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Martynchyk A, Chowdhury R, Hawkes EA, Keane C. Prognostic Markers within the Tumour Microenvironment in Classical Hodgkin Lymphoma. Cancers (Basel) 2023; 15:5217. [PMID: 37958391 PMCID: PMC10649036 DOI: 10.3390/cancers15215217] [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: 09/29/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Classical Hodgkin lymphoma (cHL) accounts for 0.4% of all new cancer cases globally. Despite high cure rates with standard treatment, approximately 15% of patients still experience relapsed or refractory (RR) disease, and many of these eventually die from lymphoma-related causes. Exciting new targeted agents such as anti-PD-1 agents and brentuximab vedotin have changed the therapeutic paradigm beyond chemotherapy and radiotherapy alone. Advances in understanding of the molecular biology are providing insights in the context of novel therapies. The signature histology of cHL requires the presence of scant malignant Hodgkin Reed-Sternberg cells (HRSCs) surrounded by a complex immune-rich tumour microenvironment (TME). The TME cellular composition strongly influences outcomes, yet knowledge of the precise characteristics of TME cells and their interactions with HRSCs is evolving. Novel high-throughput technologies and single-cell sequencing allow deeper analyses of the TME and mechanisms elicited by HRSCs to propagate growth and avoid immune response. In this review, we explore the evolution of knowledge on the prognostic role of immune cells within the TME and provide an up-to-date overview of emerging prognostic data on cHL from new technologies that are starting to unwind the complexity of the cHL TME and provide translational insights into how to improve therapy in the clinic.
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Affiliation(s)
- Arina Martynchyk
- Olivia Newton-John Cancer Research & Wellness Centre, Austin Health, 145 Studley Rd., Heidelberg, VIC 3084, Australia; (A.M.); (E.A.H.)
| | - Rakin Chowdhury
- Princess Alexandra Hospital, 199 Ipswich Rd., Woolloongabba, QLD 4102, Australia;
- Frazer Institute, University of Queensland, St. Lucia, QLD 4072, Australia
| | - Eliza A. Hawkes
- Olivia Newton-John Cancer Research & Wellness Centre, Austin Health, 145 Studley Rd., Heidelberg, VIC 3084, Australia; (A.M.); (E.A.H.)
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Rd., Melbourne, VIC 3004, Australia
| | - Colm Keane
- Princess Alexandra Hospital, 199 Ipswich Rd., Woolloongabba, QLD 4102, Australia;
- Frazer Institute, University of Queensland, St. Lucia, QLD 4072, Australia
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Ferhanoglu B, Ozbalak M. Sequencing novel agents in the treatment of classical Hodgkin lymphoma. Expert Rev Hematol 2023; 16:991-1015. [PMID: 37897182 DOI: 10.1080/17474086.2023.2276212] [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: 05/30/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Classical Hodgkin lymphoma (cHL) is a curable disease, with durable remission achieved in about 80% of patients following first-line treatment. Three new drugs were introduced to the daily use in cHL: brentuximab vedotin (BV), nivolumab, and pembrolizumab. All three drugs were initially approved for the treatment of relapsed/refractory cHL (RRHL) and with their promising outcomes, they are now incorporated in different stages of the treatment. AREAS COVERED We performed a literature search using PubMed on all cHL studies investigating BV and CPIs within the past 10 years. We analyzed literature to presume the sequencing of these novel agents. EXPERT OPINION Addition of BV or nivolumab to AVD backbone in the frontline setting showed promising activity in advanced stage cHL. BV and CPIs combined with chemotherapy in the second-line treatment of cHL are evaluated in phase 2 studies and comparable results are reported. The results of BrECADD, with good efficacy and toxicity profile, should be followed. Pembrolizumab was shown to be more effective in RRHL compared to BV in patients who have relapsed post-ASCT or ineligible for ASCT. BV is used in post-ASCT maintenance in high-risk cases, although its role will be questioned as it is increasingly used in the frontline treatment.
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Affiliation(s)
- Burhan Ferhanoglu
- Department of Internal Medicine, Division of Hematology, Koc University School of Medicine, Istanbul, Turkey
| | - Murat Ozbalak
- Basaksehir Cam ve Sakura City Hospital, Division of Hematology, Istanbul, Turkey
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Alhamss M, El Fakih R. Thinking Outside the Box in Mediastinal Lymphoma Management. Clin Hematol Int 2023:10.1007/s44228-023-00045-7. [PMID: 37195392 DOI: 10.1007/s44228-023-00045-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
- Marwa Alhamss
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Riad El Fakih
- Section of Adult Hematology/HSCT, Oncology Centre, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia.
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Yang T, Liu S, Zuo R, Liang H, Xu L, Wang Z, Chen X, Pang H. Prognostic role of pretreatment 18F-FDG PET/CT and hematological parameters in relapsed/refractory Hodgkin lymphoma patients treated with immune checkpoint inhibitors and chemotherapy: a dual-center cohort study. BMC Med Imaging 2023; 23:12. [PMID: 36681824 PMCID: PMC9867864 DOI: 10.1186/s12880-023-00967-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The combination of anti-programmed death-1 antibodies and chemotherapy is effective; however, there are no reliable outcome prediction factors. We investigated the prognostic factors based on 18Fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) quantitative and hematological parameters to predict progression-free survival (PFS) in relapsed/refractory classical Hodgkin lymphoma (R/R cHL) patients treated with immune checkpoint inhibitors (ICIs) and chemotherapy. METHODS This retrospective study included 31 patients who underwent 18F-FDG PET/CT before and during treatment. Pretreatment metabolic and hematological parameters were evaluated using Cox regression analysis to identify predictors of PFS. Based on the cut-off values calculated using the receiver operating characteristic (ROC) curve, patients were classified into low-, intermediate-, and high-risk groups. Kaplan-Meier curves and the log-rank test were used to compare survival differences between the groups. RESULTS Cox multivariable analysis indicted that the treatment response based on Lactate dehydrogenase (LDH), Lugano classification and SUVmax were independent predictors of PFS (P = 0.004, 0.007 and 0.039, respectively). The optimal cut-off values for SUVmax and LDH were 11.62 and 258.5 U/L, respectively (P < 0.01). Survival curves showed that LDH ≥ 258.5U/L and SUVmax ≥ 11.62 were correlated to shorter PFS (P < 0.001, P = 0.003, respectively). The differences in PFS between the low-, intermediate-, and high-risk groups were statistically significant (P = 0.0043). CONCLUSION In R/R cHL patients treated with ICIs and chemotherapy, Lugano classification, SUVmax, and LDH were significantly correlated with PFS. The combination of metabolic and hematological parameters predicts PFS and may help to improve patient selection.
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Affiliation(s)
- Tianyu Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Shuang Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Rui Zuo
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Hongwei Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Lu Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Zhengjie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
| | - Xiaoliang Chen
- Department of Nuclear Medicine, Chongqing University Cancer Hospital, Chongqing, 400030 China
| | - Hua Pang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042 China
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Zawati I, Adouni O, Manai M, Nagara M, Tacam M, Reduzzi C, Gamoudi A, Manai M. FOXP3+/CD68+ ratio within the tumor microenvironment may serve as a potential prognostic factor in classical Hodgkin lymphoma. Hum Immunol 2022; 83:843-856. [PMID: 36068099 DOI: 10.1016/j.humimm.2022.08.013] [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: 03/20/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022]
Abstract
Classical Hodgkin lymphoma (CHL) is characterized by extensive inflammatory immune cells, which predict the disease prognosis. Therefore, this study aimed to explore the significance of different tumor-infiltrated immune cells and subpopulation ratios observed in the tumor microenvironment of CHL, particularly relating to the disease's prognosis-focusing on overall survival (OS) and event-free survival (EFS). Utilizing immunohistochemistry, the quantification and exploration of selected immune cells' subsets, including CD3+, CD4+, CD8+, FOXP3+, CD20+, and CD68+ were conducted on 102 histological samples with primary CHL. Eosinophils were pathologically assessed. Besides, we determined the ratios between different tumor-infiltrated immune cells for each patient. Kaplan-Meier method and Cox regression modeling were used for survival analysis. We demonstrated that among all ratios and immune cells individually, only a higher FOXP3+/CD68+ ratio (≥1.36 cutoff) displayed a tendency towards a favorable OS (p = 0.057, HR = 0.43 [0.18-1.02]) and EFS (p = 0.067, HR = 0.44 [0.18-1.06]) using Cox regression modeling. Moreover, the Kaplan-Meier method showed an association of a higher FOXP3+/CD68+ ratio with a longer 5-years OS (p = 0.037) and a tendency to a better EFS (p = 0.051); however, neither the combined FOXP3+ and CD68+ nor FOXP3+ or CD68+ separately was correlated to the CHL survival. Together, these results demonstrated that the FOXP3+/CD68+ ratio could predict the outcomes of CHL, providing more informative significance than FOXP3+ and CD68+ combined or FOXP3+ and CD68+ individually and might be a potential indicator of risk stratification, which has an important value for guiding the clinical treatment.
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Affiliation(s)
- Imen Zawati
- Department of Immuno-Histo-Cytology, Salah Azaiez Institute, 1006 Tunis, Tunisia; Department of Biology, Mycology, Pathologies, and Biomarkers Laboratory (LR16ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Ariana, Tunisia.
| | - Olfa Adouni
- Department of Immuno-Histo-Cytology, Salah Azaiez Institute, 1006 Tunis, Tunisia; Department of Biology, Mycology, Pathologies, and Biomarkers Laboratory (LR16ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Ariana, Tunisia
| | - Maroua Manai
- Department of Immuno-Histo-Cytology, Salah Azaiez Institute, 1006 Tunis, Tunisia; Laboratory of Human Genetics (LR99ES10), Faculty of Medicine of Tunis, University of Tunis El Manar, 2092 Tunis, Tunisia; Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine, 1300 York Ave, 10021 NY, NY, USA
| | - Majdi Nagara
- Inserm, UMR-S 1251, MMG, Faculty of Medicine Timone, Aix Marseille University, Marseille, France
| | - Moisis Tacam
- Department of OB/Gyn, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Carolina Reduzzi
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine, 1300 York Ave, 10021 NY, NY, USA
| | - Amor Gamoudi
- Department of Immuno-Histo-Cytology, Salah Azaiez Institute, 1006 Tunis, Tunisia
| | - Mohamed Manai
- Department of Biology, Mycology, Pathologies, and Biomarkers Laboratory (LR16ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Ariana, Tunisia
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Hojo N, Nagasaki M, Mihara Y. Gray zone lymphoma effectively treated with cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab chemotherapy: A case report. World J Clin Cases 2022; 10:5708-5716. [PMID: 35979119 PMCID: PMC9258378 DOI: 10.12998/wjcc.v10.i17.5708] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (BCLu-DLBCL/cHL), also referred to as gray zone lymphoma (GZL), is known to share features with cHL and DLBCL. However, GZL is often difficult to diagnose. There is no consensus regarding the optimal therapeutic regimen. Most reported cases of GZL have been in Caucasian and Hispanic individuals, and its incidence is lower in African-American and Asian populations, including the Japanese population.
CASE SUMMARY A 69-year-old female presented at our hospital with a growing mass on the right side of her neck. An elastic, soft mass measuring 9 cm × 6 cm was palpable in the right cervical region. Laboratory analyses showed pancytopenia, increased serum lactate dehydrogenase levels, and markedly increased levels of soluble interleukin-2 receptor. Enhanced computed tomography (CT) and fluorodeoxyglucose positron emission tomography (PET)/CT revealed multiple lesions throughout her body. She was diagnosed with GZL based on the characteristic pathological findings, the immunophenotype [CD20+, PAX5+, OCT2+/BOB1 (focal+), CD30+, CD15-], and the strong positive expression of neoplastic programmed cell death protein ligand 1 (PD-L1) in her lymphoma cells. The lymphoma was stage IV according to the Lugano classification and high-risk according to the International Prognostic Index for aggressive non-Hodgkin lymphoma. The patient received cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (R-CHOP) chemotherapy because the tumor cells were CD20+. She has remained in complete remission for 3 years.
CONCLUSION GZL was diagnosed based on histopathology and immunophenotyping with ancillary PD-L1 positivity. R-CHOP chemotherapy was an effective treatment.
