CD52 expression after alemtuzumab treatment in two of 21 T-PLL patients resulting from loss of GPI-anchor expression caused by inactivating mutations of the PIGA gene. One patient with relapsed T-PLL exhibited a single PIGA mutation, causing a CD52-negative escape variant of the initial leukemic cell clone, preventing alemtuzumab-retreatment. The second patient with continued complete remission after alemtuzumab treatment harbored three different PIGA mutations that affected either the non-neoplastic T cell or the mononuclear cell compartment and resulted in symptomatic paroxysmal nocturnal hemoglobinuria. Next generation sequencing of T-PLL cells collected before the initiation of treatment revealed PIGA wild-type sequence reads in all 16 patients with samples available for testing. CONCLUSION These data indicate that PIGA mutations were acquired during or after completion of alemtuzumab treatment.
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Affiliation(s)
- Patricia Johansson
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ludger Klein-Hitpass
- Institute of Cell Biology (Cancer Research), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexander Röth
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Möllmann
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans Christian Reinhardt
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
| | - Ulrich Dührsen
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Dürig
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,Department of General Internal Medicine, St. Josef-Krankenhaus, Medical Faculty, University of Duisburg-Essen, Essen, Germany
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12
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Statuto T, D'Auria F, Del Vecchio L, Mansueto GR, Villani O, Lalinga AV, Possidente L, Nozza F, Vona G, Rago L, Storto G, Gasparini VR, Zambello R, D'Arena G, Valvano L. Atypical Mature T-Cell Neoplasms: The Relevance of the Role of Flow Cytometry. Onco Targets Ther 2020; 13:7605-7614. [PMID: 32848413 PMCID: PMC7425660 DOI: 10.2147/ott.s258512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022] Open
Abstract
Lymphoproliferative disorders are a heterogeneous group of malignant clonal proliferations of lymphocytes whose diagnosis remains challenging, despite diagnostic criteria are now well established, due to their heterogeneity in clinical presentation and immunophenotypic profile. Lymphoid T-cell disorders are more rarely seen than B-cell entities and more difficult to diagnose for the absence of a specific immunophenotypic signature. Flow cytometry is a useful tool in diagnosing T-cell lymphoproliferative disorders since it is not only able to better characterize T-cell neoplasms but also to resolve some very complicated cases, in particular those in which a small size population of neoplastic cells is available for the analysis. Here, we report three patients with mature T-cell neoplasms with atypical clinical and biological features in which analysis of peripheral blood and bone marrow specimens by means of multicolor flow cytometry was very useful to identify and characterize three rare T-cell lymphoproliferative disorders, such as angioimmunoblastic T-cell lymphoma, peripheral T-cell lymphoma not otherwise specified and T-cell prolymphocytic leukemia. The aim of this case series report is not only to describe three rare cases of lymphoproliferative neoplasms but also to raise awareness that a fast, highly sensitive, and reproducible procedure, such as flow cytometry immunophenotyping, can have a determinant diagnostic role in these patients.
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Affiliation(s)
- Teodora Statuto
- Laboratory of Clinical Research and Advanced Diagnostics, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Fiorella D'Auria
- Unit of Clinical Pathology, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Luigi Del Vecchio
- CEINGE Biotecnologie Avanzate S.c.a.r.l, Federico II University, Naples, Italy.,Department of Molecular Medicine and Medical Biotechnology (DMMBM), Federico II University, Naples, Italy
| | - Giovanna Rosaria Mansueto
- Hematology Department of Basilicata, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Oreste Villani
- Hematology Department of Basilicata, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Anna Vittoria Lalinga
- Pathology Unit, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Luciana Possidente
- Pathology Unit, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Filomena Nozza
- Laboratory of Clinical Research and Advanced Diagnostics, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Gabriella Vona
- Laboratory of Clinical Research and Advanced Diagnostics, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Luciana Rago
- Radiotherapy Unit, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Giovanni Storto
- Department of Nuclear Medicine, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Vanessa Rebecca Gasparini
- Department of Medicine, University of Padova - Veneto Institute of Molecular Medicine, VIMM, Padova, PD, Italy
| | - Renato Zambello
- Hematology and Clinical Immunology, Department of Medicine, Padua School of Medicine, Padova, PD, Italy
| | - Giovanni D'Arena
- Hematology Department of Basilicata, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Luciana Valvano
- Laboratory of Clinical Research and Advanced Diagnostics, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
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13
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Dong S, Khedro T, Ward P, Dubeau L, Yaghmour B, Siddiqi I, Yaghmour G. First reported case of BRAF V600E mutation in T-cell prolymphocytic leukaemia. Br J Haematol 2020; 191:e52-e55. [PMID: 32712959 DOI: 10.1111/bjh.16992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Stephen Dong
