1
|
Pan Q, Cao X, Li J, Li F, Luo Y. Different extramedullary disease shown in chemokine receptor 4 targeted PET/CT with [68Ga]Ga-pentixafor in patients with Waldenström macroglobulinemia and smoldering disease. Nucl Med Commun 2024:00006231-990000000-00299. [PMID: 38745523 DOI: 10.1097/mnm.0000000000001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
INTRODUCTION It is important to distinguish Waldenström macroglobulinemia from smoldering Waldenström macroglobulinemia (sWM), because only patients with Waldenström macroglobulinemia require treatment, however the distinction can be clinically complex. The aim of this study is to investigate whether [68Ga]Ga-pentixafor PET/CT shows different characteristics in sWM and Waldenström macroglobulinemia patients and therefore can help to differentiate Waldenström macroglobulinemia and sWM. RESULTS Thirty-seven patients with newly diagnosed Waldenström macroglobulinemia and 11 sWM patients were analyzed [35 men and 13 women; 64.3 ± 10.7 (range, 29-87) years old]. The SUVmax of bone marrow disease, lymph nodes, and other extramedullary diseases on [68Ga]Ga-pentixafor were significantly higher than those on 2-[18F]FDG PET/CT (P < 0.05). On [68Ga]Ga-pentixafor PET/CT, patients with Waldenström macroglobulinemia had more lymph node regions involved, significantly higher incidence of involvement in more than three lymph node regions, larger nodal disease, and higher incidence of other extramedullary disease when compared with sWM patients (P < 0.05). Waldenström macroglobulinemia patients showed significantly higher total lesions uptake, total lesion volume, and SUVmax of extramedullary disease than sWM patients did (P < 0.05). None of the visual or semiquantitative indexes in 2-[18F]FDG PET/CT showed significant difference between Waldenström macroglobulinemia and sWM patients. CONCLUSION [68Ga]Ga-pentixafor PET/CT had better diagnostic performance than 2-[18F]FDG PET/CT in Waldenström macroglobulinemia. Patients with Waldenström macroglobulinemia presented with more extensive extramedullary disease shown in [68Ga]Ga-pentixafor PET/CT than sWM patients did.
Collapse
Affiliation(s)
- Qingqing Pan
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine
| | - Xinxin Cao
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Jian Li
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Fang Li
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine
| | - Yaping Luo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine
| |
Collapse
|
2
|
Hussain M, Yellapragada S, Al Hadidi S. Differential Diagnosis and Therapeutic Advances in Multiple Myeloma: A Review Article. Blood Lymphat Cancer 2023; 13:33-57. [PMID: 37731771 PMCID: PMC10508231 DOI: 10.2147/blctt.s272703] [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: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
Multiple myeloma (MM) is a hematologic malignancy characterized by the abnormal clonal proliferation of plasma cells that may result in focal bone lesions, renal failure, anemia, and/or hypercalcemia. Recently, the diagnosis and treatment of MM have evolved due to a better understanding of disease pathophysiology, improved risk stratification, and new treatments. The incorporation of new drugs, including proteasome inhibitors, immunomodulatory drugs, anti-CD38 antibodies and high-dose chemotherapy followed by hematopoietic stem cell transplantation, has resulted in a significant improvement in patient outcomes and QoL. In this review, we summarize differential diagnoses and therapeutic advances in MM.
Collapse
Affiliation(s)
- Munawwar Hussain
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sarvari Yellapragada
- Michael E. DeBakey VA Medical Center and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Samer Al Hadidi
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
García-Sanz R, Hunter ZR, Poulain S, Varettoni M, Owen RG. New developments in the diagnosis and characterization of Waldenström's macroglobulinemia. Expert Rev Hematol 2023; 16:835-847. [PMID: 37905549 DOI: 10.1080/17474086.2023.2270779] [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: 06/22/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Waldenström's macroglobulinemia (WM) is defined as a lymphoplasmacytic lymphoma (LPL) with immunoglobulin M (IgM) monoclonal gammopathy and morphologic evidence of bone marrow infiltration by LPL. Immunophenotyping and genotyping provide a firm pathological basis for diagnosis and are particularly valuable in differential diagnosis between WM and related diseases. Emerging technologies in mutational analysis present new opportunities, but challenges remain around standardization of methodologies and reporting of mutational data across centers. AREAS COVERED The review provides an overview of the diagnosis of WM, with a particular focus on the role of immunophenotyping and genotyping. EXPERT OPINION Demonstration of LPL with a bone marrow biopsy is essential to reach a definitive diagnosis of WM. However, MYD88L265P and a typical WM immunophenotypic profile are valuable for the differential diagnosis of WM and related diseases, such as marginal zone lymphoma, multiple myeloma, and chronic lymphocytic leukemia. These methodologies must be utilized across centers and with appropriate standards followed in the evaluation and reporting of sensitivities and specificities. The diagnostic and/or prognostic value of mutations in genes such as CXCR4 and TP53 that are currently not routinely evaluated in the diagnosis of WM should be explored.
Collapse
Affiliation(s)
- Ramón García-Sanz
- Hematology Department, University Hospital of Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Zachary R Hunter
- Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stéphanie Poulain
- Service d'Hématologie Cellulaire, CHRU de Lille, University of Lille, Lille, France
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roger G Owen
- Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| |
Collapse
|
5
|
Passo RM, Scruggs BA, Bailey ST. PARACENTRAL ACUTE MIDDLE MACULOPATHY AS AN EARLY SIGN OF WALDENSTRÖM MACROGLOBULINEMIA. Retin Cases Brief Rep 2023; 17:343-345. [PMID: 37364196 PMCID: PMC10293751 DOI: 10.1097/icb.0000000000001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
PURPOSE To report a case of paracentral acute middle maculopathy as the earliest sign of an undiagnosed, life-threatening hyperviscosity syndrome. METHODS A 78-year-old man with an acute paracentral scotoma and examination findings of bilateral arteriolar tortuosity and unilateral paracentral acute middle maculopathy. RESULTS Work-up revealed anemia and elevated serum viscosity. Protein electrophoresis demonstrated an immunoglobulin M kappa monoclonal protein spike, and bone marrow biopsy confirmed an immunoglobulin M gammopathy consistent with Waldenström macroglobulinemia. Systemic chemotherapy was initiated. CONCLUSION This case demonstrates typical optical coherence tomography findings of paracentral acute middle maculopathy, which led to the diagnosis of a rare lymphoproliferative disorder. This highlights the importance of a prompt work-up for paracentral acute middle maculopathy to detect underlying systemic diseases, including hyperviscosity syndromes.
Collapse
Affiliation(s)
- Ross M. Passo
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - Brittni A. Scruggs
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
- Current Address: Mayo Clinic, Department of Ophthalmology, Rochester, MN, USA
| | - Steven T. Bailey
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
6
|
Riva E, Tietsche de Moraes Hungría V, Chiattone C, Martínez-Cordero H. Management of Waldenström Macroglobulinemia in Limited-Resource Settings. Hematol Oncol Clin North Am 2023:S0889-8588(23)00044-8. [PMID: 37258356 DOI: 10.1016/j.hoc.2023.04.010] [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: 06/02/2023]
Abstract
Waldenström macroglobulinemia (WM) is a rare, indolent, and currently incurable B-cell neoplasm characterized by monoclonal immunoglobulin M gammopathy, frequent nodal involvement, and lymphoplasmacytic infiltration of the bone marrow. The clinical pattern at diagnosis is similar to that reported in developed countries but, unfortunately, the tools for a complete diagnosis and access to novel therapies are suboptimal. Older drugs such as bendamustine, cyclophosphamide, and chlorambucil may still play a role in treating WM. Prospective studies in resource-limited regions are required to further evaluate these essential aspects of the disease. In this document, we issue recommendations based on our local reality.
Collapse
Affiliation(s)
- Eloisa Riva
- Clinical Hospital Dr Manuel Quintela, University of the Republic, British Hospital, Montevideo, Uruguay
| | | | - Carlos Chiattone
- Hematology and Oncology Discipline, Santa Casa Medical School, Sao Paulo, Brazil
| | | |
Collapse
|
7
|
García-Sanz R, Tedeschi A. The Management of Relapsed or Refractory Waldenström's Macroglobulinemia. Hematol Oncol Clin North Am 2023:S0889-8588(23)00040-0. [PMID: 37246089 DOI: 10.1016/j.hoc.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Waldenström's macroglobulinemia (WM) is an immunoglobulin M monoclonal gammopathy produced by a bone marrow lymphoplasmacytic lymphoma, an indolent non-Hodgkin lymphoma in which the cure is still an unmet challenge. Combinations with alkylating agents, purine analogs, and monoclonal antibodies, Bruton tyrosine kinase, and proteasome inhibitors are used for the treatment of relapsed and refractory patients. Moreover, new additional agents can be seen on the horizon as potential effective therapies. No consensus on a preferred treatment in the relapsed setting is available yet.