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Affiliation(s)
- Nobumasa Hojo
- Department of General Medicine, National Hospital Organization Hamada Medical Center, Hamada City 697-8511, Shimane, Japan
| | - Makoto Nagasaki
- Department of Pathology, National Hospital Organization Hamada Medical Center, Hamada City 697-8511, Shimane, Japan
| | - Yasuha Mihara
- Clinical Resident, National Hospital Organization Hamada Medical Center, Hamada City 697-8511, Shimane, Japan
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Ishida T, Sato M, Kamoda Y, Hirao M, Iizuka H, Kida M, Hashimoto H, Miura S, Morikawa T, Usuki K. [Transformation of follicular lymphoma to classical Hodgkin lymphoma during observation]. Rinsho Ketsueki 2022; 63:544-549. [PMID: 35831186 DOI: 10.11406/rinketsu.63.544] [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: 06/15/2023]
Abstract
A 44-year-old female was diagnosed with follicular lymphoma (FL), grade 3A stage III, by right cervical lymph node biopsy at the age of 43 years. The patient chose to not receive the treatment despite the high tumor burden. The patient came back after 18 months with respiratory distress and had systemic infiltration and pleural effusion. Positron emission tomography (PET)/computed tomography (CT) showed fluorine-18 deoxyglucose accumulation with maximum standardized uptake value ranging from 10 to 18 in bone marrow, liver, spleen, lung, and systemic lymph nodes (cervical, supraclavicular, infraclavicular, axillary, mediastinal, hilar, para-aortic, iliac, and inguinal). Left inguinal lymph node biopsy revealed mixed cellularity classical Hodgkin lymphoma (CHL), which was thought to be an FL transformation or a composite condition. The patient was treated with A + AVD and achieved lymph node shrinkage as well as improvement of tumor fever and pleural effusion. Interim PET/CT showed improvement in most parts after two courses; however, it revealed some new or progressive lesions in the bone marrow and left cervical lymph nodes. Left cervical lymph node biopsy revealed nodular sclerosis CHL. The patient was treated with ESHAP, which resulted in stable disease; following this, the patient was treated with nivolumab, which was highly effective. FL transformation to CHL is rare, and this is the first report of such transformation without treatment.
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Affiliation(s)
- Taiki Ishida
- Department of Hematology, NTT Medical Center Tokyo
- Department of Hematology and Oncology, the University of Tokyo Hospital
| | - Michiaki Sato
- Department of Hematology and Oncology, the University of Tokyo Hospital
| | | | - Masako Hirao
- Department of Hematology, NTT Medical Center Tokyo
| | | | - Michiko Kida
- Department of Hematology, NTT Medical Center Tokyo
| | | | - Sakiko Miura
- Department of Diagnostic Pathology, NTT Medical Center Tokyo
| | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Center Tokyo
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Hatanaka N, Sata H, Kusakabe S, Yasumi M, Karasuno T. [Development of classical Hodgkin lymphoma in a patient receiving tocilizumab for rheumatoid arthritis]. Rinsho Ketsueki 2021; 62:1505-1509. [PMID: 34732624 DOI: 10.11406/rinketsu.62.1505] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 66-year-old woman was being treated with methotrexate and etanercept for rheumatoid arthritis (RA). Because her RA symptoms worsened, her medication was changed to tocilizumab (TCZ), and her symptoms improved. However, one year and six months later, she was referred to our hospital because of fever, cervical and para-aortic lymphadenopathy, and massive lesions of the liver/spleen. She was diagnosed with clinical stage IVB mixed cellularity classical Hodgkin lymphoma (cHL) on the basis of right cervical lymph node biopsy. Immunohistochemically, Hodgkin cells were positive for CD20, CD30, PAX-5, LMP-1, PD-L1, and EBER and were negative for CD5, CD15, and EBNA2. Her fever and lymphadenopathy did not improve after the discontinuation of TCZ. Therefore, she was administered ABVd therapy and achieved complete remission (CR) after six cycles of ABVd therapy. She was found to be alive and in CR on regular follow up till February 2021. To the best of our knowledge, there are limited reports of immunodeficiency-related lymphoproliferative disorders associated with TCZ in literature, and our case may be a valuable report on the association of TCZ with the development of cHL in patients with RA.
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Affiliation(s)
| | - Hiroshi Sata
- Department of Hematology, Daini Osaka Police Hospital
| | | | - Masato Yasumi
- Department of Hematology, Rinku General Medical Center
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Ding XS, Mi L, Song YQ, Liu WP, Yu H, Lin NJ, Zhu J. Relapsed/refractory classical Hodgkin lymphoma effectively treated with low-dose decitabine plus tislelizumab: A case report. World J Clin Cases 2021; 9:6041-6048. [PMID: 34368325 PMCID: PMC8316945 DOI: 10.12998/wjcc.v9.i21.6041] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/17/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Academic studies have proved that anti-programmed death-1 (PD-1) monoclonal antibodies demonstrated remarkable activity in relapsed/refractory classical Hodgkin lymphoma (cHL). However, most patients ultimately experienced failure or resistance. It is urgent and necessary to develop a novel strategy for relapsed/refractory cHL. The aim of this case report is to evaluate the combination approach of low-dose decitabine plus a PD-1 inhibitor in relapsed/ refractory cHL patients with prior PD-1 inhibitor exposure.
CASE SUMMARY The patient was a 27-year-old man who complained of enlarged right-sided cervical lymph nodes and progressive pain aggravation of the right shoulder over the past 3 mo before admission. Histological analysis of lymph node biopsy was suggestive of cHL. The patient experienced failure of eight lines of therapy, including multiple cycles of chemotherapy, PD-1 blockade, and anti-CD47 antibody therapy. Contrast-enhanced CT showed that the tumors of the chest and abdomen significantly shrunk or disappeared after three cycles of treatment with decitabine plus tislelizumab. The patient had been followed for 11.5 mo until March 2, 2021, and no progressive enlargement of the tumor was observed.
CONCLUSION The strategy of combining low-dose decitabine with tislelizumab could reverse the resistance to PD-1 inhibitors in patients with heavily pretreated relapsed/ refractory cHL. The therapeutic effect of this strategy needs to be further assessed.
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Affiliation(s)
- Xiao-Sheng Ding
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Lan Mi
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yu-Qin Song
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Wei-Ping Liu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hui Yu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ning-Jing Lin
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jun Zhu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
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Tao Y, Chen H, Liu D, Dai X. Survival among patients with composite and sequential lymphoma between primary mediastinal lymphoma/diffuse large B-cell lymphoma and classical Hodgkin lymphoma: A population-based study. Leuk Res 2021; 111:106669. [PMID: 34333276 DOI: 10.1016/j.leukres.2021.106669] [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: 06/06/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Data on composite and sequential lymphoma between primary mediastinal lymphoma/diffuse large B-cell lymphoma (LBCL) and classical Hodgkin lymphoma (cHL) are rare. METHODS We identified 25 cases with composite lymphoma (CL), 116 cases developing LBCL as a second primary cancer after cHL (cHL-LBCL), and 74 cases developing cHL as a second primary cancer after LBCL (LBCL-cHL) from the Surveillance, Epidemiology, and End Results (SEER) 18 database. Comparisons of overall survival (OS) and lymphoma cause-specific survival (CSS) between patients with cHL-LBCL or cHL-LBCL and their de novo counterparts were performed. RESULTS The 5-year OS of patients with CL was 74.8 %. No significant difference in unadjusted OS and lymphoma CSS were observed between patients with de novo LBCL (LBCL-1 group) and patients with cHL-LBCL. However, the age- and stage-adjusted cHL-LBCL group had inferior OS and lymphoma CSS compared with that in the LBCL-1 group. The unadjusted and adjusted OS and lymphoma CSS in the LBCL-cHL group were significantly worse than patients with de novo cHL. CONCLUSIONS CL between LBCL and cHL may have good outcomes. cHL survivors had poorer outcomes after a LBCL diagnosis versus patients with LBCL-1. Significantly poor outcomes were observed in patients with LBCL-cHL compared with patients with de novo cHL.
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Affiliation(s)
- Yunxia Tao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Haizhu Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Dan Liu
- Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming, China
| | - Xiumei Dai
- Department of Medical Oncology, Xuzhou Central Hospital, Clinical School of Xuzhou Medical University, Xuzhou, China.
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Pánisová E, Lünemann A, Bürgler S, Kotur M, Lazarovici J, Danu A, Kaulfuss M, Mietz J, Chijioke O, Münz C, Busson P, Berger C, Ghez D, Azzi T. Reduced frequency of cytotoxic CD56 dim CD16 + NK cells leads to impaired antibody-dependent degranulation in EBV-positive classical Hodgkin lymphoma. Cancer Immunol Immunother 2021. [PMID: 33993319 DOI: 10.1007/s00262-021-02956-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/11/2020] [Accepted: 04/28/2021] [Indexed: 12/16/2022]
Abstract
Around 30–50% of classical Hodgkin lymphoma (cHL) cases in immunocompetent individuals from industrialized countries are associated with the B-lymphotropic Epstein-Barr virus (EBV). Although natural killer (NK) cells exhibit anti-viral and anti-tumoral functions, virtually nothing is known about quantitative and qualitative differences in NK cells in patients with EBV+ cHL vs. EBV- cHL. Here, we prospectively investigated 36 cHL patients without known immune suppression or overt immunodeficiency at diagnosis. All 10 EBV+ cHL patients and 25 out 26 EBV- cHL were seropositive for EBV antibodies, and EBV+ cHL patients presented with higher plasma EBV DNA levels compared to EBV- cHL patients. We show that the CD56dim CD16+ NK cell subset was decreased in frequency in EBV+ cHL patients compared to EBV- cHL patients. This quantitative deficiency translates into an impaired CD56dim NK cell mediated degranulation toward rituximab-coated HLA class 1 negative lymphoblastoid cells in EBV+ compared to EBV- cHL patients. We finally observed a trend to a decrease in the rituximab-associated degranulation and ADCC of in vitro expanded NK cells of EBV+ cHL compared to healthy controls. Our findings may impact on the design of adjunctive treatment targeting antibody-dependent cellular cytotoxicity in EBV+ cHL.
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Abuelgasim KA, Shammari RA, Alshieban S, Alahmari B, Alzahrani M, Alhejazi A, Alaskar A, Damlaj M. Impact of cluster of differentiation 20 expression and rituximab therapy in classical Hodgkin lymphoma: Real world experience. Leuk Res Rep 2021; 15:100240. [PMID: 33936943 PMCID: PMC8076710 DOI: 10.1016/j.lrr.2021.100240] [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: 09/28/2020] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
The prognostic impact of CD20 expression and rituximab therapy in classical Hodgkin lymphoma (cHL) is unclear. Among 310 patients, CD20 was expressed in 66 (22%) cases. The 3-year PFS was 75.1% for CD20+and 70% for CD20− (p = 0.36). The 3-year PFS was 84.7% for the rituximab group and 67.8% for the no rituximab group (p = 0.23). Only constitutional symptoms and positive interim PET/CT were significantly associated with worse outcome, HR 3.2 (1.14–9.01; p = 0.028) and 4.3 (2.27–8.1; p < 0.0001), respectively. Neither CD20 expression nor rituximab use significantly impacted outcome.
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Affiliation(s)
- Khadega A Abuelgasim
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raed Al Shammari
- Internal Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saeed Alshieban
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Pathology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bader Alahmari
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Moussab Damlaj
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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13
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Fujii H, Tsuji T, Sugitani M, Matsumoto Y, Yuba T, Tanaka S, Suga Y, Matsuyama A, Goda S, Omura A, Shiotsu S, Takumi C, Ono S, Hiraoka N. Prolonged persistence of SARS-CoV-2 infection during A+AVD therapy for classical Hodgkin's lymphoma: A case report. Curr Probl Cancer 2021; 45:100739. [PMID: 33810911 PMCID: PMC7988448 DOI: 10.1016/j.currproblcancer.2021.100739] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/14/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
We describe a case of coronavirus disease 2019 (COVID-19) in a patient with mixed cellularity classical Hodgkin lymphoma (cHL) undergoing brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD) therapy. A 43-year-old man presented to our hospital with a complaint of fever, for which he was diagnosed with COVID-19 after a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and antiviral therapy with favipiravir and ciclesonide was started subsequently. The fever persisted for the first few days of treatment, but his respiratory status was stable, and he became asymptomatic and afebrile on day 9. Although the PCR tests remained positive, he met the updated discharge criteria of the World Health Organization (WHO) on day 12. However, his fever recurred, and his condition worsened on day 16. A chest X-ray showed a new opacity. It is likely that favipiravir and ciclesonide treatment probably did not completely eliminate the virus in the patient, and therefore the infection persisted. We added remdesivir from day 21, and the improvement was remarkable. He was discharged on day 29 after two consecutive PCR test results were negative. PCR tests are not mandatory for the updated WHO discharge criteria. However, even after antiviral therapy, COVID-19 patients with hematologic malignancies may have prolonged active infection with impaired viral excretion. Depending on the background disease and comorbidities, there may be some patient populations for whom it is not appropriate to simply comply with the current discharge criteria. Therefore, more emphasis may be needed on PCR examinations.
