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Cox MC, Esposito F, Postorino M, Venditti A, Di Napoli A. Serum Paraprotein Is Associated with Adverse Prognostic Factors and Outcome, across Different Subtypes of Mature B-Cell Malignancies-A Systematic Review. Cancers (Basel) 2023; 15:4440. [PMID: 37760410 PMCID: PMC10527377 DOI: 10.3390/cancers15184440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/20/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
The presence of a serum paraprotein (PP) is usually associated with plasma-cell dyscrasias, Waldenstrom Macroglobulinemia/lymphoplasmacytic lymphoma, and cryoglobulinemia. However, PP is also often reported in other high- and low-grade B-cell malignancies. As these reports are sparse and heterogeneous, an overall view on this topic is lacking, Therefore, we carried out a complete literature review to detail the characteristics, and highlight differences and similarities among lymphoma entities associated with PP. In these settings, IgM and IgG are the prevalent PP subtypes, and their serum concentration is often low or even undetectable without immunofixation. The relevance of paraproteinemia and its prevalence, as well as the impact of IgG vs. IgM PP, seems to differ within B-NHL subtypes and CLL. Nonetheless, paraproteinemia is almost always associated with advanced disease, as well as with immunophenotypic, genetic, and clinical features, impacting prognosis. In fact, PP is reported as an independent prognostic marker of poor outcome. All the above call for implementing clinical practice, with the assessment of paraproteinemia, in patients' work-up. Indeed, more studies are needed to shed light on the biological mechanism causing more aggressive disease. Furthermore, the significance of paraproteinemia, in the era of targeted therapies, should be assessed in prospective trials.
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Affiliation(s)
- Maria Christina Cox
- UOC Malattie Linfoproliferative, Fondazione Policlinico Tor Vergata, 00133 Roma, Italy
| | - Fabiana Esposito
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, 00133 Roma, Italy; (F.E.)
| | - Massimiliano Postorino
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, 00133 Roma, Italy; (F.E.)
| | - Adriano Venditti
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, 00133 Roma, Italy; (F.E.)
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University, 00189 Roma, Italy;
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2
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Lee AC, Pingali SR, Pinilla-Ibarz JA, Atchison ML, Koumenis C, Argon Y, Thomas-Tikhonenko A, De Trez C, Hu CCA, Tang CHA. Loss of AID exacerbates the malignant progression of CLL. Leukemia 2022; 36:2430-2442. [PMID: 36042317 PMCID: PMC9522595 DOI: 10.1038/s41375-022-01663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 01/16/2023]
Abstract
Activation-induced cytidine deaminase (AID) has been implicated as both a positive and a negative factor in the progression of B cell chronic lymphocytic leukemia (CLL), but the role that it plays in the development and progression of this disease is still unclear. We generated an AID knockout CLL mouse model, AID-/-/Eμ-TCL1, and found that these mice die significantly earlier than their AID-proficient counterparts. AID-deficient CLL cells exhibit a higher ER stress response compared to Eμ-TCL1 controls, particularly through activation of the IRE1/XBP1s pathway. The increased production of secretory IgM in AID-deficient CLL cells contributes to their elevated expression levels of XBP1s, while secretory IgM-deficient CLL cells express less XBP1s. This increase in XBP1s in turn leads AID-deficient CLL cells to exhibit higher levels of B cell receptor signaling, supporting leukemic growth and survival. Further, AID-/-/Eμ-TCL1 CLL cells downregulate the tumor suppressive SMAD1/S1PR2 pathway and have altered homing to non-lymphoid organs. Notably, CLL cells from patients with IgHV-unmutated disease express higher levels of XBP1s mRNA compared to those from patients with IgHV-mutated CLL. Our studies thus reveal novel mechanisms by which the loss of AID leads to worsened CLL and may explain why unmutated CLL is more aggressive than mutated CLL.
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Affiliation(s)
- Avery C Lee
- Center for Translational Research in Hematologic Malignancies, Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
- Cell & Molecular Biology Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sai Ravi Pingali
- Center for Translational Research in Hematologic Malignancies, Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Javier A Pinilla-Ibarz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Michael L Atchison
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yair Argon
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Cell Pathology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrei Thomas-Tikhonenko
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Cancer Pathobiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carl De Trez
- Laboratory of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Chih-Chi Andrew Hu
- Center for Translational Research in Hematologic Malignancies, Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA.
| | - Chih-Hang Anthony Tang
- Center for Translational Research in Hematologic Malignancies, Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA.
