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Criscuolo M, Tosti ME, Broccoli A, Varettoni M, Maraglino AME, Anastasia A, Cantonetti M, Trentin L, Kovalchuk S, Orsucci L, Deodato M, Spolzino A, Volpetti S, Annibali O, Storti S, Stelitano C, Marchesi F, Morè S, Fianchi L, Falini B, Pulsoni A, Tiacci E, Zinzani PL, Pagano L. Second Neoplasms in Italian Patients with Hairy Cell Leukemia after Treatment with Cladribine: A Multicenter Investigation and Literature Review. Cancers (Basel) 2024; 16:1475. [PMID: 38672557 PMCID: PMC11048584 DOI: 10.3390/cancers16081475] [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: 03/07/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Concern has emerged about the prevalence of second cancers among patients with hairy cell leukemia (HCL) treated with purine analogs. We investigated 513 patients with HCL treated with cladribine over the last 30 years at 18 Italian centers and calculated their standardized incidence ratios (SIRs). We identified 24 patients with a second cancer diagnosed at a median time from treatment with cladribine of 59.9 months (range: 9.2-169.7 months). All patients with solid neoplasms presented with a limited-stage disease, except four cases of locally advanced cancer; multiple myeloma patients had a smoldering disease, while lymphoma patients had stage Ie and stage IV diseases. Response to therapy was complete in 19 cases; 1 patient is still receiving treatment for a relapsing bladder disease, while 2 patients progressed during treatment and died. These two patients died from unrelated causes: one from infection and one due to surgery complications. The median OS from HCL was 98.5 months (range: 38.4-409.2 months), while the median OS from second cancer was 27.6 months (range: 1-117.8 months). The SIR was 0.86 (95% CI: 0.54-1.30) for males and 1.13 (95% CI: 0.36-2.73) for females: no statistically significant differences were highlighted. We were not able to demonstrate an excess of second cancer or a significant association with the specific studied neoplasm.
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Affiliation(s)
- Marianna Criscuolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.C.); (L.F.)
| | | | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, 40138 Bologna, Italy; (A.B.); (P.L.Z.)
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, 40126 Bologna, Italy
| | - Marzia Varettoni
- Divisione di Ematologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | | | | | - Maria Cantonetti
- Dipartimento di Oncoematologia Policlinico Tor Vergata, Università Tor Vergata, 00133 Rome, Italy;
| | - Livio Trentin
- Division of Haematology and Clinical Immunology, University of Padova, 35137 Padua, Italy;
| | | | - Lorella Orsucci
- S.C. Ematologia, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Marina Deodato
- Divisione di Ematologia, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Angelica Spolzino
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, 43125 Parma, Italy;
- Oncoematologia, Istituto Oncologico Veneto IOV-IRCSS, 31033 Castelfranco Veneto, Italy
| | - Stefano Volpetti
- Clinica Ematologia, Azienda Sanitaria Universitaria Integrata, 33100 Udine, Italy;
| | - Ombretta Annibali
- Hematology and Stem Cell Transplantation Unit, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Sergio Storti
- UOC Oncoematologia Fondazione di Ricerca e Cura Giovanni Paolo II, Campobasso—Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy;
| | - Caterina Stelitano
- Divisione di Ematologia, Azienda Ospedaliera “Bianchi Melacrino Morelli”, 89125 Reggio Calabria, Italy;
| | - Francesco Marchesi
- Haematology and Stem Cell Transplantation Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Sonia Morè
- Clinica di Ematologia, AOU delle Marche, 60126 Ancona, Italy;
| | - Luana Fianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.C.); (L.F.)
| | - Brunangelo Falini
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia, Santa Maria della Misericordia Hospital, 06123 Perugia, Italy; (B.F.); (E.T.)
| | - Alessandro Pulsoni
- Divisione di Ematologia, Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Enrico Tiacci
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia, Santa Maria della Misericordia Hospital, 06123 Perugia, Italy; (B.F.); (E.T.)
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, 40138 Bologna, Italy; (A.B.); (P.L.Z.)
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, 40126 Bologna, Italy
| | - Livio Pagano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.C.); (L.F.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Troussard X, Maître E, Paillassa J. Hairy cell leukemia 2024: Update on diagnosis, risk-stratification, and treatment-Annual updates in hematological malignancies. Am J Hematol 2024; 99:679-696. [PMID: 38440808 DOI: 10.1002/ajh.27240] [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: 12/20/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 03/06/2024]
Abstract
DISEASE OVERVIEW Hairy cell leukemia (HCL) and HCL-like disorders, including HCL variant (HCL-V) and splenic diffuse red pulp lymphoma (SDRPL), are a very heterogenous group of mature lymphoid B-cell disorders characterized by the identification of hairy cells, a specific genetic profile, a different clinical course and the need for appropriate treatment. DIAGNOSIS Diagnosis of HCL is based on morphological evidence of hairy cells, an HCL immunologic score of 3 or 4 based on the CD11c, CD103, CD123, and CD25 expression, the trephine biopsy which makes it possible to specify the degree of tumoral bone marrow infiltration and the presence of BRAFV600E somatic mutation. RISK STRATIFICATION Progression of patients with HCL is based on a large splenomegaly, leukocytosis, a high number of hairy cells in the peripheral blood, and the immunoglobulin heavy chain variable region gene mutational status. VH4-34 positive HCL cases are associated with a poor prognosis, as well as HCL with TP53 mutations and HCL-V. TREATMENT Patients should be treated only if HCL is symptomatic. Chemotherapy with risk-adapted therapy purine analogs (PNAs) are indicated in first-line HCL patients. The use of chemo-immunotherapy combining cladribine (CDA) and rituximab (R) represents an increasingly used therapeutic approach. Management of relapsed/refractory disease is based on the use of BRAF inhibitors (BRAFi) plus R, MEK inhibitors (MEKi), recombinant immunoconjugates targeting CD22, Bruton tyrosine kinase inhibitors (BTKi), and Bcl-2 inhibitors (Bcl-2i). However, the optimal sequence of the different treatments remains to be determined.
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Affiliation(s)
| | - Elsa Maître
- Laboratoire Hématologie, CHU Côte de Nacre, Caen Cedex, France
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3
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Claves F, Carras S, Burroni B, Maitre E, Boutonnat J, Troussard X, Molina L. Atypical meningeal localization of classical hairy cell leukemia with an impressive response to rituximab and cladribine association. A case report and literature review. EJHAEM 2024; 5:242-246. [PMID: 38406549 PMCID: PMC10887254 DOI: 10.1002/jha2.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024]
Abstract
Hairy cell leukemia (HCL) is a rare lymphoproliferative disorder classically presenting with cytopenia and recurrent infections but atypical manifestations such as bone lesions, skin lesions and effusion have been described. We report here an unusual meningeal localization in a 33 years old man who presented with headache, hand paresthesia and visual symptoms. Brain magnetic resonance imaging revealed an occipital meningeal lesion. Diagnostic explorations led to the diagnosis of classical HCL with meningeal localization. After treatment by cladribine and rituximab the patient rapidly improved and is still in complete remission 12 months after end of treatment. The literature review identified 9 other cases of HCL with central nervous system localization (CNS) presenting with brain parenchyma and/or meninges localization. Four out of 9 patients presented with hyperleukocytosis. Most patients experienced good responses with various treatments. Cladribine alone or with rituximab led to complete responses similar to our patient. In our patient, molecular biology revealed KLF2 mutations, which implication in the atypical localization could be suspected but would need dedicated studies. In conclusion, CNS localizations of HCL are rare but can be observed and treatment with cladribine alone or with rituximab appears as an effective strategy.