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Affiliation(s)
- Hiroyuki Fujii
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan.
| | - Taisuke Tsuji
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Mio Sugitani
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Yosuke Matsumoto
- Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Tatsuya Yuba
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan; Department of Infection Control, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Shunya Tanaka
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Yoshifumi Suga
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Aosa Matsuyama
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Shiho Goda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Ayaka Omura
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Shinsuke Shiotsu
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan; Department of Clinical Oncology, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Chieko Takumi
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan; Department of Clinical Oncology, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Seiko Ono
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan; Department of Infection Control, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
| | - Noriya Hiraoka
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama, Kyoto, Japan
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14
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Eichenauer DA, Müller H, Elger L, Goergen H, Fuchs M, Kreissl S, Böll B, Diehl V, von Tresckow B, Borchmann P, Engert A. Non-Hodgkin lymphoma after treatment for classical Hodgkin lymphoma: a report from the German Hodgkin Study Group. Br J Haematol 2021; 193:515-519. [PMID: 33486762 DOI: 10.1111/bjh.17327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/19/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
Data on non-Hodgkin lymphoma (NHL) after classical Hodgkin lymphoma (cHL) are scarce. We therefore performed a retrospective analysis comprising 11·841 cHL patients who had first-line treatment within the randomized German Hodgkin Study Group (GHSG) HD7-HD15 studies. After a median follow-up of 106 months, 175 patients (1·5%) had developed NHL. The median time to NHL was 44 months, the median age at NHL diagnosis was 54 years. The five-year event-free survival and overall survival estimates from the diagnosis of NHL were 36·9% and 44·2%, respectively. Thus, NHL after cHL is a rare event primarily affecting older individuals and often resulting in the patient´s death.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Horst Müller
- First Department of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Leonard Elger
- First Department of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Helen Goergen
- First Department of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Michael Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Stefanie Kreissl
- First Department of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Boris Böll
- First Department of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany.,Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Andreas Engert
- First Department of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
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15
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Chowdhary G, Mehta R, Tyagi R. Primary pulmonary Hodgkin's lymphoma with pulmonary histoplasmosis. Med J Armed Forces India 2020; 76:462-465. [PMID: 33162658 PMCID: PMC7606111 DOI: 10.1016/j.mjafi.2018.11.009] [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: 03/03/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022] Open
Abstract
Primary pulmonary Hodgkins lymphoma is a rare and enigmatic neoplasm commonly seen in females. The aim of this case report is to emphasize that pulmonary lymphoma should be considered as a differential diagnosis in a young patient presenting with a lung mass and B symptoms. Extensive clinical details, imaging should be done to rule out the secondary involvement of lung by other lymphomas.
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Affiliation(s)
- G.S. Chowdhary
- Senior Advisor (Medicine & Oncology), INHS Asvini, Mumbai, India
| | - Ritu Mehta
- Classified Specialist (Pathology & Oncopathology), INHS Asvini, Mumbai, India
| | - Rahul Tyagi
- Classified Specialist (Pulmonary Medicine), INHS Asvini, Mumbai, India
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16
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Siref A, McCormack C, Huang Q, Lim W, Alkan S. Diminished expression of 5hmc in Reed-Sternberg cells in classical Hodgkin lymphoma is a common epigenetic marker. Leuk Res 2020; 96:106408. [PMID: 32659407 DOI: 10.1016/j.leukres.2020.106408] [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: 02/13/2019] [Revised: 04/28/2020] [Accepted: 06/28/2020] [Indexed: 02/08/2023]
Abstract
Loss of the epigenetic marker 5-hydroxymethylcytosine (5hmC) has been demonstrated in a variety of neoplasms. Several recent studies have shown epigenetic alteration in Classical Hodgkin lymphoma (CHL), which may impact treatment. We demonstrate near universal depletion of 5hmC in the neoplastic Hodgkin Reed-Sternberg (H/RS) cells in all cases of CHL (49/49). We hypothesized that the addition of vitamin C-a cofactor for the ten-eleven translocation (TET) enzymes which oxidize 5-methylcytosine (5mC) to 5hmC - may replenish levels of 5hmC. The CHL cell line L428 was grown in optimal conditions and then subjected to vitamin C treatment, which demonstrated reduced cell viability as well as caspase activation and increased concentration of 5hmC. A more detailed understanding of the epigenetic landscape of CHL may help guide future therapies.
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Affiliation(s)
- Andrew Siref
- Cedars-Sinai Medical Center, Department of Pathology and Laboratory Medicine, 8700 Beverly Blvd., Room #4711, Los Angeles, CA 90048-1804, United States
| | - Colin McCormack
- Cedars-Sinai Medical Center, Department of Pathology and Laboratory Medicine, 8700 Beverly Blvd., Room #4711, Los Angeles, CA 90048-1804, United States
| | - Qin Huang
- Cedars-Sinai Medical Center, Department of Pathology and Laboratory Medicine, 8700 Beverly Blvd., Room #4711, Los Angeles, CA 90048-1804, United States
| | - Washington Lim
- Cedars-Sinai Medical Center, Department of Pathology and Laboratory Medicine, 8700 Beverly Blvd., Room #4711, Los Angeles, CA 90048-1804, United States
| | - Serhan Alkan
- Cedars-Sinai Medical Center, Department of Pathology and Laboratory Medicine, 8700 Beverly Blvd., Room #4711, Los Angeles, CA 90048-1804, United States.
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17
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Zawati I, Adouni O, Finetti P, Manai M, Manai M, Gamoudi A, Birnbaum D, Bertucci F, Mezlini A. Adolescents and young adults with classical Hodgkin lymphoma in northern Tunisia: insights from an adult single-institutional study. Cancer Radiother 2020; 24:206-214. [PMID: 32171674 DOI: 10.1016/j.canrad.2020.01.004] [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: 11/20/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The aim of this study was to extensively describe the epidemiological, clinical and therapeutic outcomes of adolescents and young adults (AYA) population with classical Hodgkin Lymphoma (cHL). Then, a comparison between AYAs and adults and between the subgroups of AYAs treated with the same adult protocol was accomplished to further inform on optimal therapy approach of choice for adolescent patients. MATERIAL AND METHODS In this mono-centric, retrospective study, we reviewed the medical records. We analyzed 112 consecutive North Tunisian patients, including 66 AYAs (15 to 39 years) and 46 adults (≥40years) affected by cHL treated from 2000 to 2015 at Salah Azaiez Institute. Then, we performed a comparative analysis between AYA and 46 adult patients and a subgroup analysis between adolescents and young adults. All patients were treated according to the national protocol for HL, edited by the Tunisian Society of Hematology. The treatment included chemotherapy and involved-field radiotherapy (RT) at a dose of 20 or 30 Grays (Gy) for responders and 36Gy for non-responders. RESULTS AYA patients presented with adverse features with nodular sclerosis subtype (p=3.88×10-02) and mediastinal mass involvement (p=9.40×10-04). At a median follow-up of 51 and 32 months for AYAs and adults, respectively, no statistical difference in terms of 3 and 5-years overall survival (OS) and event-free survival (EFS) was shown. Using the Kaplan-Meier method, in AYAs, the ABVD regimen has an impact on 3-years EFS (p=4.63×10-02). The 36Gy RT was associated with the best 3-years EFS (p=9.24×10-03). Besides, AYA patients with advanced-stage had the worst 3-years OS (76%) (p=2.41×10-02). Although the adolescents and young adults shared similar clinical presentation, we noted that the adolescent group had the worst 3-years EFS (48%), but the best 3-years OS (91%). We identified 15% of primary refractory patients and a rate of toxicity of 5.3% in AYA. CONCLUSION The treatment approach used is well tolerated by adult patients. However, the AYA patients and particularly adolescent subgroup had more advanced disease at diagnosis and should be treated more intensively in dedicated units. RT dose<36Gy and ABVD chemotherapy were associated with lower EFS in this population.
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Affiliation(s)
- I Zawati
- Department of Immunohistocytology, Salah Azaiez Institute, 1006 Tunis, Tunisia; Department of Biology, Mycology, Pathologies and Biomarkers Laboratory (LR16ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Ariana, Tunisia.
| | - O Adouni
- Department of Immunohistocytology, Salah Azaiez Institute, 1006 Tunis, Tunisia; Department of Biology, Mycology, Pathologies and Biomarkers Laboratory (LR16ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Ariana, Tunisia
| | - P Finetti
- Predictive Oncology Laboratory, Cancer Research Center of Marseille, Aix Marseille University, 13009 Marseille, Tunisia
| | - Ma Manai
- Department of Immunohistocytology, Salah Azaiez Institute, 1006 Tunis, Tunisia; Predictive Oncology Laboratory, Cancer Research Center of Marseille, Aix Marseille University, 13009 Marseille, Tunisia; Human Genetics Laboratory (LR99ES10), Faculty of Medicine of Tunis, University of Tunis, El Manar, 2092 Tunis, Tunisia
| | - M Manai
- Department of Biology, Mycology, Pathologies and Biomarkers Laboratory (LR16ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, 2092 Ariana, Tunisia
| | - A Gamoudi
- Department of Immunohistocytology, Salah Azaiez Institute, 1006 Tunis, Tunisia
| | - D Birnbaum
- Predictive Oncology Laboratory, Cancer Research Center of Marseille, Aix Marseille University, 13009 Marseille, Tunisia
| | - F Bertucci
- Predictive Oncology Laboratory, Cancer Research Center of Marseille, Aix Marseille University, 13009 Marseille, Tunisia; Department of Medical Oncology, Paoli-Calmettes Institute, 13009 Marseille, France; Training and Research Unit of Medicine, Aix Marseille University, 13009 Marseille, France
| | - A Mezlini
- Department of Medical Oncology, Salah Azaiez Institute, 1006 Tunis, Tunisia
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18
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Allen PB, Ayers A, Behera M, Evens AM, Flowers C. A systematic review of therapeutic regimens for older patients with newly diagnosed Hodgkin lymphoma. Leuk Lymphoma 2020; 61:1555-1564. [PMID: 32102579 DOI: 10.1080/10428194.2020.1731497] [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] [Indexed: 10/24/2022]
Abstract
Classical Hodgkin lymphoma (cHL) in older adults is associated with inferior outcomes and increased toxicity compared to younger patients. Novel therapies like brentuximab vedotin (BV) have yielded promising results, yet their optimal use in older cHL remains unclear. We performed a systematic review to assess outcomes and toxicity associated with frontline regimens in older cHL. We screened 196 references involving chemotherapy without BV and 662 references containing BV and included 9 studies (12 arms) without BV and 6 studies (7 arms) with BV. Progression-free survival (PFS) ranged from 47 to 84% at 2 years in BV-containing arms and 42-79% at 5 years in non-BV containing trials. Pulmonary toxicity was more common in arms receiving >2 cycles of bleomycin, whereas peripheral neuropathy was associated with cumulative BV dose. This review summarizes available treatment outcomes in newly diagnosed older cHL patients and may aid clinicians in decision-making regarding available frontline approaches.Key PointsThis systematic review suggests that >2 cycles of bleomycin is associated with excess pulmonary toxicity in cHL patients older than 60 years of age.Peripheral neuropathy was more frequent in patients receiving BV-containing regimens and was associated with cumulative BV dose.BV-containing regimens are associated with high response rates in advanced-stage patients, but follow-up is limited.
