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Qian WS, Shen L, Wulipan F, Wu M, Ma JX, Chen PP, Xu Y, Xie YH. [Clinical characteristics and prognosis of patients with aggressive NK cell leukemia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:424-426. [PMID: 35680601 PMCID: PMC9250961 DOI: 10.3760/cma.j.issn.0253-2727.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- W S Qian
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - L Shen
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - Fulati Wulipan
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - M Wu
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - J X Ma
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - P P Chen
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - Y Xu
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai 200040, China
| | - Y H Xie
- Department of Hematology, Huadong Hospital, Fudan University, Shanghai 200040, China
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2
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Lineage Assignment in Acute Leukemia: A Challenging Case in a Pediatric Patient. J Pediatr Hematol Oncol 2021; 43:e109-e114. [PMID: 32097282 DOI: 10.1097/mph.0000000000001759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of a 2-year-old girl who was diagnosed with natural killer cell acute lymphoblastic leukemia and treated with an acute lymphoblastic leukemia chemotherapy regimen. Two months posttherapy, the disease relapsed with a myeloid immunophenotype. Complete response was then achieved with acute myeloid leukemia therapy followed by unrelated donor umbilical cord allogenic stem cell transplant. Retrospectively, reanalysis of the diagnostic specimen showed minimal myeloperoxidase expression that was called negative by conventional single parameter linear gating but better appreciated on histogram overlays. This case illustrates that even low levels of myeloperoxidase expression should be considered significant in lineage assignment in acute leukemia.
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3
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Abstract
OPINION STATEMENT While there is a high initial response rate with standard chemotherapeutic regimens for blastic plasmacytoid dendritic cell neoplasm (BPDCN), the responses are typically not durable and this remains a very aggressive disease with generally poor outcomes. For this reason, the standard approach for eligible patients has been high-dose induction chemotherapy preferably with acute lymphoblastic leukemia (ALL)-based regimens followed by consolidation with allogeneic hematopoietic stem cell transplantation (alloHSCT). Unfortunately, many patients with this disease are elderly and/or frail and cannot tolerate this therapy, and the low-dose regimens being used in this population are generally not as effective. However, this paradigm may be changing with the advent of newer targeted therapies, particularly the exploitation of CD123. SL-401 has shown very promising results with manageable toxicities and durable responses and appears to be a viable option for elderly or frail patients who are not eligible for transplant. The other CD123-directed therapies, especially chimeric antigen receptor-therapy (CAR-T), may also give promising results in trials that are currently underway. CAR-T has shown promise in a number of other hematologic malignancies, and toxicities have become more manageable as its use is becoming more widespread. While SL-401 has shown potential to provide durable responses even without transplant, we do not yet know whether it will be effective as a means to avoid transplant in patients who are otherwise eligible. All transplant-eligible patients should undergo alloHSCT consolidation given the current available data indicating this is the optimal approach to achieve a long-term remission. Once the CD123-directed therapies are established as standard regimens, future studies may be designed to investigate whether these therapies can be utilized without the use of transplant. Furthermore, combination therapy using anti-CD123 agents with high-dose induction chemotherapy or other low-dose regimens for elderly/frail patients should be investigated. Given the promising results in early clinical trials, it appears CD123 is the most viable target for BPDCN, and future studies should continue to exploit its expression on BPDCN cells.