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Affiliation(s)
- Fabien Claves
- Hematology Department University Hospital of Grenoble Alpes Grenoble France
- Grenoble Alpes University Grenoble France
| | - Sylvain Carras
- Hematology Department University Hospital of Grenoble Alpes Grenoble France
- Grenoble Alpes University Grenoble France
- Genetic of Hematological Malignancies Department University Hospital of Grenoble Grenoble France
- Institute for Advanced Biosciences Grenoble France
| | - Barbara Burroni
- Pathology Department Cochin University Hospital Paris France
| | - Elsa Maitre
- University Hospital Caen Caen France
- INSERM U1245 Normandie University Caen France
| | - Jean Boutonnat
- Pathology Department University Hospital of Grenoble Alpes Grenoble France
| | - Xavier Troussard
- University Hospital Caen Caen France
- INSERM U1245 Normandie University Caen France
- Hematology Department University Hospital Caen Caen France
| | - Lysiane Molina
- Hematology Department University Hospital of Grenoble Alpes Grenoble France
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[Chinese guideline for diagnosis and treatment of hairy cell leukemia (2023)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:969-976. [PMID: 38503518 PMCID: PMC10834873 DOI: 10.3760/cma.j.issn.0253-2727.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Indexed: 03/21/2024]
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5
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Broccoli A, Argnani L, Nanni L, Stefoni V, Pellegrini C, Casadei B, Gugliotta G, Carella M, Coppola PE, Bagnato G, Zinzani PL. Single-agent rituximab is an effective salvage therapy in pretreated patients with hairy cell leukemia. Blood Adv 2023; 7:6762-6766. [PMID: 37738174 PMCID: PMC10659999 DOI: 10.1182/bloodadvances.2023010742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Affiliation(s)
- Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Lisa Argnani
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Laura Nanni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Vittorio Stefoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Cinzia Pellegrini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
| | - Beatrice Casadei
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
| | - Gabriele Gugliotta
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
| | - Matteo Carella
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Paolo Elia Coppola
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Gianmarco Bagnato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
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Dehghani M, Kashkooe A, Namdari N, Majidi R, Karimi M, Haghighat S, Rezvani A, Safari N. Long-term follow-up of patients with hairy cell leukemia in the south of Iran. Expert Rev Hematol 2023; 16:289-295. [PMID: 36709461 DOI: 10.1080/17474086.2023.2174520] [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: 01/30/2023]
Abstract
BACKGROUND Hairy cell leukemia (HCL) is an indolent chronic lymphoproliferative disorder and first-line treatment with either intravenous or subcutaneous cladribine generally leads to long-lasting remissions. METHOD All 131 patients with hairy-cell leukemia (HCL) were analyzed, with a median follow-up of 91 months. Data is from 2007 to 2020. We evaluated the response rate to cladribine as the first line and the response rate to cladribine with or without rituximab in relapsed patients. Further, we assessed relapse-free survival, complications, and secondary malignancy. RESULTS After a median follow-up of 91 months, the recurrence rate was 24%. The 5-year and 10-year RFS rates were 85% and 66%, respectively. Adding rituximab to 2-CDA leads to a better response rate than just cladribine (90% vs. 27.3%, p-value = 0.002) in the relapsed patients. CONCLUSION HCL patients have long-term survival when cladribine is the first line of treatment. Furthermore, adding rituximab to cladribine leads to a higher response rate.
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Affiliation(s)
- Mehdi Dehghani
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Kashkooe
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Namdari
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Majidi
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Karimi
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirin Haghighat
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rezvani
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Safari
- Hematology Research Center, Department of Hematology and Medical Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
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Dasanu CA, Alvarez-Argote J, Goff CB. Selecting appropriate therapy for hairy cell leukemia: current state and future prospects based on molecularly defined characterization. Expert Opin Pharmacother 2022; 23:1239-1241. [PMID: 35703589 DOI: 10.1080/14656566.2022.2089561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Constantin A Dasanu
- Lucy Curci Cancer Center, Eisenhower Health, Rancho Mirage, CA, USA.,University of California in San Diego Health System, San Diego, CA, USA
| | | | - Catherine B Goff
- Department of Internal Medicine, Eisenhower Health, Rancho Mirage, CA, USA
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A 3-decade multicenter European experience with cladribine as upfront treatment in 384 hairy cell leukemia patients. Blood Adv 2022; 6:4224-4227. [PMID: 35584397 PMCID: PMC9327549 DOI: 10.1182/bloodadvances.2022007854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022] Open
Abstract
Cladribine is regarded as the first treatment of choice for symptomatic hairy cell leukemia. This large international study reports a complete response in 72% of cases and a continuous complete response in 20% of patients.
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Otieno SB, Ogbeide O. Remarkable Response of Hairy Cell Leukemia Variant to Single-Agent Cladribine. Cureus 2022; 14:e24976. [PMID: 35698717 PMCID: PMC9188828 DOI: 10.7759/cureus.24976] [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] [Accepted: 03/12/2022] [Indexed: 11/27/2022] Open
Abstract
Classical hairy cell leukemia (cHCL) and related mature lymphoid B-cell neoplasms including hairy cell leukemia variant (HCLv) and splenic diffuse red pulp lymphoma (SDRPL) are a rare subset of lymphoid neoplasms. cHCL accounts for around 2% of all leukemias and is characterized by a peripheral smear with large lymphoid cells with cytoplasmic projections giving the cells a hairy appearance, splenomegaly, and cytopenias. Majority of cHCL cases harbor a BRAFV600E mutation. cHCL usually responds well to single-agent purine analogs. HCLv is even rarer and constitutes around 0.4% of lymphoid malignancies. Unlike cHCL, HCLv is less responsive to standard single-agent purine analogs and typically does not harbor the BRAFV600E mutation. The “hairy cells,” splenomegaly, and cytopenias are common in both. We report a case of a patient with HCLv who was treated with a single purine analog and achieved a near-complete response.
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Nagy ZF, Ferenczi K, Istenes I, Eid H, Bödör C, Timár B, Demeter J. Case Report: Development of Diffuse Large B Cell Lymphoma a Long Time After Hairy Cell Leukemia. Pathol Oncol Res 2022; 28:1610338. [PMID: 35570843 PMCID: PMC9098676 DOI: 10.3389/pore.2022.1610338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022]
Abstract
Hairy cell leukaemia (HCL) is a rare B cell malignancy with an indolent course leading to pancytopaenia due to bone marrow infiltration. It has been proposed that HCL patients are at risk of developing a secondary malignancy, with a marked likelihood of the development of other hematologic malignancies including Hodgkin lymphoma and high-grade non-Hodgkin lymphomas. Here, we present the case of two patients who developed diffuse large B cell lymphoma after a long course of hairy cell leukaemia. In the case of the female patient, we report on the occurrence of a third malignant disease, which is very uncommon. With our case descriptions we contribute to the very small number of similar cases reported.
