1
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Chandra G, Wang J, Siirtola P, Röning J. Leveraging machine learning for predicting acute graft-versus-host disease grades in allogeneic hematopoietic cell transplantation for T-cell prolymphocytic leukaemia. BMC Med Res Methodol 2024; 24:112. [PMID: 38734644 PMCID: PMC11088760 DOI: 10.1186/s12874-024-02237-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
Orphan diseases, exemplified by T-cell prolymphocytic leukemia, present inherent challenges due to limited data availability and complexities in effective care. This study delves into harnessing the potential of machine learning to enhance care strategies for orphan diseases, specifically focusing on allogeneic hematopoietic cell transplantation (allo-HCT) in T-cell prolymphocytic leukemia. The investigation evaluates how varying numbers of variables impact model performance, considering the rarity of the disease. Utilizing data from the Center for International Blood and Marrow Transplant Research, the study scrutinizes outcomes following allo-HCT for T-cell prolymphocytic leukemia. Diverse machine learning models were developed to forecast acute graft-versus-host disease (aGvHD) occurrence and its distinct grades post-allo-HCT. Assessment of model performance relied on balanced accuracy, F1 score, and ROC AUC metrics. The findings highlight the Linear Discriminant Analysis (LDA) classifier achieving the highest testing balanced accuracy of 0.58 in predicting aGvHD. However, challenges arose in its performance during multi-class classification tasks. While affirming the potential of machine learning in enhancing care for orphan diseases, the study underscores the impact of limited data and disease rarity on model performance.
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Affiliation(s)
- Gunjan Chandra
- Biomimetics and Intelligent Systems Group, University of Oulu, Pentti Kaiteran katu 1, 90570, Oulu, Finland.
| | - Junfeng Wang
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Pekka Siirtola
- Biomimetics and Intelligent Systems Group, University of Oulu, Pentti Kaiteran katu 1, 90570, Oulu, Finland
| | - Juha Röning
- Biomimetics and Intelligent Systems Group, University of Oulu, Pentti Kaiteran katu 1, 90570, Oulu, Finland
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2
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Drozd-Sokolowska J, Gras L, Koster L, Martino R, Salas MQ, Salmenniemi U, Zudaire T, Yañez L, Bellido M, Collin M, Kaufmann M, Kozlowski P, Poiré X, Ferra C, Sampol A, Wilson KMO, Cairoli A, Gedde-Dahl T, Deconinck E, Mirabile M, Suarez F, Raj K, Van Gelder M, Yakoub-Agha I, Tournilhac O, McLornan DP. Autologous hematopoietic cell transplantation for T-cell prolymphocytic leukemia: a retrospective study on behalf of the Chronic Malignancies Working Party of the EBMT. Haematologica 2024; 109:1608-1613. [PMID: 38205539 PMCID: PMC11063836 DOI: 10.3324/haematol.2023.284359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024] Open
Abstract
Not available.
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Affiliation(s)
| | - Luuk Gras
- EBMT Statistical Unit, Leiden, the Netherlands;.
| | - Linda Koster
- EBMT Leiden Study Unit, Leiden, the Netherlands;.
| | | | - María Queralt Salas
- Hematology Department (ICHMO). Hospital Clinic de Barcelona, Barcelona, Spain;.
| | - Urpu Salmenniemi
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland;.
| | - Teresa Zudaire
- Unidad de Ensayos Clínicos de Hematología Pabellón A, bajo., Pamplona, Spain;.
| | | | - Mar Bellido
- University Medical Center Groningen (UMCG), Groningen, Netherlands;.
| | | | | | | | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium;.
| | - Christelle Ferra
- ICO-Hospital Universitari Germans Trias i Pujol, Badalona, Spain;.
| | - Antònia Sampol
- Hospital Son Espases, IDISBA, Palma de Mallorca, Balearic Islands, Spain.
| | | | - Anne Cairoli
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;.
| | | | - Eric Deconinck
- Université de Franche-Comté, CHU Besançon, EFS, INSERM, UMR RIGHT, F-25000 Besançon, France;.
| | | | - Felipe Suarez
- Adult hematology, Hôpital Necker-Enfants Malades, AP-HP.Centre Université Paris Cité, Paris, France;.
| | - Kavita Raj
- University College London Hospitals NHS Trust, London, United Kingdom;.
| | | | | | - Olivier Tournilhac
- CHU Estaing, Clermont-Ferrand University Hospital, Clermont-Ferrand, France;.
| | - Donal P McLornan
- University College London Hospitals NHS Trust, London, United Kingdom;.