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Tarek Khedro
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Pamela Ward
- Department of Pathology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Louis Dubeau
- Department of Pathology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Bassam Yaghmour
- Pulmonary, Critical Care, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Imran Siddiqi
- Department of Pathology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - George Yaghmour
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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14
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Wahnschaffe L, Herling M. What to Look Out for when Transplanting T-Cell Prolymphocytic Leukemia. Acta Haematol 2020; 144:1-3. [PMID: 32369824 DOI: 10.1159/000507415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Linus Wahnschaffe
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, University of Cologne, Cologne, Germany
- Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Marco Herling
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), Aachen-Bonn-Cologne-Duesseldorf, University of Cologne, Cologne, Germany,
- Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany,
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany,
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15
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Sun S, Fang W. Current understandings on T-cell prolymphocytic leukemia and its association with TCL1 proto-oncogene. Biomed Pharmacother 2020; 126:110107. [PMID: 32247279 DOI: 10.1016/j.biopha.2020.110107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/02/2023] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a rare mature T cell leukemia with aggressive clinical course, poor response to conventional therapies and high mortality rates. Classical cytogenetics and various genetic techniques have observed complex karyotypes and associated genes involved in the molecular pathogenesis of T-PLL, among which the proto-oncogene T-cell leukemia/lymphoma 1 (TCL1) as a hallmark of malignancy is hyper-activated and abnormally expressed in many T-PLL cases. Progress has been made to identify the presence of chromosomal rearrangements and subsequent changes in key molecular pathways typically involving Akt, which may hint cytogenetic mechanisms underlying the pathogenesis of T-PLL and indicate new treatment targets. In this article, we describe current insights of T-PLL with an emphasis on the potential role of TCL1 gene disorders and TCL1-Akt interactions in cell transformation and disease progression, followed by discussion on current treatment options and novel therapeutic approaches based on cytogenetics, which still remains to be explored for the effective management of T-PLL and other TCL1-driven hematological malignancies.
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Affiliation(s)
- Siyu Sun
- Medical College of Nanchang University, Nanchang, 330000, China; Queen Mary University of London, London, E1 4NS, UK.
| | - Wenjia Fang
- Medical College of Nanchang University, Nanchang, 330000, China; Queen Mary University of London, London, E1 4NS, UK.
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16
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Patil P, Cieslak A, Bernhart SH, Toprak UH, Wagener R, López C, Wiehle L, Bens S, Altmüller J, Franitza M, Scholz I, Jayne S, Ahearne MJ, Scheffold A, Jebaraj BMC, Schneider C, Costa D, Braun T, Schrader A, Campo E, Dyer MJS, Nürnberg P, Dürig J, Johansson P, Böttcher S, Schlesner M, Herling M, Stilgenbauer S, Macintyre E, Siebert R. Reconstruction of rearranged T-cell receptor loci by whole genome and transcriptome sequencing gives insights into the initial steps of T-cell prolymphocytic leukemia. Genes Chromosomes Cancer 2019; 59:261-267. [PMID: 31677197 DOI: 10.1002/gcc.22821] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 12/20/2022] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is an aggressive tumor with leukemic presentation of mature T-lymphocytes. Here, we aimed at characterizing the initial events in the molecular pathogenesis of T-PLL and particularly, at determining the point in T-cell differentiation when the hallmark oncogenic events, that is, inv(14)(q11q32)/t(14;14)(q11;q32) and t(X;14)(q28;q11) occur. To this end, we mined whole genome and transcriptome sequencing data of 17 and 11 T-PLL cases, respectively. Mapping of the 14q32.1 locus breakpoints identified only TCL1A, which was moreover significantly overexpressed in T-PLL as compared to benign CD4+ and CD8+ T-cells, as the only common oncogenic target of aberrations. In cases with t(14;14), the breakpoints mapped telomeric and in cases with inv(14) centromeric or in the 3'-untranslated region of TCL1A. Regarding the T-cell receptor alpha (TRA) locus-TCL1A breakpoint junctions, all 17 breakpoints involved recombination signal sequences and 15 junctions contained nontemplated (N-) nucleotides. All T-PLL cases studied carried in-frame TRA rearrangements on the intact allele, which skewed significantly toward usage of distal/central TRAV/TRAJ gene segments as compared to the illegitimate TRA rearrangements. Our findings suggest that the oncogenic TRA-TCL1A/MTCP1 rearrangements in T-PLL occur during opening of the TRA locus, that is, during the progression from CD4+ immature single positive to early double positive thymocyte stage, just before physiologic TCL1A expression is silenced. The cell carrying such an oncogenic event continues maturation and rearranges the second TRA allele to achieve a functional T-cell receptor. Thereafter, it switches off RAG and DNTT expression in line with the mature T-cell phenotype at presentation of T-PLL.