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Affiliation(s)
- Pamela B Allen
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Amy Ayers
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Department of Research Informatics, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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19
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Xie Y, Wang X, Leng X, Zheng W, Ping L, Zhang C, Liu W, Deng L, Wu M, Song Y, Zhu J. High-dose chemotherapy followed by autologous stem cell transplantation for patients with refractory/relapsed classical Hodgkin lymphoma: a single center experience from China. Ann Hematol 2020; 99:549-555. [PMID: 31980860 DOI: 10.1007/s00277-019-03812-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/26/2019] [Indexed: 01/20/2023]
Abstract
To evaluate the outcomes of refractory/relapsed cHL patients after high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) in Beijing Cancer hospital and to identify the prognostic risk factors. We retrospectively analyzed 115 relapsed/refractory cHL patients who accepted HDCT and ASCT in our cancer center and had complete follow-up data from April 2000 to May 2017. Ages of these 115 patients at ASCT ranged from 14 to 63 (median age 28). Forty-four (38.3%) patients achieved CR and 50 (43.5%) patients achieved PR before ASCT. Thirty-seven (48.7%) patients of those 76 patients who did PET-CT before ASCT had negative PET-CT scans. The median follow-up time was 72 months. A total of 23 patients died in our study. The 5-year OS and PFS rates of all patients after ASCT were 78.7% and 53%, respectively. The 5-year OS rates after ASCT of patients who were in CR or PR or less than PR status before ASCT were 92.8%, 68.2%, and 76.2%, respectively (log-rank = 2.913, p = 0.233). And their 5-year PFS rates after ASCT were 69.2%, 54.2%, and 18.5%, respectively (log-rank = 13.615, p = 0.001). Univariate analysis revealed that ECOG (p = 0.010; hazard ratio = 1.578), disease status before ASCT (CR: p = 0.001; hazard ratio = 0.227) and after ASCT (CR: p < 0.001; hazard ratio = 0.154), and PET-CT results after ASCT (p = 0.023; hazard ratio = 0.438) significantly impact patients' PFS while number of pretransplant salvage chemotherapy (p = 0.037; hazard ratio = 2.521), radiotherapy (p = 0.046; hazard ratio = 0.423), and disease status after ASCT (CR: p = 0.010; hazard ratio = 0.197) significantly affected patients' OS. Multivariate analysis shown only disease status before ASCT (p = 0.002) had significant impact on PFS and disease status after ASCT (p = 0.021) had significant impact on OS. R/R HL patients can still obtain long-term PFS after HDCT and ASCT and disease status before ASCT was the most significant prognostic factor for PFS.
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Affiliation(s)
- Yan Xie
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaopei Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xin Leng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wen Zheng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lingyan Ping
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chen Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Weiping Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lijuan Deng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuqin Song
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ju Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China.
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20
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Elborai Y, Elgammal A, Salama A, Fawzy M, El-Desouky ED, Attia I, Shalaby LM. Cyclooxygenase-2 expression as a prognostic factor in pediatric classical Hodgkin lymphoma. Clin Transl Oncol 2020; 22:1539-1547. [PMID: 31970686 DOI: 10.1007/s12094-020-02297-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/09/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Cyclooxygenase-2 (COX-2) is an inflammation-related enzyme that has been shown to have a role in tumor initiation, angiogenesis, and proliferation. It has been demonstrated that COX-2 expression is increased in many tumors and is a negative prognostic parameter. Our objective is to investigate the prognostic value of COX-2 expression in pediatric patients with classical Hodgkin lymphoma (CHL). METHODS This was a retrospective analysis in pediatric patients (n = 127) diagnosed with CHL and treated at the pediatric oncology department, National Cancer Institute, Cairo University, January 2005-June 2013. We correlated COX-2 immunostaining in Reed-Sternberg (RS) cells with clinical variables and outcome. RESULTS COX-2 was expressed on 38.6% of RS cells. The median follow-up time was 48.4 months (range 4-114 months). The 5-year OS and PFS, in COX-2(+ve) versus COX-2(-ve) was 85.3% versus 96.0% (p = 0.248) and 78.6% versus 84.3% (p = 0.354), respectively. A multivariate analysis showed that COX-2(+ve) was not significantly associated with the 5-year OS (HR = 2.9; 95% CI 0.7-12.4, p = 0.149) or with the 5-year PFS (HR = 1.4; 95% CI 0.6-3.2, p = 0.490). High-risk patients in the COX-2(+ve) group had a significantly lower 5-year OS (p = 0.021). The 5-year PFS was significantly lower in the COX-2(+ve) group with B symptoms (p = 0.023) and bulky disease (p = 0.028). Radiotherapy was given only to high-risk patients; survival was much better in radiation-treated children in both the Cox-2(+ve) and Cox-2(-ve) groups. The magnitude of the radiotherapy effect was also greater in the Cox-2(+ve) group, but this difference was not statistically significant. CONCLUSION COX-2 expression showed a tendency to be a poor prognostic factor, but it failed to provide meaningful independent information. Further larger studies are needed to investigate COX-2 as a prognostic factor and potential therapeutic target.
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Affiliation(s)
- Y Elborai
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt.
| | - A Elgammal
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt
| | - A Salama
- Pathology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - M Fawzy
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt
| | - E D El-Desouky
- Biostatistics and Cancer Epidemiology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - I Attia
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt
| | - L M Shalaby
- Pediatric Oncology Department, National Cancer Institute (NCI), Cairo University, Fom El-khalig Square Kasr El-Aini St., Cairo, 11796, Egypt
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21
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Ichikawa S, Fukuhara N, Saito K, Onodera K, Shirai T, Onishi Y, Yokoyama H, Fujii H, Ichinohasama R, Harigae H. Successful treatment of methotrexate-associated classical Hodgkin lymphoma with brentuximab vedotin-combined chemotherapy: a case series. Int J Hematol 2020; 111:667-672. [PMID: 31955346 DOI: 10.1007/s12185-020-02822-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 12/01/2022]
Abstract
Methotrexate (MTX)-associated classical Hodgkin lymphoma (CHL) is unlikely to regress following discontinuation of MTX, and its treatment usually requires chemotherapy. Standard chemotherapy for CHL is the ABVD regimen, which contains pneumotoxic bleomycin. This can be problematic in MTX-CHL patients suffering from an autoimmune disease (AID), such as rheumatoid arthritis (RA), as they frequently have pulmonary complications. However, brentuximab vedotin (BV)-containing chemotherapy without bleomycin (A + AVD regimen) was recently reported to show favorable efficacy for CHL, and could therefore be beneficial in MTX-CHL. We treated three cases of MTX-CHL using the A + AVD regimen. All were female and had received MTX for more than 15 years. Underlying AIDs in these patients were RA in two patients, and overlap syndrome with systemic lupus erythematosus and dermatomyositis in one patient. The A + AVD regimen resulted in a complete response in all patients. Peripheral neuropathy developed in two patients, necessitating reduction of the BV dose. All three patients experienced hematological toxicity necessitating dose reduction; however, no severe adverse effects, including infection or pulmonary complication, were documented. RA was well-controlled without additional immunosuppressants. The A + AVD regimen is a promising chemotherapy for MTX-CHL with favorable efficacy and tolerable toxicity profiles.
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Affiliation(s)
- Satoshi Ichikawa
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan.
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Kei Saito
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Koichi Onodera
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Tsuyoshi Shirai
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Yasushi Onishi
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Hisayuki Yokoyama
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Hiroshi Fujii
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Ryo Ichinohasama
- Department of Hematopathology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
| | - Hideo Harigae
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1 Seiryo-cho, Sendai, 980-8574, Japan
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22
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Abstract
BACKGROUND Extranodal lymphomas occurring in the head and neck region account for 12-15% of all malignant tumors of this locality. Classical Hodgkin lymphoma (cHL) is a rare subtype, representing around 1% of all lymphomas in Waldeyer's ring. Cases diagnosed in the Reference Centre for Lymph Node Pathology at the Pathological Institute of the University of Würzburg were further analyzed in this study. MATERIALS AND METHODS Histological subtype and EBV association of 21 cases were reviewed in conjunction with clinical data. RESULTS Data of 12 male and 9 female patients with an average age of 51 years (median 45; 35-72) were reviewed. All samples were taken from the lymphatic tissue of the Waldeyer's ring (nasopharynx n = 15, palatine tonsils n = 5, lingual tonsils n = 1). The most common symptoms leading to a consultation with an otorhinolaryngologist were otalgia, swelling, or impaired nasal breathing. Only four patients showed typical B‑symptoms. In 6 cases (29%), an isolated extranodal manifestation was found, 15 patients (71%) showed simultaneous infiltration of cervical lymph nodes during staging, and 6 cases (29%) were EBV positive. CONCLUSION An exclusively extranodal manifestation of cHL in Waldeyer's ring is rare, whereas infiltration of extranodal tissue in the case of a primary manifestation of lymphoma in cervical nodes can occur more frequently and may often remain undiagnosed. Therefore, a specialized ENT consultation could be a reasonable complementary module in tumor staging to determine the correct tumor extent.
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Affiliation(s)
- H-U Völker
- Pathologie, Leopoldina Krankenhaus der Stadt Schweinfurt GmbH, Schweinfurt, Deutschland
| | - E Becker
- Pathologie, Leopoldina Krankenhaus der Stadt Schweinfurt GmbH, Schweinfurt, Deutschland
| | | | - M Scheich
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland.
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23
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Umino K, Fujiwara SI, Ikeda T, Kawaguchi SI, Toda Y, Ito S, Ochi SI, Nagayama T, Mashima K, Minakata D, Nakano H, Yamasaki R, Morita K, Kawasaki Y, Yamamoto C, Ashizawa M, Hatano K, Sato K, Oh I, Ohmine K, Muroi K, Kanda Y. Predictive value of soluble interlukin-2 receptor level at diagnosis on the outcome for patients with classical Hodgkin lymphoma treated with ABVD with or without radiotherapy. Ann Hematol 2019; 98:2121-2129. [PMID: 31240469 DOI: 10.1007/s00277-019-03738-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/25/2018] [Accepted: 06/12/2019] [Indexed: 01/20/2023]
Abstract
We retrospectively analyzed 70 patients with classical Hodgkin lymphoma (cHL) who were treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) with or without radiotherapy to assess the influence of the soluble interleukin-2 receptor (sIL-2R) level at diagnosis on the clinical outcome. Receiver operating characteristic analyses determined that the optimal cutoff value of the sIL-2R level for progression-free survival (PFS) was 2490 U/mL. Using this cutoff value, patients were classified into low (n = 46) and high (n = 24) sIL-2R groups. The patients in the high sIL-2R group exhibited a significantly inferior PFS (44.1% vs. 90.4% at 5 years, P < 0.001) and overall survival (OS) (67.6% vs. 94.7% at 5 years, P = 0.001) compared with those in the low sIL-2R group. Multivariate analysis showed that a high sIL-2R level was an independent prognostic factor for PFS after adjusting for stage, white blood cell, hemoglobin, and B symptoms, and also OS after adjusting for age and stage (hazard ratio (HR) 6.49, P < 0.001 and HR 5.98, P = 0.009, respectively). In patients with advanced-stage cHL, a high sIL-2R level predicted 5-year PFS even after adjustment for international prognostic score > 4 (HR 6.00, P = 0.007). These results demonstrate that the sIL-2R level can be a useful prognostic factor in patients with cHL treated with ABVD with or without radiotherapy.
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Affiliation(s)
- Kento Umino
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shin-Ichiro Fujiwara
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takashi Ikeda
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shin-Ichiro Kawaguchi
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yumiko Toda
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shoko Ito
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shin-Ichi Ochi
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takashi Nagayama
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kiyomi Mashima
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Daisuke Minakata
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hirofumi Nakano
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Ryoko Yamasaki
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kaoru Morita
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yasufumi Kawasaki
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Chihiro Yamamoto
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masahiro Ashizawa
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kaoru Hatano
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kazuya Sato
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Iekuni Oh
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Ken Ohmine
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kazuo Muroi
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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24
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von Tresckow B, Fanale M, Ardeshna KM, Chen R, Meissner J, Morschhauser F, Moskowitz C, Zinzani PL, Giezek H, Balakumaran A, Vo TT, Raut M, Brice P. Patient-reported outcomes in KEYNOTE-087, a phase 2 study of pembrolizumab in patients with classical Hodgkin lymphoma. Leuk Lymphoma 2019; 60:2705-2711. [PMID: 31012356 DOI: 10.1080/10428194.2019.1602262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/12/2022]
Abstract
In KEYNOTE-087, pembrolizumab had a 69% overall response rate and acceptable safety in patients with relapsed/refractory classical Hodgkin lymphoma (rrHL). We assessed health-related quality of life (HRQoL) in KEYNOTE-087. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and the EuroQoL Five Dimensions Questionnaire 3-level version (EQ-5D) were administered to 206 patients across three cohorts defined by lymphoma progression after: (1) autologous stem cell transplantation (ASCT) and subsequent brentuximab vedotin (BV) (n = 69); (2) salvage chemotherapy and BV (n = 79); and (3) ASCT without post-transplantation BV (n = 58). Compliance/completion rates were ≥90% at week 12 and ≥70% at week 24. QLQ-C30 global health status/QoL and EQ-5D visual analog scale scores showed mean increases from baseline in overall health at all assessed timepoints. With few exceptions, mean improvements from baseline to weeks 12 and 24 in QLQ-C30 functional and symptom scores occurred in all cohorts.Clinicaltrials.gov identifier: NCT02453594.