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3
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Vardell VA, Ermann DA, Fitzgerald L, Shah H, Hu B, Stephens DM. T-cell prolymphocytic leukemia: Epidemiology and survival trends in the era of novel treatments. Am J Hematol 2024; 99:494-496. [PMID: 38240336 DOI: 10.1002/ajh.27205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/12/2023] [Accepted: 12/15/2023] [Indexed: 02/15/2024]
Abstract
Survival remains poor for T-cell prolymphocytic leukemia, though treatment in recent years, associated with access to novel therapies, and management at academic medical centers is associated with improved outcomes. There remains a critical need to improve the available treatment options for this population, and access to specialized academic medical centers, comprehensive supportive care, clinical trials, and early palliative care remains essential for T-PLL patients.
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Affiliation(s)
- Victoria A Vardell
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Daniel A Ermann
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Lindsey Fitzgerald
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Harsh Shah
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Boyu Hu
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Deborah M Stephens
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Division of Hematology and Hematologic Malignancies, University of North Carolina, Chapel Hill, North Carolina, USA
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4
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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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5
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Wasifuddin M, Ilerhunmwuwa NP, Becerra H, Wang JC. Characteristics and survival outcomes of patients with T cell prolymphocytic leukemia in the United States: 2011-2020 analysis of the SEER database. Leuk Lymphoma 2023; 64:2051-2053. [PMID: 37531079 DOI: 10.1080/10428194.2023.2243354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Mustafa Wasifuddin
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
| | | | | | - Jen C Wang
- Department of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, NY, USA
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6
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Gjelberg HK, Helgeland L, Liseth K, Micci F, Sandnes M, Russnes HG, Reikvam H. Long-Smoldering T-prolymphocytic Leukemia: A Case Report and a Review of the Literature. Curr Oncol 2023; 30:10007-10018. [PMID: 37999147 PMCID: PMC10669936 DOI: 10.3390/curroncol30110727] [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] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
T-prolymphocytic leukemia (T-PLL) is a rare malignancy of mature T-cells with distinct clinical, cytomorphological, and molecular genetic features. The disease typically presents at an advanced stage, with marked leukocytosis, B symptoms, hepatosplenomegaly, and bone marrow failure. It usually follows an aggressive course from presentation, and the prognosis is often considered dismal; the median overall survival is less than one year with conventional chemotherapy. This case report describes a patient with T-PLL who, after an unusually protracted inactive phase, ultimately progressed to a highly invasive, organ-involving disease. After initial treatments failed, a novel treatment approach resulted in a significant response.
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Affiliation(s)
- Hilde K. Gjelberg
- Department of Pathology, Haukeland University Hospital, N-5021 Bergen, Norway; (H.K.G.); (L.H.)
| | - Lars Helgeland
- Department of Pathology, Haukeland University Hospital, N-5021 Bergen, Norway; (H.K.G.); (L.H.)
- Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Knut Liseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, N-5021 Bergen, Norway;
| | - Francesca Micci
- Section for Cancer Cytogenetics, Institute of Cancer Genetics and Informatics, Oslo University Hospital, N-0424 Oslo, Norway;
| | - Miriam Sandnes
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway;
| | - Hege G. Russnes
- Department of Pathology, Oslo University Hospital, N-0424 Oslo, Norway;
- Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, N-0424 Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, N-0424 Oslo, Norway
| | - Håkon Reikvam
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway;
- Department of Medical Science, University of Bergen, N-5021 Bergen, Norway
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7
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Fox CP, Ahearne MJ, Pettengell R, Dearden C, El-Sharkawi D, Kassam S, Cook L, Cwynarski K, Illidge T, Collins G. Guidelines for the management of mature T- and natural killer-cell lymphomas (excluding cutaneous T-cell lymphoma): a British Society for Haematology Guideline. Br J Haematol 2022; 196:507-522. [PMID: 34811725 DOI: 10.1111/bjh.17951] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
MESH Headings
- Humans
- Clinical Decision-Making
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/methods
- Diagnosis, Differential
- Disease Management
- Killer Cells, Natural/metabolism
- Killer Cells, Natural/pathology
- Leukemia, Prolymphocytic, T-Cell/diagnosis
- Leukemia, Prolymphocytic, T-Cell/etiology
- Leukemia, Prolymphocytic, T-Cell/therapy
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/epidemiology
- Lymphoma, T-Cell/etiology
- Lymphoma, T-Cell/therapy
- Prognosis
- Treatment Outcome
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Affiliation(s)
- Christopher P Fox
- Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew J Ahearne
- Department of Haematology, University Hospitals of Leicester NHS Trust, Lymphoid Malignancies Group, University of Leicester, Leicester, UK
| | - Ruth Pettengell
- Haematology and Medical Oncology, St. George's Healthcare NHS Trust, London, UK
| | - Claire Dearden
- Department of Haemato-Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Dima El-Sharkawi
- Department of Haemato-Oncology, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Shireen Kassam
- Department of Haematological Medicine, King's College Hospital, London, UK
| | - Lucy Cook
- Department of Haematology and National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London, UK
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, UK
| | - Tim Illidge
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Graham Collins
- Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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8
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Shumilov E, Hasenkamp J, Szuszies CJ, Koch R, Wulf GG. Patterns of Late Relapse after Allogeneic Hematopoietic Stem Cell Transplantation in Patients with T-Cell Prolymphocytic Leukemia. Acta Haematol 2020; 144:105-110. [PMID: 32259827 DOI: 10.1159/000506302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/02/2020] [Indexed: 11/19/2022]
Abstract
Initial treatment with the monoclonal anti-CD52 antibody alemtuzumab induces responses in the majority of patients with T-cell prolymphocytic leukemia (T-PLL). In eligible patients, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an option to consolidate hematological remissions. Here, we report our experience with 10 patients who received allo-HSCT against T-PLL. Notably, 3 patients with complete remission at transplantation and durable full-donor chimerism relapsed at months 12, 59, and 84 after transplantation, respectively. This relapse was associated with rapid progressive leukemia in 1 patient and extralymphatic lymphoma growth in the other 2. Despite CD52 positivity at relapse, alemtuzumab retreatment, donor lymphocyte infusions, and/or chemotherapy including salvage therapy, allo-HSCT yielded a transient partial response, only. Alemtuzumab induction and consolidative allo-HSCT enabled prolonged disease-free survival in these patients but failed to procure cure.