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Affiliation(s)
- Zsófia F. Nagy
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Kata Ferenczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Ildikó Istenes
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Hanna Eid
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Bödör
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Botond Timár
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Judit Demeter
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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11
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Paillassa J, Safa F, Troussard X. Updates in hairy cell leukemia (HCL) and variant-type HCL (HCL-V): rationale for targeted treatments with a focus on ibrutinib. Ther Adv Hematol 2022; 13:20406207221090886. [PMID: 35450208 PMCID: PMC9016521 DOI: 10.1177/20406207221090886] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Hairy cell leukemia (HCL) and HCL-like disorders such as hairy cell leukemia variant (HCL-V) and splenic diffuse red pulp lymphoma (SDRPL) are rare indolent B-cell malignancies. Purine analogs (PNAs), alone or in association with rituximab (R), are the standard of care for HCL in the first-line setting. However, PNAs are toxic and patients may become resistant to these drugs. Therefore, new therapeutic strategies are needed. Several recent in vitro studies highlighted the importance of the interactions between HCL cells and their microenvironment, in particular with bone marrow stromal cells, endothelial cells, and the extracellular matrix. In these interactions, chemokine receptors and adhesion molecules play a major role. Moreover, the importance of signaling pathways, like BRAF, BCR, and CXCR4 has been underlined. Bruton’s tyrosine kinase (BTK) is a fundamental signal transmitter of BCR and CXCR4 in HCL. Preclinical and recent clinical data showed an efficacy of ibrutinib, a BTK inhibitor (BTKi), in HCL and HCL-V. These promising results joined those of other emerging drugs like BRAF or MEK inhibitors and anti-CD22 immunotoxins. Plain Language Summary Bruton’s tyrosine kinase (BTK) inhibitors (BTKi) in hairy cell leukemia (HCL) and variant-type HCL The treatment of hairy cell leukemia (HCL) has changed significantly in recent years. In the first-line settings, treatment with purine analogs (PNAs) with or without anti-CD20 monoclonal antibodies remains the gold standard in 2022. In relapsed/refractory HCL, other drugs are needed: BRAF inhibitors: vemurafenib monotherapy with or without rituximab or dabrafenib in combination with trametinib, an MEK inhibitor (MEKi), as well as the anti-CD22 antibody drug conjugate moxetumomab pasudotox. There are arguments for the use of Bruton’s tyrosine kinase inhibitors (BTKi). Ibrutinib was recently tested in a multisite phase 2 study in 37 patients with either HCL (28 patients: 76%) or HCL-V (nine patients: 24%) including two who were previously untreated. Patients received single-agent ibrutinib at 420 mg daily (24 patients) or 840 mg daily (13 patients) until disease progression or unacceptable toxicity. The overall response rate (ORR) at 32 weeks was 24%, increasing to 36% at 48 weeks and reaching 54% at any time since starting ibrutinib. Seven patients achieved a complete response (CR) as the best response at any time on study, while 13 patients had a partial response (PR) and 10 patients had stable disease (SD). Interestingly, the response rate was not statistically different between HCL and HCL-V patients, suggesting that ibrutinib could be an option in both entities. The estimated 36-month progression-free survival (PFS) was 73% and the estimated 36-month overall survival (OS) was 85%, with no differences between HCL and HCL-V. The frequency of cardiovascular grade 1–2 adverse events (AEs) was 16% for atrial fibrillation; 3% for atrial flutter; 32% for hypertension; and 0%, 3%, and 11%, respectively, for grade ⩾ 3 AEs. Unlike in chronic lymphocytic leukemia (CLL), where the mechanism of action of ibrutinib is well known, the mechanism of action of ibrutinib in HCL appears to be unclear. No mutations were identified in patients with progressive disease, suggesting that the mechanisms of resistance could be different between HCL and CLL. The BTKi that are not yet approved are challenged by the new other targeted treatments.
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Affiliation(s)
| | - Firas Safa
- Service des Maladies du Sang, CHU d’Angers, Angers, France
| | - Xavier Troussard
- Laboratoire Hématologie, CHU de Caen Normandie, avenue de Côte de Nacre, 14033 Caen Cedex, France
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Troussard X, Maître E, Cornet E. Hairy cell leukemia 2022: Update on diagnosis, risk-stratification, and treatment. Am J Hematol 2022; 97:226-236. [PMID: 34710243 DOI: 10.1002/ajh.26390] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Abstract
DISEASE OVERVIEW Hairy cell leukemia (HCL) and HCL-like disorders, including HCL variant (HCL-V) and splenic diffuse red pulp lymphoma (SDRPL), are a very heterogeneous group of mature lymphoid B-cell disorders characterized by the identification of hairy cells, a specific genetic profile, a different clinical course, and the need for appropriate treatment. DIAGNOSIS Diagnosis of HCL is based on morphological evidence of hairy cells, an HCL immunologic score of 3 or 4 based on the CD11C, CD103, CD123, and CD25 expression, the trephine biopsy which makes it possible to specify the degree of tumoral medullary infiltration and the presence of BRAFV600E somatic mutation. RISK STRATIFICATION Progression of patients with HCL is based on a large splenomegaly, leukocytosis, a high number of hairy cells in the peripheral blood, and the immunoglobulin heavy chain variable region gene mutational status. VH4-34-positive HCL cases are associated with a poor prognosis. TREATMENT Patients should be treated only if HCL is symptomatic. Chemotherapy with risk adapted therapy purine analogs (PNAs) are indicated in first-line HCL patients. The use of chemo-immunotherapy combining PNAs and rituximab (R) represents an increasingly used therapeutic approach. Management of relapsed/refractory disease is based on the use of BRAF inhibitors (BRAFi) plus rituximab or MEK inhibitors (MEKi), recombinant immunoconjugates targeting CD22 or Bruton Tyrosine Kinase inhibitors (BTKi). However, the optimal sequence of the different treatments remains to be determined. The Bcl2-inhibitors (Bcl-2i) can play a major role in the future.