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Affiliation(s)
- Bastian von Tresckow
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Michelle Fanale
- Department of Lymphoma and Myeloma, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Robert Chen
- Department of Hematology, City of Hope National Medical Center, Duarte, CA, USA
| | - Julia Meissner
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Craig Moskowitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pier Luigi Zinzani
- Institute of Hematology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | | | | | - Thao T Vo
- Merck & Co., Inc, Kenilworth, NJ, USA
| | | | - Pauline Brice
- Hematology Department, AP-HP Hopital Saint-Louis, Paris, France
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25
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Major A, Jackson MW, Smith DE, Kamdar M, Rabinovitch R. Inferior outcomes and treatment disparities in elderly patients with classical Hodgkin lymphoma: a national cancer data base analysis. Leuk Lymphoma 2018; 60:1234-1243. [PMID: 30501432 DOI: 10.1080/10428194.2018.1522435] [Citation(s) in RCA: 6] [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: 10/27/2022]
Abstract
Elderly patients with classical Hodgkin lymphoma (cHL) are understudied and poorly defined. The National Cancer Data Base was queried for adults with cHL diagnosed 2004-2013: 22,547 age 18-39, 12,841 age 40-59, and 10,873 age ≥60 were identified. Two-year overall survival (OS) was 97%, 91%, and 65% for the three age cohorts, respectively (p < .0001). Elderly patients age ≥60 had greater advanced comorbidity scores, stage III-IV disease, and lymphocyte-depleted histology. Elderly patients were treated less with chemotherapy, radiotherapy for stage I-II disease, and at academic/research centers (p < .001). There was improved OS in elderly patients who received chemotherapy and/or radiotherapy and were treated at academic/research centers. This largest analysis of elderly cHL demonstrates that patients ≥60 are distinct from those 40-59. Age ≥60 should be a stratification in future trials and merit distinct studies. Improving the poor rate of treatment delivery and directing care to academic centers may improve outcomes.
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Affiliation(s)
- Ajay Major
- a Department of Medicine , Internal Medicine Residency Training Program, University of Colorado School of Medicine , Aurora , CO , USA
| | - Matthew W Jackson
- b Department of Radiation Oncology , University of Colorado School of Medicine , Aurora , CO , USA
| | - Derek E Smith
- c Department of Pediatrics , Cancer Center Biostatistics Core, University of Colorado School of Medicine , Aurora , CO , USA
| | - Manali Kamdar
- d Department of Medicine , Division of Hematology, University of Colorado School of Medicine , Aurora , CO , USA
| | - Rachel Rabinovitch
- b Department of Radiation Oncology , University of Colorado School of Medicine , Aurora , CO , USA
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26
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Ishii K, Azuma Y, Konishi A, Tsubokura Y, Yoshimura H, Hotta M, Nakanishi T, Nakaya A, Fujita S, Satake A, Miyaji M, Ito T, Nomura S. [Successful treatment with brentuximab vedotin maintenance therapy after autologous stem cell transplantation in high-risk Hodgkin lymphoma]. Rinsho Ketsueki 2018; 59:1002-1006. [PMID: 30185698 DOI: 10.11406/rinketsu.59.1002] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 56-year-old woman was diagnosed with classical Hodgkin lymphoma in December 2012. She achieved complete remission (CR) with six cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD). In March 2015, she experienced a relapse marked by high fever, respiratory discomfort, and pain in the left thigh owing to tumor involvement of the femur. She was treated with one cycle of brentuximab vedotin (BV), followed by irradiation of the left femoral lesion. She achieved partial remission (PR) but developed recurrence after the third cycle of BV. She achieved PR again with two cycles of standard bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) regimen; therefore, autologous stem cell transplantation (ASCT) was performed. Because the dosing interval used for BV therapy was longer than that in the recommended schedule, we could not definitively attribute her recurrence to BV resistance. Moreover, she maintained a good performance status after recurrence during subsequent cycles of BV therapy. Because of attaining PR after ASCT, she subsequently received a total of 12 BV cycles for consolidation. She achieved CR 3 months after ASCT and has remained in CR until 29 months. For patients who show relapse after initial BV therapy, retreatment with BV should be carefully considered. Patients who show relapse after achieving at least PR with initial BV therapy are potential candidates for post-ASCT BV maintenance therapy to reduce their tumor burden.
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Affiliation(s)
| | - Yoshiko Azuma
- Department of Internal Medicine, Kansai Medical University
| | - Akiko Konishi
- Department of Internal Medicine, Kansai Medical University
| | | | | | - Masaaki Hotta
- Department of Internal Medicine, Kansai Medical University
| | | | - Aya Nakaya
- Department of Internal Medicine, Kansai Medical University
| | - Shinya Fujita
- Department of Internal Medicine, Kansai Medical University
| | - Atsushi Satake
- Department of Internal Medicine, Kansai Medical University
| | | | - Tomoki Ito
- Department of Internal Medicine, Kansai Medical University
| | - Shosaku Nomura
- Department of Internal Medicine, Kansai Medical University
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27
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Kumata H, Nakanishi C, Murakami K, Miyagi S, Fukuhara N, Carreras J, Nakamura N, Ichinohasama R, Unno M, Kamei T, Sasano H. Classical Hodgkin lymphoma-type and monomorphic-type post-transplant lymphoproliferative disorder following liver transplantation: a case report. Surg Case Rep 2018; 4:72. [PMID: 29980871 PMCID: PMC6035123 DOI: 10.1186/s40792-018-0480-x] [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: 04/15/2018] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication that can be difficult to treat; moreover, determination of the pathophysiological type is difficult. We report a rare case of a patient who developed two types of Epstein-Barr virus (EBV)-negative PTLD following living donor liver transplantation (LDLT). CASE PRESENTATION A 64-year-old man underwent LDLT for acute fulminant hepatitis B. Sixty-five months later, he developed EBV-negative monomorphic B cell PTLD. Reduction of immunosuppressive therapy and chemotherapy with rituximab resulted in a partial response. He received radioimmunotherapy with yttrium-90-ibritumomab tiuxetan, which was effective for all lesions, except for the splenic hilar lesion, which enlarged and seemed to penetrate the stomach. Therefore, he underwent resection of the pancreatic tail with splenectomy and partial gastrectomy. The pathological diagnosis was EBV-negative classical Hodgkin lymphoma (cHL)-type PTLD. CONCLUSIONS This patient showed an unexpected course of PTLD, from both a clinical and pathological perspective. There are no prior reports of an adult case of EBV-negative cHL-type PTLD coexisting with EBV-negative monomorphic B cell PTLD. When a strange and refractory lesion persists despite effective therapy for PTLD, we must consider the possibility of another type of PTLD within the residual lesion.
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Affiliation(s)
- Hiroyuki Kumata
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan.
| | - Chikashi Nakanishi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Keigo Murakami
- Department of Pathology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Shigehito Miyagi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Joaquim Carreras
- Department of Pathology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Naoya Nakamura
- Department of Pathology, School of Medicine, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Ryo Ichinohasama
- Division of Hematopathology, Tohoku University Hospital, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan
| | - Hironobu Sasano
- Department of Pathology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan
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28
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Ono K, Onishi Y, Kobayashi M, Hatta S, Nasu K, Watanabe S, Ichikawa S, Okitsu Y, Fukuhara N, Harigae H. γδ T cell clonal proliferation early after PD-1 blockade. Ann Hematol 2019; 98:219-20. [PMID: 29946908 DOI: 10.1007/s00277-018-3406-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/20/2018] [Indexed: 01/21/2023]
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29
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Mohri T, Ikura Y, Hirakoso A, Okamoto M, Hishizawa M, Takaori-Kondo A, Kato S, Nakamura S, Yoshimura K, Okabe H, Iwai Y. Classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder in a kidney transplant recipient: a diagnostic pitfall. Int J Hematol. 2018;108:218-227. [PMID: 29380181 DOI: 10.1007/s12185-018-2410-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 02/06/2023]
Abstract
We report a case of classical Hodgkin lymphoma type post-transplant lymphoproliferative disorder (HL-PTLD) after kidney transplantation to highlight the difficulty of distinguishing this disorder from Hodgkin lymphoma-like PTLD (HL-like PTLD). Through this case report and literature review, we seek to clarify definitive pathologic features to differentiate these two conditions. A 38-year-old male kidney transplant recipient who had been receiving immunosuppressants was admitted to our hospital with unidentified high fever. Computed tomography images and blood tests indicated a lymphoproliferative disorder. Abdominal lymph node biopsy was performed, and microscopic examination revealed the presence of many large atypical cells in a background of dense T cell accumulation. The large, atypical cells were positive for Epstein-Barr Virus (EBV)-encoded small RNAs (EBER) in situ hybridization, EBV-LMP1, CD30 and PAX5, but negative for CD15, CD20 and CD45. Except for CD15-negativity, this immunohistochemical pattern was consistent with that of classical Hodgkin lymphoma. By close examination of the above immunoreactivities and the patient's subsequent chemosensitive clinical course, we finally made a diagnosis of HL-PTLD.
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Abstract
The programmed cell death-1 (PD-1) pathway serves as a checkpoint for suppressing T cell-mediated immune responses. It regulates both the physiological and pathological functions of T cells and is often involved as a mechanism of tumor immune evasion. Many clinical trials have demonstrated that blockade of PD-1 and its ligands is a promising therapeutic strategy for various kinds of malignancies. The most prominent results of PD-1 blockade therapy have been shown in clinical studies of classical Hodgkin lymphoma (cHL), and the PD-1 inhibitor nivolumab was approved for treatment of relapsed/refractory cHL in Japan at the end of 2016. There is increasing evidence that PD-1 blockade therapy is also effective in several other subtypes of lymphoid malignancies. PD-1 inhibitors demonstrate a favorable safety profile, but they can cause immune-related adverse events that affect a variety of organs, such as skin, lung, thyroid, and intestine. Although infrequent, they can develop into life-threatening conditions, and specific monitoring is recommended for the early detection and treatment of these uncommon side effects during PD-1 blockade therapy.
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Affiliation(s)
- Momoko Nishikori
- Department of Hematology/Oncology, Graduate School of Medicine, Kyoto University
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Montana W, Buck DA, Smith T. Near Complete Response in a Patient with Classical Hodgkin Lymphoma Treated with Brentuximab Vedotin Concurrent with Radiation Therapy. Case Rep Oncol 2017; 10:795-801. [PMID: 29158727 PMCID: PMC5685419 DOI: 10.1159/000479224] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/06/2017] [Indexed: 11/28/2022] Open
Abstract
Brentuximab vedotin, an antibody drug conjugate that delivers monomethyl auristatin E into CD-30 expressing cells is FDA approved for the treatment of patients with Hodgkin lymphoma after the failure of autologous stem cell transplantation or at least 2 prior multi-agent chemotherapy regiments. This approval was based on a study that showed an overall response rate of 75% and complete remission in 34%. We present a case of a 24-year-old male with classical nodular sclerosing Hodgkin lymphoma who achieved near complete remission following 5 cycles of brentuximab concurrent with ISRT (involved site radiation therapy) following progression of first-line ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine) and subsequent second-line ICE (ifosfamide, carboplatin, etoposide) chemotherapy. This case not only reiterates the efficacy of brentuximab vedotin in the third-line setting but introduces the role of and need for further clinical trials of combined radiotherapy with brentuximab in Hodgkin lymphoma patients following failure of second-line options.