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Affiliation(s)
- Evgenii Shumilov
- Department of Hematology and Medical Oncology, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Justin Hasenkamp
- Department of Hematology and Medical Oncology, University Medicine Göttingen (UMG), Göttingen, Germany
| | | | - Raphael Koch
- Department of Hematology and Medical Oncology, University Medicine Göttingen (UMG), Göttingen, Germany,
| | - Gerald Georg Wulf
- Department of Hematology and Medical Oncology, University Medicine Göttingen (UMG), Göttingen, Germany
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9
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Staber PB, Herling M, Bellido M, Jacobsen ED, Davids MS, Kadia TM, Shustov A, Tournilhac O, Bachy E, Zaja F, Porkka K, Hoermann G, Simonitsch-Klupp I, Haferlach C, Kubicek S, Mayerhoefer ME, Hopfinger G, Jaeger U, Dearden C. Consensus criteria for diagnosis, staging, and treatment response assessment of T-cell prolymphocytic leukemia. Blood 2019; 134:1132-1143. [PMID: 31292114 PMCID: PMC7042666 DOI: 10.1182/blood.2019000402] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a rare, mature T-cell neoplasm with a heterogeneous clinical course. With the advent of novel treatment options that will potentially change the management of patients with T-PLL, it has become necessary to produce consensus guidelines for the design and conduct of clinical trials. The T-PLL International Study group (TPLL-ISG) set out to define standardized criteria for diagnosis, treatment indication, and evaluation of response. These criteria will facilitate comparison of results from clinical trials in T-PLL, and will thus support clinical decision making, as well as the approval of new therapeutics by healthcare authorities.
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Affiliation(s)
- Philipp B Staber
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marco Herling
- Department of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, and
- Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases, University of Cologne, Cologne, Germany
- Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Mar Bellido
- Hematology Department, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eric D Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Tapan Mahendra Kadia
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Andrei Shustov
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA
| | | | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Lyon, France
| | - Francesco Zaja
- S.C. Ematologia Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Kimmo Porkka
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Gregor Hoermann
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Innsbruck, Austria
- Department of Laboratory Medicine and
| | | | | | - Stefan Kubicek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Christian Doppler Laboratory for Chemical Epigenetics and Anti-Infectives, CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Georg Hopfinger
- Division of Blood and Marrow Transplantation, Department of Medicine I, Medical University of Vienna, Vienna, Austria; and
| | - Ulrich Jaeger
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Claire Dearden
- The Royal Marsden Hospital, NHS Foundation Trust, London, United Kingdom
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10
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Abstract
RATIONALE T-cell prolymphocytic leukaemia (T-PLL) is a rare aggressive lymphoid disease featured by a significant increased lymphocyte count and obvious hepatosplenomegaly with poor prognosis. The concomitant presentation of T-PLL and visceral leishmaniasis (VL) has not previously been reported. PATIENT CONCERNS The patient initially suffered from anorexia, skin pigmentation, fever and hepatosplenomegaly. Bone marrow smear described leishmania and antibody test was positive. VL was diagnosed and he was given antimony gluconate therapy. His symptoms recurred. DIAGNOSIS A combination of serological rk39 test, morphologic evaluation and immunophenotyping by flow cytometry finally supported the diagnosis of concomitant VL and T-PLL. OUTCOMES Amphotericin B was used for the treatment of VL first and a referral for treating T-PLL after recovery from VL was suggested. Unfortunately, the patient requested to be discharged. Telephone follow-up indicated that he died a few days after leaving the hospital. LESSONS Due to the rarity of the disease combination, the pathogenesis association of T-PLL and VL is unclear. However, a duly diagnosis is crucial for treatment. In immunosuppressed patients due to malignancies and treatment, VL should be considered as an opportunistic infection. In VL infections, the clinical manifestations mimicking hematological malignancies may cover up the underlying disease. Under such conditions, a complete work-up based on laboratory test is necessary to achieve a correct diagnosis.