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Affiliation(s)
- Xavier Troussard
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
- Université Caen Normandie Caen Cedex France
| | - Elsa Maître
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
- Université Caen Normandie Caen Cedex France
| | - Edouard Cornet
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
- Université Caen Normandie Caen Cedex France
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Cabeçadas J, Nava VE, Ascensao JL, Gomes da Silva M. How to Diagnose and Treat CD5-Positive Lymphomas Involving the Spleen. Curr Oncol 2021; 28:4611-4633. [PMID: 34898558 PMCID: PMC8628806 DOI: 10.3390/curroncol28060390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
Patients with CD5-expressing lymphomas presenting with splenomegaly are frequently diagnosed with chronic lymphocytic leukemia. The most important differential diagnosis is mantle cell lymphoma, both in its classical and leukemic, non-nodal forms, given its prognostic and therapeutic implications. Other small B-cell neoplasms that frequently involve the spleen and occasionally express CD5 include the splenic marginal zone lymphoma, hairy cell leukemia and, rarely, lymphoplasmacytic lymphoma. The frequency of CD5 positivity depends in part on the sensitivity of the detection methods employed. Usually, a combination of morphological, immunophenotypic and molecular findings allows for a precise sub-classification of CD5-positive, low-grade B-cell lymphomas of the spleen. Some of these tumors may display a mixture of small and larger B cells, raising the possibility of more aggressive lymphomas, such as diffuse large B-cell lymphomas (DLBCL). Approximately 5-10% of DLBCL are CD5-positive and some may manifest as primary splenic lesions. When available, the morphology of DLBCL in the splenic tissue is distinctive and a leukemic picture is very rare. In conclusion, the appropriate morphological and clinical context assisted by flow cytometry panels and/or immunohistochemistry allows the differential diagnosis of CD5-positive, non-Hodgkin, B-cell lymphomas involving the spleen.
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Affiliation(s)
- José Cabeçadas
- Department of Pathology, Portuguese Institute of Oncology Lisbon, 1099-023 Lisboa, Portugal;
| | - Victor E. Nava
- Department of Pathology, The George Washington University, Washington, DC 20037, USA;
- Department of Pathology, Veterans Health Administration Medical Center, Washington, DC 20422, USA
| | - Joao L. Ascensao
- School of Medicine, The George Washington University, Washington, DC 20037, USA;
| | - Maria Gomes da Silva
- Department of Hematology, Portuguese Institute of Oncology Lisbon, 1099-023 Lisboa, Portugal
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Paillassa J, Troussard X. Patients with relapsed/refractory hairy-cell leukemia. Cancer Rep (Hoboken) 2021; 5:e1495. [PMID: 34250762 PMCID: PMC8955050 DOI: 10.1002/cnr2.1495] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/26/2021] [Accepted: 06/17/2021] [Indexed: 01/17/2023] Open
Abstract
Background Hairy cell leukemia (HCL) is a rare chronic B‐cell neoplasm with good long‐term prognosis. First and second‐line therapies include purine nucleoside analogues (PNAs) and rituximab, but until recently, limited alternative options were available for patients with two or more relapses. Aim The aim of this study is to describe our real‐life experience with HCL patients in third and fourth‐line therapies. Methods and Results Data from 49 HCL patients with two or more relapses, including 16 patients with three or more relapses, were collected from the French retrospective HCL cohort covering the period from 1980 until 2011. They were analyzed to assess hematological response, relapse free survival (RFS) and overall survival (OS) after third (L3) and fourth line (L4). The median age at diagnosis was 53 years. PNAs were the most frequently used treatments. As L3 therapy, 29 patients received PNAs (66%) and 15 (34%) other treatments (rituximab [11%] or interferon [7%] alone or in combination [16%]). The distribution of L4 treatments was similar. The overall hematological response rate (OHRR) after L3 was 97% (complete hematological response 86%) with a 40% five‐year cumulative incidence of relapse (CIR), a median RFS of 104 months, and a median OS of 235 months. After L4, the OHRR was 94% with a two‐year CIR of fourth relapse of 27%. Eleven secondary cancers (5‐year cumulative incidence of 12%) were diagnosed in 10 patients. Patients with ≥2 relapses experience frequent further relapses, with increasingly shorter time to next treatment as the number of treatment lines increases. Furthermore, treatment strategies are associated with substantial toxicities. Conclusion All these points lead to the need for novel treatments.
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Affiliation(s)
- Jérôme Paillassa
- Department of Hematology, Academic Hospital of Angers, Angers, France
| | - Xavier Troussard
- Laboratory of Hematology, Academic Hospital of Caen, Caen, France
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Siddiqui R, Sardar M, Shahzad M, Jose J, Selene I, Shah Z, Qureshi A, Shafqat M, Kashif R, Ahmad M, Mejia-Garcia A, Anwer F. Management of Relapsed Hairy Cell Leukemia: A Systematic Review of Novel Agents and Targeted Therapies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:659-666. [PMID: 34275772 DOI: 10.1016/j.clml.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hairy cell leukemia (HCL) responds well to purine analogs with an overall median relapse free survival of 11-16 years. Most patients can be retreated with the same or a different purine analog however a subset of patients will become resistant or develop cumulative toxicities. Novel agents such as Vemurafenib (BRAF kinase inhibitor), Bendamustine/Rituximab (BR), Moxetumomab pasudotox (anti CD-22 recombinant immunotoxin) and Ibrutinib have emerging roles in patients with relapsed HCL. METHODS Five databases (PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov) were searched using the following search terms: "hairy cell leukemia" or "leukemia, hairy cell" AND "relapse" or "recurrence". We included only prospective clinical trials with outcome data. RESULTS Vemurafenib monotherapy was evaluated in two separate arms of a phase 2 trial. In the US arm (n=24), the ORR was 100% (CR 42%; PR 58%). In the Italian arm (n=26), the ORR was 96% (CR 35%; PR 62%). In a phase 2 study (n=25), the combination of vemurafenib and rituximab showed CR of 100%. The combination of BR achieved an ORR of 100% whereas CR was 50% and 67% at a bendamustine dose of 70mg/m2 (n=6) and 90 mg/m2 (n=6) respectively. In a phase 3 trial, moxetumomab pasudotox (n=80) had an ORR of 75% (CR 41%). Single agent Ibrutinib (n=37) had an ORR of 54%. Therapies were generally well tolerated. CONCLUSION Novel agents have good efficacy in HCL in patients with multiple relapses.
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Affiliation(s)
- Raheel Siddiqui
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City Health and Hospitals/Queens, Jamaica, NY.