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Affiliation(s)
- Wilbur Montana
- Southwestern Regional Medical Center, Cancer Treatment Centers of America, Tulsa, OK, USA
| | - Dennis Andrew Buck
- Southwestern Regional Medical Center, Cancer Treatment Centers of America, Tulsa, OK, USA
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Moore EM, Swerdlow SH, Gibson SE. J chain and myocyte enhancer factor 2B are useful in differentiating classical Hodgkin lymphoma from nodular lymphocyte predominant Hodgkin lymphoma and primary mediastinal large B-cell lymphoma. Hum Pathol 2017; 68:47-53. [PMID: 28851661 DOI: 10.1016/j.humpath.2017.08.015] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/07/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
Although most classical Hodgkin lymphomas (CHLs) are easily distinguished from nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) and primary mediastinal large B-cell lymphoma (PMBL), cases with significant CD20 expression cause diagnostic confusion. Although the absence of OCT-2 and BOB.1 are useful in these circumstances, a variable proportion of CHLs are positive for these antigens. We investigated the utility of J chain and myocyte enhancer factor 2B (MEF2B) in the diagnosis of CHL; NLPHL; PMBL; T-cell/histiocyte-rich large B-cell lymphoma (TCRLBL); and B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and CHL, compared with OCT-2 and BOB.1. J chain and MEF2B highlighted lymphocyte predominant (LP) cells in 20/20 (100%) NLPHLs and were negative in 43/43 (100%) CHLs. Fourteen of 15 (93%) PMBLs and 4/4 (100%) TCRLBLs were MEF2B positive, whereas 67% of PMBLs and 50% of TCRLBLs were J chain positive. Three of 3 B-cell lymphomas, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and CHL, were negative for J chain and MEF2B. J chain and MEF2B were 100% sensitive and specific for NLPHL versus CHL. MEF2B was 100% sensitive and 98% specific for PMBL versus CHL. Whereas loss of OCT-2 and/or BOB.1 expression had a sensitivity of only 86% and specificity of 100% for CHL versus NLPHL, PMBL, and TCRLBL, lack of both J chain and MEF2B expression was 100% sensitive and 97% specific. J chain and MEF2B are highly sensitive and specific markers of NLPHL versus CHL; are particularly useful in highlighting LP cells; and, with rare exception, are of greater utility than OCT-2 and BOB.1 in differentiating CHL from NLPHL and other large B-cell lymphomas.
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Affiliation(s)
- Erika M Moore
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
| | | | - Sarah E Gibson
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213.
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Bates JE, Dhakal S, Mazloom A, Casulo C, Constine LS. Benefit from the inclusion of radiation therapy in the treatment of patients with stage III classical Hodgkin lymphoma: A propensity matched analysis of the Surveillance, Epidemiology, and End Results database. Radiother Oncol 2017; 124:325-330. [PMID: 28778348 DOI: 10.1016/j.radonc.2017.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/16/2017] [Revised: 07/13/2017] [Accepted: 07/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND While stage III and IV classical Hodgkin lymphoma (HL) patients are often combined and defined as "advanced stage," there are significant differences in disease distribution and burden between the two stages. This may obscure advantages of radiotherapy (RT) in a combined modality therapy strategy in stage III disease due to the relative lack of benefit in stage IV patients. METHODS We queried the Surveillance, Epidemiology, and End Results (SEER) database, restricting our search to patients with stage III classical HL diagnosed from 2004 to 2012, to examine the difference in overall and cause-specific survival (OS and CSS) between patients who did or did not receive RT. RESULTS Patients treated with RT had improved OS and CSS relative to those treated without RT (5-year OS 91.6% with RT compared to 71.4% without RT, HR=0.34, p<0.001) and CSS (5-year OS 95.4% with RT compared to 84.7% without RT, HR=0.32, p<0.001). A benefit in OS and/or CSS was seen in all patient subgroups except for older adults (>64years). CONCLUSION These data support at least a cautionary approach to omitting RT from treatment strategies for patients with advanced stage HL.
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Affiliation(s)
- James E Bates
- Department of Radiation Oncology, University of Florida, Gainesville, USA
| | - Sughosh Dhakal
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Ali Mazloom
- Tacoma Valley Radiation Oncology Center, USA
| | - Carla Casulo
- Department of Medicine, Division of Medical Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Louis S Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA.
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Su P, Jug R, Liu X, Wang E. An Epstein-Barr virus-positive classical Hodgkin lymphoma with exclusive sinusoidal growth pattern: An unusual morphologic variant. Pathol Res Pract 2017; 213:710-712. [PMID: 28552534 DOI: 10.1016/j.prp.2017.02.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
Classical Hodgkin lymphoma (cHL) typically involves lymph node parenchyma, and a case with Hodgkin cells confined within nodal sinusoids is extremely rare. Herein we report a case of cHL with a sinusoidal growth pattern. This 15-year old patient presented with B symptoms and was found to have bilateral cervical lymphadenopathy and an anterior mediastinal mass. Biopsy of a cervical lymph node demonstrated cohesive clusters of Reed-Sternberg (RS)-like cells suggestive of sinusoidal growth with an extrasinusoidal mixed inflammatory cell infiltrate characteristic of the microenvironment seen in cHL. The RS cells/variants were positive for CD30 and CD15, and showed down-regulation of B-cell program and CD45, an immunophenotypic profile consistent with cHL. The sinusoidal growth pattern was also highlighted by EBV staining. To the best of our knowledge, this is the first case of EBV-positive cHL that displays a sinusoidal growth pattern. The patient was treated with children's high risk cHL chemotherapy protocol and responded well.
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Affiliation(s)
- Pu Su
- Department of Medicine, East Hospital affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China; Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Xin Liu
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA.
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Abstract
The morphology of gray zone lymphoma (GZL) is variable with tumor cells spanning the spectrum of diffuse large B-cell lymphoma (DLBCL) and classical Hodgkin lymphoma. The immunophenotype is frequently discordant. Clinically, the initial case descriptions of GZL were primarily with mediastinal presentation; however, a nonmediastinal (systemic) clinical subtype is now recognized. Patients with GZL have high relapse rates. Recommended treatment of GZL is with a DLBCL-directed regimen with consideration for consolidative radiotherapy for bulk disease. Continued biologic examination of this entity is needed and there should be exploration toward integration of novel targeted therapeutic agents into the treatment paradigm of GZL.
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Affiliation(s)
- Monika Pilichowska
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Athena Kritharis
- Division of Hematology/Oncology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Andrew M Evens
- Division of Hematology/Oncology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
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Kapke JT, Epperla N, Shah N, Richardson K, Carrum G, Hari PN, Pingali SR, Hamadani M, Karmali R, Fenske TS. Effect of Routine Surveillance Imaging on the Outcomes of Patients With Classical Hodgkin Lymphoma After Autologous Hematopoietic Cell Transplantation. Clin Lymphoma Myeloma Leuk 2017; 17:408-414. [PMID: 28756899 DOI: 10.1016/j.clml.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/14/2017] [Accepted: 05/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with relapsed and refractory classical Hodgkin lymphoma (cHL) are often treated with autologous hematopoietic cell transplantation (auto-HCT). After auto-HCT, most transplant centers implement routine surveillance imaging to monitor for disease relapse; however, there is limited evidence to support this practice. PATIENTS AND METHODS In this multicenter, retrospective study, we identified cHL patients (n = 128) who received auto-HCT, achieved complete remission (CR) after transplantation, and then were followed with routine surveillance imaging. Of these, 29 (23%) relapsed after day 100 after auto-HCT. Relapse was detected clinically in 14 patients and with routine surveillance imaging in 15 patients. RESULTS When clinically detected relapse was compared with to radiographically detected relapse respectively, the median overall survival (2084 days [range, 225-4161] vs. 2737 days [range, 172-2750]; P = .51), the median time to relapse (247 days [range, 141-3974] vs. 814 days [range, 96-1682]; P = .30) and the median postrelapse survival (674 days [range, 13-1883] vs. 1146 days [range, 4-2548]; P = .52) were not statistically different. In patients who never relapsed after auto-HCT, a median of 4 (range, 1-25) surveillance imaging studies were performed over a median follow-up period of 3.5 years. CONCLUSION A minority of patients with cHL who achieve CR after auto-HCT will ultimately relapse. Surveillance imaging detected approximately half of relapses; however, outcomes were similar for those whose relapse was detected using routine surveillance imaging versus detected clinically in between surveillance imaging studies. There appears to be limited utility for routine surveillance imaging in cHL patients who achieve CR after auto-HCT.
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Affiliation(s)
- Jonathan T Kapke
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Narendranath Epperla
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Namrata Shah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - George Carrum
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, and Houston Methodist Hospital, Houston, TX
| | - Parameswaran N Hari
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Sai R Pingali
- Division of Hematology and Oncology, Houston Methodist Cancer Center, Houston, TX
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Reem Karmali
- Division of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, IL
| | - Timothy S Fenske
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI.
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Pham M, Ressler S, Rosenthal A, Kelemen K. Classical Hodgkin lymphoma masquerading as chronic recurrent multifocal osteomyelitis: a case report. J Med Case Rep 2017; 11:45. [PMID: 28212666 DOI: 10.1186/s13256-017-1224-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/02/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma is a hematologic malignancy usually confined to lymphatic structures and commonly associated with constitutional symptoms. Bony involvement and musculoskeletal symptoms are uncommon and typically seen in advanced disease. In this case, we report an unusual presentation of classical Hodgkin lymphoma and highlight diagnostic challenges leading to the misdiagnosis and treatment as chronic recurrent multifocal osteomyelitis. CASE PRESENTATION A 38-year-old white man presented with lower extremity musculoskeletal pain. Imaging studies revealed multifocal lytic and sclerotic osseous axial lesions. Multiple core needle bone marrow and excisional lymph node biopsies were non-diagnostic. Having met the criteria, a tentative diagnosis of chronic recurrent multifocal osteomyelitis was given. He was treated with non-steroidal anti-inflammatory medications with partial clinical response but had persistent symptoms. A second medical opinion was pursued. An open bone marrow biopsy was performed and yielded a diagnosis of classical Hodgkin lymphoma after 13 months of diagnostic uncertainty. A chemotherapy regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine was instituted with complete symptomatic and radiologic response. CONCLUSIONS This case illustrates diagnostic difficulties of a musculoskeletal presentation of Hodgkin lymphoma, challenges of non-diagnostic bone marrow and lymph node biopsies, and resultant diagnostic delays in delivering a potentially curative therapy. Had the additional open bone marrow biopsy not been performed, the diagnosis and treatment of Hodgkin lymphoma would have been missed.
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de Jong D, Roemer MGM, Chan JKC, Goodlad J, Gratzinger D, Chadburn A, Jaffe ES, Said J, Natkunam Y. B-Cell and Classical Hodgkin Lymphomas Associated With Immunodeficiency: 2015 SH/EAHP Workshop Report-Part 2. Am J Clin Pathol 2017; 147:153-170. [PMID: 28395108 DOI: 10.1093/ajcp/aqw216] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The 2015 Workshop of the Society for Hematopathology/European Association for Haematopathology submitted small and large B-cell lymphomas (BCLs), including classical Hodgkin lymphoma (CHL), in the context of immunodeficiency. METHODS Clinicopathologic and molecular features were studied to explore unifying concepts in malignant B-cell proliferations across immunodeficiency settings. RESULTS Cases submitted to the workshop spanned small BCLs presenting as nodal or extranodal marginal zone lymphoma and lymphoplasmacytic lymphoma, Epstein-Barr virus (EBV) positive in 75% of cases. Submitted large BCLs formed a spectrum from diffuse large B-cell lymphoma (DLBCL) to CHL across immunodeficiency settings. Additional studies demonstrated overexpression of PD-L1 and molecular 9p24 alterations in the large BCL spectrum and across different immunodeficiency settings. CONCLUSIONS Small BCLs occur in all immunodeficiency settings, and EBV positivity is essential for their recognition as immunodeficiency related. Large BCLs include a spectrum from DLBCL to CHL across all immunodeficiency settings; immunohistochemical and molecular features are suggestive of shared pathogenetic mechanisms involving PD-L1 immune checkpoints.
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Affiliation(s)
- Daphne de Jong
- From the VU University Medical Center, Amsterdam, the Netherlands
| | - Margaretha G M Roemer
- From the VU University Medical Center, Amsterdam, the Netherlands
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - John Goodlad
- HMDS, St James's University Hospital, Leeds, United Kingdom
| | | | - Amy Chadburn
- Weill Medical College of Cornell University, New York
| | | | - Jonathan Said
- University of California Los Angeles Medical Center, Los Angeles
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Martin P, Martínez-Velasquez J, Coronado MJ, Krsnik I, Provencio M, Navarro B, Moraru M, Bellas C, Vilches C, Gomez-Lozano N. Association of DDX58 177 C > T polymorphism with decreased risk of Epstein-Barr virus-related nodular sclerosis classical Hodgkin lymphoma. Leuk Lymphoma 2017; 58:438-444. [PMID: 27267403 DOI: 10.1080/10428194.2016.1190972] [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: 02/18/2016] [Revised: 05/03/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
Classical Hodgkin lymphoma (cHL) is frequently related to Epstein-Barr virus (EBV) infection. Its malignant capacity is attributed to disruption of an EBV-host balance influenced by environmental and genetic drivers. EBV structures activate Type I interferon (IFN) pathway of the innate immunity, therefore, genetic polymorphisms could influence this response. We explored the impact of four single nucleotide polymorphisms (SNPs) on EBV-associated cHL susceptibility. Toll-like receptors 9 (TLR9_rs5743836), and 3 (TLR3_rs3775291), Interleukin-28B (IL28B_rs12979860), and DEAD-box polypeptide 58 (DDX58_rs10813831) were genotyped in 73 EBV-positive and 106 EBV-negative cHL patients and 396 controls. Only DDX58_rs10813831 T-allele was decreased among EBV-positive cHL compared to controls. A stratified analysis in EBV-positive cHL showed that the reduced rate was associated with younger age and nodular sclerosis. In conclusion, DDX58_rs10813831 T-allele may be associated with a reduced risk of nodular sclerosis EBV-related cHL, which suggests a role for RIG-I (retinoic acid-inducible gene I), encoded by DDX58, in these cases.