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Affiliation(s)
- Paurnima Patil
- Institute of Human Genetics, University of Ulm and University of Ulm Medical Center, Ulm, Germany
| | - Agata Cieslak
- Diagnostic Haematology, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut national de recherche médicale (INSERM), Paris, France
| | - Stephan H Bernhart
- Interdisciplinary Center for Bioinformatics, Transcriptome Bioinformatics, University of Leipzig, Leipzig, Germany
| | - Umut H Toprak
- Bioinformatics and Omics Data Analytics, German Cancer Research Center, Faculty of Biosciences, Heidelberg University, Heidelberg, Germany.,Division Neuroblastoma Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Hopp-Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
| | - Rabea Wagener
- Institute of Human Genetics, University of Ulm and University of Ulm Medical Center, Ulm, Germany.,Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Cristina López
- Institute of Human Genetics, University of Ulm and University of Ulm Medical Center, Ulm, Germany.,Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Laura Wiehle
- Institute of Human Genetics, University of Ulm and University of Ulm Medical Center, Ulm, Germany
| | - Susanne Bens
- Institute of Human Genetics, University of Ulm and University of Ulm Medical Center, Ulm, Germany.,Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Janine Altmüller
- Cologne Center for Genomics, Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Marek Franitza
- Cologne Center for Genomics, Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Ingrid Scholz
- Omics IT and Data Management Core Facility, German Cancer Research Center, Heidelberg, Germany
| | - Sandrine Jayne
- Ernest and Helen Scott Haematological Research Institute, Department of Cancer Studies, University of Leicester, Leicester, UK
| | - Matthew J Ahearne
- Ernest and Helen Scott Haematological Research Institute, Department of Cancer Studies, University of Leicester, Leicester, UK
| | - Annika Scheffold
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | - Billy M C Jebaraj
- Department of Internal Medicine III, University of Ulm, Ulm, Germany
| | | | - Dolors Costa
- Haematopathology Section, Hospital Clínic, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Till Braun
- Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Alexandra Schrader
- Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Elias Campo
- Haematopathology Section, Hospital Clínic, Institut d'Investigaciones Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Martin J S Dyer
- Ernest and Helen Scott Haematological Research Institute, Department of Cancer Studies, University of Leicester, Leicester, UK
| | - Peter Nürnberg
- Cologne Center for Genomics, Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Jan Dürig
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Patricia Johansson
- Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Böttcher
- Department III of Internal Medicine, University Hospital Rostock, Rostock, Germany
| | - Matthias Schlesner
- Bioinformatics and Omics Data Analytics, German Cancer Research Center, Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Marco Herling
- Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | | | - Elizabeth Macintyre
- Diagnostic Haematology, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut national de recherche médicale (INSERM), Paris, France
| | - Reiner Siebert
- Institute of Human Genetics, University of Ulm and University of Ulm Medical Center, Ulm, Germany.,Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
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17
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de Araujo ED, Orlova A, Neubauer HA, Bajusz D, Seo HS, Dhe-Paganon S, Keserű GM, Moriggl R, Gunning PT. Structural Implications of STAT3 and STAT5 SH2 Domain Mutations. Cancers (Basel) 2019; 11:E1757. [PMID: 31717342 PMCID: PMC6895964 DOI: 10.3390/cancers11111757] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 01/13/2023] Open
Abstract
Src Homology 2 (SH2) domains arose within metazoan signaling pathways and are involved in protein regulation of multiple pleiotropic cascades. In signal transducer and activator of transcription (STAT) proteins, SH2 domain interactions are critical for molecular activation and nuclear accumulation of phosphorylated STAT dimers to drive transcription. Sequencing analysis of patient samples has revealed the SH2 domain as a hotspot in the mutational landscape of STAT proteins although the functional impact for the vast majority of these mutations remains poorly characterized. Despite several well resolved structures for SH2 domain-containing proteins, structural data regarding the distinctive STAT-type SH2 domain is limited. Here, we review the unique features of STAT-type SH2 domains in the context of all currently reported STAT3 and STAT5 SH2 domain clinical mutations. The genetic volatility of specific regions in the SH2 domain can result in either activating or deactivating mutations at the same site in the domain, underscoring the delicate evolutionary balance of wild type STAT structural motifs in maintaining precise levels of cellular activity. Understanding the molecular and biophysical impact of these disease-associated mutations can uncover convergent mechanisms of action for mutations localized within the STAT SH2 domain to facilitate the development of targeted therapeutic interventions.
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Affiliation(s)
- Elvin D. de Araujo
- Centre for Medicinal Chemistry, University of Toronto at Mississauga, Mississauga, ON L5L 1C6, Canada;
- Department of Chemical & Physical Sciences, University of Toronto at Mississauga, Mississauga, ON L5L 1C6, Canada
| | - Anna Orlova
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine, A-1210 Vienna, Austria; (A.O.); (H.A.N.); (R.M.)
| | - Heidi A. Neubauer
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine, A-1210 Vienna, Austria; (A.O.); (H.A.N.); (R.M.)
| | - Dávid Bajusz
- Medicinal Chemistry Research Group, Research Center for Natural Sciences, 1117 Budapest, Hungary; (D.B.); (G.M.K.)
| | - Hyuk-Soo Seo
- Department of Cancer Biology, Dana-Farber Cancer Institute, Department of Biological Chemistry & Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA; (H.-S.S.); (S.D.-P.)