| | - Muhammad Sardar
- Department of Hematology and Oncology, Banner University Medical Center, Tucson, AZ
| | - Moazzam Shahzad
- Department of Internal Medicine, St Mary's Medical Center, Huntington, WV
| | - Jemin Jose
- Department of Internal Medicine, Carle Foundation Hospital, Champaign, IL
| | - Insija Selene
- Department of Internal Medicine, Central Michigan University, Saginaw, MI
| | - Zunaira Shah
- Department of Internal Medicine, Louis A Weiss Memorial Hospital, Chicago, IL
| | - Anum Qureshi
- Department of Internal Medicine, Greater Baltimore Medical Center, Towson, MD
| | - Madeeha Shafqat
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH
| | - Rimsha Kashif
- Midwestern University College of Osteopathic Medicine, Glendale, AZ
| | - Maheen Ahmad
- Department of Molecular, Cellular and Developmental Biology, University of California, Santa Barbara, CA
| | - Alex Mejia-Garcia
- Department of Hematology-Oncology, Cleveland Clinic- Taussig Cancer Center, Cleveland, OH
| | - Faiz Anwer
- Department of Hematology-Oncology, Cleveland Clinic- Taussig Cancer Center, Cleveland, OH
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16
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[Hairy cell leukemia: What are the best treatment options for relapsed or refractory patients?]. Bull Cancer 2021; 108:771-778. [PMID: 34023063 DOI: 10.1016/j.bulcan.2021.03.011] [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: 12/09/2020] [Revised: 02/04/2021] [Accepted: 03/20/2021] [Indexed: 11/20/2022]
Abstract
Hairy cell leukemia is a rare form of leukemia: three hundred new cases are diagnosed each year in France. The diagnosis is based on: (1) morphological examination of the blood and bone marrow smear, (2) analysis by flow cytometry of hairy cells, which express three or the four following markers: CD11c, CD25, CD103 and CD123, (3) identification of the BRAFV600E mutation, a true molecular marker of the disease. The management of treatment has evolved considerably in recent years. As of today, the purine analogues remain the standard treatment in the first line. Relapses are however observed in about 40% of cases. In the event of a first relapse, the preferred option is treatment with immunochemotherapy i.e. a combination of cladribine plus rituximab. Subsequent relapses are treated with moxetumomab pasudotox or BRAF inhibitors which provide indisputable benefits if third-line treatment is required. We will discuss in patients with relapsed/refractory hairy cell leukemia the needs for personalized medicine and the advantages and disadvantages of each treatment modality. The good prognosis for LT requires treatments that are not immunosuppressive, non-myelotoxic, and do not increase the risk of secondary cancers.
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Harrop S, Polliack A, Tam CS. Chronic lymphoproliferative disorders and secondary cancers in the era of purine analogues and beyond. Leuk Lymphoma 2020; 62:771-778. [PMID: 33222561 DOI: 10.1080/10428194.2020.1849682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The low grade chronic lymphoproliferative disorders include chronic lymphocytic leukemia, Waldenstroms macroglobulinemia, follicular lymphoma and hairy cell leukemia. Traditionally considered incurable, these disorders have been associated with a risk of haematological and solid organ malignancies secondary to both the underlying disease and the associated treatment. The introduction of purine analogues into treatment paradigms has seen increased rates of therapy related myelodysplasia reported and it remains unclear yet on the impact the targeted novel therapies play in the development of secondary cancers. We review the rates of secondary malignancy in the chronic lymphoproliferative disorders with a particular focus on the role of the purine analogues in the development of therapy related MDS.
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Affiliation(s)
- Sean Harrop
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Epworth Healthcare, Melbourne, Australia
| | - Aaron Polliack
- Department of Haematology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Constantine S Tam
- Peter MacCallum Cancer Centre, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
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Wiber M, Maitre E, Poncet JM, Duchenet V, Damaj G, Cornet E, Troussard X. A population-based study of hairy cell leukemia over a period of 20 years. Cancer Treat Res Commun 2020; 25:100236. [PMID: 33227559 DOI: 10.1016/j.ctarc.2020.100236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 10/25/2020] [Accepted: 11/04/2020] [Indexed: 06/11/2023]
Abstract
There are limited population-based studies of hairy cell leukemia (HCL), a rare chronic lymphoproliferative disorder of B-cells. We conducted a population-based study that included all patients diagnosed with HCL between 1996 and 2016 in Western Normandy. Recorded data focused on medical history, clinical presentation, biological results, treatment modalities in the first line and in relapsed/refractory patients and the occurrence of secondary malignancies. One hundred and twenty-three HCL patients were registered in the database. HCL represented 0.7% of all malignant hematological disorders and 3.0% of all leukemia. The overall age-standardized incidence ratio (SIR) was 0.39/100,000 inhabitants in men and 0.09/100,000 in women, and it remained stable over the 20-year period analyzed. One hundred and seven patients (88%) received first-line treatment, 33 patients (27%) received at least 2 lines of treatment and 14 patients (11%) received more than 2 lines. Cladribine used as first-line treatment induced a high hematological complete response (HCR) rate of 92%. The median overall survival (OS) was over 15 years, with 5-year and 10-year survival rates of 84% and 70.5%. No significant differences in OS were observed between men and women, between the calendar periods studied or between patients who received a single line treatment with IFN-α or PNA. The risk of relapse was higher with IFN-α treatment, requiring subsequent treatments in that patients. The time to next treatment (TTN) tends to be longer for PNAs compared to IFN-α even if difference is not significant. Secondary cancers were observed in 9/123 patients (7.3%) with solid tumors in 8 patients and hematological malignancy in one patient. Our data confirm in real life that single courses of cladribine administered to patients with HCL induce high response rates, the majority of which are HCR. Relapses seem less frequent than with IFN-α and the administration schedule is less restrictive for the patients. The emergence of chemo-immunotherapy and the development of effective new drugs such as recombinant immunotoxins and BRAF targeting will offer new possibilities in the management of HCL patients.
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Affiliation(s)
| | - Elsa Maitre
- Laboratoire d'Hématologie, CHU Caen, Caen, France; Normandie Université, INSERM U1245, Université de Caen, Caen, France
| | - Jean-Marc Poncet
- Registre régional des hémopathies malignes de l'ex Basse-Normandie, CHU Caen, Caen, France
| | - Virginie Duchenet
- Registre régional des hémopathies malignes de l'ex Basse-Normandie, CHU Caen, Caen, France
| | - Gandhi Damaj
- Laboratoire d'Hématologie, CHU Caen, Caen, France; Normandie Université, INSERM U1245, Université de Caen, Caen, France; Institut d'Hématologie de Basse-Normandie, CHU Caen, Caen, France
| | - Edouard Cornet
- Laboratoire d'Hématologie, CHU Caen, Caen, France; Normandie Université, INSERM U1245, Université de Caen, Caen, France; Registre régional des hémopathies malignes de l'ex Basse-Normandie, CHU Caen, Caen, France
| | - Xavier Troussard
- Laboratoire d'Hématologie, CHU Caen, Caen, France; Normandie Université, INSERM U1245, Université de Caen, Caen, France; Registre régional des hémopathies malignes de l'ex Basse-Normandie, CHU Caen, Caen, France; Institut d'Hématologie de Basse-Normandie, CHU Caen, Caen, France.