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Affiliation(s)
- Paloma Martin
- a Group of Molecular Pathology , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
| | - Jimena Martínez-Velasquez
- b Group of Immunity and Lymphoproliferative Diseases , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
| | - Maria Jose Coronado
- c Confocal Microscopy Unit , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
| | - Isabel Krsnik
- d Department of Hematology , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
| | - Mariano Provencio
- e Department of Oncology , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
| | - Belen Navarro
- d Department of Hematology , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
| | - Manuela Moraru
- f Group of Immunogenetics and Histocompatibility , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
| | - Carmen Bellas
- a Group of Molecular Pathology , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
| | - Carlos Vilches
- f Group of Immunogenetics and Histocompatibility , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
| | - Natalia Gomez-Lozano
- b Group of Immunity and Lymphoproliferative Diseases , Instituto de Investigación Puerta de Hierro (IDIPHIM) , Majadahonda , Spain
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Itonaga H, Kato T, Fujioka M, Taguchi M, Taniguchi H, Imaizumi Y, Yoshida S, Miyoshi H, Moriuchi Y, Ohshima K, Miyazaki Y. High-dose Chemotherapy with Stem Cell Rescue Provided Durable Remission for Classical Hodgkin Lymphoma-type Post-transplant Lymphoproliferative Disorder after Unrelated Cord Blood Transplantation: A Case Report and Review of the Literature. Intern Med 2017; 56:1873-1877. [PMID: 28717085 PMCID: PMC5548682 DOI: 10.2169/internalmedicine.56.7938] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
An adult woman developed polymorphic post-transplant lymphoproliferative disorder (PTLD) 58 months after unrelated cord blood transplantation. She was treated successfully with chemotherapy and radiation therapy but presented with lymphadenopathy and splenomegaly 74 months after transplantation. A lymph node biopsy confirmed the diagnosis of nodular sclerosis type Hodgkin lymphoma (classical Hodgkin lymphoma [CHL]-type PTLD). After salvage therapy and hematopoietic stem cell harvesting, she was subsequently treated with consolidative high-dose chemotherapy with melphalan followed by stem cell rescue, which resulted in durable remission. High-dose chemotherapy using stem cell rescue has potential as a therapeutic option for subsequent CHL-type PTLD.
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Affiliation(s)
- Hidehiro Itonaga
- Department of Hematology, Nagasaki University Hospital, Japan
- Department of Hematology, Sasebo City General Medical Center, Japan
| | - Takeharu Kato
- Department of Hematology, Sasebo City General Medical Center, Japan
- Department of Pathology, School of Medicine, Kurume University, Japan
| | - Machiko Fujioka
- Department of Hematology, Nagasaki University Hospital, Japan
- Department of Hematology, Sasebo City General Medical Center, Japan
| | - Masataka Taguchi
- Department of Hematology, Sasebo City General Medical Center, Japan
| | | | | | - Shinichiro Yoshida
- Department of Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Hiroaki Miyoshi
- Department of Pathology, School of Medicine, Kurume University, Japan
| | | | - Koichi Ohshima
- Department of Pathology, School of Medicine, Kurume University, Japan
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Scheidt V, Hansmann ML, Schuhmacher B, Döring C, Hartmann S. Atypical variants of nodular lymphocyte-predominant Hodgkin lymphoma show low microvessel density and vessels of distention type. Hum Pathol 2017; 60:129-36. [PMID: 27816718 DOI: 10.1016/j.humpath.2016.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/28/2016] [Accepted: 10/04/2016] [Indexed: 01/25/2023]
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) presents different histopathologic growth patterns, including atypical forms showing overlapping histopathologic and clinical features with T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL). Because growth patterns are associated with vessel distribution, the aim of the present study was to compare angiogenesis in different NLPHL patterns with THRLBCL as well as other lymphomas. Atypical variants of NLPHL and THRLBCL (n=10 per group) both showed a low microvessel density (MVD; 1.16-1.31/μm2) with a diffuse vessel distribution. In contrast, in typical NLPHL (n=10), follicular areas with low MVD were retained, whereas an increase in vessels in the interfollicular areas was observed (MVD 1.35/μm2). THRLBCL and typical NLPHL could additionally be distinguished by differences in their molecular angiogenesis signature. Furthermore, the number of intravascular T cells was significantly reduced in THRLBCL (0.0028 T cells/mm2 vessel area) when compared with typical NLPHL (0.0059 T cells/mm2 vessel area), potentially reflecting the different composition of the microenvironment in these 2 lymphoma entities. The results of our study reveal a similar vascular pattern and angiogenesis behavior in atypical NLPHL variants and THRLBCL in contrast to the retained follicular pattern in typical NLPHL.
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Goyal G, Nguyen AH, Kendric K, Caponetti GC. Composite lymphoma with diffuse large B-cell lymphoma and classical Hodgkin lymphoma components: A case report and review of the literature. Pathol Res Pract 2016; 212:1179-1190. [PMID: 27887763 DOI: 10.1016/j.prp.2016.11.002] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/18/2016] [Accepted: 11/03/2016] [Indexed: 02/07/2023]
Abstract
Composite lymphoma (CL) is an infrequently diagnosed entity in which two or more distinct types of lymphomas occur synchronously in the same organ or anatomical site. Most commonly, CLs are composed of two non-Hodgkin B-cell lymphomas. We present a case of a composite lymphoma with diffuse large B-cell lymphoma, not otherwise specified (DLBCL-NOS) and classical Hodgkin lymphoma (CHL) components involving the terminal ileum, colon and pericolic lymph nodes. Immunohistochemical evaluation for determination of cell of origin of the DLBCL-NOS component indicated a germinal center B-cell subtype. Immunoglobulin heavy chain fragment length analysis revealed identical dominant monoclonal peaks on the DH1-6-JH reaction, and also a dominant monoclonal peak observed only in the framework II reaction done on the CHL component, indicating a partial clonal relationship between the two components. Additionally, a review of the available literature reveals a total of 20 previously reported cases of CL with DLBCL-NOS and CHL components, and most of the tested cases showed clonal relationship between the two components. The overall findings indicate that in most cases, the two components of CL with DLBCL-NOS and CHL components are clonally related, and suggest a shared origin from a common B-cell precursor.
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Affiliation(s)
- Gaurav Goyal
- Department of Internal Medicine, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, USA
| | - Austin Huy Nguyen
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, USA
| | - Kayla Kendric
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, USA
| | - Gabriel C Caponetti
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA.
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Guo B, Cen H, Tan X, Ke Q. Meta-analysis of the prognostic and clinical value of tumor-associated macrophages in adult classical Hodgkin lymphoma. BMC Med 2016; 14:159. [PMID: 27745550 PMCID: PMC5066288 DOI: 10.1186/s12916-016-0711-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/04/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The prognostic significance of tumor-associated macrophages (TAM) in adult classical Hodgkin lymphoma (cHL) remains controversial. Here, we report a meta-analysis of the association of CD68 and CD163 infiltration on the clinical outcome of adult cHL. METHODS A comprehensive search to identify relevant articles was performed in PubMed, Embase, and Google Scholar on January 31, 2016. Using the fixed effect or random effects model of DerSimonian and Laird, hazard ratios (HR) or odds ratios (OR) with 95 % confidence intervals (CIs) were used as the effect size estimate. RESULTS Twenty-two eligible studies with a total of 2959 patients were identified. Our analysis indicated that a high density of CD68+ TAMs in the tumor microenvironment of adult cHL predicted poor overall survival (OS) (HR: 2.41; 95 % CI, 1.92-3.03), shorter progression-free survival (PFS) (HR: 1.78; 95 % CI, 1.45-2.18), and poor disease-specific survival (HR: 2.71; 95 % CI, 1.38-5.29). High density of CD163+ TAMs in the tumor microenvironment of adult cHL also predicted poor OS (HR: 2.75; 95 % CI, 1.58-4.78) and poor PFS (HR: 1.66; 95 % CI, 1.22-2.27). In addition, we demonstrated that a high density of either CD68+ or CD163+ TAMs was associated with the presence of Epstein-Barr virus in neoplastic cells (ORCD68: 3.13; 95 % CI, 2.02-4.84; ORCD163: 2.88; 95 % CI, 1.55-5.34). A high density of either CD68+ or CD163+ TAMs tend to be associated with a more advanced clinical stage (ORCD68: 1.25; 95 % CI, 0.93-1.67; OR CD163: 1.19; 95 % CI, 0.86-1.63), B-symptoms (ORCD68: 1.35; 95 % CI, 0.90-2.01; ORCD163: 2.19; 95 % CI, 0.96-5.03), higher International Prognostic Factors Project Score (ORCD68: 1.20; 95 % CI, 0.67-2.15; ORCD163: 2.00; 95 % CI, 0.92-4.35), and bulky disease (ORCD68: 1.47; 95 % CI, 0.88-2.47; ORCD163: 1.19; 95 % CI, 0.72-1.96). CONCLUSIONS Our analyses suggest that a high density of either CD68+ or CD163+ TAMs is a robust predictor of adverse outcomes in adult cHL. Increased TAMs should be taken into account to further improve prognostic stratification and the planning of appropriate therapeutic strategies.
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Affiliation(s)
- Baoping Guo
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Hong Cen
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China.
| | - Xiaohong Tan
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Qing Ke
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
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Makita S, Maeshima AM, Taniguchi H, Kitahara H, Fukuhara S, Munakata W, Suzuki T, Maruyama D, Kobayashi Y, Tobinai K. Classical Hodgkin lymphoma primary refractory to brentuximab vedotin, with transformation to CD30-positive diffuse large B-cell lymphoma. Int J Hematol 2016; 104:396-9. [PMID: 27169615 DOI: 10.1007/s12185-016-2018-y] [Citation(s) in RCA: 2] [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: 02/23/2016] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 11/28/2022]
Abstract
Brentuximab vedotin (BV) is an antibody-drug conjugate that targets CD30. It is highly effective for relapsed/refractory classical Hodgkin lymphoma (CHL), and has become a promising treatment option for these patients; however, approximately 25 % of patients are refractory to BV. Until now, the clinicopathologic features of CHL refractory to BV have not been well understood. Here, we report a patient with relapsed CHL with an unfavorable outcome, whose disease was primary refractory to BV and was histologically diagnosed as a transformation from mixed cellularity CHL to CD30-positive diffuse large B-cell lymphoma (DLBCL). The transformation to DLBCL showing high tumor density and high proliferative activity (Ki67 index >90 %) was possibly related to the primary refractory to BV and an aggressive clinical course, although the lymphoma was diffusely and strongly positive for CD30.