- Department of Biological Chemistry, Department of Biological Chemistry & Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Sirano Dhe-Paganon
- Department of Cancer Biology, Dana-Farber Cancer Institute, Department of Biological Chemistry & Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA; (H.-S.S.); (S.D.-P.)
- Department of Biological Chemistry, Department of Biological Chemistry & Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - György M. Keserű
- Medicinal Chemistry Research Group, Research Center for Natural Sciences, 1117 Budapest, Hungary; (D.B.); (G.M.K.)
| | - Richard Moriggl
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine, A-1210 Vienna, Austria; (A.O.); (H.A.N.); (R.M.)
| | - Patrick T. Gunning
- Centre for Medicinal Chemistry, University of Toronto at Mississauga, Mississauga, ON L5L 1C6, Canada;
- Department of Chemical & Physical Sciences, University of Toronto at Mississauga, Mississauga, ON L5L 1C6, Canada
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18
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Gilles SR, Yohe SL, Linden MA, Dolan M, Hirsch B, Grzywacz B. CD161 Is Expressed in a Subset of T-Cell Prolymphocytic Leukemia Cases and Is Useful for Disease Follow-up. Am J Clin Pathol 2019; 152:471-478. [PMID: 31305900 DOI: 10.1093/ajcp/aqz060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES CD161 (NKRP1) is a lectin-like receptor present on NK cells and rare T-cell subsets. We have observed CD161 expression in some cases of T-cell prolymphocytic leukemia (T-PLL) and found it to be useful in follow-up and detection of disease after treatment. METHODS Retrospective review of T-PLL cases with complete flow cytometry data including CD161. RESULTS We identified 10 cases of T-PLL with flow cytometric evaluation of CD161 available. Six of these cases were positive for CD161 expression. All CD161-positive cases were positive for CD8 with variable CD4 expression, whereas all CD161-negative cases were negative for CD8. In a case with two neoplastic subsets positive and negative for CD8, only the former expressed CD161. CONCLUSIONS These novel results suggest that CD161 is often aberrantly expressed in a defined subset of T-PLL positive for CD8. We are showing the utility of this immunophenotype in diagnosis and follow-up.
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Affiliation(s)
- Scott R Gilles
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Sophia L Yohe
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Michael A Linden
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Michelle Dolan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Betsy Hirsch
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Bartosz Grzywacz
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
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19
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Cohen L, Haque A, Ma S, Zhang L, Sokol L, Seminario-Vidal L. T-cell prolymphocytic leukemia presenting with erythematous patches, plaques, and erythema gyratum-like lesions masquerading as Sézary syndrome. JAAD Case Rep 2019; 5:686-690. [PMID: 31440557 PMCID: PMC6698441 DOI: 10.1016/j.jdcr.2019.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Leah Cohen
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Adel Haque
- Department of Dermatology, University of South Florida, Tampa, Florida
| | - Sophia Ma
- Department of Dermatology, University of South Florida, Tampa, Florida
| | - Ling Zhang
- Department of Hematopathology, Moffitt Cancer Center, Tampa, Florida
| | - Lubomir Sokol
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Lucia Seminario-Vidal
- Department of Dermatology, University of South Florida, Tampa, Florida.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
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20
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Pflug N, Cramer P, Robrecht S, Bahlo J, Westermann A, Fink AM, Schrader A, Mayer P, Oberbeck S, Seiler T, Zenz T, Dürig J, Kreuzer KA, Stilgenbauer S, Eichhorst B, Hallek M, Herling M, Hopfinger G. New lessons learned in T-PLL: results from a prospective phase-II trial with fludarabine-mitoxantrone-cyclophosphamide-alemtuzumab induction followed by alemtuzumab maintenance. Leuk Lymphoma 2018; 60:649-657. [PMID: 30234404 DOI: 10.1080/10428194.2018.1488253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Clinical trials in T-cell prolymphocytic leukemia (T-PLL) are scarce. Based on a precursor study testing fludarabine, mitoxantrone, and cyclophosphamide followed by alemtuzumab (FMC-A), we aimed to improve this regimen by upfront combining subcutaneous (s.c.) alemtuzumab with FMC for four cycles followed by an alemtuzumab-maintenance (FMCA + A). This prospective multicenter phase-II trial assessed response, survival, and toxicity of that regimen administered to pretreated (n = 4) and treatment-naïve (n = 12) T-PLL patients. The best overall response rate after FMCA was 68.8% (n = 11) including five CRs (31.3%) and six PRs (37.5%). Six patients entered the alemtuzumab-maintenance. Median overall and progression-free survival was 16.7 and 11.2 months, respectively. Hematologic toxicities were the most frequent grade 3/4 side effects. A reduced incidence of CMV-reactivations was attributed to the prophylactic administration of valganciclovir. Overall, FMCA + A did not improve the efficacy of the FMC-A-regimen or of single i.v. alemtuzumab. It suggests that a chemotherapy backbone prevents efficient alemtuzumab dosing and confirms that intravenous alemtuzumab is to be preferred over its s.c. route in T-PLL. ClinicalTrials.gov identifier: NCT01186640.