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4
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Kerr D, Sokol L. The advances in therapy of blastic plasmacytoid dendritic cell neoplasm. Expert Opin Investig Drugs 2018; 27:733-739. [DOI: 10.1080/13543784.2018.1512970] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Daniel Kerr
- Department of Malignant Hematology, Moffitt Cancer Center/University of South Florida, Tampa, FL, USA
| | - Lubomir Sokol
- Department of Malignant Hematology, Moffitt Cancer Center/University of South Florida, Tampa, FL, USA
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5
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Blastic Plasmacytoid Dendritic Cell Neoplasm in the Pediatric Population: A Case Series and Review of the Literature. Am J Dermatopathol 2016; 37:924-8. [PMID: 26588336 PMCID: PMC4894807 DOI: 10.1097/dad.0000000000000348] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare aggressive hematologic malignancy primarily found in adults, often carrying a poor prognosis. There are only 33 reported pediatric cases of BPDCN in the literature. Although standard treatment is not yet established for children, current literature recommends the use of high-risk acute lymphoblastic leukemia (ALL)–type chemotherapy. Recent studies, however, have explored the benefits of combining chemotherapy with stem-cell transplantation. Here, the authors present 2 cases of pediatric BPDCN treated with different modalities. The first case is a 13-year-old girl who presented with a 3-month history of an initially asymptomatic firm nodule on her left shin. The second case is a 15-year-old boy who presented with a 4-month history of an enlarging subcutaneous nodule on the lower leg. Immunohistochemical staining of both patients was positive for markers consistent with BPDCN. The latter patient received ALL-type therapy alone, whereas the former received ALL-type chemotherapy and stem-cell transplantation. Since initial treatment, both patients remain disease-free. These cases contribute to the limited number of pediatric BPDCN cases, thus helping to advance our knowledge toward an optimal treatment protocol for clinical remission.
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6
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SHIRASE H, YAMAGUCHI S, TAIRA K, HAYASHI K, KARIYA Y, YAMAMOTO Y, TAKAHASHI K, UEZATO H. Two Cases of Blastic Plasmacytoid Dendritic Cell Neoplasm. ACTA ACUST UNITED AC 2014. [DOI: 10.2336/nishinihonhifu.76.577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Haruna SHIRASE
- Department of Dermatology, School of Medicine, University of the Ryukyus
| | - Sayaka YAMAGUCHI
- Department of Dermatology, School of Medicine, University of the Ryukyus
| | - Kiyohito TAIRA
- Department of Dermatology, School of Medicine, University of the Ryukyus
| | - Kentarou HAYASHI
- Department of Dermatology, School of Medicine, University of the Ryukyus
| | - Yoshiyuki KARIYA
- Department of Dermatology, School of Medicine, University of the Ryukyus
| | - Yuichi YAMAMOTO
- Department of Dermatology, School of Medicine, University of the Ryukyus
| | - Kenzo TAKAHASHI
- Department of Dermatology, School of Medicine, University of the Ryukyus
| | - Hiroshi UEZATO
- Department of Dermatology, School of Medicine, University of the Ryukyus
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7
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Efficacy of L-asparaginase with methotrexate and dexamethasone (AspaMetDex regimen) in patients with refractory or relapsing extranodal NK/T-cell lymphoma, a phase 2 study. Blood 2011; 117:1834-9. [DOI: 10.1182/blood-2010-09-307454] [Citation(s) in RCA: 286] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Abstract
Extranodal NK/T-cell lymphoma, nasal type, is a rare and highly aggressive disease with a grim prognosis. No therapeutic strategy is currently identified in relapsing patients. We report the results of a French prospective phase II trial of an L-asparaginase-containing regimen in 19 patients with relapsed or refractory disease treated in 13 centers. Eleven patients were in relapse and 8 patients were refractory to their first line of treatment. L-Asparaginase–based treatment yielded objective responses in 14 of the 18 evaluable patients after 3 cycles. Eleven patients entered complete remission (61%), and only 4 of them relapsed. The median overall survival time was 1 year, with a median response duration of 12 months. The main adverse events were hepatitis, cytopenia, and allergy. The absence of antiasparaginase antibodies and the disappearance of Epstein-Barr virus serum DNA were significantly associated with a better outcome. These data confirm the excellent activity of L-asparaginase–containing regimens in extranodal NK/T-cell lymphoma. L-Asparaginase–based treatment should thus be considered for salvage therapy, especially in patients with disseminated disease. First-line L-asparaginase combination therapy for extranodal NK/T-cell lymphoma warrants evaluation in prospective trials. This trial is registered at www.clinicaltrials.gov as #NCT00283985.
