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Schop RFJ, Kuehl WM, Van Wier SA, Ahmann GJ, Price-Troska T, Bailey RJ, Jalal SM, Qi Y, Kyle RA, Greipp PR, Fonseca R. Waldenström macroglobulinemia neoplastic cells lack immunoglobulin heavy chain locus translocations but have frequent 6q deletions. Blood 2002; 100:2996-3001. [PMID: 12351413 DOI: 10.1182/blood.v100.8.2996] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lymphoplasmacytic lymphoma (LPL) is characterized by t(9;14)(p13;q32) in 50% of patients who lack paraproteinemia. Waldenström macroglobulinemia (WM), which has an immunoglobulin M (IgM) paraproteinemia, is classified as an LPL. Rare reports have suggested that WM sometimes is associated with 14q23 translocations, deletions of 6q, and t(11;18)(q21;q21). We tested for these abnormalities in the clonal cells of WM patients. We selected patients with clinicopathologic diagnosis of WM (all had IgM levels greater than 1.5 g/dL). Southern blot assay was used to detect legitimate and illegitimate IgH switch rearrangements. In addition to conventional cytogenetic (CC) and multicolor metaphase fluorescence in situ hybridization (M-FISH) analyses, we used interphase FISH to screen for t(9;14)(p13;q32) and other IgH translocations, t(11;18)(q21;q21), and 6q21 deletions. Genomic stability was also assessed using chromosome enumeration probes for chromosomes 7, 9, 11, 12, 15, and 17 in 15 patients. There was no evidence of either legitimate or illegitimate IgH rearrangements by Southern blot assay (n = 12). CC (n = 37), M-FISH (n = 5), and interphase FISH (n = 42) failed to identify IgH or t(11;18) translocations. Although tumor cells from most patients were diploid for the chromosomes studied, deletions of 6q21 were observed in 42% of patients. In contrast to LPL tumors that are not associated with paraproteinemia and that have frequent t(9;14)(p13;q32) translocations, IgH translocations are not found in WM, a form of LPL tumor distinguished by IgM paraproteinemia. However, WM tumor cells, which appear to be diploid or near diploid, often have deletions of 6q21.
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MESH Headings
- Blotting, Southern
- Bone Marrow/pathology
- Chromosome Mapping
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 6
- Chromosomes, Human, Pair 8
- Humans
- Immunoglobulin Heavy Chains/genetics
- In Situ Hybridization, Fluorescence
- Interphase
- Karyotyping
- Leukemia/genetics
- Microscopy, Fluorescence/methods
- Sequence Deletion
- Translocation, Genetic
- Waldenstrom Macroglobulinemia/genetics
- Waldenstrom Macroglobulinemia/pathology
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Affiliation(s)
- Roelandt F J Schop
- Department of Hematology and Internal Medicine and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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202
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Vela-Ojeda J, García-Ruiz Esparza MA, Padilla-González Y, Rosas-Cabral A, García-Chávez J, Xolotl-Castillo M, Salazar-Exaire D, Arenas-Osuna J, Aviña-Zubieta JA, Vadillo-Buenfil M, Abraham-Majluf S. IFN-alpha as induction and maintenance treatment of patients newly diagnosed with Waldenström's macroglobulinemia. J Interferon Cytokine Res 2002; 22:1013-6. [PMID: 12433280 DOI: 10.1089/107999002760624233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Waldenström's macroglobulinemia is a rare malignant disorder of B lymphocytes. There are no studies on the use of interferon-alpha (IFN-alpha) as frontline therapy in this disease. Between April 1991 and September 2000, we treated 21 newly diagnosed patients using 8 mg/m(2) chlorambucil and 40 mg/m(2) prednisone p.o. daily for 10 days and 3 megaU/m(2) IFN-alpha three times a week. Patients who responded after induction continued receiving IFN until relapse or death. We found a high frequency of peripheral neuropathy (43%) and grade 3 diffuse marrow fibrosis (43%). Objective response was achieved in 12 (57%) patients, including 4 (19%) complete responders. Median time from treatment to response was 8 months (range 3-18). Median progression-free survival was 70 months (95% CI 47-93), and overall survival was 91 months (95% CI 50-132). Patients who achieved objective response lived longer (91 vs. 33 months, p < 0.03), as did patients who had lactic dehydrogenase (LDH) < 180 U/L (89 vs. 54 months, p < 0.01). Grade 3 hematologic toxicity was observed during induction in 5 patients. IFN-alpha is an effective agent for the induction and maintenance treatment of Waldenström's macroglobulinemia patients. LDH > 180 U/L and failure to respond are adverse prognostic factors.