Collapse
Affiliation(s)
- Ramón García-Sanz
- Department of Hematology, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Accelerator Project, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369 and Center for Cancer Research-IBMCC (USAL-CSIC), Paseo de San Vicente, 58-182, Salamanca 37007, Spain; Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
| | - Alessandra Tedeschi
- Department of Hematology, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Accelerator Project, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369 and Center for Cancer Research-IBMCC (USAL-CSIC), Paseo de San Vicente, 58-182, Salamanca 37007, Spain; Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Xiang Y, Fang SQ, Liu YW, Wang H, Lu ZX. A rare case report of waldenström macroglobulinemia converted to serum low IgM. Front Genet 2023; 13:1051917. [PMID: 36744182 PMCID: PMC9893496 DOI: 10.3389/fgene.2022.1051917] [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: 09/23/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023] Open
Abstract
Waldenström Macroglobulinemia (WM) is a rare chronic lymphoproliferative disease, accounting for less than 2% of hematological malignancies. It is characterized by plasma cytoid lymphocyte infiltration in bone marrow and abnormal increase of monoclonal IgM in peripheral blood. Only 5%-10% of cases of WM secrete monoclonal IgG and IgA components or do not secrete monoclonal long immunoglobulin. This case is the first to report of serum protein recombination from lgM and Igkappa band mutation to abnormal lgG and Igkappa band after 6 years of treatment in a male patient with WM.
Collapse
Affiliation(s)
| | | | - Yi-Wen Liu
- *Correspondence: Yi-Wen Liu, ; Hui Wang, ; Zhong-Xin Lu,
| | - Hui Wang
- *Correspondence: Yi-Wen Liu, ; Hui Wang, ; Zhong-Xin Lu,
| | - Zhong-Xin Lu
- *Correspondence: Yi-Wen Liu, ; Hui Wang, ; Zhong-Xin Lu,
| |
Collapse
|
10
|
Paggi R, Mariotti F, Mencarini J, Bresci S, Campolmi I, Bartalesi F, Borchi B, Nassi L, Sordi B, Vannucchi AM, Bartoloni A. Orbital Infiltration in a Patient with Waldenström Macroglobulinemia: Need for Multidisciplinary Approach and Comparison with the Literature. Mediterr J Hematol Infect Dis 2023; 15:e2023028. [PMID: 37180207 PMCID: PMC10171213 DOI: 10.4084/mjhid.2023.028] [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: 01/31/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023] Open
Abstract
The use of specific inhibitory drugs of intracellular signalling pathways (such as Bruton-Kinase inhibitors) for the treatment of Waldenström's macroglobulinaemia (WM) is a recognised risk factor for Aspergillus spp. infections. The overlapping clinical manifestations of the two diseases may require the involvement of different medical specialities. We describe the clinical course of a patient with pulmonary and encephalic aspergillosis, with concomitant orbital infiltration, which represented a difficult diagnosis: the case required a multidisciplinary approach to define the ocular lesions and an in-depth study of the literature.
Collapse
Affiliation(s)
- Riccardo Paggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Mariotti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jessica Mencarini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Bresci
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Irene Campolmi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Bartalesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Luca Nassi
- Hematology Unit, Careggi University Hospital, Florence, Italy
| | - Benedetta Sordi
- Hematology Unit, Careggi University Hospital, Florence, Italy
- Center for Innovation and Research in Myeloproliferative Neoplasms, Hematology Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessandro Maria Vannucchi
- Center for Innovation and Research in Myeloproliferative Neoplasms, Hematology Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
11
|
Ali EA, Sardar S, Yassin MA. Priapism in Lymphoproliferative Disorders: A Systematic Review. Hematol Oncol Stem Cell Ther 2022; 15:176-182. [PMID: 34157311 DOI: 10.1016/j.hemonc.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 01/14/2023] Open
Abstract
Priapism is defined as a persistent penile erection lasting more than 4 h. We searched the literature for reviews, case reports, and series for patients with lymphoproliferative disorders who developed priapism. The search involved all the lymphoproliferative disorders included in the revised 2016 World Health Organization classification of lymphoid neoplasms including chronic lymphocytic leukemia, multiple myeloma, Waldenström macroglobulinemia, and lymphomas. A total of 16 articles were found. The search included cases up to 4th January 2021. Priapism was seen most commonly as the first manifestation of lymphoproliferative disorders, rarely seen after treatment or after diagnosis.
Collapse
Affiliation(s)
- Elrazi A Ali
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Sundus Sardar
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Hematology and Oncology, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
12
|
Bing–Neel Syndrome: Update on Diagnosis and Treatment. HEMATO 2022. [DOI: 10.3390/hemato3040051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bing–Neel syndrome (BNS) is a rare neurological complication of Waldenström macroglobulinaemia. We highlight key issues in clinical presentation, diagnosis, and treatment while focusing on new and emerging therapies available for patients diagnosed with BNS. It is anticipated that further development of Bruton Tyrosine Kinase (BTK) inhibitors and less toxic chemoimmunotherapies will improve treatment delivery and response.
Collapse
|
13
|
Deen R, Austin C, Bowden A, Bullen A. Rare presentation of Waldenström’s macroglobulinaemia requiring bilateral above-knee amputations: a case report. J Med Case Rep 2022; 16:417. [PMID: 36329532 PMCID: PMC9632102 DOI: 10.1186/s13256-022-03622-1] [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: 03/09/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
Background Waldenström’s macroglobulinaemia is a rarely encountered B-lymphocytic malignancy. Waldenström’s macroglobulinaemia-associated paraproteinaemia is linked to an increase in serum viscosity, which results in a hypercoagulable state. Burning bilateral foot pain in a man with alcohol dependence and controlled atrial fibrillation presenting to the emergency department was attributed to peripheral neuropathy, given satisfactory angiographic evidence of bilateral foot arterial blood supply. Subsequently, his presentation as an emergency with acute bilateral critical lower limb ischemia that was managed by bilateral above-knee amputations, prompted a wider search for other etiologies. We present a hitherto unreported case of Waldenström’s macroglobulinaemia-related acute bilateral lower limb ischemia, which required bilateral above-knee amputations. Case presentation A 50-year-old Caucasian man, who was an alcohol dependent heavy smoker, presented with burning pain in his right foot that was deemed to be related to alcoholic neuropathy. A computerized tomographic angiogram demonstrated an occluded right distal anterior tibial artery but a patent posterior tibial artery supplying the foot arch, findings that were associated with noncritical ischemia. After multiple presentations within a week, he was admitted following sudden clinical deterioration with acute confusion, hyponatremia, and bilateral foot pain. Over the course of 24 hours, the patient deteriorated rapidly, with bilateral lower limb ischemia requiring bilateral above-knee amputations. Subsequent investigations revealed a diagnosis of Waldenström’s macroglobulinaemia. Conclusions To the best of our knowledge, this is the only reported case of Waldenström’s macroglobulinaemia-induced bilateral lower limb ischemia requiring major bilateral amputations.
Collapse
Affiliation(s)
- Raeed Deen
- grid.417154.20000 0000 9781 7439Department of Vascular Surgery, Wollongong Hospital, Wollongong, NSW Australia
| | - Calyb Austin
- grid.417154.20000 0000 9781 7439Department of Vascular Surgery, Wollongong Hospital, Wollongong, NSW Australia
| | - Alexander Bowden
- grid.417154.20000 0000 9781 7439Department of Haematology, Wollongong Hospital, Wollongong, NSW Australia
| | - Andrew Bullen
- grid.417154.20000 0000 9781 7439Department of Vascular Surgery, Wollongong Hospital, Wollongong, NSW Australia
| |
Collapse
|
14
|
Guemara R, Pieren A, Brulhart L. Angioinvasive aspergillosis mimicking giant cell arteritis in an 81-year-old man with jaw pain and vision loss. RMD Open 2022; 8:rmdopen-2022-002489. [DOI: 10.1136/rmdopen-2022-002489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
The present case report focuses on an immunocompromised 81-year-old patient initially diagnosed with Waldenström’s disease. The patient experienced a gradual vision loss and jaw pain with high erythrocyte sedimentation rate. We first suspected giant cell arteritis, despite inconclusive assessment, including a negative temporal artery biopsy. We rapidly started a corticosteroid pulse therapy followed by high-dose corticosteroid therapy that was followed even after discharge from the hospital. The patient was readmitted 20 days later with severe left retro-orbital pain and progressive left vision loss. Clinical examination revealed complete left eyelid ptosis and unilateral blindness with fixed mydriasis and no eye movement. MRI showed signs of ischaemic optic neuropathy with lysis of the left ethmoid sinus wall; thus, indicating ischaemic optic neuropathy related to lymphoplasmacytic infiltration of Waldenström’s disease (Bing-Neel syndrome). Oncological treatment of ibrutinib, a tyrosine kinase inhibitor, was then administered. Despite a favourable prognosis, no improvement was seen. An infectious aetiology was finally confirmed. The left sphenoid sinus biopsy highlighted an angioinvasive aspergillosis with rhino-orbital infiltration observed as ischaemic optic neuropathy. Oncologic treatment was discontinued and antifungal therapy with voriconazole was introduced, leading to a favourable radiological development and analgesic control, without ophtalmological improvement.
