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Chen H, Wang Y, Xu Z, Li D, Du H, Chen Y, Feng J. Multimodal Imaging Characteristics and Risk Factors Analysis of Waldenström Macroglobulinemia Retinopathy. Am J Ophthalmol 2023; 253:233-242. [PMID: 36963604 DOI: 10.1016/j.ajo.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE To summarize the multimodal imaging features and analyze the risk factors of Waldenström macroglobulinemia retinopathy (WMR). DESIGN Retrospective, cross-sectional study. METHODS Patients diagnosed with WM and underwent ophthalmic examination in Peking Union Medical College Hospital in the last decade were included. Multimodal imaging characteristics of WMR were summarized. Univariate and multivariate logistic regression analysis of WMR and potential systemic and ocular factors was performed. RESULTS A total of 50 patients with WM were included in this study, and 28 patients had WMR in at least 1 eye. WMR was found to have worse LogMAR visual acuity (0.52 ± 0.54 vs 0.21 ± 0.18, P = .009) and was characterized by tortuous retinal vessels, extensive retinal hemorrhage, distinctive shape of macular edema, and so on. In univariate analysis, the presence of WMR was significantly associated with the mean visual acuity (LogMAR), serum red blood cell counts, serum platelet counts, hemoglobin level, serum M protein, serum IgM level, and lactate dehydrogenase (with P < .05). In multivariate analysis, WMR was significantly correlated with M protein (adjusted odds ratio = 1.127, 95% CI: 1.052-1.209, P= .001) and serum IgM (adjusted odds ratio = 1.059, 95% CI: 1.023-1.095, P = .001) with the predicted areas under the curve of 0.859 and 0.820, respectively. The optimal cutoff values were 26.2 g/L for M protein and 51.0 g/L for IgM, which accounts for a sensitivity of 95.4% and 95.4% and specificity of 64.3% and 60.7%, respectively. CONCLUSIONS WMR has specific characteristics in ophthalmic examinations. Serum IgM levels and M protein are good predictors of WMR, which could attach important value of fundus examinations for patients with WM.
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Affiliation(s)
- Huan Chen
- From the Department of Ophthalmology, Peking Union Medical College Hospital (H.C., Y.W., Z.X., D.L., H.D., Y.C.); Key Laboratory of Ocular Fundus Diseases (H.C., Y.W., Z.X., D.L., H.D., Y.C.)
| | - Yuelin Wang
- From the Department of Ophthalmology, Peking Union Medical College Hospital (H.C., Y.W., Z.X., D.L., H.D., Y.C.); Key Laboratory of Ocular Fundus Diseases (H.C., Y.W., Z.X., D.L., H.D., Y.C.)
| | - Zhengbo Xu
- From the Department of Ophthalmology, Peking Union Medical College Hospital (H.C., Y.W., Z.X., D.L., H.D., Y.C.); Key Laboratory of Ocular Fundus Diseases (H.C., Y.W., Z.X., D.L., H.D., Y.C.)
| | - Donghui Li
- From the Department of Ophthalmology, Peking Union Medical College Hospital (H.C., Y.W., Z.X., D.L., H.D., Y.C.); Key Laboratory of Ocular Fundus Diseases (H.C., Y.W., Z.X., D.L., H.D., Y.C.)
| | - Hong Du
- From the Department of Ophthalmology, Peking Union Medical College Hospital (H.C., Y.W., Z.X., D.L., H.D., Y.C.); Key Laboratory of Ocular Fundus Diseases (H.C., Y.W., Z.X., D.L., H.D., Y.C.)
| | - Youxin Chen
- From the Department of Ophthalmology, Peking Union Medical College Hospital (H.C., Y.W., Z.X., D.L., H.D., Y.C.); Key Laboratory of Ocular Fundus Diseases (H.C., Y.W., Z.X., D.L., H.D., Y.C.).
| | - Jun Feng
- Department of Hematology, Peking Union Medical College Hospital (J.F.), Chinese Academy of Medical Sciences, Beijing, China.
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Abstract
Waldenström macroglobulinemia (WM) is a rare subtype of non-Hodgkin lymphoma characterized by the presence of lymphoplasmacytic lymphoma (LPL) in the bone marrow accompanied by a monoclonal immunoglobulin type M (IgM) in the serum. WM was first described only 80 years ago and became reportable in the US as a malignancy in 1988. Very little systematic research was conducted prior to 2000 to characterize incidence, clinical characteristics, risk factors or diagnostic and prognostic criteria, and there were essentially no WM-specific clinical interventional trials. Since the inaugural meeting of the International Workshop in Waldenström's Macroglobulinemia (IWWM) in 2000, WM has become the focus of a steadily increasing and productive body of research, engaging a growing number of investigators throughout the world. This introductory overview provides summary of the current understanding of the epidemiology of WM/LPL as a backdrop for a series of consensus panel recommendations arising from research presented at the 11th IWWM.
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Affiliation(s)
- Mary L McMaster
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health and Human Services, Commissioned Corps of the United States Public Health Service, Washington, DC.
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Sun H, Fang T, Wang T, Yu Z, Gong L, Wei X, Wang H, He Y, Liu L, Yan Y, Sui W, Xu Y, Yi S, Qiu L, Hao M. Single-cell profiles reveal tumor cell heterogeneity and immunosuppressive microenvironment in Waldenström macroglobulinemia. J Transl Med 2022; 20:576. [PMID: 36494694 PMCID: PMC9733185 DOI: 10.1186/s12967-022-03798-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Waldenström macroglobulinemia (WM) is a rare and incurable indolent B-cell malignancy. The molecular pathogenesis and the role of immunosuppressive microenvironment in WM development are still incompletely understood. METHODS The multicellular ecosystem in bone marrow (BM) of WM were delineated by single-cell RNA-sequencing (scRNA-seq) and investigated the underlying molecular characteristics. RESULTS Our data uncovered the heterogeneity of malignant cells in WM, and investigated the kinetic co-evolution of WM and immune cells, which played pivotal roles in disease development and progression. Two novel subpopulations of malignant cells, CD19+CD3+ and CD138+CD3+, co-expressing T-cell marker genes were identified at single-cell resolution. Pseudotime-ordered analysis elucidated that CD19+CD3+ malignant cells presented at an early stage of WM-B cell differentiation. Colony formation assay further identified that CD19+CD3+ malignant cells acted as potential WM precursors. Based on the findings of T cell marker aberrant expressed on WM tumor cells, we speculate the long-time activation of tumor antigen-induced immunosuppressive microenvironment that is involved in the pathogenesis of WM. Therefore, our study further investigated the possible molecular mechanism of immune cell dysfunction. A precursor exhausted CD8-T cells and functional deletion of NK cells were identified in WM, and CD47 would be a potential therapeutic target to reverse the dysfunction of immune cells. CONCLUSIONS Our study facilitates further understanding of the biological heterogeneity of tumor cells and immunosuppressive microenvironment in WM. These data may have implications for the development of novel immunotherapies, such as targeting pre-exhausted CD8-T cells in WM.