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3
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Harris RA, Gary EB, Rout ED, Avery AC, Moore AR. Detection and Characterization of Paraproteinemia in Canine Chronic B-cell Lymphocytic Leukemia Using Routine and Free Light Chain Immunofixation. Vet Clin Pathol 2022; 51:551-559. [PMID: 35883213 PMCID: PMC10087490 DOI: 10.1111/vcp.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/14/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyperglobulinemia is reported in 26% of canine chronic B-cell lymphocytic leukemia (B-CLL) cases. However, few cases have been characterized by protein electrophoresis and immunofixation (IF), and the incidence of a monoclonal protein (M-protein) is unknown using these techniques. OBJECTIVE To characterize and determine the proportion of canine B-CLL cases with an M-protein using plasma protein electrophoresis (PPE), routine and free light chain (fLC) IF, and to assess if productive B-CLL cases express MUM1/IRF4 by cell tube block (CTB). METHODS PPE, routine (targeting IgG, IgA, IgM, IgG4, and light chain) and fLC IF were performed using 48 dog B-CLL plasma samples from patients diagnosed via peripheral blood flow cytometry. CTB was performed on a separate cohort of 15 patients. RESULTS Hyperproteinemia (>7.5 g/dL) was present in 17/48 cases (35%). An M-protein was detected in 32/48 cases (67%). Of these, 19/32 cases (59%) had only complete (monoclonal heavy and light chain) M-proteins detected, 10/32 cases (31%) had both complete and fLC M-proteins detected, and 3/32 cases (9%) had only an fLC M-protein detected. IgM was the most common clonal immunoglobulin isotype detected (23 cases). CD21+ cell counts were higher in cases with detectable M-protein. Plasma fLC IF suggested β-γ region interference, likely caused by clotting proteins. All B-CLL cases consistently expressed PAX5 and did not express MUM1/IRF4. CONCLUSIONS Most B-CLL cases had an M-protein and were not hyperproteinemic. Most cases with paraproteins had a complete IgM monoclonal gammopathy; a subset had documented fLCs. The prognostic significance of heavy and fLC presence should be evaluated.
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Affiliation(s)
- R Adam Harris
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Erik B Gary
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Emily D Rout
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Anne C Avery
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - A Russell Moore
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
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4
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Ma T, Wang H, Su T, Wang S. Case Report: Chronic Lymphocytic Leukemia With Recurrent Complement-Mediated Thrombotic Microangiopathy and C3 Glomerulonephritis. Front Med (Lausanne) 2022; 9:813439. [PMID: 35223908 PMCID: PMC8866726 DOI: 10.3389/fmed.2022.813439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a monoclonal B cell lymphocytosis that produces nephrotoxic monoclonal immunoglobulin (MIg). However, the role of MIg in CLL and how it affects CLL patient survival are still unknown. Here, we report a case of MIg with renal significance (MGRS) associated with CLL. A 59-year-old Chinese woman complaining of abdominal pain, skin purpura, and typical soy-colored urine was admitted to the hospital for investigation. Laboratory tests revealed that she had microangiopathic hemolytic anemia, thrombocytopenia, acute kidney injury (AKI), and hypocomplementemia. She also reported cryoglobulinemia, thrombotic microangiopathy (TMA), and AKI 2 years previously. Peripheral blood smears at that time showed 4% schistocytes, a negative Coombs' test, and elevated lactate dehydrogenase (LDH). Based on a diagnosis of complement-mediated TMA, the patient was treated by plasmapheresis and achieved clinical disease remission. However, the serum hypocomplement 4 and cryoglobulinemia persisted. Further investigation showed elevated B lymphocytes and monoclonal serum IgMκ; however, the cryoprecipitate contained monoclonal IgMκ and polyclonal IgG, as well as immunoglobulins κ and λ. After plasmapheresis, her LDH, platelets, and complement 3 (C3) levels returned to normal. Biopsies of the bone marrow and an enlarged subclavicular lymph node revealed CLL/SLL. Renal pathological findings indicated significant arteriolar endothelial cells myxoid edema and glomerular endothelial cells swelling, however no thromboli, cryoglobulin formation and vasculitis were observed. We also found mild mesangial proliferative C3 glomerulonephritis and renal interstitial CLL cells infiltration. Collectively, these clinical and pathological manifestations were attributed to monoclonal IgMκ, which triggered C3 activation. MGRS associated with CLL was finally confirmed. Six cycles of rituximab, cyclophosphamide, verodoxin, and dexamethasone therapy were administered, after which she received ibrutinib. The patient experienced disease remission, and her serum C4 level returned to normal. Cryoglobulin and IgMκ were not detected. This is a special presentation of CLL/SLL with monoclonal IgMκ, which is a type of MGRS. Activation of the complement system by MIg led to TMA with C3 glomerulonephritis. Treatment for TMA and CLL/SLL should be initiated in a timely manner to improve patient prognosis.