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MESH Headings
- Amphotericin B/administration & dosage
- Amphotericin B/therapeutic use
- Antiprotozoal Agents/therapeutic use
- Fatal Outcome
- Hepatomegaly/etiology
- Humans
- Immunophenotyping/methods
- Leishmania donovani/isolation & purification
- Leishmaniasis, Visceral/blood
- Leishmaniasis, Visceral/drug therapy
- Leishmaniasis, Visceral/parasitology
- Leishmaniasis, Visceral/pathology
- Leukemia, Prolymphocytic, T-Cell/blood
- Leukemia, Prolymphocytic, T-Cell/complications
- Leukemia, Prolymphocytic, T-Cell/pathology
- Leukemia, Prolymphocytic, T-Cell/therapy
- Male
- Middle Aged
- Splenomegaly/etiology
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11
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Hu Z, Li S, Medeiros LJ, Sun T. TCL-1-positive hematogones in a patient with T-cell prolymphocytic leukemia after therapy. Hum Pathol 2017; 65:175-179. [PMID: 28232160 DOI: 10.1016/j.humpath.2016.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/15/2016] [Revised: 12/03/2016] [Accepted: 12/07/2016] [Indexed: 11/15/2022]
Abstract
T-prolymphocytic leukemia (T-PLL) is a rare mature T-cell neoplasm characterized by proliferation of prolymphocytes. Most cases involve the T-cell leukemia-1 (TCL1) gene at 14q11.2 resulting in overexpression of TCL-1, which is helpful for distinguishing T-PLL from other T-cell neoplasms. We report a patient with T-PLL whose leukemic cells were positive for TCL-1 by immunohistochemistry but with a normal karyotype. The patient had anti-CD52 antibody therapy for 12 weeks. In a follow-up bone marrow biopsy specimen, numerous TCL-1-positive cells were present, which raised the differential diagnosis of residual T-PLL. However, further immunophenotypic studies confirmed that these cells were hematogones. Therefore a diagnosis of recovering bone marrow was established. The patient underwent stem cell transplant and is now in complete remission. This case demonstrates that hematogones can express TCL-1, and this knowledge is very important for the differential diagnosis in the follow-up marrow of T-PLL patients.
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MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Biopsy
- Bone Marrow Cells/drug effects
- Bone Marrow Cells/metabolism
- Bone Marrow Examination
- Diagnosis, Differential
- Humans
- Immunohistochemistry
- Karyotyping
- Leukemia, Prolymphocytic, T-Cell/genetics
- Leukemia, Prolymphocytic, T-Cell/metabolism
- Leukemia, Prolymphocytic, T-Cell/therapy
- Male
- Middle Aged
- Predictive Value of Tests
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins/metabolism
- Remission Induction
- Stem Cell Transplantation
- Treatment Outcome
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Affiliation(s)
- Zhihong Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Shaoying Li
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
| | - Tsieh Sun
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030.
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12
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Abstract
B-cell (B-PLL) and T-cell (T-PLL) prolymphocytic leukemias are rare, poor-prognosis lymphoid neoplasms with similar presentation characterized by symptomatic splenomegaly and lymphocytosis. They can be distinguished from each other and from other T- and B-cell leukemias by careful evaluation of morphology, immunophenotyping, and molecular genetics. The clinical behavior is typically aggressive, although a subset of patients may have an indolent phase of variable length. First-line therapy for T-PLL is with intravenous alemtuzumab and for B-PLL is with combination purine analog-based chemo-immunotherapy. New B-cell receptor inhibitors, such as ibrutinib and idelalisib, may have a role in the management of B-PLL, especially for the patients harboring abnormalities of TP53. Allogenic stem cell transplantation should still be considered for eligible patients and may be the only current therapy capable of delivering a cure. In the past few years, many of the molecular mechanisms underlying disease pathogenesis and progression have been revealed and are likely to lead to the development of novel targeted approaches.
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Affiliation(s)
- Claire Dearden
- Department of Haemato-Oncology, Royal Marsden Biomedical Research Centre, London, UK
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13
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Paul RN, Alizadeh L, Ajayi OI, Karpurapu H, Ganesan C, Taddesse-Heath L, Aggarwal A. A case report of T cell prolymphocytic leukemia and Kaposi sarcoma and a review of T cell prolymphocytic leukemia. Acta Haematol 2012; 127:235-43. [PMID: 22517037 DOI: 10.1159/000336241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 12/28/2011] [Indexed: 11/19/2022]
Abstract
T cell prolymphocytic leukemia (T-PLL) is a rare mature T cell lymphoproliferative disease. It has been associated with an aggressive course, a poor response to conventional chemotherapy and a short median survival. Here we present a rare case of concurrent T-PLL and Kaposi sarcoma who achieved a complete hematologic and cytogenetic remission after a very short course of treatment with alemtuzumab. A review of T-PLL was done. In this review, clinical features, laboratory features and current therapeutic strategies of T-PLL are presented.