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Affiliation(s)
- Hao Sun
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Teng Fang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Tingyu Wang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Zhen Yu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Lixin Gong
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Xiaojing Wei
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Huijun Wang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Yi He
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Lanting Liu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Yuting Yan
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Weiwei Sui
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Yan Xu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Shuhua Yi
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China
| | - Lugui Qiu
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
| | - Mu Hao
- grid.506261.60000 0001 0706 7839State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020 China ,Tianjin Institutes of Health Science, Tianjin, 301600 China
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Hu X, Wang H, Yuan D, Qu H, Li Y, Wang N, Wang X, Liu X, Xu H, Zhang Y, Wang X. An Extended Prognostic Index of the ISSWM Score Based on Thyroid Complications in Waldenström Macroglobulinemia/Lymphoplasmacytoid Lymphoma. Front Oncol 2022; 12:870258. [PMID: 35646661 PMCID: PMC9136013 DOI: 10.3389/fonc.2022.870258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/04/2022] [Indexed: 12/23/2022] Open
Abstract
Waldenström macroglobulinemia/lymphoplasmacytoid lymphoma (WM/LPL) is a rare lymphoproliferative neoplasm characterized by clonally related lymphocytes, lymphoplasmacytic cells, and plasma cell proliferation. WM/LPL patients commonly present with elevated immunoglobulin, predominantly immunoglobulin M (IgM). Previous studies reported that thyroid dysfunction was associated with the development and progression of solid tumors. However, only limited information is available on the correlation between thyroid complications and lymphoid malignancies. The aim of our study was to explore the prognostic significance of thyroid complications in WM/LPL. Herein, 13.3% of WM/LPL patients were diagnosed with thyroid complications, which were significantly associated with unfavorable progression-free survival (PFS), overall survival (OS), and adverse treatment response. Co-existing thyroid disease was significantly related to alleviated serum IgM levels, providing an answer to practical problems. Furthermore, the presence of thyroid complications was identified as an independent prognostic indicator for PFS in WM/LPL. Incorporating the ISSWM score with thyroid complications was superior to ISSWM alone in risk stratification and prognostic prediction. Furthermore, subgroup analyses of WM/LPL patients revealed that subclinical hypothyroidism predicted undesirable outcomes at the early stage. These results were also supported by independent microarray dataset analyses. In conclusion, the primary strength of this study is that it provides robust real-world evidence on the prognostic role of thyroid complications, highlighting further clinical concerns in the management of WM/LPL patients.
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Affiliation(s)
- Xinting Hu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
| | - Hua Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
| | - Dai Yuan
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huiting Qu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ying Li
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Na Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xianghua Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Liu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongzhi Xu
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ya Zhang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Xin Wang, ; Ya Zhang,
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Shandong University, Jinan, China
- Shandong Provincial Engineering Research Center of Lymphoma, Jinan, China
- Branch of National Clinical Research Center for Hematologic Diseases, Jinan, China
- National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Xin Wang, ; Ya Zhang,
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Levy A, Guidez S, Debiais C, Princet I, Bouyer S, Dindinaud E, Delwail V, Systchenko T, Moya N, Gruchet C, Sabirou F, Bobin A, Gardeney H, Nsiala L, Cailly L, Olivier G, Motard C, Fleck E, Corby A, Roul C, Denis G, Dieval C, Leleu X, Tomowiak C. Waldenström macroglobulinemia and relationship to immune deficiency. Leuk Lymphoma 2021; 62:2665-2670. [PMID: 34085595 DOI: 10.1080/10428194.2021.1907379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Primary or secondary immune deficiency (ID) is a risk factor, although rare, to develop Waldenström macroglobulinemia (WM). We aimed to better understand the incidence of this occurrence in the real-life and the outcome of either entity. We conducted a review of 194 WM in the Poitou-Charentes registry and identified 7 (3.6%) with a prior history of ID. Across the 7 WM with ID, 4 progressed to active WM disease and required treatment for WM with a median time between WM diagnosis and the first treatment of 1.5 years (range 0-3). The median time from ID to WM occurrence was 8 years (1-18). WM could develop from ID, although a rare event. Our first action was to systematically decrease immunosuppression with long-term control of ID. Half of indolent WM remained indolent despite ID and for remaining WM none appeared of poor risk WM.
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Affiliation(s)
- Anthony Levy
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Stéphanie Guidez
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Céline Debiais
- Laboratoire d'Anatomie Pathologie, CHU, Poitiers, France
| | | | | | | | - Vincent Delwail
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Thomas Systchenko
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Niels Moya
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Cécile Gruchet
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Florence Sabirou
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Arthur Bobin
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Hélène Gardeney
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Laly Nsiala
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Laura Cailly
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | | | | | | | - Anne Corby
- Service d'Onco-Hématologie, La Rochelle, France
| | | | | | | | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Cécile Tomowiak
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
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Dalal NH, Dores GM, Curtis RE, Linet MS, Morton LM. Cause-specific mortality in individuals with lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia, 2000-2016. Br J Haematol 2020; 189:1107-1118. [PMID: 32090327 DOI: 10.1111/bjh.16492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023]
Abstract
Data on cause-specific mortality after lymphoplasmacytic lymphoma (LPL) and Waldenström macroglobulinaemia (WM) are lacking. We identified causes of death amongst 7289 adults diagnosed with incident first primary LPL (n = 3108) or WM (n = 4181) during 2000-2016 in 17 USA population-based cancer registries. Based on 3132 deaths, 16-year cumulative mortality was 23·2% for lymphomas, 8·4% for non-lymphoma cancers and 14·7% for non-cancer causes for patients aged <65 years at diagnosis of LPL/WM, versus 33·4%, 11·2% and 48·7%, respectively, for those aged ≥75 years. Compared with the general population, patients with LPL/WM had a 20% higher risk of death due to non-cancer causes (n = 1341 deaths, standardised mortality ratio [SMR] 1·2, 95% confidence interval [CI] 1·1-1·2), most commonly from infectious (n = 188; SMR 1·8, 95% CI 1·6-2·1), respiratory (n = 143; SMR 1·2, 95% CI 1·0-1·4), and digestive (n = 80; SMR 1·8, 95% CI 1·4-2·2) diseases, but no excess mortality from cardiovascular diseases (n = 477, SMR 1·1, 95% CI 1·0-1·1). Risks were highest for non-cancer causes within 1 year of diagnosis (n = 239; SMR<1year 1·3, 95% CI 1·2-1·5), declining thereafter (n = 522; SMR≥5years 1·1, 95% CI 1·1-1·2). Myelodysplastic syndrome/acute myeloid leukaemia deaths were notably increased (n = 46; SMR 4·4, 95% CI 3·2-5·9), whereas solid neoplasm deaths were only elevated among ≥5-year survivors (n = 145; SMR≥5years 1·3, 95% CI 1·1-1·5). This work identifies new areas for optimising care and reducing mortality for patients with LPL/WM.