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Affiliation(s)
- J Vela-Ojeda
- Department of Hematology, Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social, México DF, México.
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203
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Abstract
Waldenström's macroglobulinemia (WM) is a rare monoclonal gammopathy. Its clinical signs and symptoms include fatigue, weakness, hepatomegaly, splenomegaly, lymphadenopathy, and neuropathies. Patients with WM have a circulating tumor marker, the monoclonal immunoglobulin M protein. High levels of this protein can produce hyperviscosity syndrome, which often is characterized by bleeding from the mucous membranes of the nose and mouth. Asymptomatic patients with WM usually are not treated. Treatment of symptomatic patients and patients with relapsed WM may include alkylating agents, particularly chlorambucil; purine nucleoside analogs, such as fludarabine and cladribine; and, most recently, the use of rituximab. With knowledge about this unusual disease, oncology nurses can provide better care and education for patients with WM.
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204
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Rothschild BM, Ruhli F, Rothschild C. Skeletal clues apparently distinguishing Waldenstrom's macroglobulinemia from multiple myeloma and leukemia. Am J Hum Biol 2002; 14:532-7. [PMID: 12112574 DOI: 10.1002/ajhb.10077] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study was conducted to characterize macroscopically and by conventional radiography the bony lesions in a case of Waldenstrom's macroglobulinemia and to compare and contrast it with those of the other major hematologic lymphoproliferative disorders, multiple myeloma and leukemia. Two varieties of lytic skeletal lesions were found in Waldenstrom's macroglobulinemia. One was sharply defined, spheroid lesions with smooth borders and effaced/erased trabeculae. The second was in the form of coalescing pits (holes) with smooth, minimally remodeled edges. The appearance combined features of multiple myeloma and leukemia, but were mutually exclusive in those diseases. Spheroid lesions with effaced edges were absent in leukemia, while pits were absent in multiple myeloma. Fronts of resorption were not noted in Waldenstrom's macroglobulinemia. The combination of some of the features of leukemia and myeloma appear to allow recognition of Waldenstrom's macroglobulinemia.
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Affiliation(s)
- B M Rothschild
- Arthritis Center of Northeast Ohio, Youngstown, Ohio 44512, USA.
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205
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Stone MJ. Myeloma and macroglobulinemia: what are the criteria for diagnosis? CLINICAL LYMPHOMA 2002; 3:23-5. [PMID: 12141951 DOI: 10.3816/calm2002.n.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) is much more common than either multiple myeloma or Waldenström's macroglobulinemia. Since individuals with MGUS do not need treatment but only monitoring, it is important to distinguish this group from those with progressive plasma cell disorders. Criteria for diagnosis of myeloma and macroglobulinemia and laboratory pitfalls related to meeting these criteria are discussed. The importance of using the serum protein electrophoretic pattern in determining the magnitude of the monoclonal immunoglobulin component and the need for accurate quantification and characterization of urine protein are emphasized. Uniform definitions and consensus on diagnostic standards are becoming increasingly necessary if more effective and less toxic therapeutic approaches for patients with myeloma and macroglobulinemia are to be applied in an optimal manner.
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Affiliation(s)
- Marvin J Stone
- Baylor Charles A Sammons Cancer Center, Dallas 75246, TX, USA.
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206
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Anagnostopoulos A, Giralt S. Stem cell transplantation (SCT) for Waldenstrom's macroglobulinemia (WM). Bone Marrow Transplant 2002; 29:943-7. [PMID: 12098060 DOI: 10.1038/sj.bmt.1703580] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Waldenstrom's macroglobulinemia (WM) is a low-grade lymphoplasmacytoid malignancy of unknown etiology. It primarily affects elderly patients and is characterized by a monoclonal IgM component, varying degrees of cytopenias, lymphadenopathy and manifestations related to hyperviscosity syndromes. WM is usually treated with single agent nucleoside analogues or alkylating agents that often provide high response rates and durable remissions. Recurrence of the disease after primary therapy is not uncommon, and resistance to both alkylating agents and nucleoside analogs eventually emerges. Small numbers of patients have undergone high-dose chemotherapy (HDC) with either autologous (n = 24) or allogeneic (n = 6) stem cell transplantation (SCT) as treatment for this disease. Most patients in both groups achieved remission. Results are promising and a more in-depth analysis of possible applications of this treatment modality is attempted with this mini-review.