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Affiliation(s)
- Tiantian Ma
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Hui Wang
- Laboratory of Electron Microscopy, Ultrastructural Pathology Center, Peking University First Hospital, Beijing, China
| | - Tao Su
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Institute of Nephrology, Peking University, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Ultrastructural Pathology Center, Peking University First Hospital, Beijing, China
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5
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Wang H, Yu X, Zhang X, Wang S, Zhao M. The pathological features of leukemic cells infiltrating the renal interstitium in chronic lymphocytic leukemia/small lymphocytic lymphoma from a large single Chinese center. Diagn Pathol 2021; 16:59. [PMID: 34218814 PMCID: PMC8254985 DOI: 10.1186/s13000-021-01120-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is rare in Asians, and patients with CLL/SLL seldomly undergo kidney biopsy. The histopathological features and clinical relevance of tubulointerstitial injury in CLL/SLL have not been extensively characterized. Hence, we attempted to describe the clinical characteristics, renal pathology and clinical outcome of a well-characterized population of CLL/SLL patients with CLL cell infiltration in the renal interstitium from a large single center in China. Methods Between January 1st, 2010 and September 31st, 2020, 31946renal biopsies were performed at Peking University First Hospital, and 10 CLL/SLL patients with CLL cell infiltration in the renal interstitium were included. Complete clinical data were collected from these 10 patients, and renal specimens were examined by routine light microscopy, immunofluorescence and electron microscopy. Results The extent of the infiltrating CLL cells in patients with CLL/SLL varied among different patients and ranged from 10 to 90% of kidney parenchyma. Six (60%) of 10 patients presented with an extent of infiltrating CLL cells ≥50%. Interestingly, we found that three patients (3/10, 30%) expressed monoclonal immunoglobulins in the infiltrating CLL cells, and special cytoplasmic crystalline structures were found in two of the three patients by electron microscopy for the first time. Severe renal insufficiency (Scr ≥200 μmol/L) was associated with ≥50% interstitial infiltration of CLL cells in the renal interstitium. Conclusions The current study confirmed that CLL cells infiltrating the renal interstitium can directly secrete monoclonal immunoglobulins, indicating that the interstitial infiltrating CLL cells possibly cause renal injury directly by secreting monoclonal immunoglobulins in situ. This finding may prove a new clue to elucidate the pathogenetic mechanism of renal injury involved with CLL/SLL. Supplementary Information The online version contains supplementary material available at 10.1186/s13000-021-01120-4.
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Affiliation(s)
- Hui Wang
- Laboratory of Electron Microscopy, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China
| | - Xiaojuan Yu
- Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China.,Department of Nephrology, Peking University First Hospital, Beijing, 100034, People's Republic of China
| | - Xu Zhang
- Laboratory of Electron Microscopy, Peking University First Hospital, Beijing, 100034, People's Republic of China.,Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Peking University First Hospital, Beijing, 100034, People's Republic of China. .,Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China.