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Affiliation(s)
- Nicole H Dalal
- Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Graça M Dores
- Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA.,United States Food and Drug Administration, Center for Biologics Evaluation and Research, Silver Spring, MD, USA
| | - Rochelle E Curtis
- Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Martha S Linet
- Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
| | - Lindsay M Morton
- Department of Health and Human Services, National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD, USA
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Imaging of Waldenström Macroglobulinemia: A Comprehensive Review for the Radiologist in the Era of Personalized Medicine. AJR Am J Roentgenol 2019; 213:W248-W256. [PMID: 31287727 DOI: 10.2214/ajr.19.21493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Almufti T, Eversheim F, Akra G, Kigotho A. Rare presentation of Waldenström macroglobulinemia post shoulder replacement and dynamic hip screw procedures. JSES OPEN ACCESS 2019; 3:208-212. [PMID: 31709364 PMCID: PMC6835020 DOI: 10.1016/j.jses.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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McMaster ML, Berndt SI, Zhang J, Slager SL, Li SA, Vajdic CM, Smedby KE, Yan H, Birmann BM, Brown EE, Smith A, Kleinstern G, Fansler MM, Mayr C, Zhu B, Chung CC, Park JH, Burdette L, Hicks BD, Hutchinson A, Teras LR, Adami HO, Bracci PM, McKay J, Monnereau A, Link BK, Vermeulen RCH, Ansell SM, Maria A, Diver WR, Melbye M, Ojesina AI, Kraft P, Boffetta P, Clavel J, Giovannucci E, Besson CM, Canzian F, Travis RC, Vineis P, Weiderpass E, Montalvan R, Wang Z, Yeager M, Becker N, Benavente Y, Brennan P, Foretova L, Maynadie M, Nieters A, de Sanjose S, Staines A, Conde L, Riby J, Glimelius B, Hjalgrim H, Pradhan N, Feldman AL, Novak AJ, Lawrence C, Bassig BA, Lan Q, Zheng T, North KE, Tinker LF, Cozen W, Severson RK, Hofmann JN, Zhang Y, Jackson RD, Morton LM, Purdue MP, Chatterjee N, Offit K, Cerhan JR, Chanock SJ, Rothman N, Vijai J, Goldin LR, Skibola CF, Caporaso NE. Two high-risk susceptibility loci at 6p25.3 and 14q32.13 for Waldenström macroglobulinemia. Nat Commun 2018; 9:4182. [PMID: 30305637 PMCID: PMC6180091 DOI: 10.1038/s41467-018-06541-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 09/04/2018] [Indexed: 01/07/2023] Open
Abstract
Waldenström macroglobulinemia (WM)/lymphoplasmacytic lymphoma (LPL) is a rare, chronic B-cell lymphoma with high heritability. We conduct a two-stage genome-wide association study of WM/LPL in 530 unrelated cases and 4362 controls of European ancestry and identify two high-risk loci associated with WM/LPL at 6p25.3 (rs116446171, near EXOC2 and IRF4; OR = 21.14, 95% CI: 14.40-31.03, P = 1.36 × 10-54) and 14q32.13 (rs117410836, near TCL1; OR = 4.90, 95% CI: 3.45-6.96, P = 8.75 × 10-19). Both risk alleles are observed at a low frequency among controls (~2-3%) and occur in excess in affected cases within families. In silico data suggest that rs116446171 may have functional importance, and in functional studies, we demonstrate increased reporter transcription and proliferation in cells transduced with the 6p25.3 risk allele. Although further studies are needed to fully elucidate underlying biological mechanisms, together these loci explain 4% of the familial risk and provide insights into genetic susceptibility to this malignancy.
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Affiliation(s)
- Mary L McMaster
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA.
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
| | - Jianqing Zhang
- Department of Epidemiology, School of Public Health and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, 35233, AL, USA
| | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, 55905, MN, USA
| | - Shengchao Alfred Li
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick National Lab for Cancer Research, Frederick, 20877, MD, USA
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, 2052, NSW, Australia
| | - Karin E Smedby
- Department of Medicine, Solna Karolinska Institutet, Stockholm, 17176, Sweden
- Hematology Center, Karolinska University Hospital, Stockholm, 17176, Sweden
| | - Huihuang Yan
- Department of Health Sciences Research, Mayo Clinic, Rochester, 55905, MN, USA
| | - Brenda M Birmann
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, 02115, MA, USA
| | - Elizabeth E Brown
- Department of Pathology, University of Alabama at Birmingham, Birmingham, 35233, AL, USA
| | - Alex Smith
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Geffen Kleinstern
- Department of Health Sciences Research, Mayo Clinic, Rochester, 55905, MN, USA
| | - Mervin M Fansler
- Tri-Institutional Training Program in Computational Biology and Medicine, Weill Cornell Graduate College, New York, 10021, NY, USA
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Christine Mayr
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Bin Zhu
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick National Lab for Cancer Research, Frederick, 20877, MD, USA
| | - Charles C Chung
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick National Lab for Cancer Research, Frederick, 20877, MD, USA
| | - Ju-Hyun Park
- Department of Statistics, Dongguk University, Seoul, 100-715, Republic of Korea
| | - Laurie Burdette
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick National Lab for Cancer Research, Frederick, 20877, MD, USA
| | - Belynda D Hicks
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick National Lab for Cancer Research, Frederick, 20877, MD, USA
| | - Amy Hutchinson
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick National Lab for Cancer Research, Frederick, 20877, MD, USA
| | - Lauren R Teras
- Epidemiology Research Program, American Cancer Society, Atlanta, 30303, GA, USA
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 17177, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
- Institute of Health and Society, Clinical Effectiveness Research Group, University of Oslo, Oslo, NO-0316, Norway
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, 94118, CA, USA
| | - James McKay
- International Agency for Research on Cancer (IARC), Lyon, 69372, France
| | - Alain Monnereau
- Epidemiology of Childhood and Adolescent Cancers Group, Inserm, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, F-94807, France
- Université Paris Descartes, Paris, 75006, France
- Registry of Hematological Malignancies in Gironde, Institut Bergonié, University of Bordeaux, Inserm, Team EPICENE, UMR 1219, Bordeaux, 33000, France
| | - Brian K Link
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, 52242, IA, USA
| | - Roel C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, 3508 TD, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Stephen M Ansell
- Department of Internal Medicine, Mayo Clinic, Rochester, 55905, MN, USA
| | - Ann Maria
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, 30303, GA, USA
| | - Mads Melbye
- Division of Health Surveillance and Research, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, 2300, Denmark
- Department of Medicine, Stanford University School of Medicine, Stanford, 94305, CA, USA
| | - Akinyemi I Ojesina
- Department of Epidemiology, School of Public Health and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, 35233, AL, USA
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, 10029, NY, USA
| | - Jacqueline Clavel
- Epidemiology of Childhood and Adolescent Cancers Group, Inserm, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, F-94807, France
- Université Paris Descartes, Paris, 75006, France
| | - Edward Giovannucci
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, 02115, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, 02115, MA, USA
| | - Caroline M Besson
- Service d'hématologie et Oncologie, Centre Hospitalier de Versailles, Le Chesnay, Inserm U1018, Centre pour la Recherche en Epidémiologie et Santé des Populations (CESP), Villejuif, 78157, France
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany
| | - Ruth C Travis
- Cancer Epidemiology Unit, University of Oxford, Oxford, OX3 7LF, UK
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, W2 1PG, UK
- Human Genetics Foundation, Turin, 10126, Italy
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 17177, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, 9019, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, 0379, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center and University of Helsinki, Helsinki, 00250, Finland
| | | | - Zhaoming Wang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, 38105, TN, USA
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20877, MD, USA
| | - Meredith Yeager
- Cancer Genomics Research Laboratory, Leidos Biomedical Research, Inc., Frederick National Lab for Cancer Research, Frederick, 20877, MD, USA
| | - Nikolaus Becker
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, 69120, Baden-Württemberg, Germany
| | - Yolanda Benavente
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, 28029, Spain
| | - Paul Brennan
- International Agency for Research on Cancer (IARC), Lyon, 69372, France
| | - Lenka Foretova
- Department of Cancer Epidemiology and Genetics, Masaryk Memorial Cancer Institute and MF MU, Brno, 65653, Czech Republic
| | - Marc Maynadie
- EA 4184, Registre des Hémopathies Malignes de Côte d'Or, University of Burgundy and Dijon University Hospital, Dijon, 21070, France
| | - Alexandra Nieters
- Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, 79108, Baden-Württemberg, Germany
| | - Silvia de Sanjose
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, 08908, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, 28029, Spain
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin, 9, Ireland
| | - Lucia Conde
- Bill Lyons Informatics Centre, UCL Cancer Institute, University College London, London, WC1E 6DD, UK
| | - Jacques Riby
- Department of Epidemiology, School of Public Health and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, 35233, AL, USA