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Affiliation(s)
- Natali Pflug
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Paula Cramer
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Sandra Robrecht
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Jasmin Bahlo
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Anne Westermann
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Anna-Maria Fink
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Alexandra Schrader
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Petra Mayer
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Sebastian Oberbeck
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Till Seiler
- b Medizinische Klinik und Poliklinik III , LMU University of Munich , Munich , Germany
| | - Thorsten Zenz
- c National Center for Tumor Diseases Heidelberg , Heidelberg , Germany
| | - Jan Dürig
- d Klinik für Hämatologie , University of Essen , Essen , Germany
| | - Karl-Anton Kreuzer
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | | | - Barbara Eichhorst
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Michael Hallek
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Marco Herling
- a Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Deutsche CLL Studiengruppe (DCLLSG), Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD), and Center of Molecular Medicine Cologne (CMMC) , University of Cologne , Cologne , Germany
| | - Georg Hopfinger
- f AKH Wien , Universitätsklinik für Innere Medizin I , Vienna , Austria
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Shi Z, Yu J, Shao H, Cheng K, Zhai J, Jiang Q, Li H. Exploring the molecular pathogenesis associated with T-cell prolymphocytic leukemia based on a comprehensive bioinformatics analysis. Oncol Lett 2018; 16:301-307. [PMID: 29928415 PMCID: PMC6006439 DOI: 10.3892/ol.2018.8615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/27/2017] [Indexed: 12/25/2022] Open
Abstract
As a rare hematological malignancy, T-cell prolymphocytic leukemia (T-PLL) has a high mortality rate. However, the comprehensive mechanisms of the underlying pathogenesis of T-PLL are unknown. The purpose of the present study was to investigate the pathogenesis of T-PLL based on a comprehensive bioinformatics analysis. The differentially expressed genes (DEGs) between T-PLL blood cell samples and normal peripheral blood cell samples were investigated using the GSE5788 Affymetrix microarray data from the Gene Expression Omnibus database. To investigate the functional changes associated with tumor progression, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were used on the identified DEGs, followed by protein-protein interaction (PPI) and sub-PPI analysis. Transcription factors and tumor-associated genes (TAGs) were investigated further. The results identified 84 upregulated genes and 354 downregulated genes in T-PLL samples when compared with healthy samples. These DEGs featured in various functions including cell death and various pathways including apoptosis. The functional analysis of DEGs revealed 17 dysregulated transcription factors and 37 dysregulated TAGs. Furthermore, the PPI network analysis based on node degree (a network topology attribute) identified 61 genes, including the core downregulated gene of the sub-PPI network, signal transducer and activator of transcription 3 (STAT3; degree, 13) and the core upregulated gene, insulin receptor substrate-1 (IRS1; degree, 5), that may have important associations with the progression of T-PLL. Alterations to cell functions, including cell death, and pathways, including apoptosis, may contribute to the process of T-PLL. Candidate genes identified in the present study, including STAT3 and IRS1, should be targets for additional studies.
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Affiliation(s)
- Zhangzhen Shi
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Jing Yu
- Department of Nephrology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Hui Shao
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Kailiang Cheng
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Jingjie Zhai
- Department of Implantology, Jilin University Stomatology Hospital, Changchun, Jilin 130021, P.R. China
| | - Qi Jiang
- Department of Nephrology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Hongjun Li
- Medical Examination Center, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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Laribi K, Lemaire P, Sandrini J, Baugier de Materre A. Advances in the understanding and management of T-cell prolymphocytic leukemia. Oncotarget 2017; 8:104664-104686. [PMID: 29262669 PMCID: PMC5732835 DOI: 10.18632/oncotarget.22272] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/27/2017] [Indexed: 12/02/2022] Open
Abstract
T-prolymphocytic leukemia (T-PLL) is a rare T-cell neoplasm with an aggressive clinical course. Leukemic T-cells exhibit a post-thymic T-cell phenotype (Tdt-, CD1a-, CD5+, CD2+ and CD7+) and are generally CD4+/CD8-, but CD4+/CD8+ or CD8+/CD4- T-PLL have also been reported. The hallmark of T-PLL is the rearrangement of chromosome 14 involving genes for the subunits of the T-cell receptor (TCR) complex, leading to overexpression of the proto-oncogene TCL1. In addition, molecular analysis shows that T-PLL exhibits substantial mutational activation of the IL2RG-JAK1-JAK3-, STAT5B axis. T-PLL patients have a poor prognosis, due to a poor response to conventional chemotherapy. Monoclonal antibody therapy with antiCD52-alemtuzumab has considerably improved outcomes, but the responses to treatment are transient; hence, patients who achieve a response to therapy are considered for stem cell transplantation (SCT). This combined approach has extended the median survival to four years or more. Nevertheless, new approaches using well-tolerated therapies that target growth and survival signals are needed for most patients unable to receive intensive chemotherapy.