Collapse
|
15
|
Coming of Age for BTK Inhibitor Therapy: A Review of Zanubrutinib in Waldenström Macroglobulinemia. Cells 2022; 11:cells11203287. [PMID: 36291152 PMCID: PMC9600142 DOI: 10.3390/cells11203287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Waldenström macroglobulinemia (WM) is a rare form of non-Hodgkin B-cell lymphoma with a variable clinical presentation that can impact a patient’s quality of life by causing anemia, peripheral neuropathy, serum hyperviscosity, extramedullary disease, and other symptoms. There are several safe and effective treatment regimens for patients with WM, and the choice of therapy should be made in a personalized fashion considering the patient’s symptoms, comorbidities, and genomic profile. Bruton tyrosine kinase (BTK) inhibitors are a new option to treat patients with WM. Zanubrutinib is a next-generation covalent BTK inhibitor designed to have fewer off-target effects than previous BTK inhibitors. This review summarizes the pharmacokinetic and pharmacodynamic properties of zanubrutinib as well as safety and efficacy findings. Then, it explores the health economic and outcomes research associated with the costs of treating patients with WM and the reasons why zanubrutinib may be a more cost-effective treatment option compared with ibrutinib, a first-generation BTK inhibitor. Future directions for the treatment of WM focus on the use of zanubrutinib in combination therapy. Combinations based on effective ibrutinib or acalabrutinib treatments may be effectively applied with zanubrutinib given the similar mechanism of action for these BTK inhibitors. Combination therapies could also help prevent the development of disease resistance, minimize toxicity, and support treatment regimens of finite duration.
Collapse
|
16
|
Baseline 18 F-FDG PET/CT May Portend the Prognosis of Patients With Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma After First-Line Treatment. Clin Nucl Med 2022; 47:954-960. [PMID: 35961637 DOI: 10.1097/rlu.0000000000004362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The outcome of patients with Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) is variable. We aim to study if baseline 18 F-FDG PET/CT has some prognostic significance in WM/LPL. METHODS Thirty-three patients with newly diagnosed WM/LPL who underwent baseline 18 F-FDG PET/CT and received active treatment thereafter were recruited in this retrospective study. Semiquantitative indices of baseline 18 F-FDG PET/CT were measured as total lesion glycolysis (TLG), metabolic tumor volume (MTV), and SUV max . The patients were followed up for at least 3 years or until reaching the endpoint, which were defined as progression-free survival (PFS) and the time to next treatment (TTNT). RESULTS The overall response rate of the first-line treatment in the recruited patients was 84.8% (28/33). The 3-year PFS and overall survival rates were 56.3% and 89.3%, respectively. Patients with PFS <36 months and TTNT <36 months showed TLG and MTV significantly higher than those with PFS ≥36 months and TTNT ≥36 months ( P < 0.05). SUV max in patients with PFS <36 months was significantly higher than those with PFS ≥36 months ( P = 0.033). Receiver operating characteristic analysis demonstrated that cutoff values of TLG >291.28 SUVbw * mL, MTV >108.78 mL, and SUV max >3.16 were optimal for predicting PFS <36 months. Kaplan-Meier analysis showed that TLG >291.28 SUVbw * mL and MTV >108.78 mL were predictive for shorter PFS ( P = 0.003) and TTNT ( P = 0.002). In multivariate analysis, TLG >291.28 SUVbw * mL and MTV >108.78 mL were independent predictors for shorter PFS (hazard ratio, 3.06; 95% confidence interval, 1.09-8.57; P = 0.033) and TTNT (hazard ratio, 10.01; 95% confidence interval, 2.56-39.22; P = 0.001). CONCLUSIONS The metabolic indices of TLG and MTV in baseline 18 F-FDG PET/CT were independent prognostic factors to predict PFS and TTNT in patients with WM/LPL.
Collapse
|
17
|
Riva E, Duarte PJ, Valcárcel B, Remaggi G, Murrieta I, Corzo A, del Carpio D, Peña C, Vásquez J, Bove V, Teixeira L, Fleury-Perini G, Yantorno S, Samánez C, Lopresti S, Altamirano M, Villela L, Ruiz-Arguelles GJ, Ruiz-Delgado GJ, Montaño E, Verri V, Zamora Pérez E, Pérez Jacobo F, Idrobo H, Martínez-Cordero H, Beltran BE, Ramírez J, Castillo JJ, Malpica Castillo LE. Treatment and Survival Outcomes of Waldenstrom Macroglobulinemia in Latin American Patients: A Multinational Retrospective Cohort Study. JCO Glob Oncol 2022; 8:e2100380. [PMID: 35939775 PMCID: PMC9470138 DOI: 10.1200/go.21.00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features, and data from Latin American patients are lacking. Therefore, we aim to investigate the clinical, therapy, and outcome patterns of WM in Latin America. Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features. Data from Latin American WM patients are lacking. In this article, we report, for the first time, the results of a retrospective analysis focused on the clinical, therapy, and outcome patterns of WM in Latin America. Moreover, we have validated the IPSSWM score as a prognostic factor for mortality and disease progression. Despite the limitations we acknowledge, this is the first study to provide novel real-world data on WM in Latin America.
Collapse
Affiliation(s)
- Eloísa Riva
- Hematology Department, Hospital Británico & Hospital de Clinicas, Montevideo, Uruguay
| | | | - Bryan Valcárcel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | | | - Ariel Corzo
- Hospital de Clínicas de Buenos Aires, Buenos Aires, Argentina
| | | | - Camila Peña
- Hospital del Salvador, Santiago de Chile, Chile
| | - Jule Vásquez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Virginia Bove
- Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | | | | | | | | | - Sergio Lopresti
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | | | - Luis Villela
- Centro Médico Dr Ignacio Chavez, Hospital Fernando Ocaranza, Universidad del Valle, Mexico City, Mexico
| | | | | | | | - Verónica Verri
- Instituto de Investigaciones Médicas Alfredo Lanari, Buenos Aires, Argentina
| | | | | | | | | | | | | | - Jorge J. Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA
| | - Luis E. Malpica Castillo
- Division of Cancer Medicine, Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
18
|
Elessa D, Debureaux PE, Villesuzanne C, Davi F, Bravetti C, Harel S, Talbot A, Oksenhendler E, Malphettes M, Thieblemont C, Moatti H, Maarek O, Arnulf B, Royer B. Inflammatory Waldenström's macroglobulinaemia: A French monocentric retrospective study of 67 patients. Br J Haematol 2022; 197:728-735. [PMID: 35393650 DOI: 10.1111/bjh.18157] [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: 12/18/2021] [Revised: 02/23/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Abstract
Waldenström's macroglobulinaemia (WM) is a B-cell neoplasm resulting from bone marrow lymphoplasmacytic infiltration and monoclonal IgM secretion. Some patients present concomitant inflammatory syndrome attributed to the disease activity; we named this syndrome inflammatory WM (IWM). We retrospectively analysed all WM patients seen in a single tertiary referral centre from January 2007 to May 2021, and after excluding aetiologies for the inflammatory syndrome using a pertinent blood workup, including C-reactive protein (CRP), and imaging, we identified 67 (28%) IWM, 166 (68%) non-IWM, and nine (4%) WM with inflammatory syndrome of unknown origin. At treatment initiation, IWM patients had more severe anaemia (median Hb 90 vs 99 g/l; p < 0.01), higher platelet count (median 245 vs 196 × 109/l; p < 0.01) and comparable serum IgM level (median 24.9 vs 23.0 g/l; p = 0.28). A positive correlation was found between inflammatory and haematological responses (minimal response or better) (odds ratio 32.08; 95% confidence interval 8.80-98.03; p < 0.001). Overall survivals (OS) were similar (median OS: 17 vs 20 years; p = 0.11) but time to next treatment (TNT) was significantly shorter for IWM (TNT1: 1.6 vs 4.8 years, p < 0.0001). IWM mostly shared the same presentation and outcome as WM without inflammatory syndrome.