- Division of Environmental Health Sciences, University of California Berkeley School of Public Health, Berkeley, 94720, CA, USA
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, 75105, Sweden
| | - Henrik Hjalgrim
- Division of Health Surveillance and Research, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, 2300, Denmark
- Department of Hematology, Rigshospitalet, Copenhagen, 2100, Denmark
| | - Nisha Pradhan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, 55905, MN, USA
| | - Anne J Novak
- Department of Internal Medicine, Mayo Clinic, Rochester, 55905, MN, USA
| | | | - Bryan A Bassig
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
| | - Tongzhang Zheng
- Department of Epidemiology, Brown University, Providence, 02903, RI, USA
| | - Kari E North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, 27599, NC, USA
- Carolina Center for Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, 27599, NC, USA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, 98117, WA, USA
| | - Wendy Cozen
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, Los Angeles, 90033, CA, USA
- Norris Comprehensive Cancer Center, USC Keck School of Medicine, University of Southern California, Los Angeles, 90033, CA, USA
| | - Richard K Severson
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, 48201, MI, USA
| | - Jonathan N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, 06520, CT, USA
| | - Rebecca D Jackson
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Columbus, 43210, OH, USA
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
| | - Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
- Ontario Health Study, Toronto, M5S 1C6, ON, Canada
| | - Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, 21205, MD, USA
- Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, 21205, MD, USA
| | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, 55905, MN, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
| | - Joseph Vijai
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, 10065, NY, USA
| | - Lynn R Goldin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
| | - Christine F Skibola
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, 30322, GA, USA
| | - Neil E Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, 20892, MD, USA
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10
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Simon L, Baron M, Leblond V. How we manage patients with Waldenström macroglobulinaemia. Br J Haematol 2018; 181:737-751. [PMID: 29637541 DOI: 10.1111/bjh.15202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Waldenström macroglobulinaemia (WM) is a rare, indolent B-cell lymphoproliferative disorder characterized by cellular involvement in bone marrow and monoclonal IgM production. Symptoms can be related to cytopenias, tumoural involvement, or IgM-related disorders. Somatic mutations in the MYD88 gene have been described in the majority of WM cases. The mutation is responsible for a gain-of-function and induces activation of nuclear factor-κB, for DNA transcription and cell survival. It seems that MYD88 mutation is associated with better prognosis and better response to some treatment. Treatments are started when WM is symptomatic, following systematic biological and morphological assessments. Therapeutic choice depends on age, frailty and urgent efficacy need. In first line, the majority of patients are treated with monoclonal anti-CD20 antibody-based regimens combined with cytotoxic chemotherapy. Rituximab, cyclophosphamide and dexamethasone remain the most commonly used regimen with good safety. Nevertheless, increasing numbers of new drugs are becoming available or are in development. Proteasome inhibitors, such as bortezomib or carfilzmib, showed good and rapid responses. Bruton tyrosine kinase (BTK) inhibitor demonstrated excellent results and is now available for relapse/refractory disease or as first line for some patients. This review highlights the diagnostic procedures and therapeutic approaches in WM.
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Affiliation(s)
- Laurence Simon
- Department of Haematology, APHP Hôpital Pitié-Salpétrière, Paris, France
| | - Marine Baron
- Department of Haematology, APHP Hôpital Pitié-Salpétrière, Paris, France
| | - Véronique Leblond
- Department of Haematology, APHP Hôpital Pitié-Salpétrière, Paris, France
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Schmidt S, Mor A, Schønheyder H, Sørensen H, Dekkers O, Cronin-Fenton D. Herpes zoster as a marker of occult cancer: A systematic review and meta-analysis. J Infect 2017; 74:215-235. [DOI: 10.1016/j.jinf.2016.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 01/14/2023]
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12
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Waldenstrom Macroglobulinemia: Familial Predisposition and the Role of Genomics in Prognosis and Treatment Selection. Curr Treat Options Oncol 2016; 17:16. [DOI: 10.1007/s11864-016-0391-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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13
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Brandefors L, Kimby E, Lundqvist K, Melin B, Lindh J. Familial Waldenstrom's macroglobulinemia and relation to immune defects, autoimmune diseases, and haematological malignancies--A population-based study from northern Sweden. Acta Oncol 2015; 55:91-8. [PMID: 26559865 DOI: 10.3109/0284186x.2015.1096019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Waldenstrom's macroglobulinemia (WM) is a rare lymphoprolipherative disorder with geographic and ethnic disparities in incidence. The cause of WM remains mostly unknown although a role for genetic, immune-related, and environmental factors has been suggested. Most cases of WM are sporadic although familial cases occur. AIM This study estimated the incidence of WM in northern Sweden and identified and described patients with familial WM in this area. PATIENTS AND METHODS The Swedish and Northern Lymphoma Registry, the Swedish Cancer Registry (1997-2011), and medical records were used to identify patients with WM in two counties (Norrbotten and Västerbotten) in northern Sweden and to calculate the overall age-adjusted incidence (2000-2012). We identified 12 families with a family history of WM, IgM monoclonal gammophathy (MGUS), and/or multiple myeloma (MM). RESULTS In Norrbotten and Västerbotten, the age-adjusted incidence of WM/LPL is 1.75 and 1.48 per 100,000 persons per year, respectively (2000-2012), rates that are higher than the overall incidence of WM/LPL in Sweden (1.05 per 100,000 persons per year; 2000-2012). Autoimmune diseases and other haematological malignancies in the medical history (their own or in relatives) were reported in 9/12 and 5/12 families, respectively. A high proportion of abnormal serum protein electrophoresis was found in the relatives; 12/56 (21%) had a MGUS and 13/56 (25%) showed abnormalities in the immunoglobulin levels (i.e. subnormal levels and poly/oligoclonality). CONCLUSION The incidence of WM in Norrbotten and Västerbotten counties was higher than expected. We found a strong correlation between autoimmune/inflammatory diseases, other haematological malignancies, and familial WM and a high frequency of serum immunoglobulin abnormalities in the relatives of the WM patients, findings that strengthen the hypothesis that the aetiology of WM depends on both immune-related and genetic factors.
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Affiliation(s)
| | - Eva Kimby
- Department of Hematology, Karolinska University Hospital Stockholm, Sweden
| | - Kristina Lundqvist
- Department of Radiation Science, Oncology, Umeå University, Umeå, Sweden
| | - Beatrice Melin
- Department of Radiation Science, Oncology, Umeå University, Umeå, Sweden
| | - Jack Lindh
- Department of Radiation Science, Oncology, Umeå University, Umeå, Sweden
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14
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Vajdic CM, Landgren O, McMaster ML, Slager SL, Brooks-Wilson A, Smith A, Staines A, Dogan A, Ansell SM, Sampson JN, Morton LM, Linet MS. Medical history, lifestyle, family history, and occupational risk factors for lymphoplasmacytic lymphoma/Waldenström's macroglobulinemia: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr 2015; 2014:87-97. [PMID: 25174029 DOI: 10.1093/jncimonographs/lgu002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lymphoplasmacytic lymphoma/Waldenström's macroglobulinemia (LPL/WM), a rare non-Hodgkin lymphoma subtype, shows strong familial aggregation and a positive association with chronic immune stimulation, but evidence regarding other risk factors is very limited. METHODS The International Lymphoma Epidemiology Consortium (InterLymph) pooled data from 11 predominantly population-based case-control studies from North America, Europe, and Australia to examine medical history, lifestyle, family history, and occupational risk factors for LPL/WM. Age-, sex-, race/ethnicity-, and study-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression for a total of 374 LPL/WM cases and 23 096 controls. RESULTS In multivariate analysis including all putative risk factors, LPL/WM risk was associated with history of Sjögren's syndrome (OR = 14.0, 95% CI = 3.60 to 54.6), systemic lupus erythematosus (OR = 8.23, 95% CI = 2.69 to 25.2), hay fever (OR = 0.73, 95% CI = 0.54 to 0.99), positive hepatitis C serology (OR = 2.51, 95% CI = 1.03 to 6.17), hematologic malignancy in a first-degree relative (OR = 1.64, 95% CI = 1.02 to 2.64), adult weight (OR = 0.61, 95% CI = 0.44 to 0.85 for highest vs. lowest quartile), duration of cigarette smoking (OR = 1.46, 95% CI = 1.04 to 2.05 for ≥ 40 years vs. nonsmokers), and occupation as a medical doctor (OR = 5.54, 95% CI = 2.19 to 14.0). There was no association with other medical conditions, lifestyle factors, or occupations. CONCLUSIONS This pooled analysis confirmed associations with immune conditions and family history of hematologic malignancy, and identified new associations with hay fever, weight, smoking, and occupation, and no association with other lifestyle factors. These findings offer clues to LPL/WM biology and prevention.