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Affiliation(s)
- Kamel Laribi
- Department of Hematology, Centre Hospitalier du Mans, Le Mans, France
| | - Pierre Lemaire
- Laboratory of Biology and Hematology, Centre Hospitalier du Mans, Le Mans, France
| | - Jeremy Sandrini
- Laboratory of Anatomopathology, Centre Hospitalier du Mans, Le Mans, France
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Abstract
Mature T-cell leukemias are a group of uncommon lymphoid neoplasms. These disorders have widely variable clinical features, ranging from indolent, slowly progressive processes to diseases with rapidly progressive courses, leading to death. Cytogenetic aberrations have long been identified in some of these diseases, and recent studies have found recurrent genetic mutations that contribute to their pathogenesis. Conventional multiagent chemotherapy lacks significant efficacy in this group of diseases and therapies vary from immunosuppression to treatment with monoclonal antibodies, antiviral agents, and hematopoietic stem cell transplantation. The recent expansion of knowledge regarding the underlying genetic basis of these disorders raises hope that new, more targeted therapeutic approaches will be available to patients in the near future.
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Affiliation(s)
- Nathanael G Bailey
- Department of Pathology, University of Michigan, M5242 Medical Science 1 1301 Catherine St, Ann Arbor, MI, 48109, USA.
| | - Kojo S J Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, 422 Curie Boulevard, Philadelphia, PA, 19104, USA.
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25
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Malkan UY, Gunes G, Yayar O, Demiroglu H, Yesilirmak A, Uner A. A T-cell prolymphocytic leukemia case with central nervous system involvement. Int J Clin Exp Med 2015; 8:14207-14209. [PMID: 26550397 PMCID: PMC4613082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/21/2015] [Indexed: 06/05/2023]
Abstract
T-cell prolymphocytic leukemia (T-PLL) is an aggressive mature T cell neoplasm that typically involves peripheral blood, bone marrow, lymph nodes and spleen. It is a rare disease that comprises 2-5% of mature lymphocytic leukemia in adults. Here we present a T-PLL patient with CNS involvement. A 74-year-old man admitted to a hospital in April 2014 with vomiting. He was diagnosed as chronic lymphocytic leukemia (CLL) and R-CVP (Rituximab, cyclophosphamide, vincristine and prednisolone) chemotherapy protocol was started. After the first two cycles of chemotherapy, the patient's mental functions improved. However after the 3(rd) cycle of chemotherapy was given in July 2014 the general situation of the patient deteriorated and ptosis of the left eye and facial paralysis developed. Then the patient was referred to our medical center. An MR of the brain revealed linear contrast enhancement around the bilateral 3(rd), 7(th) and 8(th) cranial nerves which indicated cranial involvement by the lymphoproliferative process (Figure 1). Cerebrospinal fluid cytological examination confirmed the diagnosis. Based on these and bone marrow aspiration and biopsy findings a diagnosis of T-PLL was rendered (Figure 3). In September 2014 the patient died suddenly due to a cardiac arrest. Differential diagnosis is very important in T-PLL. Both T-PLL and chronic lymphocytic leukemia (CLL) may present with splenomegaly and lymphocytosis as well as circulating prolymphocytes in blood. Typical CLL cells are like mature lymphocytes with dense nucleus and aggregated chromatin. To conclude, CNS involvement in T-PLL is a rare finding and differential diagnosis of T-PLL is very important.
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Affiliation(s)
- Umit Yavuz Malkan
- Department of Hematology, Faculty of Medicine, Hacettepe UniversityAnkara, Turkey
| | - Gursel Gunes
- Department of Hematology, Faculty of Medicine, Hacettepe UniversityAnkara, Turkey
| | - Okan Yayar
- Department of Hematology, Faculty of Medicine, Hacettepe UniversityAnkara, Turkey
| | - Haluk Demiroglu
- Department of Hematology, Faculty of Medicine, Hacettepe UniversityAnkara, Turkey
| | - Aysun Yesilirmak
- Department of Pathology, Faculty of Medicine, Hacettepe UniversityAnkara, Turkey
| | - Aysegul Uner
- Department of Pathology, Faculty of Medicine, Hacettepe UniversityAnkara, Turkey
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26
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Mitton B, Coutre S, Willert J, Schlis K, Porteus M, Kharbanda S, Agarwal-Hashmi R. A pediatric case of T-cell prolymphocytic leukemia. Pediatr Blood Cancer 2015; 62:1061-2. [PMID: 25417638 DOI: 10.1002/pbc.25336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/07/2014] [Indexed: 11/07/2022]
Abstract
T-cell Prolymphocytic Leukemia (T-PLL) is a rare entity, and to date has never been reported in children. Here, we describe the first pediatric case of T-PLL in a 16-year old male and review his clinical course through treatment. He underwent therapy with alemtuzumab and pentostatin, which was successful in inducing initial remission. He then underwent an allogeneic matched sibling stem cell transplant following a myeloablative conditioning regimen and remains disease-free 1.5 years after diagnosis.