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Affiliation(s)
- Shinichi Makita
- Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akiko Miyagi Maeshima
- Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Hirokazu Taniguchi
- Department of Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hideaki Kitahara
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tatsuya Suzuki
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukio Kobayashi
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Hofmann A, Thiesler T, Gerrits B, Behnke S, Sobotzki N, Omasits U, Bausch-Fluck D, Bock T, Aebersold R, Moch H, Tinguely M, Wollscheid B. Surfaceome of classical Hodgkin and non-Hodgkin lymphoma. Proteomics Clin Appl 2016; 9:661-70. [PMID: 26076441 DOI: 10.1002/prca.201400146] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/09/2015] [Accepted: 06/10/2015] [Indexed: 11/06/2022]
Abstract
PURPOSE Classical Hodgkin lymphoma (cHL) is characterized by a low percentage of tumor cells in a background of diverse, reactive immune cells. cHL cells commonly derive from preapoptotic germinal-center B cells and are characterized by the loss of B-cell markers and the varying expression of other hematopoietic lineage markers. This phenotypic variability and the scarcity of currently available cHL-specific cell surface markers can prevent clear distinction of cHL from related lymphomas. EXPERIMENTAL DESIGN We applied the cell surface capture technology to directly measure the pool of cell surface exposed proteins in four cHL and four non-Hodgkin lymphoma (NHL) cell lines. RESULTS More than 1000 membrane proteins, including 178 cluster of differentiation annotated proteins, were identified and allowed the generation of lymphoma surfaceome maps. The functional properties of identified cell surface proteins enable, but also limit the information exchange of lymphoma cells with their microenvironment. CONCLUSION AND CLINICAL RELEVANCE Selected candidate proteins with potential diagnostic value were evaluated on a tissue microarray (TMA). Primary lymphoma tissues of 126 different B cell-derived lymphoma cases were included in the TMA analysis. The TMA analysis indicated gamma-glutamyltranspeptidase 1 as a potential additional marker that can be included in a panel of markers for differential diagnosis of cHL versus NHL.
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Affiliation(s)
- Andreas Hofmann
- Department of Biology, Institute of Molecular Systems Biology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.,Ph.D. Program in Molecular Life Sciences, University of Zurich (UZH)/ETH Zurich, Zurich, Switzerland
| | - Thore Thiesler
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Bertran Gerrits
- Functional Genomics Center Zurich, UZH/ETH Zurich, Zurich, Switzerland
| | - Silvia Behnke
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Nadine Sobotzki
- Department of Biology, Institute of Molecular Systems Biology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Ulrich Omasits
- Department of Biology, Institute of Molecular Systems Biology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Damaris Bausch-Fluck
- Department of Biology, Institute of Molecular Systems Biology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Thomas Bock
- Department of Biology, Institute of Molecular Systems Biology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Ruedi Aebersold
- Department of Biology, Institute of Molecular Systems Biology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.,Faculty of Science, UZH, Zurich, Switzerland
| | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Marianne Tinguely
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Bernd Wollscheid
- Department of Biology, Institute of Molecular Systems Biology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Abstract
Hodgkin lymphoma (HL) accounts for approximately 0.6% of all new cancer cases, 10% of all lymphomas in the USA, leading to an approximate 9000 new cases per year. It is very unique in that the neoplastic Hodgkin and Reed-Sternberg (HRS) cells of classical HL account for only 1% of the tumor tissue in most cases, with various inflammatory cells including B-cells, T-cells, mast cells, macrophages, eosinophils, neutrophils, and plasma cells comprising the tumor microenvironment. Recent research has identified germinal center B-cells to be the cellular origin of HRS cells. Various transcription factor dysregulation in these neoplastic cells that explains for the loss of B-cell phenotype as well as acquisition of survival and anti-apoptotic features of HRS cells has been identified. Aberrant activation of nuclear factor-kappa B (NF-κB), Janus kinase (JAK)/signal transducer and activator of transcription (STAT), and phosphoinositide 3-kinase (PI3K) pathways play a central role in HL pathogenesis. Both intrinsic genetic mechanisms as well as extrinsic signals have been identified to account for the constitutive activation of these pathways. The extrinsic factors that regulate the activation of transcription pathways in HRS cells have also been studied in detail. Cytokines and chemokines produced both by the HRS cells as well as cells of the microenvironment of HL work in an autocrine and/or paracrine manner to promote survival of HRS cells as well as providing mechanisms for immune escape from the body's antitumor immunity. The understanding of various mechanisms involved in the lymphomagenesis of HL including the importance of its microenvironment has gained much interest in the use of these microenvironmental features as prognostic markers as well as potential treatment targets. In this article, we will review the pathogenesis of HL starting with the cellular origin of neoplastic cells and the mechanisms supporting its pathogenesis, especially focusing on the microenvironment of HL and its associated cytokines.
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47
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Wang S, Medeiros LJ, Xu-Monette ZY, Zhang S, O'Malley DP, Orazi A, Zuo Z, Bueso-Ramos CE, Yin CC, Liu Z, Miranda RN, Young KH. Epstein-Barr virus-positive nodular lymphocyte predominant Hodgkin lymphoma. Ann Diagn Pathol 2014; 18:203-9. [PMID: 24852241 DOI: 10.1016/j.anndiagpath.2014.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 02/07/2014] [Accepted: 03/13/2014] [Indexed: 01/24/2023]
Abstract
Hodgkin lymphoma (HL) is classified into 2 largely distinct subgroups, namely nodular lymphocyte predominant HL (NLPHL) and classic HL (CHL). CHL is further divided into nodular sclerosis, lymphocyte-rich, mixed cellularity (MCCHL) and lymphocyte-depleted (LDCHL) subtypes. In industrialized nations, Epstein-Barr virus (EBV) has been associated with all types of CHL, especially the MCCHL and LDCHL subtypes, but is rare in NLPHL. We report 8 cases of EBV-positive NLPHL occurring in patients in the United States. All 8 patients have no history of immunosuppression and presented with localized or systemic lymphadenopathy. Histologically, 6 cases had a vaguely nodular pattern and 2 cases had a nodular and diffuse pattern. In all cases, lymphocyte predominant (LP) cells were observed in a background of small lymphocytes and histiocytes. Immunohistochemical analysis showed that the LP cells in all cases were positive for CD20, CD79a, PAX5, OCT2, and CD45 and were negative for CD15. CD30 was expressed variably in 7 cases. EBV encoded RNA was present in all LP cells in 5 cases and in a subset of LP cells in 3 cases. One patient was treated with radiation therapy and 7 patients received chemotherapy, including 4 of 7 patients who underwent autologous stem cell transplantation. EBV infection is a rare primary or secondary event in NLPHL that correlates with poorer prognosis and often requires more aggressive therapy. The variable expression of CD30 in most of these cases could be the result of EBV infection.
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Klein JL, Nguyen TT, Bien-Willner GA, Chen L, Foyil KV, Bartlett NL, Duncavage EJ, Hassan A, Frater JL, Kreisel F. CD163 immunohistochemistry is superior to CD68 in predicting outcome in classical Hodgkin lymphoma. Am J Clin Pathol 2014; 141:381-7. [PMID: 24515766 DOI: 10.1309/ajcp61tlmxlsljys] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 01/20/2023] Open
Abstract
OBJECTIVES In recent years, research has increasingly focused on the microenvironment of classical Hodgkin lymphoma (CHL) as a predictor of treatment outcome. The focus of this study was to assess the interobserver reproducibility in interpreting macrophage-associated immunohistochemistry (IHC) for CD68 and CD163 in a retrospective cohort of 88 patients with CHL. METHODS Staining results were correlated with clinical outcome in all patients and those with a high international prognostic score (IPS). RESULTS The intraclass correlation (ICC) for the five hematopathologists interpreting the IHC was stronger for CD163 (0.70) than for CD68 (0.50). Using a cutoff of 25% mean macrophage reactivity and including all patients, a statistically significant difference in overall survival (OS) was seen only for CD163 (P = .0006) and not for CD68 (P = .414). Patients with a mean CD163 reactivity of 25% or more had a median OS of 71 months vs 101 months for patients with less than 25% reactivity. CD163 retained statistical significance in multivariate analysis. In patients with advanced-stage CHL with high IPS, OS was also significantly worse for those with a mean CD163 reactivity of 25% or higher. CONCLUSIONS Our study confirms previous reports of a prognostic role of tumor-infiltrating macrophages in CHL, but only for CD163. Although most of the literature supports an increasing role of macrophage IHC as a predictor of clinical outcome, successful clinical translation will require a standardized method and reporting system.
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Affiliation(s)
- Jonathan L. Klein
- Department of Pathology and Immunology, Washington University Medical Center, St Louis, MO
| | - TuDung T. Nguyen
- Department of Pathology and Immunology, Washington University Medical Center, St Louis, MO
| | | | - Ling Chen
- Divisions of Biostatistics, Washington University School of Medicine, St Louis, MO
| | - Kelley V. Foyil
- Oncology, Washington University School of Medicine, St Louis, MO
| | | | - Eric J. Duncavage
- Department of Pathology and Immunology, Washington University Medical Center, St Louis, MO
| | - Anjum Hassan
- Department of Pathology and Immunology, Washington University Medical Center, St Louis, MO
| | - John L. Frater
- Department of Pathology and Immunology, Washington University Medical Center, St Louis, MO
| | - Friederike Kreisel
- Department of Pathology and Immunology, Washington University Medical Center, St Louis, MO
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Abstract
OBJECTIVES We have recently demonstrated that classical Hodgkin lymphoma (CHL) can be immunophenotyped by flow cytometry (FC), thus obviating the need for immunohistochemistry in many cases. The previously described nine-color assay, however, cannot be used by laboratories that do not have access to a nine- or ten-color flow cytometer. Therefore, a six-color FC tube was designed employing the following combination: CD64-FITC/CD30-PE/CD40-PeCy5.5/CD20-PECy7/CD95-APC/CD3-APC-H7. METHODS To validate this assay, we analyzed 408 tissue specimens (including 55 CHL cases, 26 of which had been previously cryopreserved). Specimen inclusion criteria included the identification of an abnormal population by FC or (if no abnormal population was identified) greater than 50,000 viable events and specimen age less than 4 days. All FC studies were examined blinded to any clinical, laboratory, or histologic information. RESULTS The diagnostic sensitivity and specificity of the six-color FC assay was 85.4% and 99.7%, respectively. CONCLUSIONS Taken together, these results suggest that the six-color FC assay has acceptable sensitivity and specificity for clinical use, allowing more FC laboratories to immunophenotype CHL by this method.
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Affiliation(s)
- Jonathan R. Fromm
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Brent L. Wood
- Department of Laboratory Medicine, University of Washington, Seattle, WA
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50
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Tanhaei AP, Ziaei A, Mazrouei S, Keyhanian K, Salehi M. Livin, a novel marker in lymphoma type distinction. Ann Diagn Pathol 2014; 18:157-62. [PMID: 24767895 DOI: 10.1016/j.anndiagpath.2014.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/19/2013] [Revised: 01/10/2014] [Accepted: 02/18/2014] [Indexed: 12/24/2022]
Abstract
Despite advances in immunohistochemical and molecular diagnostics, there are persistent difficulties in differentiating between several subtypes of non-Hodgkin lymphoma (NHL) and classic Hodgkin lymphoma (CHL). Considering high level of livin expression in hematologic malignancies, we aimed to examine the utility of livin expression ratio, as an ancillary biomarker, in distinguishing CHL from NHL in ambiguous cases. We evaluated livin expression in 38 CHL, 23 NHL, and 39 nonneoplastic lymph nodes in paraffin-embedded blocks. Tissue microarray-based semiquantitative immunoflourecent staining was applied for protein expression. Criterion standard of diagnosis was based on selection of only definite cases and not the cases suspected by hemathopathologists. A significant difference was found in the livin/GAPDH mean ratio (M.R) of expression between NHL and CHL cases. A receiver operating characteristic curve analysis confirmed 0.6370 to be the best diagnostic cut-off value for the livin/GAPDH expression M.R in diffuse large B-cell lymphoma (DLBCL) (area under the curve = 0.944); it yielded 92% sensitivity, 94% specificity, likelihood ratios positive 17.5, and likelihood ratios negative 0.07 for diagnosing DLBCL from CHL. Mean ratio of livin/Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) expression seems to be a valuable index in differentiating DLBCL from CHL. We suggested an optimal cut-off point for livin/GAPDH expression M.R with a high sensitivity and specificity. Thus, in diagnostically difficult cases of DLBCL and CHL, focus on livin as marker may provide useful corroborative information.
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Affiliation(s)
- Amir Pouya Tanhaei
- Medical School, Isfahan University of Medical Sciences, Genetics and Molecular Biology, Isfahan, Iran; Medical School, Isfahan University of Medical Science, Medical Student Research Center, Isfahan, Iran
| | - Amin Ziaei
- Medical School, Isfahan University of Medical Sciences, Genetics and Molecular Biology, Isfahan, Iran; Medical School, Isfahan University of Medical Science, Medical Student Research Center, Isfahan, Iran.
| | - Safoura Mazrouei
- Faculty of Medicine, Friedrich Schiller, University of Jena, Jena, Germany
| | | | - Mansoor Salehi
- Medical School, Isfahan University of Medical Sciences, Genetics and Molecular Biology, Isfahan, Iran
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