| | - Minghui Zhao
- Renal Pathology Center, Institute of Nephrology, Peking University, Beijing, 100034, People's Republic of China.,Department of Nephrology, Peking University First Hospital, Beijing, 100034, People's Republic of China
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6
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Rout ED, Labadie JD, Yoshimoto JA, Avery PR, Curran KM, Avery AC. Clinical outcome and prognostic factors in dogs with B-cell chronic lymphocytic leukemia: A retrospective study. J Vet Intern Med 2021; 35:1918-1928. [PMID: 33998726 PMCID: PMC8295712 DOI: 10.1111/jvim.16160] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND B-cell chronic lymphocytic leukemia (BCLL) in dogs generally is considered an indolent disease, but previous studies indicate a wide range in survival times. OBJECTIVES We hypothesized that BCLL has a heterogeneous clinical course, similar to chronic lymphocytic leukemia in humans. We aimed to assess presentation and outcome in dogs with BCLL and evaluate the prognostic relevance of clinical and flow cytometric factors. ANIMALS One hundred and twenty-one dogs with BCLL diagnosed by flow cytometry. Three breed groups were represented: small breed dogs (n = 55) because of increased risk of BCLL; Boxers (n = 33) because of preferential use of unmutated immunoglobulin genes; and other breeds (n = 33). METHODS Retrospective study reviewing signalment, clinicopathologic data, physical examination findings, treatment, and survival of dogs with BCLL. Cellular proliferation, determined by the percentage of Ki67-expressing CD21+ B-cells by flow cytometry, was measured in 39 of 121 cases. Clinical and laboratory variables were evaluated for association with survival. RESULTS The median survival time (MST) for all cases was 300 days (range, 1-1644 days). Boxers had significantly shorter survival (MST, 178 days) than non-Boxers (MST, 423 days; P < .0001), and no significant survival difference was found between small breeds and other non-Boxer breeds. Cases with high Ki67 (>40% Ki67-expressing B-cells) had significantly shorter survival (MST, 173 days) than did cases with <40% Ki67 (MST undetermined; P = .03), regardless of breed. Cases with a high lymphocyte count (>60 000 lymphocytes/μL) or clinical signs at presentation had significantly shorter survival. CONCLUSIONS AND CLINICAL IMPORTANCE B-cell chronic lymphocytic leukemia had a variable clinical course and Boxer dogs and cases with high Ki67 had more aggressive disease.
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Affiliation(s)
- Emily D Rout
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Julia D Labadie
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Janna A Yoshimoto
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Paul R Avery
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Kaitlin M Curran
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Anne C Avery
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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7
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Gayet M, Leymarie V, Derouault P, Guérin E, Vaidié J, Pascal V, Boulin M, Dmytruk N, Chauzeix J, Trimoreau F, Gachard N, Feuillard J, Rizzo D. Flow cytometry detection of CD138 expression continuum between monotypic B and plasma cells is associated with both high IgM peak levels and MYD88 mutation and contributes to diagnosis of Waldenström macroglobulinemia. CYTOMETRY PART B-CLINICAL CYTOMETRY 2021; 102:62-69. [PMID: 33634586 DOI: 10.1002/cyto.b.21995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/13/2021] [Accepted: 02/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Differential diagnosis of Waldenström macroglobulinemia (WM) with other indolent B-cell malignancies is still a challenge. Here, we propose an original and simple analysis of routine flow cytometry (FCM) unraveling the characteristic ongoing plasma cell (PC) differentiation of WM tumor B-cells. METHODS FCM analysis of both B-cells and PC was performed on a series of 77 patients with IgM peak. MYD88 and CXCR4 mutations were studied using an allele-specific PCR and by high throughput sequencing. RESULTS Twenty seven (35%), 46 (58%) and 4 (5%) patients were classified as WM, IgM monoclonal gammopathy of undetermined significance (MGUS) or other B-NHL respectively. MYD88 mutation was found in 25/27 WM (93%) and in 29/46 MGUS (63%). Using FCM, monotypic B-cells were found in 27/27 WM (100%) and 34/46 MGUS (74%). Monotypic CD138pos/CD38pos PCs were detected in 23/27 WM (85%) and 25/46 MGUS (54%). Highlighting the ongoing PC differentiation of WM tumor B-cells by FCM, we evidenced a CD138 expression continuum between monotypic B-cells and PCs. This pattern remained absent in control samples and was significantly associated with higher IgM peaks (p = 6.10-5 ) and MYD88 mutations (p = 10-3 ) in both WM and MGUS cases. CONCLUSIONS FCM exploration of both B-cells and PC led to identify a CD138 expression continuum as an objective marker of ongoing PC differentiation of WM tumor cells and was strongly associated with increased IgM peak levels and MYD88 mutations. This approach could contribute to place FCM at the forefront of WM diagnosis.