Collapse
Affiliation(s)
- Dikelele Elessa
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Pierre-Edouard Debureaux
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Camille Villesuzanne
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Frederic Davi
- Laboratory of Haematology, Hopital Pitie-Salpetriere, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Clotilde Bravetti
- Laboratory of Haematology, Hopital Pitie-Salpetriere, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Stephanie Harel
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Alexis Talbot
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Eric Oksenhendler
- University of Paris, Paris, France.,Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marion Malphettes
- University of Paris, Paris, France.,Department of Clinical Immunology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Catherine Thieblemont
- University of Paris, Paris, France.,Department of Haemato-Oncology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Hannah Moatti
- University of Paris, Paris, France.,Department of Haemato-Oncology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Odile Maarek
- University of Paris, Paris, France.,Laboratory of Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Bertrand Arnulf
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| | - Bruno Royer
- Department of Immuno Haematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.,University of Paris, Paris, France
| |
Collapse
|
19
|
Pratt G, El-Sharkawi D, Kothari J, D'Sa S, Auer R, McCarthy H, Krishna R, Miles O, Kyriakou C, Owen R. Diagnosis and management of Waldenström macroglobulinaemia-A British Society for Haematology guideline. Br J Haematol 2022; 197:171-187. [PMID: 35020191 DOI: 10.1111/bjh.18036] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022]
Abstract
SCOPE The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with Waldenström macroglobulinaemia. In individual patients, circumstances may dictate an alternative approach. METHODOLOGY This guideline was compiled according to the British Society for Haematology (BSH) process at http://www.b-s-h.org.uk/guidelines/proposing-and-writing-a-new-bsh-guideline/. Recommendations are based on a review of the literature using Medline, Pubmed, Embase, Central, Web of Science searches from beginning of 2013 (since the publication of the previous guidelines) up to November 2021. The following search terms were used: Waldenström('s) macroglobulin(a)emia OR lymphoplasmacytic lymphoma, IgM(-related) neuropathy OR cold h(a)emagglutinin disease OR cold agglutinin disease OR cryoglobulin(a)emia AND (for group a only) cytogenetic OR molecular OR mutation OR MYD88 OR CXCR4, management OR treatment OR transfusion OR supportive care OR plasma exchange OR plasmapheresis OR chemotherapy OR bendamustine OR bortezomib OR ibrutinib OR fludarabine OR dexamethasone OR cyclophosphamide OR rituximab OR everolimus, bone marrow transplantation OR stem cell transplantation. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org. Review of the manuscript was performed by the British Society for Haematology (BSH) Guidelines Committee Haemato-Oncology Task Force, the BSH Guidelines Committee and the Haemato-Oncology sounding board of BSH. It was also on the members section of the BSH website for comment. It has also been reviewed by UK Charity WMUK; these organisations do not necessarily approve or endorse the contents.
Collapse
Affiliation(s)
- Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jaimal Kothari
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Shirley D'Sa
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Helen McCarthy
- University Hospitals Dorset NHS Foundation Trust, Dorset, UK
| | - Rajesh Krishna
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Oliver Miles
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Charalampia Kyriakou
- University College London Hospitals NHS Foundation Trust, London, UK
- London North West University Healthcare NHS Trust, London, UK
| | - Roger Owen
- The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
20
|
Ravi G, Kapoor P. Current approach to Waldenström Macroglobulinemia. Cancer Treat Res Commun 2022; 31:100527. [PMID: 35149375 DOI: 10.1016/j.ctarc.2022.100527] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 01/20/2022] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
Waldenström Macroglobulinemia (WM) is a unique, low grade, IgM lymphoplasmacytic lymphoma with a heterogeneous clinical course. A paucity of high-grade evidence from large phase 3 trials remains a major issue in the field despite a rapidly expanding therapeutic armamentarium against WM. Prior knowledge of the patients' MYD88L265P and CXCR4 mutation status aids in treatment decision making if Bruton's tyrosine kinase (BTK) inhibitor therapy is being considered. Head-to head comparative data to inform optimal approach are lacking, and a particularly vexing issue for the clinicians is choosing between fixed-duration bendamustine-rituximab (BR) therapy and an indefinite BTK inhibitor-based regimen, given that both approaches are well tolerated and effective, particularly for the patient population harboring MYD88L265P mutation. For the patients with MYD88WT genotype, chemo-immunotherapy such as BR is preferred, although zanubrutinib, a potent second generation BTK inhibitor, with its reduced off target effects and greater BTK occupancy compared to its predecessor, ibrutinib, has also recently shown activity in MYD88WT WM. This review summarizes the current literature pertaining to the diagnosis, prognosis, and the treatment of WM.
Collapse
Affiliation(s)
- Gayathri Ravi
- Division of Hematology Mayo Clinic, Rochester, MN, United States of America
| | - Prashant Kapoor
- Division of Hematology Mayo Clinic, Rochester, MN, United States of America.
| |
Collapse
|
21
|
Cingam S, Sidana S. Differential Diagnosis of Waldenström's Macroglobulinemia and Early Management: Perspectives from Clinical Practice. Blood Lymphat Cancer 2022; 12:107-117. [PMID: 36003901 PMCID: PMC9394652 DOI: 10.2147/blctt.s259860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022]
Abstract
Waldenström's Macroglobulinemia (WM) is a clonal B-lymphocyte neoplasm characterized by the presence of IgM monoclonal protein and ≥10% bone marrow involvement with lymphoplasmacytic cells. Several mature B-cell and plasma cell disorders can potentially produce monoclonal IgM immunoglobulin and hence, careful consideration of the differential diagnosis is vital. Clinico-pathological features, immunophenotype, and MYD88 mutation status help distinguish WM from other plasma cell and lymphoproliferative disorders. Treatment is only indicated in patients symptomatic from adenopathy or organomegaly, neuropathy, hyper viscosity, cryoglobulinemia, cold agglutinin disease, cytopenia's or amyloidosis. Alkylators (cyclophosphamide, bendamustine) in combination with anti-CD20 antibodies and novel targeted agents including Bruton tyrosine kinase (BTK) inhibitors like ibrutinib are the mainstay of frontline treatment in symptomatic WM.
Collapse
Affiliation(s)
- Shashank Cingam
- Division of Hematology and Oncology, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, 87102, USA
| | - Surbhi Sidana
- Division of BMT and Cell Therapy, Stanford University School of Medicine, Stanford, CA, 94305, USA
| |
Collapse
|
22
|
Multimodal Imaging of Waldenstrom Macroglobulinemia-Associated Hyperviscosity-Related Retinopathy Treated with Plasmapheresis. Case Rep Ophthalmol Med 2021; 2021:6816195. [PMID: 34956683 PMCID: PMC8695004 DOI: 10.1155/2021/6816195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 01/18/2023] Open
Abstract
While plasmapheresis is well known to significantly improve both retinal findings and systemic manifestations associated with Waldenstrom macroglobulinemia, few reports exist documenting changes in optical coherence tomography angiography (OCT-A). The authors present a case of a patient with Waldenstrom macroglobulinemia who had resolution of white-centered peripheral retinal lesions and parafoveal outer nuclear layer hyperreflective material following plasmapheresis. Applying image analysis software to before and after OCT-A images, the authors were able to show an objective decrease in retinal capillary and large vessel density following plasmapheresis. This technique can be used to guide treatment and surveillance for patients with hyperviscosity-related retinopathy.
Collapse
|
23
|
Sandhu S, Sandhu PK, Sroussi HY. The peculiar palatal mass. J Am Dent Assoc 2021; 153:1184-1188. [PMID: 34836619 DOI: 10.1016/j.adaj.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
|
24
|
Ahmed S, Zhao Q, Hanel W, Qazilbash MH, Patel K, Narra R, Kansagra A, Iqbal M, Awan FT, Christian B, Jaglowski SM, Kharfan-Dabaja MA, Hamadani M, Epperla N. Post-relapse survival in Waldenstrom macroglobulinemia patients experiencing therapy failure following autologous transplantation. Hematol Oncol 2021; 40:48-56. [PMID: 34763367 DOI: 10.1002/hon.2946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 11/05/2022]
Abstract
Waldenström macroglobulinemia (WM) is a rare B-cell lymphoproliferative malignancy. Autologous hematopoietic cell transplantation (auto-HCT) is considered in a subset of WM patients with relapsed disease. While registry data has shown a benefit for auto-HCT in relapsed WM, there is a paucity of data on outcomes of patients relapsing after auto-HCT. Eligibility criteria included adult patients with relapsed/refractory WM who underwent auto-HCT between 2007 and 2017. The primary endpoint was post-relapse overall survival (PR-OS). Secondary endpoints were to identify factors prognostic of PR-OS. Of the 48 patients with WM who underwent auto-HCT, 22 (46%) experienced relapse following auto-HCT. Median PR-OS of relapsed WM patients after auto-HCT (n = 22) was not reached (NR) (95% confidence interval [CI]: 17.5 months-NR). Among patients who relapsed <1 year versus ≥1 year from auto-HCT, the median PR-OS was 18.4 months (95%CI: 0.8-NR) months and NR (95%CI: 17.5-NR), respectively (p = 0.06). Of note, disease status at the time of transplant, CR/VGPR versus partial remission did not appear to impact PR-OS. The median PR-OS was significantly longer in patients who received ibrutinib in the post-transplant setting compared to those who did not (NR vs. 18.4 months, 95%CI: 9.1-NR, p = 0.02). On univariable analysis, the presence of complex karyotype (RR = 4.87, 95% CI = 1.22-19.53) and a higher number of prior lines of therapy (RR = 1.81, 95% CI = 1.23-2.67) were associated with a significantly higher risk of relapse. This is the only study to date that evaluated outcomes of WM patients who relapsed following auto-HCT and provides a benchmark for future trials evaluating survival following auto-HCT relapse.