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MESH Headings
- Aged
- Aged, 80 and over
- Alemtuzumab
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antigens, CD
- Antigens, Neoplasm
- Antineoplastic Agents/therapeutic use
- CD52 Antigen
- Glycoproteins/antagonists & inhibitors
- Humans
- Leukemia, Prolymphocytic, T-Cell/diagnosis
- Leukemia, Prolymphocytic, T-Cell/immunology
- Leukemia, Prolymphocytic, T-Cell/therapy
- Male
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/immunology
- Neoplasms, Multiple Primary/therapy
- Remission Induction
- Sarcoma, Kaposi/radiotherapy
- Sarcoma, Kaposi/therapy
- Time Factors
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Affiliation(s)
- R N Paul
- Division of Hematology/Oncology, Department of Medicine, Howard University Hospital, Washington, DC 20060, USA.
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14
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Krishnan B, Else M, Tjonnfjord GE, Cazin B, Carney D, Carter J, Ketterer N, Catovsky D, Ethell M, Matutes E, Dearden CE. Stem cell transplantation after alemtuzumab in T-cell prolymphocytic leukaemia results in longer survival than after alemtuzumab alone: a multicentre retrospective study. Br J Haematol 2010; 149:907-10. [PMID: 20201944 DOI: 10.1111/j.1365-2141.2010.08134.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Kruspe RC, Ashraf KK, Foran JM, Salzman DE, Reddy VVB, Vaughan WP. Successful treatment of T-cell prolymphocytic leukemia with full-intensity conditioning followed by matched unrelated donor allogeneic stem cell transplantation. Clin Adv Hematol Oncol 2007; 5:882-884. [PMID: 18185486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Rachel C Kruspe
- Hematology/Oncology and Bone Marrow Transplantation, University of Alabama at Birmingham, Birmingham, AL 35249, USA.
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16
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Beck C, Humpe A, Harder S, Schmid M, Horst HA. Myelodysplastic syndrome of donor origin subsequent to successful treatment of myeloid/NK-cell precursor leukaemia with allogeneic PBSCT: two very rare conditions in one patient. Ann Hematol 2005; 84:616-8. [PMID: 15782344 DOI: 10.1007/s00277-005-1032-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2004] [Accepted: 02/22/2005] [Indexed: 10/25/2022]
Abstract
We report a 36-year-old male with myeloid/natural killer (NK)-cell precursor acute leukaemia with a complex aberrant karyotype, who was treated according to an acute-myeloid-leukaemia (AML) treatment protocol (idarubicine, cytarabine, and etoposide) followed by high-dose cytarabine consolidation and achieved complete remission. He underwent allogeneic matched unrelated donor (MUD) peripheral blood stem-cell transplantation (PBSCT) and remained in remission throughout his remaining life. Seven months posttransplantation, a myelodysplastic syndrome (MDS) with (20q-) of donor origin was diagnosed causing severe thrombocytopenia and finally leading to infection and death. This patient represents one of the few cases published achieving remission for a significant period of time after being diagnosed with myeloid/NK-cell precursor acute leukaemia, a very rare malignant disease. We conclude, despite the fatal outcome due to infection, that allogeneic PBSCT is a therapeutic option for patients with this entity. In addition, the development of a myelodysplastic syndrome of donor origin is extremely rare and only very few cases are published worldwide.
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17
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Abstract
T-cell prolymphocytic leukemia (T-PLL) is a rare mature T-cell lymphoproliferative disorder. While the etiology of T-PLL is unknown, recent progress in unraveling the molecular basis of leukemogenesis has been substantial and may yield novel therapeutic targets. T-PLL is a distinct disease entity and the diagnosis can be readily made based on characteristic clinical features and laboratory findings. Prior to the appearance of pentostatin and alemtuzumab in clinical protocols, outcome for T-PLL patients was exceedingly poor with median survival measured in months. While the use of alemtuzumab in particular has improved remissions, the disease remains incurable. Future collaborative efforts investigating novel treatment approaches will be crucial to improving survival for patients with this disease.