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Affiliation(s)
- Mylene Gayet
- Biological Hematology Department, University Hospital Dupuytren, Limoges, France
| | - Vincent Leymarie
- Biological Hematology Department, University Hospital Dupuytren, Limoges, France
| | - Paco Derouault
- Department of Biochemistry and Molecular Biology, University Hospital Dupuytren, Limoges, France
| | - Estelle Guérin
- Biological Hematology Department, University Hospital Dupuytren, Limoges, France.,UMR CNRS 7276/INSERM 1262 - CRIBL, Faculty of Medicine, Limoges, France
| | - Julien Vaidié
- Clinical Hematology and Cellular Therapy, University Hospital Dupuytren, Limoges, France
| | - Virginie Pascal
- UMR CNRS 7276/INSERM 1262 - CRIBL, Faculty of Medicine, Limoges, France.,Department of Immunology and Immunogenetics, University Hospital Dupuytren, Limoges, France
| | - Mélanie Boulin
- Biological Hematology Department, University Hospital Dupuytren, Limoges, France
| | - Nataliya Dmytruk
- Clinical Hematology and Cellular Therapy, University Hospital Dupuytren, Limoges, France
| | - Jasmine Chauzeix
- Biological Hematology Department, University Hospital Dupuytren, Limoges, France.,UMR CNRS 7276/INSERM 1262 - CRIBL, Faculty of Medicine, Limoges, France
| | - Franck Trimoreau
- Biological Hematology Department, University Hospital Dupuytren, Limoges, France
| | - Nathalie Gachard
- Biological Hematology Department, University Hospital Dupuytren, Limoges, France.,UMR CNRS 7276/INSERM 1262 - CRIBL, Faculty of Medicine, Limoges, France
| | - Jean Feuillard
- Biological Hematology Department, University Hospital Dupuytren, Limoges, France.,UMR CNRS 7276/INSERM 1262 - CRIBL, Faculty of Medicine, Limoges, France
| | - David Rizzo
- Biological Hematology Department, University Hospital Dupuytren, Limoges, France.,UMR CNRS 7276/INSERM 1262 - CRIBL, Faculty of Medicine, Limoges, France
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8
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Corbingi A, Innocenti I, Tomasso A, Pasquale R, Visentin A, Varettoni M, Flospergher E, Autore F, Morelli F, Trentin L, Reda G, Efremov DG, Laurenti L. Monoclonal gammopathy and serum immunoglobulin levels as prognostic factors in chronic lymphocytic leukaemia. Br J Haematol 2020; 190:901-908. [PMID: 32712965 DOI: 10.1111/bjh.16975] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/31/2020] [Indexed: 12/17/2022]
Abstract
The relationship between chronic lymphocytic leukaemia (CLL) and qualitative/quantitative gammaglobulin abnormalities is well established. Nevertheless, in order to better understand this kind of connection, we examined 1505 patients with CLL and divided them into four subgroups on the basis of immunoglobulin (Ig) aberrations at diagnosis. A total of 73 (4·8%), 149 (10%), 200 (13·2%) and 1083 (72%) patients were identified with IgM monoclonal gammopathy (IgM/CLL), IgG monoclonal gammopathy (IgG/CLL), hypogammaglobulinaemia (hypo-γ) and normal Ig levels (γ-normal) respectively. IgM paraprotein was significantly associated with a more advanced Binet/Rai stage and del(17p)/TP53 mutation, while IgG abnormalities correlated with a higher occurrence of trisomy 12. Patients with any type of Ig abnormality had shorter treatment-free survival (TFS) but no significant impact affecting overall survival (OS) compared to those with normal Ig levels.