Collapse
Affiliation(s)
- Sairah Ahmed
- Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas, USA.,Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Qiuhong Zhao
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Walter Hanel
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Muzaffar H Qazilbash
- Department of Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Krina Patel
- Department of Lymphoma and Myeloma, M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Ravi Narra
- Department of Medicine, BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ankit Kansagra
- Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madiha Iqbal
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Farrukh T Awan
- Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Beth Christian
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Samantha M Jaglowski
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida, USA
| | - Mehdi Hamadani
- Department of Medicine, BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Narendranath Epperla
- Division of Hematology, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
25
|
Askari E, Rodriguez S, Garcia-Sanz R. Waldenström's Macroglobulinemia: An Exploration into the Pathology and Diagnosis of a Complex B-Cell Malignancy. J Blood Med 2021; 12:795-807. [PMID: 34512060 PMCID: PMC8416181 DOI: 10.2147/jbm.s267938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/19/2021] [Indexed: 12/22/2022] Open
Abstract
After 77 years since the initial description, Waldenström macroglobulinemia (WM) remains as a bone marrow neoplastic disorder with lymphoplasmacytic differentiation oversecreting a monoclonal immunoglobulin M (IgM). However, many biological and genetic aspects of this entity have been unraveled and it is now easy to correctly diagnose patients with this illness. The diagnosis requires the presence of a monoclonal IgM component and bone marrow lymphoid infiltration must be demonstrated. In addition, other small B-cell lymphoid neoplasms with plasma cell differentiation must be discarded. Although the clinical picture is highly heterogeneous, the diagnosis is much easier today compared to the past, since now we can demonstrate the presence of somatic mutations, especially the L265P mutation in the MYD88 gene, highly characteristic of WM (>90% of the patients), followed by the WHIM-like mutations in the CXCR4 gene (~35%). The identification of these mutations is very important, because they can modulate the response to new treatments with Bruton's tyrosine kinase (BTK) inhibitors. Thus, the conventional prognostic factors that predict the outcome of these patients (anemia, thrombopenia, high M component, high B2M, and advanced age), must be complemented with the genetic evaluation of the patient, that can help us in the prediction of the risk of transformation from asymptomatic to symptomatic forms (Del6q) and/or from indolent forms of the disease to aggressive lymphomas (CD79b mutations).
Collapse
Affiliation(s)
- Elham Askari
- Hematology Department, Fundación Jiménez Díaz, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369, Madrid, Spain
| | - Sara Rodriguez
- Clinica Universidad de Navarra, Centro de Investigación Medica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Accelerator project, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369, Pamplona, Spain
| | - Ramon Garcia-Sanz
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Accelerator project, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369 and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| |
Collapse
|
26
|
Weng Q, Xu J, Shen P, Xu T, Gao C, Xie J, Ren H, Pan X. Fulminant type I cryoglobulinemic glomerulonephritis with unique ultrastructural plugs: a case report. Int J Hematol 2021; 114:620-625. [PMID: 34302594 DOI: 10.1007/s12185-021-03194-8] [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: 02/01/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Type I cryoglobulinemia is a rare disease which affects the skin, central nervous system and kidneys. It is usually associated with lymphoproliferative disorders such as multiple myeloma, lymphoma and monoclonal gammopathy of renal significance. Proteinuria and membranoproliferative glomerulonephritis are the most common renal manifestations; Case presentation: Here we report the case of a female patient in her late 40 s who had proteinuria accompanied by Raynaud's phenomenon, high blood and plasma viscosity, hearing loss, and cardiac and central nervous system involvement. Monoclonal immunoglobulin G-λ protein was detected and serum was positive for cryoglobulin. Renal biopsy revealed massive cryo-plugs with unique ultrastructural appearance in the glomerular and peritubular capillary lumina. Immunofluorescence showed predominant IgG3/λ deposition in cryo-plugs. As reported, the clinical manifestations of this patient resulted from cryoprecipitate and hyperviscosity syndrome; Conclusion: Cryoglobulinemia should be considered as a possible diagnosis in patients with Raynaud's phenomenon, hyperviscosity syndrome and monoclonal immunoglobulin.
Collapse
Affiliation(s)
- Qinjie Weng
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jing Xu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Pingyan Shen
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Tian Xu
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Chenni Gao
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jingyuan Xie
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Hong Ren
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Xiaoxia Pan
- Department of Nephrology, Institute of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| |
Collapse
|
27
|
Gary P, Gianniosis M, Ryu J, Flynn S. Chylothorax as a complication of Waldenström macroglobulinaemia with a patient's perspective. BMJ Case Rep 2021; 14:14/5/e241707. [PMID: 33962927 PMCID: PMC8108664 DOI: 10.1136/bcr-2021-241707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chylothorax has rarely been reported as a pleuropulmonary complication of Waldenström macroglobulinaemia (WM). In general, when a unilateral effusion is discovered particularly in patients with a history of cancer or active malignancy, a broad differential including chylothorax needs to be considered. We present the case of a 50-year-old woman found to have chylothorax secondary to progression of WM as confirmed by cytology and presence of MYD88 L265P mutation in the pleural fluid specimen and subsequent resolution with chemotherapy. This review centres particularly on non-traumatic causes of chylothorax with a focus on WM and includes a unique patient perspective.
Collapse
Affiliation(s)
- Phillip Gary
- Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania, USA .,Pulmonary and Critical Care, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Jay Ryu
- Pulmonary, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Samantha Flynn
- Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| |
Collapse
|
28
|
Lai CC, Chang CH. Hyperviscosity-related retinopathy and serous macular detachment in Waldenström's macroglobulinemia: A mortal case in 5 years. Eur J Ophthalmol 2021; 32:NP109-NP114. [PMID: 33719618 DOI: 10.1177/11206721211002066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To present a 5-year mortal case of Waldenström's macroglobulinemia-related retinopathy and serous macular detachment. CASE REPORT A 63-year-old man, with unremarkable medical history, presented with bilateral decreased vision for 2 months. Fundus examination revealed bilateral scattered retinal hemorrhages, exudates, venous tortuosity, and serous macular detachment. Hematologic and biochemistry profiles showed pancytopenia with blood smear demonstrating erythrocyte rouleaux formation. Hyperviscosity syndrome was suspected and later Waldenström's macroglobulinemia was diagnosed by bone marrow biopsy and high concentration of serum IgM. Plasmapheresis and subsequent chemotherapy were arranged. In spite of resolution of most retinal abnormalities, his visual acuity still showed no improvement with a persistent bilateral macular detachment. The patient then died 5 years after the diagnosis of Waldenström's macroglobulinemia. CONCLUSIONS Long-term toxicity of IgM to the retinal pigment epithelium may impede the resolution of the persistent serous macular detachment, resulting in an inability of recovery in his vision. Therefore, early diagnosis and timely reduction of serum paraproteins by plasmapheresis and chemotherapy is critical for preventing permanent damages to patients' health and vision.
Collapse
Affiliation(s)
- Chun-Chieh Lai
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan
| | - Chun-Hsiang Chang
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan
| |
Collapse
|
29
|
Cho R, Myers DT, Onwubiko IN, Williams TR. Extraosseous multiple myeloma: imaging spectrum in the abdomen and pelvis. Abdom Radiol (NY) 2021; 46:1194-1209. [PMID: 32870348 DOI: 10.1007/s00261-020-02712-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/29/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
Multiple myeloma represents a subset of plasma cell dyscrasias characterized by the proliferation of plasma cells typically in the bone marrow, representing approximately 1% of all cancers and 15% of hematologic malignancies. Often multiple myeloma is limited to the skeletal system; however, a small percentage (<5%) of patients will develop extraosseous manifestations. We review the current WHO classification of plasma cell dyscrasias and use multimodality imaging including US, CT, MRI, and PET-CT to illustrate the spectrum of extraosseous multiple myeloma in the abdomen and pelvis. Because extraosseous multiple myeloma is associated with a poorer prognosis and decreased survival, it is important for the radiologist to become familiar with a variety of extraosseous manifestations in the abdomen and pelvis, especially in a patient with a known diagnosis of multiple myeloma and the development of an abdominal or pelvic mass.