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Affiliation(s)
- A Anagnostopoulos
- Department of Blood and Marrow Transplantation at the University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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207
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Dimopoulos MA, Zervas C, Zomas A, Kiamouris C, Viniou NA, Grigoraki V, Karkantaris C, Mitsouli C, Gika D, Christakis J, Anagnostopoulos N. Treatment of Waldenström's macroglobulinemia with rituximab. J Clin Oncol 2002; 20:2327-33. [PMID: 11981004 DOI: 10.1200/jco.2002.09.039] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Waldenström's macroglobulinemia (WM) is a low-grade lymphoplasmacytic lymphoma in which CD20 is usually expressed on tumor cells. There is evidence that patients with WM may benefit from treatment with the anti-CD20 monoclonal antibody rituximab. We performed a prospective phase II study to clearly define the activity of rituximab in patients with this disease. PATIENTS AND METHODS Twenty-seven patients with WM were treated with rituximab 375 mg/m(2) intravenously (IV) for 4 weeks. Three months after completion of rituximab, patients without evidence of progressive disease received repeat 4-week courses of this agent. All patients were symptomatic, their median age was 72 years, and 15 patients were previously untreated. RESULTS Twelve patients (44%; 95% confidence interval, 25.5% to 64.7%) achieved a partial response after treatment with rituximab. Median time to response was 3.3 months (range, 2.2 to 7.1 months). Responses occurred in six (40%) of 15 previously untreated patients and in six (50%) of 12 pretreated patients. Patients with a serum immunoglobulin M less than 40 g/L had a significantly higher response rate. The median time to progression for all patients was 16 months, and with a median follow-up of 15.7 months, nine of 12 responding patients remain free of progression. Treatment with rituximab was well tolerated, with approximately one fourth of patients experiencing some mild form of infusion-related toxicity, usually fever and chills. CONCLUSION Our prospective data indicate that rituximab is well tolerated and active in patients with WM. Previously untreated and pretreated patients seem to benefit equally. Repeat 4-week courses of rituximab may prolong the duration of response of the disease, but this observation requires confirmation in prospective, randomized trials. Furthermore, studies that will combine rituximab with chemotherapy may be relevant.
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Affiliation(s)
- Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Greece.
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208
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Schop RFJ, Jalal SM, Van Wier SA, Ahmann GJ, Bailey RJ, Kyle RA, Greipp PR, Rajkumar SV, Gertz MA, Lust JA, Lacy MQ, Dispenzieri A, Witzig TE, Fonseca R. Deletions of 17p13.1 and 13q14 are uncommon in Waldenström macroglobulinemia clonal cells and mostly seen at the time of disease progression. CANCER GENETICS AND CYTOGENETICS 2002; 132:55-60. [PMID: 11801310 DOI: 10.1016/s0165-4608(01)00526-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Waldenström macroglobulinemia (WM) is a plasma cell dyscrasia characterized by a monoclonal IgM paraproteinemia. Deletions of 17p13.1 and 13q14 are associated with tumor progression and worsened outcome in multiple myeloma (MM), and we thus investigated WM patients for their presence. Patients (n = 40) were required to have a > or = 1.5 g/dl serum IgM paraproteinemia and a monoclonal lymphoplasmacytic infiltrate. We used interphase fluorescence in situ hybridization (FISH) with probes that localized to 17p13.1(LSI p53/CEP 17) and 13q14 (D13S319 and LSI 13 Rb). Of 40 successfully studied patients for 17p13.1(p53) deletions, 6 were abnormal, consistent with hemizygous deletion (15%). Of 37 cases successfully studied for the 13q14 deletions, 6 were also abnormal with one pair of signals deleted (16%). Patients with deletions were more likely to be later in the course of the disease. No obvious clinical associations were noted with the exception that patients with 17p13.1(p53) deletions had a higher percent involvement of clonal cells in the bone marrow. Deletions of these two regions are uncommon in WM, being more common in the late stages of the disease, thus unlikely playing a role in primary disease pathogenesis.