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Affiliation(s)
- Andrea Corbingi
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Idanna Innocenti
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annamaria Tomasso
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Raffaella Pasquale
- Department of Hematology, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Marzia Varettoni
- Department of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Flospergher
- Department of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Autore
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Morelli
- Department of Hematology, Università degli Studi di Firenze, Florence, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Gianluigi Reda
- Department of Hematology, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dimitar G Efremov
- Molecular Haematology, International Centre for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Luca Laurenti
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Smolej L. Incidence and prognostic significance of serum immunoglobulins and paraproteins in patients with chronic lymphocytic leukaemia: another valuable piece of the puzzle. Br J Haematol 2020; 190:815-816. [PMID: 32686123 DOI: 10.1111/bjh.16972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Lukáš Smolej
- 4th Department of Internal Medicine - Hematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
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10
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IgA levels at diagnosis predict for infections, time to treatment, and survival in chronic lymphocytic leukemia. Blood Adv 2020; 3:2188-2198. [PMID: 31324639 DOI: 10.1182/bloodadvances.2018026591] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/01/2019] [Indexed: 01/29/2023] Open
Abstract
To better understand the relationship between baseline immunoglobulin measurements and subsequent clinical outcomes in chronic lymphocytic leukemia (CLL), we performed a retrospective analysis on 660 patients with CLL (72%), monoclonal B-cell lymphocytosis (MBL) (13%), and small lymphocytic lymphoma (SLL) (14%), diagnosed between 2005 and 2014 at CancerCare Manitoba. Of 511 patients who had their first immunoglobulin level determined within 3 months of diagnosis, abnormal (either increased or decreased) immunoglobulin M (IgM), IgG, and IgA values were observed in 58% of patients with CLL, 27% of patients with MBL, and 20% of patients with SLL. Immunoglobulin deviances were similar for MBL and CLL Rai stage 0 and for SLL and Rai stages I and II; for CLL, IgG and IgA abnormalities occurred with increasing frequency with advancing Rai stage. In contrast, the frequency of IgM abnormalities was similar in all patient groups. IgA abnormalities significantly correlated with high β2-microglobulin (B2M) expression, whereas abnormal IgG and IgA levels were associated with the use of IGHV1-69, 3-21, and 3-49 subtypes. Increases in IgG or IgM were commonly associated with the presence of a CLL-type M-band, whereas oligoclonal bands were frequently observed with increased IgA levels. Although abnormal levels of IgG and IgA at diagnosis were independent predictors for future immunoglobulin replacement, only abnormal IgA levels were associated with shorter time to first treatment and overall survival. These findings indicate that both reduced and elevated levels of IgG and IgA at diagnosis are important and independent prognostic markers for infection in CLL, with IgA being more relevant as a marker of disease progression and survival.
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11
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de Groen RAL, Schrader AMR, Kersten MJ, Pals ST, Vermaat JSP. MYD88 in the driver's seat of B-cell lymphomagenesis: from molecular mechanisms to clinical implications. Haematologica 2019; 104:2337-2348. [PMID: 31699794 PMCID: PMC6959184 DOI: 10.3324/haematol.2019.227272] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022] Open
Abstract
More than 50 subtypes of B-cell non-Hodgkin lymphoma (B-NHL) are recognized in the most recent World Health Organization classification of 2016. The current treatment paradigm, however, is largely based on 'one-size-fits-all' immune-chemotherapy. Unfortunately, this therapeutic strategy is inadequate for a significant number of patients. As such, there is an indisputable need for novel, preferably targeted, therapies based on a biologically driven classification and risk stratification. Sequencing studies identified mutations in the MYD88 gene as an important oncogenic driver in B-cell lymphomas. MYD88 mutations constitutively activate NF-κB and its associated signaling pathways, thereby promoting B-cell proliferation and survival. High frequencies of the hotspot MYD88(L265P) mutation are observed in extranodal diffuse large B-cell lymphoma and Waldenström macroglobulinemia, thereby demonstrating this mutation's potential as a disease marker. In addition, the presence of mutant MYD88 predicts survival outcome in B-NHL subtypes and it provides a therapeutic target. Early clinical trials targeting MYD88 have shown encouraging results in relapsed/refractory B-NHL. Patients with these disorders can benefit from analysis for the MYD88 hotspot mutation in liquid biopsies, as a minimally invasive method to demonstrate treatment response or resistance. Given these clear clinical implications and the crucial role of MYD88 in lymphomagenesis, we expect that analysis of this gene will increasingly be used in routine clinical practice, not only as a diagnostic classifier, but also as a prognostic and therapeutic biomarker directing precision medicine. This review focuses on the pivotal mechanistic role of mutated MYD88 and its clinical implications in B-NHL.