Collapse
|
30
|
Lymphoplasmacytic lymphoma manifesting as a cervical spine mass with Parkinson-like symptoms treated with ibrutinib. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2020.100046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
31
|
Branagan AR, Lei M, Treon SP, Castillo JJ. Clinical application of genomics in Waldenström macroglobulinemia. Leuk Lymphoma 2021; 62:1805-1815. [PMID: 33569985 DOI: 10.1080/10428194.2021.1881514] [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: 10/22/2022]
Abstract
Waldenström Macroglobulinemia (WM) is an incurable hematologic malignancy characterized by lymphoplasmacytic infiltration of the bone marrow and the presence of monoclonal immunoglobulin (IgM). Although a portion of WM patients may experience a relatively indolent course, patients may experience IgM-related morbidity and/or disease-related mortality. This underscores the need for novel approaches to improve response and survival rates. Significant progress had been made in our understanding of the genomics and biology of WM. The discovery of the highly recurrent somatic mutations in the MYD88 gene detected in 90-95% and the CXCR4 gene detected in 30-40% of WM patients has provided an opportunity to develop novel targeted approaches. Mutational status has important implications in predicting response to therapies such as BTK inhibitors. Treatment of WM should be guided by many factors including performance status, comorbidities, goals of therapy, and toxicities. In this review, we describe how current genomics may be utilized to optimize WM treatment selection. As the therapeutic landscape of WM continues to expand with more targeted approaches, the genomics in WM will likely play a greater role in individualizing treatment.
Collapse
Affiliation(s)
- Andrew R Branagan
- Department of Hematologic Oncology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mathew Lei
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Steven P Treon
- Harvard Medical School, Boston, MA, USA.,Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jorge J Castillo
- Harvard Medical School, Boston, MA, USA.,Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
32
|
Maheswaranathan M, Lagoo AS, Diehl L, Shah A. A 79-Year-Old Female with Altered Mental Status and Anemia. Arthritis Care Res (Hoboken) 2021; 74:555-561. [PMID: 33555132 DOI: 10.1002/acr.24571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/05/2021] [Accepted: 02/02/2021] [Indexed: 11/12/2022]
Abstract
The authors declare that there are no disclosures or conflicts of interest regarding the publication of this manuscript. We did not receive any financial support and have no financial interests which could create a potential conflict of interest or the appearance of a conflict of interest with regard to the work.
Collapse
Affiliation(s)
| | - Anand S Lagoo
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA
| | - Louis Diehl
- Division of Hematology, Duke University School of Medicine, Durham, NC, USA
| | - Ankoor Shah
- Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
33
|
Krishnamurthy K, Sriganeshan V, Medina AM. An unusual case of lymphoplasmacytic lymphoma/Waldenström macroglobulinemia presenting with intractable seizures and interference with automated testing. J Hematop 2021. [DOI: 10.1007/s12308-020-00432-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
34
|
Gunaratne MDSK, Sahakian AJ, Abeykoon JP, Ansell SM, Gertz MA, Kapoor P, Paulus A, Ailawadhi S, Reeder CB, Witzig TE, Habermann TM, Novak AJ, Lacy MQ, Kyle RA, Go RS, Paludo J. Treatment facility volume and patient outcomes in Waldenstrom macroglobulinemia. Leuk Lymphoma 2020; 62:308-315. [PMID: 33054437 DOI: 10.1080/10428194.2020.1832669] [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: 10/23/2022]
Abstract
Waldenstrom macroglobulinemia (WM) has an annual incidence of 3-3.2 cases per million-person/year. National Cancer Data Base was used to identify newly diagnosed WM cases requiring initiation of therapy and their annual facility volume was used to divide the treatment facilities into four quartiles (Qs). Cox regression was used to analyze the association between facility volume and survival, adjusted by demographics, socioeconomic, geographic, comorbidity factors and year of diagnosis. A total of 3064 patients treated in 795 facilities were included. The unadjusted median overall survival (OS) by facility volume was: Q1:6.5 years (5-year OS 55%), Q2:7 years (5-year OS 60%), Q3:8 years (5-year OS 64%), and Q4: NR (5-year OS 71%), p < 0.0001. Our results demonstrated that a volume-outcome relationship exists in WM and is an independent predictor of overall survival in addition to the established risk factors as age and disease severity.
Collapse
Affiliation(s)
| | | | | | | | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Aneel Paulus
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Craig B Reeder
- Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Anne J Novak
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jonas Paludo
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
35
|
García-Sanz R, Dogliotti I, Zaccaria GM, Ocio EM, Rubio A, Murillo I, Escalante F, Aguilera C, García-Mateo A, García de Coca A, Hernández R, Dávila J, Puig N, García-Álvarez M, Chillón MDC, Alcoceba M, Medina A, González de la Calle V, Sarasquete ME, González M, Gutiérrez NC, Jiménez C. 6q deletion in Waldenström macroglobulinaemia negatively affects time to transformation and survival. Br J Haematol 2020; 192:843-852. [PMID: 32780894 DOI: 10.1111/bjh.17028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/12/2020] [Indexed: 12/20/2022]
Abstract
Deletion of the long arm of chromosome 6 (del6q) is the most frequent cytogenetic abnormality in Waldenström macroglobulinaemia (WM), occurring in approximately 50% of patients. Its effect on patient outcome has not been completely established. We used fluorescence in situ hybridisation to analyse the prevalence of del6q in selected CD19+ bone marrow cells of 225 patients with newly diagnosed immunoglobulin M (IgM) monoclonal gammopathies. Del6q was identified in one of 27 (4%) cases of IgM-monoclonal gammopathy of undetermined significance, nine of 105 (9%) of asymptomatic WM (aWM), and 28/93 (30%) of symptomatic WM (sWM), and was associated with adverse prognostic features and higher International Prognostic Scoring System for WM (IPSSWM) score. Asymptomatic patients with del6q ultimately required therapy more often and had a shorter time to transformation (TT) to symptomatic disease (median TT, 30 months vs. 199 months, respectively, P < 0·001). When treatment was required, 6q-deleted patients had shorter progression-free survival (median 20 vs. 47 months, P < 0·001). The presence of del6q translated into shorter overall survival (OS), irrespective of the initial diagnosis, with a median OS of 90 compared with 131 months in non-del6q patients (P = 0·01). In summary, our study shows that del6q in IgM gammopathy is associated with symptomatic disease, need for treatment and poorer clinical outcomes.
Collapse
Affiliation(s)
- Ramón García-Sanz
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Irene Dogliotti
- Unit of Haematology, Department of Biotechnology & Health Sciences, University of Torino, Torino, Italy
| | - Gian Maria Zaccaria
- Unit of Haematology, Department of Biotechnology & Health Sciences, University of Torino, Torino, Italy
| | - Enrique María Ocio
- Haematology Department, University Hospital of Marqués de Valdecilla, Santander, Spain
| | - Araceli Rubio
- Haematology Department, Miguel Servet Hospital, Zaragoza, Spain
| | - Ilda Murillo
- Haematology Department, Miguel Servet Hospital, Zaragoza, Spain
| | | | - Carmen Aguilera
- Haematology Department, Regional Hospital of El Bierzo, León, Spain
| | | | | | | | - Julio Dávila
- Haematology Department, Nuestra Señora de Sonsoles Hospital, Ávila, Spain
| | - Noemí Puig
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - María García-Álvarez
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - María Del Carmen Chillón
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Miguel Alcoceba
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Alejandro Medina
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Verónica González de la Calle
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - María Eugenia Sarasquete
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Marcos González
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Norma Carmen Gutiérrez
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| | - Cristina Jiménez
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), CIBERONC and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
| |
Collapse
|
36
|
Weaver A, Rubinstein S, Cornell RF. Hyperviscosity Syndrome in Paraprotein Secreting Conditions Including Waldenstrom Macroglobulinemia. Front Oncol 2020; 10:815. [PMID: 32509586 PMCID: PMC7248405 DOI: 10.3389/fonc.2020.00815] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022] Open
Abstract
Hyperviscosity syndrome is a serious complication associated with high levels of paraproteins in patients with hematological malignancies. Therapeutic advances in disease control may reduce the incidence of hyperviscosity syndrome; however, management of acute cases requires an understanding of key symptoms and prompt treatment to mitigate serious consequences.