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209
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García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A, Rodríguez-García JA, Massó P, Pérez-Aliaga A, Monteagudo MD, Navarro I, Moreno G, Toledo C, Alonso A, Besses C, Besalduch J, Jarque I, Salama P, Rivas JA, Navarro B, Bladé J, Miguel JF. Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases. Br J Haematol 2001; 115:575-82. [PMID: 11736938 DOI: 10.1046/j.1365-2141.2001.03144.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this report we analyse the presenting features of a series of patients diagnosed with Waldenström macroglobulinaemia (WM) in Spain over the last 10 years. Criteria for diagnosis required a serum monoclonal IgM protein > or = 30 g/l and > 20% bone marrow lymphocytes. Two hundred and seventeen patients were included in the study, with a median age of 69 years and male/female ratio of 2:1. The most common symptoms at diagnosis were anaemia (38%), hyperviscosity (31%), B symptoms (23%), bleeding (23%) and neurological symptoms (22%). Sixty-one patients (27%) were asymptomatic at diagnosis and, to date, 32 of them have not received chemotherapy. Variables predicting a shorter survival free of therapy were haemoglobin < 12.5 g/dl and high beta2microglobulin (beta2M). The 83% of patients who did receive treatment were distributed as follows: chlorambucil/prednisone (43%), intermittent chlorambucil (11%), continuous chlorambucil (26%), cyclophosphamide/vincristine/prednisone (COP, 13.5%) and other (6.5%). Response to therapy was complete in 2%, partial in 48% and minor in 10%. Finally, 28% and 13% of patients presented stable and progressive disease, respectively, which was more common among patients treated with COP. Progression-free survival was 43% at 5 years, with three independent predictors for shorter progression-free survival (PFS): COP treatment, age > 65 and B symptoms at diagnosis. The 10-year projected overall survival (OS) was 55%. The two most frequent causes of death were development of second malignancies (31%), or infections (19%). The two main variables predicting a poor OS were hyperviscosity and high beta2M. In summary, this study favours the use of chlorambucil-based therapy as the standard treatment for WM, and describes a subset of patients who should be considered as suffering a smouldering form and who therefore do not require treatment for a long period of time.
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Affiliation(s)
- R García-Sanz
- Department of Haematology, University Hospital of Salamanca, Paseo de San Vicente, Salamanca, Spain.
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210
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Leblond V, Lévy V, Maloisel F, Cazin B, Fermand JP, Harousseau JL, Remenieras L, Porcher R, Gardembas M, Marit G, Deconinck E, Desablens B, Guilhot F, Philippe G, Stamatoullas A, Guibon O. Multicenter, randomized comparative trial of fludarabine and the combination of cyclophosphamide-doxorubicin-prednisone in 92 patients with Waldenström macroglobulinemia in first relapse or with primary refractory disease. Blood 2001; 98:2640-4. [PMID: 11675332 DOI: 10.1182/blood.v98.9.2640] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Few reports are available on the treatment of patients with Waldenström macroglobulinemia (WM) and primary or secondary resistance to alkylating-agent-based regimens. From December 1993 through December 1997, 92 patients with WM resistant to first-line therapy (42) or with first relapse (50) after alkylating-agent therapy were randomly assigned to receive fludarabine (25 mg/m(2) of body-surface area on days 1-5) or cyclophosphamide, doxorubicin (Adriamycin), and prednisone (CAP; 750 mg/m(2) cyclophosphamide and 25 mg/m(2) doxorubicin on day 1 and 40 mg/m(2) prednisone on days 1-5). The first end point evaluated was the response rate after 6 treatment courses. Forty-five patients received CAP and 45 received fludarabine. Two patients died before the first course of chemotherapy. No statistical differences were observed between the 2 treatment arms with respect to hematologic toxicity or infections. Mucositis and alopecia occurred significantly more often in patients treated with CAP. Partial responses were obtained in 14 patients (30%) treated with fludarabine and 5 patients (11%) treated with CAP (P =.019). Responses were more durable in patients treated with fludarabine (19 months versus 3 months), and the event-free survival rate was significantly higher in this group (P <.01). Forty-four patients died, 22 in the fludarabine group and 22 in the CAP group. There was no statistical difference in the median overall survival time in the 2 study arms. Fludarabine was thus more active than CAP in salvage therapy of WM and should be tested as first-line therapy in a randomized comparison with alkylating agents.