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Affiliation(s)
| | | | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam.,Lymphoma and Myeloma Center Amsterdam-LYMMCARE, Amsterdam.,Cancer Center Amsterdam, Amsterdam
| | - Steven T Pals
- Department of Hematology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam.,Cancer Center Amsterdam, Amsterdam.,Department of Pathology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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12
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Tedeschi A, Conticello C, Rizzi R, Benevolo G, Laurenti L, Petrucci MT, Zaja F, Varettoni M. Diagnostic framing of IgM monoclonal gammopathy: Focus on Waldenström macroglobulinemia. Hematol Oncol 2018; 37:117-128. [DOI: 10.1002/hon.2539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Alessandra Tedeschi
- Department of HematologyNiguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda Milan Italy
| | - Concetta Conticello
- Department of Clinical and Molecular Biomedicine, Haematology SectionUniversity of Catania Catania Italy
| | - Rita Rizzi
- Department of Emergency and Organ Transplantation, Hematology SectionUniversity of Bari Medical School Bari Italy
| | - Giulia Benevolo
- Division of HematologyAOU Città della Salute e della Scienza Torino Italy
| | - Luca Laurenti
- Department of HematologyCatholic University Hospital “A. Gemelli” Rome Italy
| | - Maria Teresa Petrucci
- Hematology, Department of Cellular Biotechnologies and Hematology“Sapienza” University Rome Italy
| | - Francesco Zaja
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari “Carlo Melzi”University of Udine Udine Italy
| | - Marzia Varettoni
- Division of HematologyFondazione IRCCS Policlinico S. Matteo Pavia Italy
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13
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Chauzeix J, Laforêt M, Deveza M, Crowther L, Marcellaud E, Derouault P, Lia A, Boyer F, Bargues N, Olombel G, Jaccard A, Feuillard J, Gachard N, Rizzo D. Normal serum protein electrophoresis and mutated IGHV genes detect very slowly evolving chronic lymphocytic leukemia patients. Cancer Med 2018; 7:2621-2628. [PMID: 29745034 PMCID: PMC6010869 DOI: 10.1002/cam4.1510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 12/01/2022] Open
Abstract
More than 35 years after the Binet classification, there is still a need for simple prognostic markers in chronic lymphocytic leukemia (CLL). Here, we studied the treatment-free survival (TFS) impact of normal serum protein electrophoresis (SPE) at diagnosis. One hundred twelve patients with CLL were analyzed. The main prognostic factors (Binet stage; lymphocytosis; IGHV mutation status; TP53, SF3B1, NOTCH1, and BIRC3 mutations; and cytogenetic abnormalities) were studied. The frequencies of IGHV mutation status, cytogenetic abnormalities, and TP53, SF3B1, NOTCH1, and BIRC3 mutations were not significantly different between normal and abnormal SPE. Normal SPE was associated with Binet stage A, nonprogressive disease for 6 months, lymphocytosis below 30 G/L, and the absence of the IGHV3-21 gene rearrangement which is associated with poor prognosis. The TFS of patients with normal SPE was significantly longer than that of patients with abnormal SPE (log-rank test: P = 0.0015, with 51% untreated patients at 5.6 years and a perfect plateau afterward vs. a median TFS at 2.64 years for abnormal SPE with no plateau). Multivariate analysis using two different Cox models and bootstrapping showed that normal SPE was an independent good prognostic marker for either Binet stage, lymphocytosis, or IGHV mutation status. TFS was further increased when both normal SPE and mutated IGHV were present (log-rank test: P = 0.008, median not reached, plateau at 5.6 years and 66% untreated patients). A comparison with other prognostic markers suggested that normal SPE could reflect slowly advancing CLL disease. Altogether, our results show that a combination of normal SPE and mutated IGHV genes defines a subgroup of patients with CLL who evolve very slowly and who might never need treatment.