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8
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Ham MF, Ko YH. Natural killer cell neoplasm: biology and pathology. Int J Hematol 2010; 92:681-9. [PMID: 21132576 DOI: 10.1007/s12185-010-0738-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 11/13/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
Natural killer (NK) cell neoplasm is a heterogeneous disease group. In the latest World Health Organization (WHO) classification of tumours of hematopoietic and lymphoid tissues (2008), disease entities considered as NK-cell derivation include NK-lymphoblastic leukemia/lymphoma, chronic lymphoproliferative disorders of NK cells, aggressive NK-cell leukemia, and extranodal NK-cell lymphoma, nasal-type. Despite recent advances in NK-cell research, which have expanded our understanding of the biology of NK-cell neoplasm, it cannot yet be sharply delineated from myeloid neoplasms and T-cell neoplasms even in some "well-known" entity, such as extranodal NK/T-cell lymphoma. This review describes current knowledge of the biology of NK cells and pathology of NK neoplasms as classified in the 2008 WHO classification of tumours of hematopoietic and lymphoid tissues.
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Affiliation(s)
- Maria Francisca Ham
- Department of Anatomic Pathology, University of Indonesia/Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia.
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9
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Morimoto M, Kondoh K, Keino D, Ohyama R, Ban S, Kinoshita A, Kitoh T. A child with myeloid/natural killer cell precursor acute leukemia treated successfully with acute myeloid leukemia-oriented chemotherapy incorporating L-asparaginase. Leuk Res 2010; 34:1677-9. [PMID: 20637505 DOI: 10.1016/j.leukres.2010.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 06/19/2010] [Accepted: 06/19/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Mizuho Morimoto
- Department of Pediatrics, St. Marianna University School of Medicine, Miyamae-ku, Kanagawa, Japan
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10
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Imai T, Michizawa M, Degami H. NK cell lymphoblastic lymphoma in the masticator space: a case of non-Hodgkin lymphoma with challenging maxillofacial manifestation and immunophenotype. ACTA ACUST UNITED AC 2009; 108:897-903. [DOI: 10.1016/j.tripleo.2009.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 07/06/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
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Abstract
The authors report a case of nasal-type natural killer/T (NK/T)-cell lymphoma in a 15 years old girl, with rapid fatal evolution. NK/T proliferations are very rare and only a few cases have been described in children, most of them NK/T-cell lymphoma or leukemia, but not nasal-type NK/T-cell lymphoma. Clinical and biologic characteristics of these diseases are discussed with focus on their aggressivity and poor response to conventional chemotherapy.
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12
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Abstract
This article comprises detailed information about L-asparaginase, encompassing topics such as microbial and plant sources of L-asparaginase, treatment with L-asparaginase, mechanism of action of L-asparaginase, production, purification, properties, expression and characteristics of l-asparaginase along with information about studies on the structure of L-asparaginase. Although L-asparaginase has been reviewed by Savitri and Azmi (2003), our effort has been to include recent and updated information about the enzyme covering new aspects such as structural modification and immobilization of L-asparaginase, recombinant L-asparaginase, resistance to L-asparaginase, methods of assay of L-asparagine and L-asparaginase activity using the biosensor approach, L-asparaginase activity in soil and the factors affecting it. Also, side-effects of L-asparaginase treatment in acute lymphoblastic leukemia (ALL) have been discussed in the current review. L-asparaginase has been and is still one of the most widely studied therapeutic enzymes by researchers and scientists worldwide.
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Affiliation(s)
- Neelam Verma
- Biosensor Technology Lab, Department of Biotechnology, Punjabi University, Patiala, Punjab, India.