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Affiliation(s)
- Bryan Mitton
- Department of Pediatrics, Division of Hematology-Oncology and Stem Cell Transplantation, Lucile Packard Children's Hospital at Stanford University, Palo Alto, California
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Dessart P, Lemaire P, Le Dû K, Sandrini J, Prophette B, Maillard H. [ T-cell prolymphocytic leukemia: potential diagnostic pitfalls]. Ann Dermatol Venereol 2014; 141:777-81. [PMID: 25433931 DOI: 10.1016/j.annder.2014.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/07/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sezary syndrome (SS) presents clinically as erythroderma, which may be pigmented, and pruritic, associated with peripheral lymphadenopathies. Erythroderma may also occur in a broad range of reactive and malignant conditions including T-cell prolymphocytic leukemia (T-PLL). We report a case initially diagnosed as SS but ultimately diagnosed as T-PLL based upon skin involvement. CASE REPORT A 70-year-old man was referred by his hematologist for management of SS. Physical examination revealed lymphadenopathies and mild diffuse erythema without infiltration. His WBC count was elevated at 8.3 G/L. A peripheral blood smear showed Sezary-like cells. Flow cytometry of peripheral blood revealed prolymphocytic T-cells staining positively for CD2, CD3, CD4 and CD7. Cytogenetic studies showed chromosomal abnormalities in terms of number and structure with missing chromosomes 6 and13, as well as deletion of chromosome 17. Finally, a diagnosis of T-PLL was made. Pentostatin was initiated pending treatment with alemtuzumab, but the patient's overall condition deteriorated rapidly and he died 10 days later. DISCUSSION Diagnosis of LPLT is based upon a number of factors. In the case presented herein, the clinically atypical nature of the skin lesions prompted the dermatologist to review the diagnosis. The morphology of the circulating T-lymphocytes and their immunologic and phenotypic characteristics finally ruled out the diagnosis of Sezary syndrome, while their association with compatible cytogenetic anomalies enabled a diagnosis of prolymphocytic leukemia to be made instead. CONCLUSION Prolymphocytic leukemia involves complex differential diagnosis with regard to Sezary syndrome, posing potential pitfalls for hematologists and dermatologists.
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Affiliation(s)
- P Dessart
- Service de dermatologie, centre hospitalier, 194, avenue Rubillard, 72000 Le Mans, France
| | - P Lemaire
- Laboratoire d'hématologie-hémostase, centre hospitalier, 194, avenue Rubillard, 72000 Le Mans, France
| | - K Le Dû
- Service d'hématologie, centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - J Sandrini
- Laboratoire d'anatomopathologie, centre hospitalier, 194, avenue Rubillard, 72000 Le Mans, France
| | - B Prophette
- Laboratoire d'anatomopathologie, centre hospitalier, 194, avenue Rubillard, 72000 Le Mans, France
| | - H Maillard
- Service de dermatologie, centre hospitalier, 194, avenue Rubillard, 72000 Le Mans, France.
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Wei Q, Papavassiliou P, Rehder C, Sebastian S, Wang E. T-cell prolymphocytic leukemia in a 63-year-old female with a pre-existing T-cell large granular lymphocytic leukemia: metachronous T-cell leukemias with discordant subset restrictions (CD4 versus CD8) and distinct clonal identities. Pathol Res Pract 2014; 210:1100-5. [PMID: 25238936 DOI: 10.1016/j.prp.2014.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/28/2014] [Accepted: 08/11/2014] [Indexed: 11/18/2022]
Abstract
A 55-year-old female with T-cell large granular lymphocytic leukemia (T-LGL) (CD8+) was initially treated with anti-thymocyte globulin and then cyclosporine due to anemia/neutropenia. While the severity of cytopenia varied with the therapy, the T-LGL persisted. Eight years after the initial diagnosis, she developed lymphadenopathy and hepatosplenomegaly. A complete blood cell count revealed leukocytosis, anemia and thrombocytopenia with ∼ 80% lymphocytes. In contrast to the LGL cells, the blood lymphocytes at this time were medium-large in size and had oval/irregular nuclei, condensed chromatin, indistinct nucleoli and a moderate amount of basophilic cytoplasm, many with elongated vacuoles, and some with cytoplasmic projections. The abnormal lymphocytes comprised ∼ 30% of the bone marrow cellularity with interstitial infiltrates/aggregates. Immunophenotypic analyses demonstrated a T-cell neoplasm with features suggestive of T-cell prolymphocytic leukemia (T-PLL) (CD4+). Cytogenetic analysis revealed a novel clone with complex abnormalities. PCR-based TRG gene rearrangement studies detected a clonal amplicon distinct from that of the preexisting T-LGL. Because of the chronological sequence of the two T-cell neoplasms, this case was initially considered an aggressive transformation of T-LGL. However, this was ultimately excluded by a discordant CD4-subset restriction and the presence of a distinct clonal identity. While these two T-cell neoplasms may have intrinsic connections, the underlying pathogenesis remains to be investigated.