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MESH Headings
- Aged
- Biomarkers, Tumor
- Blood Proteins
- Cytogenetic Analysis
- Electrophoresis
- Female
- High-Throughput Nucleotide Sequencing
- Humans
- Immunoglobulin Heavy Chains/blood
- Immunoglobulin Heavy Chains/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Male
- Middle Aged
- Mutation
- Neoplasm Metastasis
- Neoplasm Staging
- Prognosis
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Affiliation(s)
- Jasmine Chauzeix
- Hématologie BiologiqueCentre Hospitalier Universitaire de LimogesLimogesFrance
- Faculté de Médecine de LimogesUMR CNRS 7276 CRIBLLimogesFrance
| | | | - Mélanie Deveza
- Hématologie BiologiqueCentre Hospitalier Universitaire de LimogesLimogesFrance
| | - Liam Crowther
- Faculté de Médecine de LimogesUMR CNRS 7276 CRIBLLimogesFrance
| | | | | | | | - François Boyer
- Faculté de Médecine de LimogesUMR CNRS 7276 CRIBLLimogesFrance
| | - Nicolas Bargues
- Hématologie BiologiqueCentre Hospitalier Universitaire de LimogesLimogesFrance
| | - Guillaume Olombel
- Faculté de Médecine de LimogesUMR CNRS 7276 CRIBLLimogesFrance
- ImmunologieCentre Hospitalier Universitaire de LimogesLimogesFrance
| | - Arnaud Jaccard
- Faculté de Médecine de LimogesUMR CNRS 7276 CRIBLLimogesFrance
- Hématologie Clinique et Thérapie CellulaireCentre Hospitalier Universitaire de LimogesLimogesFrance
| | - Jean Feuillard
- Hématologie BiologiqueCentre Hospitalier Universitaire de LimogesLimogesFrance
- Faculté de Médecine de LimogesUMR CNRS 7276 CRIBLLimogesFrance
| | - Nathalie Gachard
- Hématologie BiologiqueCentre Hospitalier Universitaire de LimogesLimogesFrance
- Faculté de Médecine de LimogesUMR CNRS 7276 CRIBLLimogesFrance
| | - David Rizzo
- Hématologie BiologiqueCentre Hospitalier Universitaire de LimogesLimogesFrance
- Faculté de Médecine de LimogesUMR CNRS 7276 CRIBLLimogesFrance
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14
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García-Sanz R, Jiménez C, Puig N, Paiva B, Gutiérrez NC, Rodríguez-Otero P, Almeida J, San Miguel J, Orfão A, González M, Pérez-Andrés M. Origin of Waldenstrom's macroglobulinaemia. Best Pract Res Clin Haematol 2016; 29:136-147. [PMID: 27825459 DOI: 10.1016/j.beha.2016.08.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 08/23/2016] [Indexed: 11/27/2022]
Abstract
Waldenstrom's macroglobulinaemia (WM) is an MYD88L265P-mutated lymphoplasmacytic lymphoma that invades bone marrow and secretes monoclonal immunoglobulin M (IgM). WM cells are usually unable to undergo class switch recombination, and have mutated IGHV, with a typical immunophenotype CD19+/CD22low+/CD23-/CD25+/CD27+/CD45+/CD38low+/SmIgM+ (negative for CD5, CD10, CD11c, CD103). This immunophenotype matches memory B cells (smIgM-/+/CD10-/CD19+/CD20+/CD27+/CD38low+/CD45+), representing 30% of B cells in the blood. Fifty percent of them have not undergone class switch recombination and are IgM+. These cells have suffered somatic hypermutation as WM cells. Genetic abnormalities do not abrogate the capacity to progress to plasma cells that usually belong to the clonal WM compartment, with a normal immunophenotype and functional characteristics. However, some WM cells are CD27-, MYD88WT, without somatic hypermutation, or with class switch recombination capable of reactivation. Thus, most data support a B-memory-cell origin for WM, but a small fraction of cases may have a different origin.
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Affiliation(s)
- Ramón García-Sanz
- Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer de Salamanca, Salamanca, Spain.
| | - Cristina Jiménez
- Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer de Salamanca, Salamanca, Spain
| | - Noemí Puig
- Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer de Salamanca, Salamanca, Spain
| | - Bruno Paiva
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto De Investigación Sanitaria De Navarra, Pamplona, Spain
| | - Norma C Gutiérrez
- Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer de Salamanca, Salamanca, Spain
| | - Paula Rodríguez-Otero
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto De Investigación Sanitaria De Navarra, Pamplona, Spain
| | - Julia Almeida
- Servicio General de Citometría de la Universidad de Salamanca, Salamanca, Spain
| | - Jesús San Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto De Investigación Sanitaria De Navarra, Pamplona, Spain
| | - Alberto Orfão
- Servicio General de Citometría de la Universidad de Salamanca, Salamanca, Spain
| | - Marcos González
- Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer de Salamanca, Salamanca, Spain
| | - Martín Pérez-Andrés
- Servicio General de Citometría de la Universidad de Salamanca, Salamanca, Spain
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15
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Andersen MA, Vojdeman FJ, Andersen MK, Brown PDN, Geisler CH, Weis Bjerrum O, Niemann CU. Hypogammaglobulinemia in newly diagnosed chronic lymphocytic leukemia is a predictor of early death. Leuk Lymphoma 2016; 57:1592-9. [DOI: 10.3109/10428194.2016.1142082] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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