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13
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Jaccard A, Petit B, Girault S, Suarez F, Gressin R, Zini JM, Coiteux V, Larroche C, Devidas A, Thiéblemont C, Gaulard P, Marin B, Gachard N, Bordessoule D, Hermine O. L-asparaginase-based treatment of 15 western patients with extranodal NK/T-cell lymphoma and leukemia and a review of the literature. Ann Oncol 2008; 20:110-6. [PMID: 18701429 DOI: 10.1093/annonc/mdn542] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Extranodal natural killer (NK)/T-cell lymphoma, nasal type, and aggressive NK-cell leukemia are highly aggressive diseases with a poor outcome. PATIENTS AND METHODS We report a multicentric French retrospective study of 15 patients with relapsed, refractory, or disseminated disease, treated with L-asparaginase-containing regimens in seven French centers. Thirteen patients were in relapse and/or refractory and 10 patients were at stage IV. RESULTS All but two of the patients had an objective response to L-asparaginase-based treatment. Seven patients reached complete remission and only two relapsed. CONCLUSION These data, although retrospective, confirm the excellent activity of L-asparaginase-containing regimens in refractory extranodal NK/T-cell lymphoma and aggressive NK-cell leukemia. Therefore, L-asparaginase-based regimen should be considered as a salvage treatment, especially for patients with disseminated disease. First-line L-asparaginase combination therapy for extranodal NK/T-cell lymphoma and aggressive NK-cell leukemia should be tested in prospective trials.
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Affiliation(s)
- A Jaccard
- Department of Hematology, Centre Hospitalier Universitaire, Limoges, France.
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14
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Abstract
Natural killer (NK) cell tumors are a rare and heterogeneous group of disorders. Immature NK cell tumors are less common, and are less recognized and defined than mature NK cell tumors. There is insufficient experience of diagnosis and treatment with immature NK cell tumors, especially in pediatric patients. Here we describe a pediatric patient with precursor NK cell leukemia and review the literature of the previously reported cases in children to further help characterize the diagnosis, treatment, and outcome.
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Affiliation(s)
- Xiayuan Liang
- Department of Pathology, University of Colorado School of Medicine, Denver, USA.
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15
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16
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CD4+/CD56+ hematodermic neoplasm: blastic NK cell lymphoma in a 6-year-old child: report of a case and review of literature. J Pediatr Hematol Oncol 2007; 29:766-9. [PMID: 17984695 DOI: 10.1097/mph.0b013e318159a4e6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 6-year-old girl presented with disseminated polymorphous skin lesions of several months' duration, joint pains, recurrent fever, anemia, and inguinal adenopathy. Subsequent evaluation of skin, lymph node, and bone marrow morphology showed infiltration of atypical lymphocytic cells. Immunohistochemical and flow cytometric analysis showed findings consistent with the rare but highly malignant blastic Natural killer cell lymphoma/leukemia also termed CD4/CD56 hematodermic neoplasm.
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17
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Tjiu JW, Hsiao CH. Blastic Natural Killer-Cell Lymphoma Presenting in the Skin. Tzu Chi Med J 2007. [DOI: 10.1016/s1016-3190(10)60012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Abstract
T-cell malignancies are rare, making up 10% to 15% of all lymphoid neoplasms in adults. They include many different types of disorders such as T-cell prolymphocytic leukemia, T-cell large granular lymphocytic leukemia, adult T-cell leukemia/lymphoma, cutaneous T-cell lymphoma, and peripheral T-cell lymphoma, which are themselves divided into multiple subcategories. Most T-cell malignancies arise as a result of chromosomal abnormalities, including T-cell receptor rearrangement anomalies. Viral infections are implicated in the development of adult T-cell leukemia/lymphoma and some cases of peripheral T-cell lymphoma have been linked to Epstein-Barr virus or human immunodeficiency virus infection. With the possible exception of T-cell large granular lymphocytic leukemia, which often has an indolent course, T-cell malignancies have not responded well to conventional chemotherapeutic treatment. The introduction of monoclonal antibodies for the treatment of cancer has changed the outlook for patients with T-cell malignancies. Recent studies with single-agent alemtuzumab, an anti-CD52 monoclonal antibody, have shown improved response rates and survival in patients with T-cell prolymphocytic leukemia and cutaneous T-cell lymphoma. Preliminary data also suggest that alemtuzumab may have activity in patients with heavily pretreated peripheral T-cell lymphoma who are refractory to conventional chemotherapy. Preclinical studies with mice bearing human adult T-cell leukemia/lymphoma cells suggest that alemtuzumab may have a potential therapeutic role in this setting. Treatment of T-cell hematologic malignancies with alemtuzumab appears promising. Earlier treatment and combination with chemotherapeutic agents may improve treatment outcome for patients with these malignancies and allow for consolidation with stem cell transplant strategies in selected patients.