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Affiliation(s)
- Qiang Wei
- Department of Pathology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China; Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Paulie Papavassiliou
- Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Catherine Rehder
- Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Siby Sebastian
- Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, United States.
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Suzuki R, Matsushita H, Kawai H, Matsuzawa H, Tsuboi K, Watanabe S, Kawada H, Ogawa Y, Ando K. Identification of a novel SEPT9-ABL1 fusion gene in a patient with T-cell prolymphocytic leukemia. Leuk Res Rep 2014; 3:54-7. [PMID: 25068103 DOI: 10.1016/j.lrr.2014.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/15/2014] [Accepted: 06/16/2014] [Indexed: 11/21/2022] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL), a rare type of peripheral T-cell leukemia, is characterized by marked splenomegaly with rapidly progressive lymphocytosis and a poor prognosis. Nine kinds of ABL1 chimeric genes have been identified in various kinds of hematological malignancies, such as chronic myeloid leukemia and B- or T-lymphoblastic leukemia. However, there have been no reports describing T-PLL cases with ABL1 rearrangements. We herein report a case of T-PLL with a novel SEPT9-ABL1 fusion gene which induced strong resistance to tyrosine kinase inhibitors such as imatinib and dasatinib. We herein report a case of T-PLL with a novel SEPT9-ABL1 fusion. Ten ABL fusions, including SEPT9-ABL1, have so far been reported. The current case was resistant to tyrosine kinase inhibitors.
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30
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Göçmen S, Kutlay M, Erikçi A, Atabey C, Sayan O, Haholu A. Central nervous system involvement of T-cell prolymphocytic leukemia diagnosed with stereotactic brain biopsy: case report. Turk J Haematol 2014; 31:75-8. [PMID: 24764733 PMCID: PMC3996638 DOI: 10.4274/tjh.2012.0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 11/06/2012] [Indexed: 12/01/2022] Open
Abstract
Prolymphocytic leukemia (PLL) is a generalized malignancy of the lymphoid tissue characterized by the accumulation of monoclonal lymphocytes, usually of B cell type. Involvement of the central nervous system (CNS) is an extremely rare complication of T-cell prolymphocytic leukemia (T-PLL). We describe a case of T-PLL presenting with symptomatic infiltration of the brain that was histopathologically proven by stereotactic brain biopsy. We emphasize the importance of rapid diagnosis and immediate treatment for patients presenting with CNS involvement and a history of leukemia or lymphoma.
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Affiliation(s)
- Selçuk Göçmen
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Neurosurgery, İstanbul, Turkey
| | - Murat Kutlay
- Gülhane Military Medical Academy, Department of Neurosurgery, Ankara, Turkey
| | - Alev Erikçi
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Hematology, İstanbul, Turkey
| | - Cem Atabey
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Neurosurgery, İstanbul, Turkey
| | - Ozkan Sayan
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Hematology, İstanbul, Turkey
| | - Aptullah Haholu
- Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of Pathology, İstanbul, Turkey
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31
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Abstract
OBJECTIVES To review clinical data, cytogenetic findings, and flow cytometric analysis in 20 patients with T-cell prolymphocytic leukemia (T-PLL), a rare, aggressive, mature T-cell leukemia with poor prognosis and short survival. METHODS Using multiparameter flow cytometry with a large combination of antibodies, we summarize the immunophenotypic features of T-PLL, including unusual immunophenotypic variants, and illustrate immunophenotypic clues that may help distinguish this entity from other T-cell malignancies. RESULTS By flow cytometry, T-PLL is characterized by a postthymic mature T-cell immunophenotype with a variety of abnormalities that usually allow distinction from other mature T-cell leukemias. CONCLUSIONS Although definitive diagnosis of T-PLL requires a systemic approach with integration of clinical data, morphology, immunophenotype, cytogenetics/fluorescence in situ hybridization, and molecular features, our results indicate immunophenotyping by multiparameter flow cytometry greatly facilitates diagnosis and assists with subclassification of this mature T-cell leukemia.
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Affiliation(s)
- Xueyan Chen
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Sindhu Cherian
- Department of Laboratory Medicine, University of Washington, Seattle, WA
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Audemard A, Boutemy J, Guilpain P, Sabatier R, Silva NM, Bienvenu B. Coronary vasculitis associated with T-cell prolymphocytic leukemia. Joint Bone Spine 2013; 81:93-4. [PMID: 23731632 DOI: 10.1016/j.jbspin.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jonathan Boutemy
- CHU de Caen, Department of Internal Medicine, 14000 Caen, France; Université de Caen-Basse Normandie, Medical School, 14000 Caen, France
| | - Philippe Guilpain
- CHRU de Montpellier, hôpital Saint-Eloi, Department of Internal Medicine A, 34000 Montpellier, France
| | - Rémi Sabatier
- CHU de Caen, Department of Cardiology, 14000 Caen, France
| | | | - Boris Bienvenu
- CHU de Caen, Department of Internal Medicine, 14000 Caen, France; Université de Caen-Basse Normandie, Medical School, 14000 Caen, France
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