Collapse
Affiliation(s)
- Allison Weaver
- Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Samuel Rubinstein
- Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert F Cornell
- Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| |
Collapse
|
37
|
Ravindran A, Lackore KA, Glasgow AE, Drake MT, Hobbs MA, Kourelis T, Kumar S, Kyle RA, Leung N, Muchtar E, Go RS. Monoclonal Gammopathy of Undetermined Significance: Indications for Prediagnostic Testing, Subsequent Diagnoses, and Follow-up Practice at Mayo Clinic. Mayo Clin Proc 2020; 95:944-954. [PMID: 32370855 DOI: 10.1016/j.mayocp.2019.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 12/13/2019] [Accepted: 12/23/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the indications for prediagnostic testing, subsequent diagnoses found, and follow-up practices in patients who were incidentally diagnosed with monoclonal gammopathy of undetermined significance (MGUS). PATIENTS AND METHODS From our prospective MGUS database, we identified 329 patients residing in southeastern Minnesota who were diagnosed from January 1, 2011, through December 31, 2014, and followed up at Mayo Clinic. RESULTS Most test orders came from nonhematologists (n=310, 94.2%). The top 5 indications were neuropathy (n=65, 19.8%), renal disease (n=45, 13.7%), anemia (n=42, 12.8%), bone disorder or connective tissue pain (n=42, 12.8%), and cutaneous disease (n=19, 5.8%). Hypercalcemia was an infrequent indication (n=9, 2.7%). The final diagnosis for all neuropathy evaluations was sensory/motor neuropathy-not otherwise specified, with 18.7% having IgM MGUS. Chronic kidney disease-not otherwise specified, iron deficiency, and osteoporosis/osteopenia were the most common subsequent diagnoses for test indications of renal disease, anemia, and bone disorder or connective tissue pain, respectively. Most patients (n=213, 64.7%) had 1 or more follow-up visit during the study period. A minority were followed by hematologists (43.5%, n=143). Patients with low-risk MGUS comprised 45.0% (n=148) of the cohort. Male patients and younger patients were more likely to be followed up than their counterparts (P<.01). About one-third (n=27, 32.1%) of patients 80 years or older (n=84) continued to have regular follow-up visits. Hematologists were more likely to follow patients with MGUS more closely than nonhematologists (P<.001). However, the intensity of follow-up was not based on MGUS risk. CONCLUSION Monoclonal protein testing is commonly performed for signs and symptoms not typically associated with lymphoplasmacytic malignancies. There is a significant variation in MGUS follow-up between hematologists and nonhematologists (P<.001) that is not based on risk factors or clinical practice guidelines.
Collapse
Affiliation(s)
- Aishwarya Ravindran
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Kandace A Lackore
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Amy E Glasgow
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Matthew T Drake
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Endocrinology, Mayo Clinic, Rochester, MN
| | | | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
38
|
Rodriguez Botero N, Zerrate Misas A, Galvez Cardenas KM, Ramirez Quintero JD. Chylothorax as an Initial Manifestation of Waldenström macroglobulinemia. Cureus 2020; 12:e7566. [PMID: 32382468 PMCID: PMC7202585 DOI: 10.7759/cureus.7566] [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] [Indexed: 01/10/2023] Open
Abstract
Waldenström macroglobulinemia (WM) is an uncommon disease whose most common presenting features are anemia, hyperviscosity-related symptoms, B symptoms, bleeding, and neurological symptoms. Pulmonary compromise is rare, and there are a few cases reported of chylothorax as a manifestation of Waldenström macroglobulinemia. We present the case of a patient who presented with a refractory chylothorax as the initial manifestation of Waldenström macroglobulinemia.
Collapse
|
39
|
Zanwar S, Abeykoon JP, Durot E, King R, Perez Burbano GE, Kumar S, Gertz MA, Quinquenel A, Delmer A, Gonsalves W, Cornillet‐Lefebvre P, He R, Warsame R, Buadi FK, Novak AJ, Greipp PT, Inwards D, Habermann TM, Micallef I, Go R, Muchtar E, Kourelis T, Dispenzieri A, Lacy MQ, Dingli D, Nowakowski G, Thompson CA, Johnston P, Thanarajasingam G, Bennani NN, Witzig TE, Villasboas J, Leung N, Lin Y, Kyle RA, Rajkumar SV, Ansell SM, Le‐Rademacher JG, Kapoor P. Impact of MYD88 L265P mutation status on histological transformation of Waldenström Macroglobulinemia. Am J Hematol 2020; 95:274-281. [PMID: 31814157 DOI: 10.1002/ajh.25697] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 12/28/2022]
Abstract
Histological transformation in Waldenström macroglobulinemia (WM) is an uncommon complication, with limited data, particularly regarding the impact of MYD88 L265P mutation on transformation. We examined risk factors and outcomes associated with transformation in WM, highlighting the role of MYD88 L265P mutation. Patients with WM seen at Mayo Clinic, Rochester, USA and University Hospital of Reims, France, between 01/01/1996 and December 31, 2017 were included; 50 (4.3%) of 1147 patients transformed to a high-grade lymphoma, with median time-to-transformation of 4.5 (range 0-21) years in the transformed cohort. The MYD88 L265P mutation status was known in 435/1147 (38%) patients (406 with non-transformed WM and 29 patients in transformed cohort). On multivariate analysis, MYD88 WT status alone was an independent predictor of transformation (odds ratio, 7[95%CI: 2.1-23]; P = .003). Additionally, the MYD88 WT status was independently associated with shorter time-to-transformation (HR 7.9 [95%CI: 2.3-27; P = .001]), with a 5-year transformation rate of 16% for MYD88 WT vs 2.8% with MYD88 L265P mutated patients. Patients with transformation demonstrated a significant increase in risk of death compared to patients who did not transform (HR 5.075; 95%CI: 3.8-6.8; P < .001). In conclusion, the MYD88 WT status is an independent predictor of transformation and associated with a shorter time-to-transformation. Additionally, transformation conferred an inferior overall survival in patients with WM.
Collapse
Affiliation(s)
- Saurabh Zanwar
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Jithma P. Abeykoon
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Eric Durot
- Department of HematologyUniversity Hospital of Reims and UFR Médecine Reims France
| | - Rebecca King
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Minnesota
| | - Gabriela E. Perez Burbano
- Division of Biomedical Statistics and Informatics, Department of Health Sciences ResearchMayo Clinic Rochester Minnesota
| | - Shaji Kumar
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Morie A. Gertz
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Anne Quinquenel
- Department of HematologyUniversity Hospital of Reims and UFR Médecine Reims France
| | - Alain Delmer
- Department of HematologyUniversity Hospital of Reims and UFR Médecine Reims France
| | - Wilson Gonsalves
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Rong He
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Minnesota
| | - Rahma Warsame
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Francis K. Buadi
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Anne J. Novak
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - David Inwards
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Thomas M. Habermann
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Ivana Micallef
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Ronald Go
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Eli Muchtar
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Taxiarchis Kourelis
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Angela Dispenzieri
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Martha Q. Lacy
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - David Dingli
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Grzegorz Nowakowski
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Carrie A. Thompson
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Patrick Johnston
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Gita Thanarajasingam
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - N. Nora Bennani
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Thomas E. Witzig
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Jose Villasboas
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Nelson Leung
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Yi Lin
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Robert A. Kyle
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - S. Vincent Rajkumar
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Stephen M. Ansell
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Jennifer G. Le‐Rademacher
- Division of Biomedical Statistics and Informatics, Department of Health Sciences ResearchMayo Clinic Rochester Minnesota
| | - Prashant Kapoor
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Maqbool MG, Tam CS, Morison IM, Simpson D, Mollee P, Schneider H, Chan H, Juneja S, Harvey Y, Nath L, Hissaria P, Prince HM, Wordsworth H, Opat S, Talaulikar D. A practical guide to laboratory investigations at diagnosis and follow up in Waldenström macroglobulinaemia: recommendations from the Medical and Scientific Advisory Group, Myeloma Australia, the Pathology Sub-committee of the Lymphoma and Related Diseases Registry and the Australasian Association of Clinical Biochemists Monoclonal Gammopathy Working Group. Pathology 2020; 52:167-178. [PMID: 31902622 DOI: 10.1016/j.pathol.2019.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 01/30/2023]
Abstract
Waldenström macroglobulinaemia (WM) is an indolent non-Hodgkin lymphoma which usually presents with symptoms related to infiltration of bone marrow or other tissues like lymph nodes, liver or spleen and has certain unusual clinical manifestations, e.g., renal and central nervous system (CNS) involvement. It also has an array of laboratory features including hypersecretion of IgM, cryoglobulinaemia, increased plasma viscosity and identification of mutated MYD88L265P in more than 90% of cases. In this review, we aim to provide a guide to the laboratory investigations recommended for WM at initial diagnosis and at follow-up. A discussion on the nuances of diagnosis and differential diagnoses is followed by bone marrow (BM) assessment, measurement of paraprotein and other ancillary investigations. Recommendations are provided on laboratory work-up at diagnosis, in the asymptomatic follow-up phase, and during and post-treatment. Finally, we briefly discuss the implications of laboratory diagnosis in regard to recruitment and monitoring on clinical trials.