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Affiliation(s)
- Claire M Vajdic
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD).
| | - Ola Landgren
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Mary L McMaster
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Susan L Slager
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Angela Brooks-Wilson
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Alex Smith
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Anthony Staines
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Ahmet Dogan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Stephen M Ansell
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Joshua N Sampson
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Lindsay M Morton
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
| | - Martha S Linet
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (CMV); Multiple Myeloma Section, Metabolism Branch (OL) and Division of Cancer Epidemiology and Genetics (MLM, JNS, LMM, MSL), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Health Sciences Research, College of Medicine (SLS) and Division of Hematology (SMA), Mayo Clinic, Rochester, MN; Genome Sciences Centre, BC Cancer Agency, Vancouver, BC, Canada (AB-W); Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada (ABW); Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, UK (ASm); School of Nursing and Human Sciences, Dublin City University, Dublin, Leinster, Ireland (ASt); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (AD)
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15
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The cellular origin and malignant transformation of Waldenström macroglobulinemia. Blood 2015; 125:2370-80. [DOI: 10.1182/blood-2014-09-602565] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/27/2015] [Indexed: 01/14/2023] Open
Abstract
Key Points
Benign (ie, IgM MGUS and smoldering WM) clonal B cells already harbor the phenotypic and molecular signatures of the malignant WM clone. Multistep transformation from benign (ie, IgM MGUS and smoldering WM) to malignant WM may require specific copy number abnormalities.
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16
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Autoimmune Manifestations in Patients With Waldenström Macroglobulinemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:456-9. [DOI: 10.1016/j.clml.2014.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 12/31/2013] [Accepted: 04/30/2014] [Indexed: 12/25/2022]
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17
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Novel treatment options for Waldenström macroglobulinemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 13 Suppl 2:S310-6. [PMID: 24290218 DOI: 10.1016/j.clml.2013.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/06/2013] [Indexed: 12/17/2022]
Abstract
Waldenström macroglobulinemia (WM), first described by Jan Waldenström in 1944, is a lymphoplasmacytic lymphoma characterized by the presence of an immunoglobulin M monoclonal gammopathy in the blood and monoclonal small lymphocytes and lymphoplasmacytoid cells in the bone marrow. WM is a rare and indolent disease but remains incurable. In this review we discuss the pathogenesis of WM and focus on novel treatment options that target pathways deregulated in this disease. Recent studies have helped us identify specific genetic mutations that are commonly seen in WM and might prove to be important therapeutic targets in the future. We discuss the role of epigenetics and the changes in the bone marrow microenvironment that are important in the pathogenesis of WM. The commonly used drugs are discussed with a focus on novel agents that are currently being used as single agents or in combination to treat WM. We finally focus on some agents that have shown preclinical efficacy and might be available in the near future.
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18
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McShane CM, Murray LJ, Engels EA, Anderson LA. Community-acquired infections associated with increased risk of lymphoplasmacytic lymphoma/Waldenström macroglobulinaemia. Br J Haematol 2014; 164:653-8. [PMID: 24528127 PMCID: PMC3935765 DOI: 10.1111/bjh.12671] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/15/2013] [Indexed: 11/29/2022]
Abstract
Emerging evidence supports the role of immune stimulation in the development of lymphoplasmacytic lymphoma/Waldenström Macroglobulinaemia (LPL/WM). Using the population-based Surveillance, Epidemiology End Results-Medicare database we investigated the exposure to 14 common community-acquired infections and subsequent risk of LPL/WM in 693 LPL/WM cases and 200 000 controls. Respiratory tract infections, bronchitis [odds ratio (OR) 1·56], pharyngitis (OR 1·43), pneumonia (OR 1·42) and sinusitis (OR 1·33) and skin infection, herpes zoster (OR 1·51) were all significantly associated with subsequent increased risk of LPL/WM. For each of these infections, the findings remained significantly elevated following the exclusion of more than 6 years of Medicare claims data prior to LPL/WM diagnosis. Our findings may support a role for infections in the development of LPL/WM or could reflect an underlying immune disturbance that is present several years prior to diagnosis and thereby part of the natural history of disease progression.
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Affiliation(s)
- Charlene M McShane
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
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19
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Owen RG, Pratt G, Auer RL, Flatley R, Kyriakou C, Lunn MP, Matthey F, McCarthy H, McNicholl FP, Rassam SM, Wagner SD, Streetly M, D'Sa S. Guidelines on the diagnosis and management of Waldenström macroglobulinaemia. Br J Haematol 2014; 165:316-33. [PMID: 24528152 DOI: 10.1111/bjh.12760] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/06/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Roger G Owen
- St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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20
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Waldenström macroglobulinemia: clinical and immunological aspects, natural history, cell of origin, and emerging mouse models. ISRN HEMATOLOGY 2013; 2013:815325. [PMID: 24106612 PMCID: PMC3782845 DOI: 10.1155/2013/815325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 07/26/2013] [Indexed: 12/22/2022]
Abstract
Waldenström macroglobulinemia (WM) is a rare and currently incurable neoplasm of IgM-expressing B-lymphocytes that is characterized by the occurrence of a monoclonal IgM (mIgM) paraprotein in blood serum and the infiltration of the hematopoietic bone marrow with malignant lymphoplasmacytic cells. The symptoms of patients with WM can be attributed to the extent and tissue sites of tumor cell infiltration and the magnitude and immunological specificity of the paraprotein. WM presents fascinating clues on neoplastic B-cell development, including the recent discovery of a specific gain-of-function mutation in the MYD88 adapter protein. This not only provides an intriguing link to new findings that natural effector IgM+IgD+ memory B-cells are dependent on MYD88 signaling, but also supports the hypothesis that WM derives from primitive, innate-like B-cells, such as marginal zone and B1 B-cells. Following a brief review of the clinical aspects and natural history of WM, this review discusses the thorny issue of WM's cell of origin in greater depth. Also included are emerging, genetically engineered mouse models of human WM that may enhance our understanding of the biologic and genetic underpinnings of the disease and facilitate the design and testing of new approaches to treat and prevent WM more effectively.
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21
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Abstract
Lymphoplasmacytic lymphoma (LPL) is a low-grade, B-cell neoplasm composed of small lymphocytes, plasmacytoid lymphocytes, and plasma cells that typically involve the bone marrow, and it is associated with an immunoglobulin M (IgM) gammopathy. The definition of Waldenström macroglobulinemia (WM) and its relationship to LPL has been confusing in the past. In addition, the diagnosis of LPL itself can be challenging because LPL lacks disease-specific morphologic, immunophenotypic, and genetic features to differentiate it from other mature B-cell neoplasms. Accurate diagnosis of LPL/WM rests on recognition of the differential diagnostic features between LPL and other diagnostic possibilities and the use of the recently refined definition of WM and its relationship with LPL: The presence of an IgM monoclonal gammopathy of any level in the setting of bone marrow involvement by LPL. This review summarizes the clinical, laboratory, and histologic features of LPL/WM, with particular emphasis on unique aspects of LPL/WM that may aid in accurate diagnosis.