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Affiliation(s)
- V Leblond
- Département d'hématologie, Hôpital Pitié-Salpétrière, AP-HP, Paris, France.
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211
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Cocito D, Isoardo G, Ciaramitaro P, Migliaretti G, Pipieri A, Barbero P, Cucci A, Durelli L. Terminal latency index in polyneuropathy with IgM paraproteinemia and anti-MAG antibody. Muscle Nerve 2001; 24:1278-82. [PMID: 11562906 DOI: 10.1002/mus.1145] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Criteria for the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) are met by the polyneuropathy associated with immunoglobulin M (IgM) paraproteinemia and anti-myelin-associated glycoprotein (MAG) antibody (MAG-CIDP). However, MAG-CIDP differs from other types of CIDP, mainly in its poorer response to treatment. The utility of terminal latency index (TLI) as an electrophysiological marker for MAG-CIDP has been debated. In this study we confirmed its diagnostic usefulness and evaluated TLI threshold values for motor nerves investigated in routine nerve conduction studies. Median, ulnar, peroneal, and tibial TLIs of 11 subjects with MAG-CIDP, 18 with CIDP, and 76 healthy controls were compared, and threshold values for MAG-CIDP evaluated as the lowest value with a likelihood ratio higher than 10. Mean TLI values and TLIs of all but the peroneal nerve were significantly lower in MAG-CIDP. Median nerve TLI of 0.26 and ulnar nerve TLI of 0.33 were identified as the threshold TLI values for MAG-CIDP.
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Affiliation(s)
- D Cocito
- Unità Operativa di Neurofisiologia Clinica, Dipartimento di Neuroscienze, Università di Torino, Via Cherasco 15, 10126 Torino, Italy.
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212
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Owen RG, Barrans SL, Richards SJ, O'Connor SJ, Child JA, Parapia LA, Morgan GJ, Jack AS. Waldenström macroglobulinemia. Development of diagnostic criteria and identification of prognostic factors. Am J Clin Pathol 2001; 116:420-8. [PMID: 11554171 DOI: 10.1309/4lcn-jmpg-5u71-uwqb] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
To establish whether a combination of morphologic and immunophenotypic criteria could be developed to more precisely define Waldenström macroglobulinemia (WM) and prognostic factors, we retrospectively assessed the clinical and laboratory features of 111 cases of WM. Bone marrow infiltration by small lymphocytes was documented in each case; and diffuse, interstitial, nodular, and paratrabecular patterns of infiltration were documented in 58%, 32%, 6%, and 4% of cases, respectively. Ninety percent were characterized by a surface immunoglobulin-positive, CD19+CD20+CD5-CD10-CD23- immunophenotype. The median overall survival from diagnosis was 60 months; univariate analysis revealed the following adverse prognostic factors: older than 60 years, performance status more than 1, platelet count less than 100 x 10(3)/microL (< 100 x 10(9)/L), pancytopenia, and diffuse bone marrow infiltration. Associated median survival was 40, 38, 46, 28, and 59 months, respectively. Multivariate analysis revealed age, performance status, and platelet count as prognostically significant, but stratification of patients according to the International Prognostic Index had limited value. We suggest defining WM by the following criteria: IgM monoclonal gammopathy; bone marrow infiltration by small lymphocytes, plasmacytoid cells, and plasma cells in a diffuse, interstitial, or nodular pattern; and a surface immunoglobulin-positive, CD19+CD20+CD5-CD10-CD23- immunophenotype.
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Affiliation(s)
- R G Owen
- Department of Hematology, HMDS Laboratory, General Infirmary at Leeds, Great George St, Leeds LS1 3EX, England
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213
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Ueda T, Hatanaka K, Kosugi S, Kishino BI, Tamaki T. Successful non-myeloablative allogeneic peripheral blood stem cell transplantation (PBSCT) for Waldenström's macroglobulinemia with severe pancytopenia. Bone Marrow Transplant 2001; 28:609-11. [PMID: 11607775 DOI: 10.1038/sj.bmt.1703190] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2000] [Accepted: 07/01/2001] [Indexed: 11/09/2022]
Abstract
We report a 62-year-old male who underwent non-myeloablative allogeneic peripheral blood stem cell transplantation (PBSCT) because of his life-threatening severe pancytopenia due to refractory Waldenström's macroglobulinemia. This therapy was performed safely and he made a marked recovery from his cytopenia that had not been improved with any other therapy. Bone marrow aspirates showed post-transplant mixed chimerism during engraftment, and became completely donor-derived after a series of GVHD symptoms, without subsequent donor lymphocyte infusion. Our results suggest that non-myeloablative allogeneic PBSCT could be a good alternative for patients suffering from multi-drug resistant Waldenström's macroglobulinemia.