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Affiliation(s)
- Claire Dearden
- Department of Haemato-oncology, The Royal Marsden Hospital, Surrey, United Kingdom
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Suzuki R, Suzumiya J, Nakamura S, Kagami Y, Kameoka JI, Sakai C, Mukai H, Takenaka K, Yoshino T, Tsuzuki T, Sugimori H, Kawa K, Kodera Y, Oshimi K. Hematopoietic stem cell transplantation for natural killer-cell lineage neoplasms. Bone Marrow Transplant 2006; 37:425-31. [PMID: 16400344 DOI: 10.1038/sj.bmt.1705244] [Citation(s) in RCA: 170] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neoplasms of natural killer (NK)-lineage are rare. Their prognosis is generally poor except for cases of solitary nasal NK-cell lymphoma. The NK-cell Tumor Study Group performed a survey in Japan on patients diagnosed between 1994 and 1998. Of 228 patients selected for analysis, 40 underwent HSCT (15 allografts and 25 autografts). The underlying diseases were myeloid/NK cell precursor acute leukemia (n = 4), blastic NK-cell lymphoma (n = 11), aggressive NK-cell leukemia (n = 3), and nasal-type extranodal NK-cell lymphoma (n = 22). At the time of HSCT, 22 patients were in complete remission (CR), 11 were in relapse, and seven were primary refractory. All patients received myeloablative conditioning regimens including total-body irradiation. Sixteen died of disease progression, and six of treatment-related causes. Overall, 4-year survival was 39% with a median follow-up of 50 months; this was significantly better than that of patients who did not undergo HSCT (21%, P = 0.0003). For patients transplanted in CR, the 4-year overall survival was 68%, which was significantly better than that of patients who went into CR but did not undergo HSCT (P = 0.03). These findings suggest that the HSCT is a promising treatment strategy for NK-cell lineage.
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Affiliation(s)
- R Suzuki
- Division of Molecular Medicine, Aichi Cancer Center, Kanokoden, Nagoya, Japan.
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20
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Beck C, Humpe A, Harder S, Schmid M, Horst HA. Myelodysplastic syndrome of donor origin subsequent to successful treatment of myeloid/NK-cell precursor leukaemia with allogeneic PBSCT: two very rare conditions in one patient. Ann Hematol 2005; 84:616-8. [PMID: 15782344 DOI: 10.1007/s00277-005-1032-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2004] [Accepted: 02/22/2005] [Indexed: 10/25/2022]
Abstract
We report a 36-year-old male with myeloid/natural killer (NK)-cell precursor acute leukaemia with a complex aberrant karyotype, who was treated according to an acute-myeloid-leukaemia (AML) treatment protocol (idarubicine, cytarabine, and etoposide) followed by high-dose cytarabine consolidation and achieved complete remission. He underwent allogeneic matched unrelated donor (MUD) peripheral blood stem-cell transplantation (PBSCT) and remained in remission throughout his remaining life. Seven months posttransplantation, a myelodysplastic syndrome (MDS) with (20q-) of donor origin was diagnosed causing severe thrombocytopenia and finally leading to infection and death. This patient represents one of the few cases published achieving remission for a significant period of time after being diagnosed with myeloid/NK-cell precursor acute leukaemia, a very rare malignant disease. We conclude, despite the fatal outcome due to infection, that allogeneic PBSCT is a therapeutic option for patients with this entity. In addition, the development of a myelodysplastic syndrome of donor origin is extremely rare and only very few cases are published worldwide.