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Affiliation(s)
- Nadia Naderi
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI 53792-2472, USA
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22
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Manasanch EE, Kristinsson SY, Landgren O. Etiology of Waldenström macroglobulinemia: genetic factors and immune-related conditions. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:194-7. [PMID: 23473950 DOI: 10.1016/j.clml.2013.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Epidemiologic studies provide an insight into the etiology of lymphoplasmacytic lymphoma/Waldenström macroglobulinemia, which indicates that repetitive immune stimulation and genetic factors play an important role. Here, the current understanding on the causes of lymphoplasmacytic lymphoma/Waldenström macroglobulinemia are reviewed. Recent studies of the literature are discussed, and future population-based studies are proposed to further elucidate the molecular mechanisms that underlie these associations. Finally, the clinical implications of these data are outlined, and perspectives on clinical follow-up and counseling are provided.
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Affiliation(s)
- Elisabet E Manasanch
- Multiple Myeloma Section, Metabolism Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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23
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Zeig-Owens R, Webber MP, Hall CB, Schwartz T, Jaber N, Weakley J, Rohan TE, Cohen HW, Derman O, Aldrich TK, Kelly K, Prezant DJ. Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: an observational cohort study. Lancet 2011; 378:898-905. [PMID: 21890054 PMCID: PMC5525140 DOI: 10.1016/s0140-6736(11)60989-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The attacks on the World Trade Center (WTC) on Sept 11, 2001 (9/11) created the potential for occupational exposure to known and suspected carcinogens. We examined cancer incidence and its potential association with exposure in the first 7 years after 9/11 in firefighters with health information before 9/11 and minimal loss to follow-up. METHODS We assessed 9853 men who were employed as firefighters on Jan 1, 1996. On and after 9/11, person-time for 8927 firefighters was classified as WTC-exposed; all person-time before 9/11, and person-time after 9/11 for 926 non-WTC-exposed firefighters, was classified as non-WTC exposed. Cancer cases were confirmed by matches with state tumour registries or through appropriate documentation. We estimated the ratio of incidence rates in WTC-exposed firefighters to non-exposed firefighters, adjusted for age, race and ethnic origin, and secular trends, with the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) reference population. CIs were estimated with overdispersed Poisson models. Additional analyses included corrections for potential surveillance bias and modified cohort inclusion criteria. FINDINGS Compared with the general male population in the USA with a similar demographic mix, the standardised incidence ratios (SIRs) of the cancer incidence in WTC-exposed firefighters was 1·10 (95% CI 0·98-1·25). When compared with non-exposed firefighters, the SIR of cancer incidence in WTC-exposed firefighters was 1·19 (95% CI 0·96-1·47) corrected for possible surveillance bias and 1·32 (1·07-1·62) without correction for surveillance bias. Secondary analyses showed similar effect sizes. INTERPRETATION We reported a modest excess of cancer cases in the WTC-exposed cohort. We remain cautious in our interpretation of this finding because the time since 9/11 is short for cancer outcomes, and the reported excess of cancers is not limited to specific organ types. As in any observational study, we cannot rule out the possibility that effects in the exposed group might be due to unidentified confounders. Continued follow-up will be important and should include cancer screening and prevention strategies. FUNDING National Institute for Occupational Safety and Health.
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Affiliation(s)
- Rachel Zeig-Owens
- Department of Medicine, Albert Einstein College of Medicine Montefiore Medical Center, Bronx, NY, USA
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24
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Kristinsson SY, Landgren O. What causes Waldenström's macroglobulinemia: genetic or immune-related factors, or a combination? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:85-7. [PMID: 21454199 DOI: 10.3816/clml.2011.n.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Population-based studies suggest a role for chronic immune stimulation and genetic factors in the causation of lymphoplasmacytic lymphoma (LPL)/Waldenström's macroglobulinemia (WM). In this review we summarize and discuss our current understanding on etiology and pathogenesis of LPL/WM. We also highlight on gaps in the literature and propose future directions for population-based and molecular studies designed to expand our knowledge and uncover biological underpinnings of identified associations. Further, we address clinical implications and provide perspective on the relevance of these data for patient counseling and clinical follow-up.
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Affiliation(s)
- Sigurdur Y Kristinsson
- Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden.
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25
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Kristinsson SY, Björkholm M, Hultcrantz M, Derolf ÅR, Landgren O, Goldin LR. Chronic immune stimulation might act as a trigger for the development of acute myeloid leukemia or myelodysplastic syndromes. J Clin Oncol 2011; 29:2897-903. [PMID: 21690473 DOI: 10.1200/jco.2011.34.8540] [Citation(s) in RCA: 216] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) often present with infections, but there are little data to assess whether a personal history of selected infections may act as pathogenic triggers. To additionally expand our knowledge on the role of immune stimulation in the causation of AML and MDS, we have conducted a large, population-based study to evaluate the risk of AML and MDS associated with a prior history of a broad range of infections or autoimmune diseases. PATIENTS AND METHODS By using population-based central registries in Sweden, we included 9,219 patients with AML, 1,662 patients with MDS, and 42,878 matched controls. We used logistic regression to calculate odds ratios (ORs) and 95% CIs for the association of AML or MDS with infectious and/or autoimmune diseases. RESULTS Overall, a history of any infectious disease was associated with a significantly increased risk of both AML (OR, 1.3; 95% CI, 1.2 to 1.4) and MDS (OR, 1.3; 95% CI, 1.1 to 1.5). These associations were significant even when we limited infections to those occurring 3 or more years before AML/MDS. A previous history of any autoimmune disease was associated with a 1.7-fold (95% CI, 1.5 to 1.9) increased risk for AML and 2.1-fold (95% CI, 1.7 to 2.6) increased risk for MDS. A large range of conditions were each significantly associated with AML and MDS. CONCLUSION Our novel findings indicate that chronic immune stimulation acts as a trigger for AML/MDS development. The underlying mechanisms may also be due to a common genetic predisposition or an effect of treatment for infections/autoimmune conditions.
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Affiliation(s)
- Sigurdur Y Kristinsson
- Dept of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden.
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26
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Ögmundsdóttir HM, Steingrímsdóttir H, Haraldsdóttir V. Familial paraproteinemia: hyper-responsive B-cells as endophenotype. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 11:82-4. [PMID: 21454198 DOI: 10.3816/clml.2011.n.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prevalence of paraproteinemias or monoclonal gammopathies increases with age. No other major risk factors have been recognized, but significant associations have been reported with chronic antigen exposure, agricultural environment, and family history. In around 130 families reported worldwide, IgG or IgA monoclonal gammopathy of undetermined significance (MGUS) occurs with multiple myeloma (MM) whereas Waldenström's macroglobulinemia (WM) is linked to IgM MGUS. Of the 8 multi-case families described here, 5 are remarkable for including both IgG/IgA and IgM type disorders. In the remaining 3 families IgG/IgA MGUS and MM occurred with Hodgkin disease and T-cell malignancies. These different patterns of familial paraproteinemia indicate different genetic backgrounds. A previously described functional phenotype of hyper-responsive B lymphocytes fulfils criteria for being an endophenotype and may be related to raised serum IgM. Identifying an endophenotype is important to ensure correct classification of affected family members and thus enhance the power of genetic studies.
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Affiliation(s)
- Helga M Ögmundsdóttir
- Faculty of Medicine, University of Iceland, Department of Clinical Haematology, Landspítali University Hospital, Reykjavík, Iceland.