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Affiliation(s)
- T Ueda
- Department of Internal Medicine, Rinku General Medical Center, Izumisano, Osaka, Japan
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214
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 27-2001. A 50-year-old man with marked splenomegaly and anemia. N Engl J Med 2001; 345:682-7. [PMID: 11547723 DOI: 10.1056/nejmcpc272001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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215
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Dimopoulos MA, Zomas A, Viniou NA, Grigoraki V, Galani E, Matsouka C, Economou O, Anagnostopoulos N, Panayiotidis P. Treatment of Waldenstrom's macroglobulinemia with thalidomide. J Clin Oncol 2001; 19:3596-601. [PMID: 11504741 DOI: 10.1200/jco.2001.19.16.3596] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We performed a prospective phase II study to assess the activity of thalidomide in patients with Waldenstrom's macroglobulinemia (WM). PATIENTS AND METHODS Twenty patients with WM were treated with thalidomide at a starting dose of 200 mg daily with dose escalation in 200-mg increments every 14 days as tolerated to a maximum of 600 mg. All patients were symptomatic, their median age was 74 years, and 10 patients were previously untreated. RESULTS On an intent-to-treat basis, five (25%) of 20 patients achieved a partial response after treatment. Responses occurred in three of 10 previously untreated and in two of 10 pretreated patients. None of the patients treated during refractory relapse or with disease duration exceeding 2 years responded to thalidomide. Time to response was short, ranging between 0.8 months to 2.8 months. Adverse effects were common but reversible and consisted primarily of constipation, somnolence, fatigue, and mood changes. The daily dose of thalidomide was escalated to 600 mg in only five patients (25%), and in seven patients (35%), this agent was discontinued within 2 months because of intolerance. CONCLUSION Our data indicate that thalidomide has activity in WM but only low doses were tolerated in this elderly patient population. Confirmatory studies as well as studies that will combine thalidomide with chemotherapy or with rituximab may be relevant.
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Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Greece.
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216
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Rosales CM, Lin P, Mansoor A, Bueso-Ramos C, Medeiros LJ. Lymphoplasmacytic lymphoma/Waldenström macroglobulinemia associated with Hodgkin disease. A report of two cases. Am J Clin Pathol 2001; 116:34-40. [PMID: 11447749 DOI: 10.1309/9dby-fbug-y10a-aaxt] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Although the clinical course of lymphoplasmacytic lymphoma (LPL)/Waldenström macroglobulinemia (WM) is usually indolent, high-grade non-Hodgkin lymphoma may develop in a small subset of patients. We have not found any patients with LPL/WM associated with Hodgkin disease (HD) described in the literature, prompting us to report 2 cases. In case 1, the patient had LPL/WM involving bone marrow diagnosed 1 week before left supraclavicular lymph node biopsy revealed LPL/WM and classical HD. In case 2, the patient had a 15-year history of LPL/WM before classical HD developed involving bone marrow, liver, and lymph node. Both cases were positive for IgM, monotypic immunoglobulin light chain, and B-cell antigens and were CD3-. The neoplastic Hodgkin cells were CD15+, CD20+ (case 1), CD30+, CD3-, and CD45- and were negative for Epstein-Barr virus RNA. Both patients were treated with chemotherapy for HD. In case 1, clinical response was excellent with no histologic evidence of HD in subsequent biopsy specimens. In case 2, HD was progressive at last follow-up, despite therapy. Patients with LPL/WM, similar to patients with other types of low-grade B-cell lymphoma, can develop HD that may respond to chemotherapy.