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MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/therapeutic use
- Antimetabolites, Antineoplastic/therapeutic use
- Chromosome Aberrations
- Chromosomes, Human, Pair 11/ultrastructure
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 14/ultrastructure
- Chromosomes, Human, Pair 8/ultrastructure
- Chromosomes, Human, X/ultrastructure
- Clinical Trials as Topic
- Diagnosis, Differential
- Disease Progression
- Female
- Humans
- Immunotherapy
- In Situ Hybridization, Fluorescence
- Leukemia, Prolymphocytic/diagnosis
- Leukemia, Prolymphocytic/genetics
- Leukemia, Prolymphocytic/therapy
- Leukemia, Prolymphocytic, T-Cell/classification
- Leukemia, Prolymphocytic, T-Cell/diagnosis
- Leukemia, Prolymphocytic, T-Cell/genetics
- Leukemia, Prolymphocytic, T-Cell/therapy
- Male
- Pentostatin/therapeutic use
- Protein Serine-Threonine Kinases/physiology
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins c-akt
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Treatment Outcome
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Affiliation(s)
- Thai M Cao
- Department of Medicine, Division of Hematology, Stanford University School of Medicine, CA 94305-5112, USA
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18
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Dearden CE, Matutes E, Cazin B, Tjønnfjord GE, Parreira A, Nomdedeu B, Leoni P, Clark FJ, Radia D, Rassam SM, Roques T, Ketterer N, Brito-Babapulle V, Dyer MJ, Catovsky D. High remission rate in T-cell prolymphocytic leukemia with CAMPATH-1H. Blood 2001; 98:1721-6. [PMID: 11535503 DOI: 10.1182/blood.v98.6.1721] [Citation(s) in RCA: 206] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a chemotherapy-resistant malignancy with a median survival of 7.5 months. Preliminary results indicated a high remission induction rate with the human CD52 antibody, CAMPATH-1H. This study reports results in 39 patients with T-PLL treated with CAMPATH-1H between March 1993 and May 2000. All but 2 patients had received prior therapy with a variety of agents, including 30 with pentostatin; none achieved complete remission (CR). CAMPATH-1H (30 mg) was administered intravenously 3 times weekly until maximal response. The overall response rate was 76% with 60% CR and 16% partial remission (PR). These responses were durable with a median disease-free interval of 7 months (range, 4-45 months). Survival was significantly prolonged in patients achieving CR compared to PR or no response (NR), including one patient who survived 54 months. Nine patients remain alive up to 29 months after completing therapy. Seven patients received high-dose therapy with autologous stem cell support, 3 of whom remain alive in CR 5, 7, and 15 months after autograft. Stem cell harvests in these patients were uncontaminated with T-PLL cells as demonstrated by dual-color flow cytometry and polymerase chain reaction. Four patients had allogeneic stem cell transplants, 3 from siblings and 1 from a matched unrelated donor. Two had nonmyeloablative conditioning. Three are alive in CR up to 24 months after allograft. The conclusion is that CAMPATH-1H is an effective therapy in T-PLL, producing remissions in more than two thirds of patients. The use of stem cell transplantation to consolidate responses merits further study.
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MESH Headings
- Adult
- Aged
- Alemtuzumab
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/adverse effects
- Antibodies, Neoplasm/therapeutic use
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Combined Modality Therapy
- Cytogenetic Analysis
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Immunophenotyping
- Leukemia, Prolymphocytic/drug therapy
- Leukemia, Prolymphocytic/mortality
- Leukemia, Prolymphocytic/therapy
- Leukemia, Prolymphocytic, T-Cell/drug therapy
- Leukemia, Prolymphocytic, T-Cell/mortality
- Leukemia, Prolymphocytic, T-Cell/therapy
- Male
- Middle Aged
- Remission Induction
- Survival Rate
- Transplantation, Homologous
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Affiliation(s)
- C E Dearden
- Royal Marsden NHS Trust, London, United Kingdom.
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19
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Kingreen D, Siegert W. Chronic lymphatic leukemias of T and NK cell type. Leukemia 1997; 11 Suppl 2:S46-9. [PMID: 9178839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
T cell chronic lymphocytic/prolymphocytic leukemia (T-CLL/T-PLL) and large granular lymphocyte leukemia of T or NK cell type (T-LGL or NK-LGL leukemia) are chronic lymphoproliferative diseases derived from post-thymic immunocompetent lymphoid cells. T-PLL is morphologically characterized by a prominent central nucleolus in a medium-sized cell expressing a mature T cell immunophenotype. Clonal genetic changes involving chromosome 14 and T cell receptor gene rearrangements are characteristics of these diseases. They are usually progressive and there is no efficient treatment available. The classification of some cases presenting with a morphological picture similar to B-CLL, but with immunophenotypic and clinical features resembling T-PLL, as T-CLL is still controversial. The phenotypic profiles and the establishment of clonality are the hallmarks of defining T-LGL leukemia and NK-LGL leukemia. The CD3+/CD57+/CD56- immunophenotype and the clonal rearrangement of the T cell receptor genes characterize T-LGL leukemia, which presents clinically with a rather indolent course of disease, complicated by frequent infections secondary to neutropenia. NK-LGL leukemia cells express CD3-/CD56+/CD57-, but in most cases clonality cannot easily be established. Clinically the patient may either present with constitutional symptoms and suffer a short and aggressive course of disease or may have a more chronic disease similar to T-LGL leukemia. Therefore, it may be reasonable to subdivide NK-LGL proliferation into the more aggressive 'NK-LGL leukemia/lymphoma' and 'chronic NK cell lymphocytosis'.