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Paillassa J, Cornet E, Noel S, Tomowiak C, Lepretre S, Vaudaux S, Dupuis J, Devidas A, Joly B, Petitdidier-Lionnet C, Haiat S, Mariette C, Thieblemont C, Decaudin D, Validire-Charpy P, Drenou B, Eisenmann JC, Uribe MO, Olivrie A, Touati M, Lambotte O, Hermine O, Karsenti JM, Feugier P, Vaillant W, Gutnecht J, Lippert E, Huysman F, Ghomari K, Boubaya M, Levy V, Riou J, Damaj G, Tanguy-Schmidt A, Hunault-Berger M, Troussard X. Analysis of a cohort of 279 patients with hairy-cell leukemia (HCL): 10 years of follow-up. Blood Cancer J 2020; 10:62. [PMID: 32461544 PMCID: PMC7253459 DOI: 10.1038/s41408-020-0328-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 11/12/2022] Open
Abstract
In total, 279 patients with hairy-cell leukemia (HCL) were analyzed, with a median follow-up of 10 years. Data were collected up to June 2018. We analyzed responses to treatment, relapses, survival, and the occurrence of second malignancies during follow-up. The median age was 59 years. In total, 208 patients (75%) were treated with purine analogs (PNAs), either cladribine (159) or pentosatin (49), as the first-line therapy. After a median follow-up of 127 months, the median overall survival was 27 years, and the median relapse-free survival (RFS) was 11 years. The cumulative 10-year relapse incidence was 39%. In patients receiving second-line therapy, the median RFS was 7 years. For the second-line therapy, using the same or another PNA was equivalent. We identified 68 second malignancies in 59 patients: 49 solid cancers and 19 hematological malignancies. The 10-year cumulative incidences of cancers, solid tumors, and hematological malignancies were 15%, 11%, and 5.0%, respectively, and the standardized incidence ratios were 2.22, 1.81, and 6.67, respectively. In multivariate analysis, PNA was not a risk factor for second malignancies. HCL patients have a good long-term prognosis. PNAs are the first-line treatment. HCL patients require long-term follow-up because of their relatively increased risk of second malignancies.
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Affiliation(s)
| | - Edouard Cornet
- Laboratoire d'Hematologie Biologique, CHU de Caen, Caen, France
| | - Stephanie Noel
- Service d'Oncologie Hematologique et Therapie Cellulaire, CHU de Poitiers, et CIC Inserm U1402, Poitiers, France
| | - Cecile Tomowiak
- Service d'Oncologie Hematologique et Therapie Cellulaire, CHU de Poitiers, et CIC Inserm U1402, Poitiers, France
| | - Stephane Lepretre
- Inserm U1245 et Service d'Hematologie, Centre Henri Becquerel et Normandie Univ UNIROUEN, Rouen, France
| | - Sandrine Vaudaux
- Inserm U1245 et Service d'Hematologie, Centre Henri Becquerel et Normandie Univ UNIROUEN, Rouen, France
| | - Jehan Dupuis
- Service d'Hematologie Clinique, CHU Henri Mondor, Assistance Publique des Hopitaux de Paris, Creteil, France
| | - Alain Devidas
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | - Bertrand Joly
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | | | - Stephanie Haiat
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | - Clara Mariette
- Service d'Hematologie, CHU de Grenoble, Grenoble, France
| | - Catherine Thieblemont
- Service Hemato-Oncologie, Hopital Saint Louis, Assistance Publique des Hopitaux de Paris, Paris, France
| | - Didier Decaudin
- Unite d'Investigation Clinique, Departement de Medecine Oncologique, Institut Curie, Paris, France
| | | | - Bernard Drenou
- Service d'Hematologie Clinique, Groupe Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Jean-Claude Eisenmann
- Service d'Hematologie Clinique, Groupe Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Mario Ojeda Uribe
- Service d'Hematologie Clinique, Groupe Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Agnès Olivrie
- Service d'Hematologie Clinique et Therapie Cellulaire, CHU de Limoges, Limoges, France
| | - Mohamed Touati
- Service d'Hematologie Clinique et Therapie Cellulaire, CHU de Limoges, Limoges, France
| | - Olivier Lambotte
- Service de Medecine Interne et Immunologie Clinique, Hopital Bicêtre, Assistance Publique des Hopitaux de Paris, Paris, France
| | - Olivier Hermine
- Service d'Hematologie Adulte, Hopital Necker-Enfants Malades, Assistance Publique des Hopitaux de Paris, Paris, France
| | | | | | - Willy Vaillant
- Service de Medecine Interne, Maladies Infectieuses, Oncologie et Hematologie, CH d'Auch, Auch, France
| | - Jean Gutnecht
- Service de Medecine Interne, CHI Frejus Saint Raphaël, Frejus, France
| | - Eric Lippert
- Laboratoire d'Hematologie Biologique, CHU de Brest, Brest, France
| | - Fabienne Huysman
- Service d'Hematologie Oncologie, CH de Beauvais, Beauvais, France
| | - Kamel Ghomari
- Service d'Hematologie Oncologie, CH de Beauvais, Beauvais, France
| | - Marouane Boubaya
- Unite de Recherche Clinique, Hopital Avicenne, Assistance Publique des Hopitaux de Paris, Bobigny, France
| | - Vincent Levy
- Unite de Recherche Clinique, Hopital Avicenne, Assistance Publique des Hopitaux de Paris, Bobigny, France
| | - Jeremie Riou
- MINT UMR INSERM 1066, CNRS 6021, Universite d'Angers, Angers, France
| | - Gandhi Damaj
- Institut d'Hematologie de Basse-Normandie, CHU de Caen, Caen, France
| | - Aline Tanguy-Schmidt
- Service des Maladies du Sang, CHU d'Angers, Angers, France
- Federation Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), Angers, France
- UFR Sante, Universite d'Angers, Angers, France
- CRCINA, INSERM, Universite de Nantes, Universite d'Angers, Angers, France
| | - Mathilde Hunault-Berger
- Service des Maladies du Sang, CHU d'Angers, Angers, France
- Federation Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), Angers, France
- UFR Sante, Universite d'Angers, Angers, France
- CRCINA, INSERM, Universite de Nantes, Universite d'Angers, Angers, France
| | - Xavier Troussard
- Laboratoire d'Hematologie Biologique, CHU de Caen, Caen, France.
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Abstract
OPINION STATEMENT Despite its rarity, hairy cell leukemia (HCL) remains a fascinating disease and the physiopathology is becoming more and more understood. The accurate diagnosis of HCL relies on the recognition of hairy cells by morphology and flow cytometry (FCM) in the blood and/or bone marrow (BM). The BRAF V600E mutation, an HCL-defining mutation, represents a novel diagnostic parameter and a potential therapeutic target. The precise cellular origin of HCL is a late-activated postgerminal center memory B cell. BRAF mutations were detected in hematopoietic stem cells (HSCs) of patients with HCL, suggesting that this is an early HCL-defining event. Watch-and-wait strategy is necessary in approximately 10% of asymptomatic HCL patients, sometimes for several years. Purine analogs (PNAs) are the established first-line options for symptomatic HCL patients. In second-line treatment, chemoimmunotherapy combining PNA plus rituximab should be considered in high-risk HCL patients. The three options for relapsed/refractory HCL patients include recombinant immunoconjugates targeting CD22, BRAF inhibitors, and BCR inhibitors. The clinical interest to investigate blood minimal residual disease (MRD) was recently demonstrated, with a high risk of relapse in patients with positive testing for MRD and a low risk in patients with negative testing. However, efforts must be made to standardize MRD analyses in the near future. Patients with HCL are at risk of second malignancies. The increased risk could be related to the disease and/or the treatment, and the respective role of PNAs in the development of secondary malignancies remains a topic of debate.