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MESH Headings
- Adult
- Bone Marrow/metabolism
- Bone Marrow/pathology
- Cytogenetic Analysis
- Female
- Hodgkin Disease/complications
- Hodgkin Disease/genetics
- Hodgkin Disease/metabolism
- Hodgkin Disease/pathology
- Humans
- Immunohistochemistry
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Waldenstrom Macroglobulinemia/complications
- Waldenstrom Macroglobulinemia/genetics
- Waldenstrom Macroglobulinemia/metabolism
- Waldenstrom Macroglobulinemia/pathology
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Affiliation(s)
- C M Rosales
- Division of Pathology and Laboratory Medicine, Box 72, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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217
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Dhodapkar MV, Jacobson JL, Gertz MA, Rivkin SE, Roodman GD, Tuscano JM, Shurafa M, Kyle RA, Crowley JJ, Barlogie B. Prognostic factors and response to fludarabine therapy in patients with Waldenström macroglobulinemia: results of United States intergroup trial (Southwest Oncology Group S9003). Blood 2001; 98:41-8. [PMID: 11418461 DOI: 10.1182/blood.v98.1.41] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Current information on Waldenström macroglobulinemia (WM) is based on retrospective or single-institution studies of patients requiring therapy. Between 1992 and 1998, 231 patients with WM were enrolled in a prospective observational multicenter clinical trial. Of these, 182 patients with symptomatic or progressive disease were treated with 4 to 8 cycles of therapy with a purine nucleoside analogue, fludarabine (FAMP; 30 mg/m(2) of body-surface area daily for 5 days every 28 days). A serum beta2-microglobulin (beta2M) level below 3 mg/L and a hemoglobin level of at least 120 g/L (12 g/dL) at presentation predicted a lower likelihood of requiring therapy. The overall rate of response to FAMP therapy was 36% (95% confidence interval, 29%-44%), with 2% complete remissions. Patients who were 70 years old or older had a substantially lower likelihood of response (odds ratio, 0.34; P =.004) than younger patients. On multivariate analysis, a serum beta2M level of 3 mg/L or higher, hemoglobin level below 120 g/L, and serum IgM level below 40 g/L [4 g/dL] were significant adverse prognostic factors for survival. We developed a simple staging system for WM by using these variables and identified 4 distinct subsets of patients with estimated 5-year overall survival rates of 87%, 64%, 53%, and 22%, and 5-year progression-free survival rates of 83%, 55%, 33%, and 12%. Prognosis in WM is highly variable and serum beta2M was the dominant predictor of a need for therapy and of survival. FAMP has activity against WM. Our staging system may provide guidance for a risk-based approach to the treatment of WM.
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Affiliation(s)
- M V Dhodapkar
- Laboratory of Cellular Physiology and Immunology, Rockefeller University, New York, NY, USA
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218
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CD20-Directed Antibody-Mediated Immunotherapy Induces Responses and Facilitates Hematologic Recovery in Patients With Waldenstrom’s Macroglobulinemia. J Immunother 2001. [DOI: 10.1097/00002371-200105000-00012] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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219
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Abstract
Autoimmune phenomena are well-recognised complications of Waldenström's macroglobulinemia (WM) and IgM monoclonal gammopathy. Peripheral neuropathy and cold agglutinin hemolytic anemia are the most common reported and occur in 5-10% of patients. Autoimmune thrombocytopenia has been rarely reported in WM and its incidence is not known. In this study we report the case of a 67-year-old man who presented with autoimmune thrombocytopenia who was subsequently found to have WM. Laboratory investigation demonstrated that platelet-associated IgM (PAIgM) but not PAIgG was clearly elevated compared to normal controls. In addition the patient's serum reacted strongly with a panel of donor platelets analysed with an indirect platelet immunofluorescence assay utilising an anti-IgM secondary antibody. Glycoprotein specificity could not however be demonstrated by ELISA techniques for platelet glycoproteins IIbIIIa, IaIIa, IbIXa, and IV. We also reviewed the case records of 104 additional cases of WM diagnosed at our institution between 5/93 and 5/99. Three further cases with clinically significant autoimmune thrombocytopenia were identified. The overall incidence of autoimmune thrombocytopenia (4/105, 3.8%) in this cohort of patients was similar to the incidence of peripheral neuropathy (7/105, 6.7%) and cold agglutinins (3/105, 2.9%).
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Affiliation(s)
- R G Owen
- Department of Hematology, Bradford Royal Infirmary, United Kingdom.
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220
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Abstract
Cancer can affect the peripheral nervous system by non-metastatic, sometimes immune-mediated mechanisms. Recognition of these paraneoplastic syndromes is important because it can lead to the detection of the tumor, and also helps to avoid unnecessary studies to determine the cause of the neurologic symptoms in patients with cancer. Many paraneoplastic syndromes of the peripheral nervous system are not associated with serum antibodies that serve as markers of paraneoplasia. For this group of disorders the diagnosis depends on the clinician's index of suspicion and conventional electrophysiologic and laboratory tests. Treatment of the tumor, immunotherapy, or both may improve some of these syndromes. This review focuses on paraneoplastic syndromes of the spinal cord, peripheral nerve, and muscle.