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21
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Suzuki R, Nakamura S, Suzumiya J, Ichimura K, Ichikawa M, Ogata K, Kura Y, Aikawa K, Teshima H, Sako M, Kojima H, Nishio M, Yoshino T, Sugimori H, Kawa K, Oshimi K. Blastic natural killer cell lymphoma/leukemia (CD56-positive blastic tumor). Cancer 2005; 104:1022-31. [PMID: 15999368 DOI: 10.1002/cncr.21268] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Blastic natural killer (NK) cell lymphoma/leukemia (BNKL) is an immature CD56-positive neoplasm, which was recognized recently and characterized by systemic proliferation of tumor cells including skin, lymph node, and bone marrow. METHODS The current study analyzed 47 patients with BNKL (27 had leukemias and 20 had lymphomas). Patient data were collected for the survey of the NK-Cell Tumor Study Group. RESULTS There were 33 males and 14 females, with a median age of 53 years (range, 3 months to 89 years). There were few clinicopathologic differences between the leukemia and lymphoma types. Cutaneous involvement was noted at diagnosis in 28 patients, who presented a tendency for older age of onset (median: 56 vs. 46 years, P = 0.11) than patients with noncutaneous BNKL. Cutaneous BNKL showed less frequent mediastinal involvement (4% vs. 53%, P = 0.0002) and less severe thrombocytopenia (P =0 .03). Phenotypic characteristics were also different, with cutaneous BNKL favoring CD4 and HLA-DR expression, and noncutaneous BNKL favoring CD16 and CD34 expression. Both groups responded well to chemotherapy for lymphoid malignancies, but disease recurrence was frequent. The prognosis of patients with noncutaneous BNKL was significantly poorer than that of patients with cutaneous BNKL (median survival: 15 vs. 25 months, P = 0.02). Multivariate analysis confirmed that cutaneous involvement was a significant and independent prognostic factor for BNKL, as were age of onset and leukocyte count. CONCLUSIONS These findings suggested that BNKL is a heterogeneous disease and contains at least two subtypes. Although further investigations are needed to settle a marker for distinction, the presence of cutaneous involvement is a useful prognostic factor.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- CD56 Antigen/analysis
- DNA Nucleotidylexotransferase/analysis
- Female
- Gene Rearrangement, T-Lymphocyte
- Humans
- Immunophenotyping
- Interleukin-3 Receptor alpha Subunit
- Karyotyping
- Killer Cells, Natural/pathology
- Leukemia, Lymphoid/immunology
- Leukemia, Lymphoid/mortality
- Leukemia, Lymphoid/therapy
- Lymphoma, T-Cell/immunology
- Lymphoma, T-Cell/mortality
- Lymphoma, T-Cell/therapy
- Male
- Middle Aged
- Prognosis
- Receptors, Interleukin-3/analysis
- Skin Neoplasms/immunology
- Skin Neoplasms/mortality
- Skin Neoplasms/therapy
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Affiliation(s)
- Ritsuro Suzuki
- Division of Molecular Medicine, Aichi Cancer Center, Nagoya, Japan
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22
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Abstract
Natural killer (NK) cell lymphomas and leukemias are a rare but clinically important group of neoplasms. Most of these tumors are aggressive, with a high rate of mortality. They include extranodal NK/T-cell lymphomas of nasal type and aggressive NK-cell leukemias. Both are Epstein-Barr virus (EBV) associated and show similar epidemiologic features. A closely related entity seen mainly in children is hydroa vacciniforme-like lymphoma, which also is EBV positive. EBV influences the pathophysiology of these tumors, through the induction of cytokines and chemokines. The differential diagnosis of NK-cell malignancies includes fulminant EBV-associated T-cell lymphoproliferative disorder, a condition referred to in the past as fatal infectious mononucleosis. Benign proliferations of NK cells can be seen in association with viral infection. The disease formerly referred to as blastic NK-cell lymphoma is now considered to be a malignancy derived from a dendritic cell precursor.
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Affiliation(s)
- Victor E Nava
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD 20892, USA
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