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MESH Headings
- Antigens, CD/analysis
- Diagnosis, Differential
- Humans
- Immunophenotyping
- Killer Cells, Natural/immunology
- Leukemia, Prolymphocytic, T-Cell/classification
- Leukemia, Prolymphocytic, T-Cell/genetics
- Leukemia, Prolymphocytic, T-Cell/immunology
- Leukemia, Prolymphocytic, T-Cell/therapy
- T-Lymphocytes/immunology
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Affiliation(s)
- D Kingreen
- Klinik und Poliklinik für Innere Medizin mS Hämatologie und Onkologie, Virchow Klinikum, Humboldt Universität, Berlin, Germany
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20
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Salutari P, Sica S, Micciulli G, Rutella S, Di Mario A, Leone G. Extramedullary relapse after allogeneic bone marrow transplantation plus buffy-coat in two high risk patients. Haematologica 1996; 81:182-5. [PMID: 8641654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In order to obtain an additional graft versus leukemia effect (GVL) and rapid engraftment, donor leukocyte infusion (DLI) was added to unseparated, sex-mismatched allogeneic bone marrow transplantation in two male patients (age 21, 26) affected by high risk hematological malignancies (refractory T-ALL, refractory B-LBL in leukemic phase). Graft versus host disease (GVHD) prophylaxis consisted of methotrexate (MTX) alone. DLI were obtained after G-CSF 16 ug/kg/day sc. A total of 2.36 and 5.8 x 10(6)/kg MNC, 5.4 and 11 x 10(6)/kg CD34+ cells, 1.3 and 1.3 x 10(6)/kg CD3+ lymphocytes, respectively, were infused. Hemopoietic recovery occurred promptly. Complete chimerism was detected by cytogenetic examination. One patient developed an extramedullary relapse that first involved the cranial nerves, and then the testes, soft tissue and skin; the other patient developed central nervous system disease and then bilateral paravertebral masses with progressive paraplegia. Despite complete medullary remission with normal female karyotype, both patients died from extramedullary progression of their disease. Our observation shows that, at least in high risk patients, no additional GVHD or GVL effect was evident after donor leukocyte infusion. Extramedullary relapse was not prevented despite good control of medullary disease.
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Affiliation(s)
- P Salutari
- Istituto di Semeiotica Medica, Cattedra di Ematologia, Università Cattolica S. Cuore, Rome, Italy
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21
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Litam PP, Loughran TP. Recurrent infection in a patient with chronic neutropenia. Hosp Pract (Off Ed) 1995; 30:117-8. [PMID: 7852460 DOI: 10.1080/21548331.1995.11443155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- P P Litam
- Veterans Affairs Medical Center, Syracuse, N.Y
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22
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Picard F, Martin T, Legras F, Lioure B, Pasquali JL. Molecular analysis of T-cell receptor V beta chains of human T-cell chronic lymphocytic leukemia does not show intraclonal variability: implications for immunotherapy. Blood 1993; 82:2152-6. [PMID: 8400265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Human T-cell chronic lymphocytic leukemia (T-cell CLL) is a heterogeneous disease characterized by a monoclonal malignant proliferation of T cells in which the T-cell receptors (TCRs) can be, when expressed, considered to be membrane tumor-specific antigens. Owing to the increasing number of available monoclonal antihuman TCR reagents, it could be of interest to evaluate the feasibility of anti-TCR treatment during T-cell CLL. To test the therapeutic potentiality of anti-TCR monoclonal antibodies, we first analyzed the intraclonal variability in two terminally ill patients suffering from TCR alpha beta-positive cell CLL bearing different immunophenotypes. The cDNA corresponding to the variable regions of the TCR beta chains originating from the malignant T cells were amplified, cloned into M13 phages, and sequenced. The sequence analysis of multiple independent clones showed no intraclonal variability, with no evidence for ongoing hypermutation in the V beta region genes. The relevance of these findings with regard to an anti-V beta therapy and the comparison with similar analysis during B-cell monoclonal lymphoproliferations are discussed.