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Hyperphosphorylated paratarg-7: a new molecularly defined risk factor for monoclonal gammopathy of undetermined significance of the IgM type and Waldenstrom macroglobulinemia. Blood 2011; 117:2918-23. [PMID: 21220746 DOI: 10.1182/blood-2010-09-306076] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We recently described paratarg-7 (P-7), a protein of unknown function, as the target of 15% of immunoglobulin A (IgA) and IgG paraproteins in monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma. To determine the frequency of P-7 as a paraprotein target in IgM-MGUS and Waldenström macroglobulinemia (WM), sera from patients with IgM-MGUS/WM were tested for reactivity with recombinant P-7 by enzyme-linked immunoabsorbent assay. The specificity of the paraprotein-mediated reaction was shown by absorption studies and cloning of the respective B-cell receptor. The paraproteins of 18 (9 WM and 9 IgM-MGUS) of 161 patients (11%) reacted with P-7. Isoelectric focusing and phosphatase treatment showed that P-7 was hyperphosphorylated (pP-7) in all patients with an anti-P-7-specific IgM paraprotein tested. Because only 4 of 200 healthy controls (2%) were carriers of pP-7, pP-7 carrier state is associated with a significantly increased risk (odds ratio = 6.2; P = .001) for developing IgM-MGUS/MW. Family analyses showed that the pP-7 carrier state is inherited as a dominant trait. After IgA/IgG-MGUS and multiple myeloma, IgM-MGUS/WM is the second neoplasia associated with pP-7 carrier state. The dominant inheritance of pP-7 explains cases of familial IgM-MGUS/WM and enables the identification of family members at increased risk.
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Koshiol J, Lam TK, Gridley G, Check D, Brown LM, Landgren O. Racial differences in chronic immune stimulatory conditions and risk of non-Hodgkin's lymphoma in veterans from the United States. J Clin Oncol 2010; 29:378-85. [PMID: 21172877 DOI: 10.1200/jco.2010.30.1515] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine underlying etiologic factors that may explain the racial disparity in non-Hodgkin's lymphoma (NHL) incidence patterns. PATIENTS AND METHODS We assessed immune-related conditions and risk of developing NHL among more than 4 million hospitalized US veterans including 9,496 patients with NHL (7,999 white patients and 1,497 black patients) with up to 26 years of follow-up. We used time-dependent Poisson regression to estimate rate ratios (RRs) and 95% CIs for NHL risk among patients with a history of specific autoimmune diseases, infections, and allergies compared with patients without such history, adjusting for attained age, calendar year, race, number of hospital visits, and time between study entry and exit. RESULTS Patients with infectious conditions had an increased risk of developing NHL (RR, 1.2; 95% CI, 1.1 to 1.2), particularly for gastrohepatic, genital, and systemic infectious conditions. Patients with autoimmune disease were generally more likely to develop NHL than patients without autoimmune disease, especially for conditions that typically present with detectable autoantibodies with systemic involvement (RR, 2.0; 95% CI, 1.8 to 2.2). Allergies were also associated with increased risk (RR, 1.4; 95% CI, 1.3 to 1.5). Although the risk of NHL was lower for blacks than whites (RR, 0.87; 95% CI, 0.82 to 0.92), blacks had a slightly higher risk of NHL associated with infections than whites (likelihood ratio test, P = .002) and a tendency toward higher risk associated with allergies (likelihood ratio test, P = .05). Risks associated with autoimmune conditions were similar by race (likelihood ratio test, P = .5). CONCLUSION The observed difference in NHL risk by race supports a role for race-related differences in genes regulating immune/inflammatory response.
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Affiliation(s)
- Jill Koshiol
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-7248, USA.
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Differential characteristics of Waldenström macroglobulinemia according to patterns of familial aggregation. Blood 2010; 115:4464-71. [PMID: 20308603 DOI: 10.1182/blood-2009-10-247973] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Familial aggregation of Waldenström macroglobulinemia (WM) and related B-cell disorders (BCDs) suggests a role for genetic factors, but few data address environmental influences. We designed a questionnaire-based study to examine clinical and environmental factors in a cohort of WM families with various patterns of case aggregation. We analyzed data on 103 WM patients and 272 unaffected relatives from 35 multiple-case WM and 46 mixed WM/BCD kindred and 28 nonfamilial (sporadic) WM patients, using logistic regression models with generalized estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for association. In this study population, the WM disease process appeared similar among patients regardless of family history. Familial WM patients were more likely than unaffected relatives to report a history of autoimmune disease (OR, 2.27; 95% CI = 1.21-4.28) and infections (OR, 2.13; 95% CI = 1.25-3.64). Familial WM patients were also more likely to report exposure to farming (OR, 2.70; 95% CI = 1.34-5.42), pesticides (OR, 2.83; 95% CI = 1.56-5.11), wood dust (OR, 2.86; 95% CI = 1.54-5.33), and organic solvents (multiple-case WM OR, 4.21; 95% CI = 1.69-10.51) compared with unaffected family members. These data provide clues to both genetic and environmental factors that may influence development of WM. Well-designed case-control studies are needed to confirm these findings.
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Kristinsson SY, Koshiol J, Björkholm M, Goldin LR, McMaster ML, Turesson I, Landgren O. Immune-related and inflammatory conditions and risk of lymphoplasmacytic lymphoma or Waldenstrom macroglobulinemia. J Natl Cancer Inst 2010; 102:557-67. [PMID: 20181958 DOI: 10.1093/jnci/djq043] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Chronic immune stimulation appears to be associated with lymphoplasmacytic lymphoma (LPL)-Waldenström macroglobulinemia (WM); however, available information is sparse. We conducted, to our knowledge, the most comprehensive study to date to evaluate associations between a personal or family history of many immune-related and/or inflammatory disorders and the subsequent risk of LPL-WM. METHODS We used Swedish population-based registries to identify 2470 case patients with LPL-WM, 9698 matched control subjects, and almost 30 000 first-degree relatives of either case patients or control subjects. We evaluated a wide range of autoimmune, infectious, allergic, and inflammatory conditions. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for each condition by use of logistic regression. RESULTS An increased risk of LPL-WM was associated with a personal history of the following autoimmune diseases: systemic sclerosis (OR = 4.7, 95% CI = 1.4 to 15.3), Sjögren syndrome (OR = 12.1, 95% CI = 3.3 to 45.0), autoimmune hemolytic anemia (OR = 24.2, 95% CI = 5.4 to 108.2), polymyalgia rheumatica (OR = 2.9, 95% CI = 1.6 to 5.2), and giant cell arteritis (OR = 8.3, 95% CI = 2.1 to 33.1). An increased risk of LPL-WM was associated with a personal history of the following infectious diseases: pneumonia (OR = 1.4, 95% CI = 1.1 to 1.7), septicemia (OR = 2.4, 95% CI = 1.2 to 4.3), pyelonephritis (OR = 1.7, 95% CI = 1.1 to 2.5), sinusitis (OR = 2.7, 95% CI = 1.4 to 4.9), herpes zoster (OR = 3.4, 95% CI = 2.0 to 5.6), and influenza (OR = 2.9, 95% CI = 1.7 to 5.0). An increased risk of LPL-WM was associated with a family history of the following autoimmune or infectious diseases: Sjögren syndrome (OR = 5.0, 95% CI = 2.1 to 12.0), autoimmune hemolytic anemia (OR = 3.8, 95% CI = 1.1 to 13.2), Guillain-Barré syndrome (OR = 4.1, 95% CI = 1.8 to 9.4), cytomegalovirus (OR = 2.7, 95% CI = 1.4 to 5.3), gingivitis and periodontitis (OR = 1.9, 95% CI = 1.3 to 2.7), and chronic prostatitis (OR = 4.3, 95% CI = 1.7 to 11.1). CONCLUSIONS Personal history of certain immune-related and/or infectious conditions was strongly associated with increased risk of LPL-WM. The association of both personal and family history of Sjögren syndrome and autoimmune hemolytic anemia with risk of LPL-WM indicates the potential for shared susceptibility for these conditions.