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Affiliation(s)
- Jérôme Paillassa
- Department of Hematology, Academic Hospital of Angers, Angers, Pays de la Loire, France
| | - Xavier Troussard
- Laboratory of Hematology, Academic Hospital of Caen, Caen, Normandy, France.
- Laboratoire d'Hématologie Biologique, CHU de Caen, Avenue de la Côte de Nacre, 14 033, Caen Cedex, France.
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21
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Abstract
PURPOSE OF REVIEW To summarise diagnostic clinical/laboratory findings and highlight differences between classical hairy cell leukaemia (HCLc) and hairy cell leukaemia variant (HCLv). Discussion of prognosis and current treatment indications including novel therapies, linked to understanding of the underlying molecular pathogenesis. RECENT FINDINGS Improved understanding of the underlying pathogenesis of HCLc, particularly the causative mutation BRAF V600E, leading to constitutive activation of the MEK/ERK signalling pathway and increased cell proliferation. HCLc is caused by BRAF V600E mutation in most cases. Purine nucleoside analogue (PNA) therapy is the mainstay of treatment, with the addition of rituximab, improving response and minimal residual disease (MRD) clearance. Despite excellent responses to PNAs, many patients will eventually relapse, requiring further therapy. Rarely, patients are refractory to PNA therapy. In relapsed/refractory patients, novel targeted therapies include BRAF inhibitors (BRAFi), anti-CD22 immunoconjugate moxetumomab and Bruton tyrosine kinase inhibitors (BTKi). HCLv has a worse prognosis with median overall survival (OS), only 7-9 years, despite the combination of PNA/rituximab improving front-line response. Moxetumomab or ibrutinib may be a viable treatment but lacks substantial evidence.
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Affiliation(s)
- Matthew Cross
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK
| | - Claire Dearden
- The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, UK.
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22
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Melamed E, Lee MW. Multiple Sclerosis and Cancer: The Ying-Yang Effect of Disease Modifying Therapies. Front Immunol 2020; 10:2954. [PMID: 31998289 PMCID: PMC6965059 DOI: 10.3389/fimmu.2019.02954] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/02/2019] [Indexed: 12/17/2022] Open
Abstract
Over the past two decades, the field of multiple sclerosis (MS) has been transformed by the rapidly expanding arsenal of new disease modifying therapies (DMTs). Current DMTs for MS aim to modulate innate and adaptive immune responses toward a less inflammatory phenotype. Since the immune system is also critical for identifying and eliminating malignant cells, immunosuppression from DMTs may predictably increase the risk of cancer development in MS patients. Compared with healthy controls, patients with autoimmune conditions, such as MS, may already have a higher risk of developing certain malignancies and this risk may further be magnified by DMT treatments. For those patients who develop both MS and cancer, these comorbid presentations create a challenge for clinicians on how to therapeutically address management of cancer in the context of MS autoimmunity. As there are currently no accepted guidelines for managing MS patients with prior history of or newly developed malignancy, we undertook this review to evaluate the molecular mechanisms of current DMTs and their potential for instigating and treating cancer in patients living with MS.
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Affiliation(s)
- Esther Melamed
- Department of Neurology, Dell Medical School, Austin, TX, United States
| | - Michael William Lee
- Department of Oncology, Department of Medical Education, Dell Medical School, Austin, TX, United States
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Maitre E, Cornet E, Troussard X. Hairy cell leukemia: 2020 update on diagnosis, risk stratification, and treatment. Am J Hematol 2019; 94:1413-1422. [PMID: 31591741 DOI: 10.1002/ajh.25653] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Abstract
DISEASE OVERVIEW Hairy cell leukemia (HCL) and HCL-like disorders, including HCL variant (HCL-V) and splenic diffuse red pulp lymphoma (SDRPL), are a very heterogeneous group of mature lymphoid B-cell disorders. They are characterized by the identification of hairy cells, a specific genetic profile, a different clinical course and the need for appropriate treatment. DIAGNOSIS Diagnosis of HCL is based on morphological evidence of hairy cells, an HCL immunologic score of three or four based on the CD11C, CD103, CD123, and CD25 expression. Also, the trephine biopsy which makes it possible to specify the degree of tumoral medullary infiltration and the presence of BRAF V600E somatic mutation. RISK STRATIFICATION Progression of patients with HCL is based on a large splenomegaly, leukocytosis, a high number of hairy cells in the peripheral blood and the immunoglobulin heavy chain variable region gene mutational status. The VH4-34 positive HCL cases are associated with poor prognosis. TREATMENT Risk adapted therapy with purine nucleoside analogs (PNA) are indicated in symptomatic first line HCL patients. The use of PNA followed by rituximab represents an alternative option. Management of progressive or refractory disease is based on the use of BRAF inhibitors associated or not with MEK inhibitors, recombinant immunoconjugates targeting CD22 or BCR inhibitors.
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Affiliation(s)
- Elsa Maitre
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
| | - Edouard Cornet
- Laboratoire Hématologie CHU Côte de Nacre Caen Cedex France
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24
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Maitre E, Wiber M, Cornet E, Troussard X. [Hairy cell leukemia]. Presse Med 2019; 48:842-849. [PMID: 31447330 DOI: 10.1016/j.lpm.2019.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022] Open
Abstract
Hairy cell leukemia (HCL) is a well-defined entity. Proliferation with hair cells, morphological aspects of hairy cells are easy to identify. Hairy cells express markers CD11c, CD25, CD103 and CD123. In 80% of cases, a BRAFV600E mutation is highlighted. In the absence of a BRAFV600E mutation, the differential diagnosis with other hair cell proliferations can be difficult, especially with the variant form of hairy leukemia, diffuse lymphoma of the red pulp of the spleen or splenic lymphoma of the marginal zone. Purine analogues (PNA) with or without anti-CD20 antibodies remain the first-line reference treatment. In case of relapse or resistance to PNA, BRAF inhibitors, with or without MEK inhibitors, are proposed in patients with the mutation. In the absence of BRAFV600E mutation, moxetumomab-pasudotox represents an interesting alternative. A multidisciplinary discussion is always necessary. In complex cases, expert advice is desirable.
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Affiliation(s)
- Elsa Maitre
- CHU de Caen, laboratoire d'hématologie, 14000 Caen, France
| | - Margaux Wiber
- CHU de Caen, laboratoire d'hématologie, 14000 Caen, France
| | - Edouard Cornet
- CHU de Caen, laboratoire d'hématologie, 14000 Caen, France
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25
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Abou Dalle I, Ravandi F. Moxetumomab pasudotox for the treatment of relapsed and/or refractory hairy cell leukemia. Expert Rev Hematol 2019; 12:707-714. [PMID: 31298972 DOI: 10.1080/17474086.2019.1643231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Hairy cell leukemia is a rare indolent B-cell malignancy, characterized by pancytopenia, recurrent infections, and splenomegaly. After initial therapy with purine nucleoside analogs, up to 50% of patients relapse after several years of remission. The number of relapsed patients is increasing and, until recently, there was no approved therapy with durable responses for hairy cell leukemia patients in the relapsed setting, thus the need for new non-chemotherapy approach with significant efficacy and less myelosuppression. Areas covered: Moxetumomab pasudotox is a recombinant immunotoxin containing a Fv fragment of an anti-CD22 monoclonal antibody and truncated Pseudomonas exotoxin (PE38). The authors reviewed pre-clinical and clinical studies that led to the FDA approval of the drug in patients with relapsed and/or refractory hairy cell leukemia, who received at least two prior therapies, including at least one purine nucleoside analog. Expert opinion: Moxetumomab pasudotox demonstrated a durable complete remission rate of 30% in heavily pretreated patients with hairy cell leukemia, and MRD eradication in 85% of responding patients. Moxetumomab pasudotox got a global FDA approval in September 2018. The US prescribing information carries boxed warnings regarding the risk of capillary leak syndrome and hemolytic uremic syndrome. Long-term follow-up of the pivotal study is ongoing (NCT01829711).