Collapse
Affiliation(s)
- M Gohar Maqbool
- Department of Haematology, ACT Pathology, Canberra Hospital, ACT, Australia; ANU Medical School, College of Medicine and Health, Australian National University, Canberra, ACT, Australia
| | - Constantine S Tam
- Peter MacCallum Cancer Center, St Vincent's Hospital and University of Melbourne, Melbourne, Vic, Australia
| | - Ian M Morison
- Southern Community Laboratories, Dunedin, New Zealand; Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia
| | - David Simpson
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Medical and Scientific Advisory Group, Myeloma Australia
| | - Peter Mollee
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Medical and Scientific Advisory Group, Myeloma Australia; Department of Haematology, Princess Alexandra Hospital and University of Queensland Medical School, Brisbane, Qld, Australia
| | - Hans Schneider
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Alfred Pathology Service and Monash University, Melbourne, Vic, Australia
| | - Henry Chan
- Department of Haematology, Waitemata District Health Board, Auckland, New Zealand; Medical and Scientific Advisory Group, Myeloma Australia
| | - Surender Juneja
- Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia
| | - Yasmin Harvey
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Lakshmi Nath
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Department of Haematology and Transfusion Medicine, Clinpath Pathology, Adelaide, SA, Australia
| | - Pravin Hissaria
- Australasian Association of Clinical Biochemists (AACB) Monoclonal Gammopathy Working Group (MGWG), Australia; Royal Adelaide Hospital, University of Adelaide and SA Pathology, Adelaide, SA, Australia
| | - H Miles Prince
- Medical and Scientific Advisory Group, Myeloma Australia; Epworth Healthcare, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Vic, Australia
| | - Helen Wordsworth
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Stephen Opat
- Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia; Department of Haematology, Monash Health, Melbourne, Vic, Australia
| | - Dipti Talaulikar
- Department of Haematology, ACT Pathology, Canberra Hospital, ACT, Australia; ANU Medical School, College of Medicine and Health, Australian National University, Canberra, ACT, Australia; Medical and Scientific Advisory Group, Myeloma Australia; Pathology Sub-committee of the Lymphoma and Related Diseases Registry (LaRDR), Australia.
| |
Collapse
|
42
|
Advani P, Paulus A, Ailawadhi S. Updates in prognostication and treatment of Waldenström’s macroglobulinemia. Hematol Oncol Stem Cell Ther 2019; 12:179-188. [DOI: 10.1016/j.hemonc.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 04/22/2019] [Accepted: 05/05/2019] [Indexed: 11/30/2022] Open
|
43
|
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]
|
44
|
Gao J, Soleimani A, Law J. An Unusual Thrombocytopenia. Am J Med 2019; 132:e815-e816. [PMID: 31247176 DOI: 10.1016/j.amjmed.2019.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jackson Gao
- Department of Medicine, University of Maryland School of Medicine, Baltimore.
| | - Arshia Soleimani
- University of Maryland School of Medicine, Greenebaum Comprehensive Cancer Center, Baltimore
| | - Jennie Law
- University of Maryland School of Medicine, Greenebaum Comprehensive Cancer Center, Baltimore
| |
Collapse
|
45
|
Khan TMA, Ansari Y, Siddiqui AH, Ansari SA, Siddiqui F. Development of Central Nervous System Vasculitis in a Patient with Waldenstrom Macroglobulinemia: A Rare Presentation with Poor Prognosis. Cureus 2019; 11:e6039. [PMID: 31824806 PMCID: PMC6886659 DOI: 10.7759/cureus.6039] [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] [Indexed: 11/26/2022] Open
Abstract
Waldenstrom macroglobulinemia (WM) is a rare lymphoproliferative disorder characterized by the presence of monoclonal immunoglobulin M in serum. WM may present with neurologic complications involving the peripheral and central nervous systems (CNS) though CNS complications associated with WM are rare. We present a case of a 72-year-old male with an 18-month history of WM who experienced neurologic and constitutional symptoms indicative of WM progression over a three-week period while on rituximab maintenance therapy. The patient’s symptoms were initially attributed to rituximab-induced asthenia though his clinical condition did not improve with rituximab discontinuation. Due to progressively worsening neurologic symptoms, the patient was re-evaluated and found to have multiple cerebral infarcts and increased serum cryoglobulin levels indicative of cryoglobulinema. The patient was promptly initiated on a combination regimen of high dose steroids, intravenous immunoglobulin (IVIG), and plasmapheresis but had a poor response. Brain biopsy revealed necrotizing vasculitis with dense intra- and peri-vascular CD3 positive T-cell infiltrates with mural necrosis. This is a unique case of WM complicated by type 1 cryoglobulinemia associated with CNS vasculitis that was unresponsive to active rituximab therapy; this case illustrates a poor prognosis of patients with CNS involvement in WM.
Collapse
Affiliation(s)
| | - Yusra Ansari
- Internal Medicine, Rawalpindi Medical College, Rawalpindi, PAK
| | - Abdul Hasan Siddiqui
- Pulmonary and Critical Care Medicine, Staten Island University Hospital / Northwell Health, Staten Island, USA
| | - Saad Ali Ansari
- Internal Medicine, Pakistan Institute of Medical Sciences, Islamabad, PAK
| | - Faraz Siddiqui
- Pulmonary and Critical Care Medicine, Robert Packer Hospital, Sayre, USA
| |
Collapse
|
46
|
Abstract
Cancer can be associated with several distinct coagulation defects which can lead to bleeding complications. The primary hyperfibrinolytic syndrome associated with acute promyelocytic leukemia has been well recognized and is one of the most severe bleeding disorders. Acquired hemophilia, while rare and not only seen in the oncology setting, can be triggered by a malignancy and must be promptly recognized in order to prevent catastrophic hemorrhage. Other, less serious coagulopathic states have been linked to cancer, including acquired von Willebrand disease. Finally, several anti-neoplastic drugs can alter hemostasis and increase the risk of bleeding. A good understanding of this field can help mitigate the risk of complications in the cancer patient.
Collapse
Affiliation(s)
- Simon Mantha
- Department of Medicine, Hematology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| |
Collapse
|
47
|
Smith T, Wong M, Goldson TM, Forjuoh SN. Diagnosis of Waldenström macroglobulinemia. Proc (Bayl Univ Med Cent) 2019; 32:394-396. [DOI: 10.1080/08998280.2019.1596681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Tyler Smith
- Department of Family and Community Medicine, Baylor Scott & White Health, and College of Medicine, Texas A&M Health Science Center, Temple, Texas
| | - Mitchell Wong
- Department of Family and Community Medicine, Baylor Scott & White Health, and College of Medicine, Texas A&M Health Science Center, Temple, Texas
| | - Tove M. Goldson
- Department of Family and Community Medicine, Baylor Scott & White Health, and College of Medicine, Texas A&M Health Science Center, Temple, Texas
| | - Samuel N. Forjuoh
- Department of Family and Community Medicine, Baylor Scott & White Health, and College of Medicine, Texas A&M Health Science Center, Temple, Texas
| |
Collapse
|
48
|
WITHDRAWN: Updates in Prognostication and Treatment of Waldenström’s Macroglobulinemia. Hematol Oncol Stem Cell Ther 2019. [DOI: 10.1016/j.hemonc.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
49
|
Klemencic S, Perkins J. Diagnosis and Management of Oncologic Emergencies. West J Emerg Med 2019; 20:316-322. [PMID: 30881552 PMCID: PMC6404710 DOI: 10.5811/westjem.2018.12.37335] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
Oncologic emergencies may be seen in any emergency department and will become more frequent as our population ages and more patients receive chemotherapy. Life-saving interventions are available for certain oncologic emergencies if the diagnosis is made in a timely fashion. In this article we will cover neutropenic fever, tumor lysis syndrome, hypercalcemia of malignancy, and hyperviscosity syndrome. After reading this article the reader should be much more confident in the diagnosis, evaluation, and management of these oncologic emergencies.
Collapse
Affiliation(s)
- Sarah Klemencic
- Virginia Tech Carilion School of Medicine, Department of Emergency Medicine, Roanoke, Virginia
| | - Jack Perkins
- Virginia Tech Carilion School of Medicine, Department of Emergency Medicine, Roanoke, Virginia
| |
Collapse
|
50
|
Espinosa-Barberi G, Galván González FJ, Miranda Fernández S, Viera Peláez D, Medina Rivero F, Marrero Saavedra D. Vasoproliferative retinopathy secondary to Waldenström's disease. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:85-89. [PMID: 30318175 DOI: 10.1016/j.oftal.2018.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/26/2018] [Accepted: 09/04/2018] [Indexed: 06/08/2023]
Abstract
A 66 year-old patient, monitored for diabetic retinopathy refractory to multiple treatment methods despite a good metabolic control, referred to progressive weight loss. For this reason, a systemic study was performed, detecting anaemia, elevation of the erythrocyte sedimentation rate, and hyperproteinaemia due to elevated serum levels of monoclonal IgM. Subsequently, by performing a bone marrow biopsy and genetic study, the diagnosis of Waldenström macroglobulinaemia was made. Waldenström's macroglobulinaemia is a low frequency lymphoproliferative disease, for which the main manifestation is a hyperviscosity syndrome that can produce ophthalmological signs detectable by funduscopy and imaging tests. A multimodal study is useful in the diagnosis and monitoring of retinal involvement. The incorporation of angiography by optical coherence tomography allows a more precise study of the microvascular disorders that may occur at the posterior pole level.
Collapse
Affiliation(s)
- G Espinosa-Barberi
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España; Escuela de Doctorado y Posgrado, Universidad Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - F J Galván González
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - S Miranda Fernández
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - D Viera Peláez
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - F Medina Rivero
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - D Marrero Saavedra
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| |
Collapse
|