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Affiliation(s)
- Sigurdur Y Kristinsson
- Department of Medicine, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden.
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Kristinsson SY, Goldin LR, Björkholm M, Koshiol J, Turesson I, Landgren O. Genetic and immune-related factors in the pathogenesis of lymphoproliferative and plasma cell malignancies. Haematologica 2009; 94:1581-9. [PMID: 19586941 DOI: 10.3324/haematol.2009.008979] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
There are data to support a role for genetic and immune-related factors in the pathogenesis of lymphomas and plasma cell diseases. In this paper, we review our published large population-based studies and other relevant studies in Hodgkin's and non-Hodgkin's lymphomas, multiple myeloma, and the precursor condition monoclonal gammopathy of undetermined significance. We discuss the overlap in risk factors between related malignancies and explore the underlying mechanisms. Based on these studies, we provide clinical implications and discuss the relevance of these data for patient counseling and clinical follow-up. Finally, we suggest future directions for new studies designed to increase our current knowledge and to define underlying biological mechanisms of our findings.
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Affiliation(s)
- Sigurdur Y Kristinsson
- Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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McMaster ML, Kristinsson SY, Turesson I, Björkholm M, Landgren O. Novel aspects pertaining to the relationship of Waldenström's macroglobulinemia, IgM monoclonal gammopathy of undetermined significance, polyclonal gammopathy, and hypoglobulinemia. ACTA ACUST UNITED AC 2009; 9:19-22. [PMID: 19362963 DOI: 10.3816/clm.2009.n.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Waldenström's macroglobulinemia (WM) is associated with a precursor condition, monoclonal gammopathy of undetermined significance (MGUS) of immunoglobulin-M (IgM) type. The etiology of these conditions is unknown. Recent studies at the population level have provided new data regarding familial aggregation of these disorders and other B-cell malignancies. Studies of familial clusters of WM have demonstrated an increased frequency of IgM MGUS compared with the general population and have provided new data suggesting that the phenotypic spectrum might also include polyclonal gammopathy and hypoglobulinemia. While the preponderance of immunoglobulin abnormalities in relatives of WM cases involves IgM, other immunoglobulin types (IgG and IgA) might also be affected. Large collaborative studies are needed to confirm these findings, which present an opportunity to define the earliest lesion(s) in the WM oncogenic pathway.
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Affiliation(s)
- Mary L McMaster
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Abstract
For more than 50 years, links between autoimmunity and lymphomas have been described based on human and animal studies. Over the last 3 decades, many studies have addressed specific hypotheses about these associations using population level data. This has been accomplished by assessing previous autoimmune history in case-control studies of patients with lymphoma (mainly non-Hodgkin lymphoma) and myeloma, and by following cohorts of patients with various autoimmune diseases for subsequent development of lymphoma and multiple myeloma. In this article, we review our recently published series of association studies based on data from Scandinavia and from US Veterans and other relevant findings. We also discuss what these associations have revealed about the mechanisms and pathways underlying both autoimmunity and lymphoma. Finally, we discuss the future directions involving a combination of population and molecular studies that are needed to better define underlying biological mechanisms.
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Affiliation(s)
- Lynn R Goldin
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892-7236, USA.
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Kristinsson SY, Koshiol J, Goldin LR, Björkholm M, Turesson I, Gridley G, McMaster ML, Landgren O. Genetics- and immune-related factors in the pathogenesis of lymphoplasmacytic lymphoma/ Waldenström's macroglobulinemia. CLINICAL LYMPHOMA & MYELOMA 2009; 9:23-6. [PMID: 19362964 PMCID: PMC2796606 DOI: 10.3816/clm.2009.n.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There are emerging data to support a role for genetic and immune-related factors in the pathogenesis of lymphoplasmacytic lymphoma/Waldenström's macroglobulinemia. In this article, we review our recently published, large, population-based studies using data from Sweden and from United States veterans and propose mechanisms and pathways underlying our observations. We also discuss future directions for new studies designed to increase our current knowledge and to define underlying biologic mechanisms of our findings. Finally, based on novel insights on this topic, we discuss clinical implications and provide perspective on the relevance of these data for patient counseling and clinical follow-up.
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Affiliation(s)
- Sigurdur Y Kristinsson
- Department of Medicine, Division of Hematology, Karolinska University Hospital, Solna and Karolinska Institutet, Stockholm, Sweden.
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Risk of plasma cell and lymphoproliferative disorders among 14621 first-degree relatives of 4458 patients with monoclonal gammopathy of undetermined significance in Sweden. Blood 2009; 114:791-5. [PMID: 19182202 DOI: 10.1182/blood-2008-12-191676] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Familial clustering of the precursor condition, monoclonal gammopathy of undetermined significance (MGUS) has been observed in case reports and in smaller studies. Using population-based data from Sweden, we identified 4458 MGUS patients, 17505 population-based controls, and first-degree relatives of patients (n = 14621) and controls (n = 58387) with the aim to assess risk of MGUS and lymphoproliferative malignancies among first-degree relatives of MGUS patients. Compared with relatives of controls, relatives of MGUS patients had increased risk of MGUS (relative risk [RR] = 2.8; 1.4-5.6), multiple myeloma (MM; RR = 2.9; 1.9-4.3), lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM; RR = 4.0; 1.5-11), and chronic lymphocytic leukemia (CLL; RR = 2.0; 1.2-2.3). Relatives of patients with IgG/IgA MGUS had a 4.0-fold (1.7-9.2), 2.9-fold (1.7-4.9), and 20-fold (2.3-170) elevated risk of developing MGUS, MM, and LPL/WM, respectively. Relatives of IgM MGUS patients had 5.0-fold (1.1-23) increased CLL risk and nonsignificant excess MM and LPL/WM risks. The results were very similar when we assessed risk by type of first-degree relative, age at MGUS (above/below 65 years), or sex. Risk of non-Hodgkin lymphoma or Hodgkin lymphoma was not increased among MGUS relatives. Among first-degree relatives of a nationwide MGUS cohort, we found elevated risks of MGUS, MM, LPL/WM, and CLL, supporting a role for germline susceptibility genes, shared environmental influences, or an interaction between both.
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Risk of lymphoproliferative disorders among first-degree relatives of lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia patients: a population-based study in Sweden. Blood 2008; 112:3052-6. [PMID: 18703425 DOI: 10.1182/blood-2008-06-162768] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A role for genetic factors in the etiology of lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) is implicated based on prior findings from multiply affected families and small case-control and cohort studies. We identified 2144 LPL/WM patients (1539 WM [72%] and 605 LPL [28%]) diagnosed in Sweden, 8279 population-based matched controls, and linkable first-degree relatives of patients (n = 6177) and controls (n = 24 609). Using a marginal survival model, we calculated relative risks and 95% confidence intervals as measures of familial aggregation. We found first-degree relatives of LPL/WM patients to have 20-fold (4.1-98.4), 3.0-fold (2.0-4.4), 3.4-fold (1.7-6.6), and 5.0-fold (1.3-18.9) increased risks of developing LPL/WM, non-Hodgkin lymphoma (NHL), chronic lymphocytic leukemia (CLL), and monoclonal gammopathy of undetermined significance (MGUS), respectively. However, there was no evidence of an increased risk of developing multiple myeloma or Hodgkin lymphoma. In analyses stratified by type of first-degree relative (parent, sibling, offspring), age at diagnosis of the probands (greater or less than 70 years), and sex of the first-degree relative, we did not observe the risk estimates to be significantly different compared with the overall analyses. Our findings of highly increased risks of developing LPL/WM, NHL, CLL, and MGUS support the operation of shared susceptibility genes that predispose to LPL/WM and other lymphoproliferative disorders.
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