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Affiliation(s)
- S A Rudnicki
- Department of Neurology, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 500, Little Rock, Arkansas 72205, USA
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221
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Brincker H, Pedersen NT, Bendix-Hansen K, Johansen P. Non-Hodgkin's lymphoma subtypes over time in an unselected population of 646 patients: a study of clinico-pathological data and incidence based on a review using the REAL-classification. Leuk Lymphoma 2000; 39:531-41. [PMID: 11342336 DOI: 10.3109/10428190009113383] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Biopsies from 646 consecutive unselected cases of non-Hodgkin's lymphoma from a Danish population-based registry were reclassified according to the REAL classification 1) to study the distribution of subtypes over time, and 2) to correlate a number of clinical parameters with the various subtypes. Two cohorts from 1986 and 1992, of 292 and 354 cases, respectively, were studied. From 1986 to 1992 diffuse large B-cell lymphoma showed a change in incidence of + 43.1%, as opposed + 2.5% for all other subtypes combined (p = 0.05), suggesting that the increasing general incidence of non-Hodgkin's lymphoma is due primarily to an increasing incidence of diffuse large B-cell lymphoma. A higher rate of cell proliferation was associated with an increasing chance of having extranodal disease. For the various subgroups there was good agreement between survival and the International prognostic index.
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Affiliation(s)
- H Brincker
- Department of Hematology, Odense University Hospital, Denmark
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222
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Owen RG, Parapia LA, Higginson J, Misbah SA, Child JA, Morgan GJ, Jack AS. Clinicopathological correlates of IgM paraproteinemias. CLINICAL LYMPHOMA 2000; 1:39-43; discussion 44-5. [PMID: 11707811 DOI: 10.3816/clm.2000.n.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
IgM paraproteinemia is considered to be the major defining feature of Waldenström's macroglobulinemia (WM), but it may also occur in other B-cell lymphoproliferative disorders. In this study we have reviewed the final pathological diagnosis of 106 patients with IgM paraproteinemia investigated in our laboratories between April 1993 and May 1999. In 22 of the 106 patients (20.8%), there was no clinical or laboratory evidence of an underlying lymphoproliferative disorder, and a diagnosis of monoclonal gammopathy of undetermined significance (MGUS) was therefore made. In 60 cases (56.6%), a diagnosis of WM was made, while in the remaining 24 patients, the final diagnosis was chronic lymphocytic leukemia (n = 10), diffuse large B-cell lymphoma (n = 5), extranodal marginal-zone lymphoma (n = 3), follicular lymphoma (n = 3), and mantle-cell lymphoma (n = 3). The median paraprotein concentration in patients with WM, MGUS, and "other" lymphoproliferative disorders was 13 g/L (range, 2-54), 6 g/L (range, 3-30), and 4.5 g/L (range, 3-61), respectively. It is clear that IgM paraproteins are demonstrable in all subtypes of peripheral B-cell disorders and, although paraprotein concentrations are generally higher in WM, there is considerable overlap. Immunophenotypic criteria are therefore essential for the accurate diagnosis of WM.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/immunology
- Antibodies, Neoplasm/immunology
- Antigens, CD/analysis
- Disease Progression
- Female
- Flow Cytometry
- Follow-Up Studies
- Humans
- Immunoglobulin M/blood
- Immunophenotyping
- Leukemia/diagnosis
- Leukemia/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Lymphoma/diagnosis
- Lymphoma/immunology
- Male
- Middle Aged
- Paraproteinemias/diagnosis
- Paraproteinemias/immunology
- Paraproteins/immunology
- Waldenstrom Macroglobulinemia/diagnosis
- Waldenstrom Macroglobulinemia/immunology
- World Health Organization
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Affiliation(s)
- R G Owen
- Department of Hematology, General Infirmary at Leeds, United Kingdom.
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223
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Stone MJ. Commentary on “Clinicopathological Correlates of IgM Paraproteinemias” What is Waldenström's Macroglobulinemia? ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s1526-9655(11)70195-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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