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MESH Headings
- Antigens, CD/blood
- Base Sequence
- CD3 Complex/blood
- CD4 Antigens/blood
- CD8 Antigens/blood
- Cloning, Molecular
- DNA Primers
- Female
- Gene Rearrangement, beta-Chain T-Cell Antigen Receptor
- Genetic Variation
- Humans
- Immunophenotyping
- Immunotherapy
- Leukemia, Prolymphocytic, T-Cell/blood
- Leukemia, Prolymphocytic, T-Cell/genetics
- Leukemia, Prolymphocytic, T-Cell/immunology
- Leukemia, Prolymphocytic, T-Cell/therapy
- Male
- Middle Aged
- Molecular Sequence Data
- Polymerase Chain Reaction/methods
- RNA, Messenger/biosynthesis
- RNA, Messenger/blood
- Receptors, Antigen, T-Cell, alpha-beta/analysis
- Receptors, Antigen, T-Cell, alpha-beta/biosynthesis
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- T-Lymphocytes/immunology
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Affiliation(s)
- F Picard
- Laboratoire d'Immunopathologie, Hôpital Central, Hôpitaux Universitaires de Strasbourg, France
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23
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Loughran TP. Clonal diseases of large granular lymphocytes. Blood 1993; 82:1-14. [PMID: 8324214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Three distinct clinical syndromes occur in patients with increased numbers of circulating LGL. Patients with T-LGL leukemia have clonal proliferations of CD3+ LGL typically associated with chronic neutropenia and autoimmune features. NK-LGL leukemia is characterized by clonal CD3- LGL proliferation with an acute clinical presentation marked by massive hepatosplenomegaly and systemic illness. However, most patients with increased numbers of CD3- LGL do not have clinical features of NK-LGL leukemia and have a chronic clinical course. X-linked gene analyses have supported a polyclonal LGL lymphocytosis in this syndrome. Further studies are needed to determine whether clonal progression can occur in these patients.
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Affiliation(s)
- T P Loughran
- Veterans Administration Hospital, Syracuse, NY 13210
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24
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Rossetti A, Bonati PL, Zannoni M, Sansoni P. [Chronic T-cell lymphatic leukemia]. G Clin Med 1990; 71:593-9, 602-6. [PMID: 2289655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A Rossetti
- VI Divisione Medica, U.S.L. N. 4, Università, Parma
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25
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Janson CH, Tehrani MJ, Mellstedt H, Wigzell H. Anti-idiotypic monoclonal antibody to a T-cell chronic lymphatic leukemia. Characterization of the antibody, in vitro effector functions and results of therapy. Cancer Immunol Immunother 1989; 28:225-32. [PMID: 2784357 PMCID: PMC11041056 DOI: 10.1007/bf00204993] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/1988] [Accepted: 09/08/1988] [Indexed: 01/02/2023]
Abstract
A murine anti-idiotypic monoclonal antibody (mAb), F1, (IgG2a) was produced against the variable part of the T-cell receptor for antigen (Ti, alpha/beta) on the tumor cells of a patient with T-cell chronic lymphatic leukemia (CD3+,8+,4-). The molecular weight of the protein reactive with mAb F1, comodulation and coprecipitation with anti-CD3 antibody, and the restricted tumor-cell reactivity strongly support the anti-idiotypic nature of mAb F1. MAb F1 also stained less than or equal to 4% of peripheral blood lymphocytes of healthy donors. MAb F1 did not stimulate the tumor cells to DNA synthesis, but stimulated a fraction of the normal peripheral blood lymphocytes, mAb F1 did not mediate antibody-dependent cellular cytotoxicity or complement lysis to any significant degree in vitro. Three infusion of 1-10 mg anti-idiotypic mAb were given over a period of 4 weeks. The plasma half-life for mAb F1 was 3 h in the first 2 h after infusion and 44 h from 2 h to 120 h after infusion. After each treatment a rapid decrease of circulating tumor cells was seen. During the observation period an 80% reduction of the total circulating tumor cells was noted. After the second infusion, IgM and IgG antimouse antibodies were detected. Side-effects from therapy were fever, chills, nausea, vomiting, diarrhea, tachycardia, increase in systolic blood pressure and shortness of breath. Thus, in T-cell malignancies a major reduction of circulating tumor cells can be accomplished by low doses of anti-idiotypic mAb. Anti-idiotypic mAb might be a therapeutic agent of significant importance.
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MESH Headings
- Aged
- Animals
- Antibodies, Anti-Idiotypic/administration & dosage
- Antibodies, Anti-Idiotypic/analysis
- Antibodies, Anti-Idiotypic/physiology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/analysis
- Antibodies, Monoclonal/physiology
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/biosynthesis
- Antineoplastic Agents/pharmacology
- Cytotoxicity Tests, Immunologic
- Female
- Humans
- Immunoglobulin Idiotypes/immunology
- Leukemia, Prolymphocytic, T-Cell/blood
- Leukemia, Prolymphocytic, T-Cell/immunology
- Leukemia, Prolymphocytic, T-Cell/therapy
- Lymphocyte Activation
- Mice
- Receptors, Antigen, T-Cell/immunology
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Affiliation(s)
- C H Janson
- Department of Immunology, Karolinska Institute, Stockholm, Sweden
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