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Affiliation(s)
- Iman Abou Dalle
- Department of leukemia, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Farhad Ravandi
- Department of leukemia, The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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26
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da Silva WF, Neto AC, da Rosa LI, de Siqueira IA, Amarante GD, Velloso EDRP, Rego EM, Rocha V, Buccheri V. Outcomes and second neoplasms in hairy cell leukemia: A retrospective cohort. Leuk Res 2019; 83:106165. [PMID: 31200147 DOI: 10.1016/j.leukres.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022]
Abstract
Hairy cell leukemia (HCL) is a rare chronic B-cell lymphoproliferative disease which is treated on the basis of small studies, making the literature still scarce of reports, especially of those conducted in Latin America. Here we intend to describe clinical characteristics, rates of response, survival and second neoplasms in HCL patients treated in a reference center in Brazil. All patients diagnosed with HCL between July/1987 and Jun/2018 were included in this analysis. Fifty-four patients were included in this analysis. Median age at diagnosis was 55 years (range, 26-88), with 37% being above 60 years-old. Most patients were treated with cladribine in our cohort (n = 36; 68%), administered through intravenous continuous infusion. Remaining patients were firstly managed with splenectomy (n = 7; 13%), IFN (n = 6; 11%) and rituximab (n = 2; 4%). In a univariate analysis, platelet count and B2M level at diagnosis were statistically associated with CR achievement (p = 0.004 and p = 0.024, respectively). A median follow-up time of 9 years was calculated. Estimated 10-year overall survival was 91.1% (95% confidence interval, 77-97). In this cohort, 10 patients had any second neoplasm, diagnosed before or after HCL. Regarding the sites of cancer, 69% were of skin - 8/16 carcinoma-type and 3/16 melanoma-type. Our response and survival data are similar to those reported by literature, which reaffirms the role of purine analogs in current HCL management. With a very long follow-up we also have observed a high incidence of second neoplasm.
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Affiliation(s)
- Wellington F da Silva
- Institute of Cancer of São Paulo (ICESP), University of São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, CEP 01246-000, Brazil.
| | - Abel Costa Neto
- Institute of Cancer of São Paulo (ICESP), University of São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, CEP 01246-000, Brazil
| | - Lidiane Inês da Rosa
- Institute of Cancer of São Paulo (ICESP), University of São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, CEP 01246-000, Brazil
| | - Isabela Assis de Siqueira
- Institute of Cancer of São Paulo (ICESP), University of São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, CEP 01246-000, Brazil
| | - Guilherme Duffles Amarante
- Institute of Cancer of São Paulo (ICESP), University of São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, CEP 01246-000, Brazil
| | - Elvira D R P Velloso
- Institute of Cancer of São Paulo (ICESP), University of São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, CEP 01246-000, Brazil; Hospital das Clinicas, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155, São Paulo, SP, CEP 05403-000, Brazil
| | - Eduardo Magalhães Rego
- Institute of Cancer of São Paulo (ICESP), University of São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, CEP 01246-000, Brazil; Hospital das Clinicas, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155, São Paulo, SP, CEP 05403-000, Brazil
| | - Vanderson Rocha
- Institute of Cancer of São Paulo (ICESP), University of São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, CEP 01246-000, Brazil; Hospital das Clinicas, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155, São Paulo, SP, CEP 05403-000, Brazil; Churchil Hospital, Oxford University Hospital, NHSBT, Oxford, UK
| | - Valeria Buccheri
- Institute of Cancer of São Paulo (ICESP), University of São Paulo, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, SP, CEP 01246-000, Brazil; Hospital das Clinicas, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 155, São Paulo, SP, CEP 05403-000, Brazil
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27
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Zheng G, Chattopadhyay S, Sud A, Sundquist K, Sundquist J, Försti A, Houlston RS, Hemminki A, Hemminki K. Types of second primary cancers influence survival in chronic lymphocytic and hairy cell leukemia patients. Blood Cancer J 2019; 9:40. [PMID: 30914634 PMCID: PMC6435725 DOI: 10.1038/s41408-019-0201-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 02/08/2023] Open
Affiliation(s)
- Guoqiao Zheng
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.,Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Subhayan Chattopadhyay
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.,Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Amit Sud
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.,Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.,Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
| | - Richard S Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany. .,Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden.
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28
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King AC, Kabel CC, Pappacena JJ, Stump SE, Daley RJ. No Loose Ends: A Review of the Pharmacotherapy of Hairy Cell and Hairy Cell Leukemia Variant. Ann Pharmacother 2019; 53:922-932. [PMID: 30841702 DOI: 10.1177/1060028019836775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To review the literature for the treatment of classical and variant hairy cell leukemia (HCL, HCLv), evaluating efficacy, safety, and supportive care involved in the use of purine analogues (PAs), interferon, BRAF inhibitors, monoclonal antibodies, Bruton's tyrosine kinase inhibitors, and new immunotoxin, moxetumomab pasudotox-tdfk (MPT). An electronic literature search of PubMed (January 1958 to January 2019) was conducted in PubMed using the MESH terms hairy cell leukemia, hairy cell leukemia variant, cladribine, pentostatin, rituximab, interferon, vemurafenib, moxetumomab pasudotox. Study Selection and Data Extraction: Studies written in the English language were considered for this article. The significance of each article was determined by authors independently. Data Synthesis: HCL and HCLv are rare B-cell lymphoproliferative disorders, each with distinct biologies. Symptoms are characterized by pancytopenia and splenomegaly. Initial treatments for HCL were suboptimal, leading to minimal and transient remissions. PAs significantly improved outcomes, inducing remission in most patients. However, those with purine-resistant disease were left with a dearth of options, leading to implementation of vemurafenib for BRAF V600 mutated disease and chemoimmunotherapy with rituximab. Despite these advances, some HCL and a majority of HCLv patients experience relapse. Newer targeted agents offer promise for relapsed and refractory patients, including the recently approved MPT. Relevance to Patient Care and Clinical Practice: This review provides a comprehensive update on the pharmacological management of HCL and HCLv for clinicians who encounter patients with this rare disease. Conclusion: HCL and HCLv are uncommon lymphoid neoplasms that lead to a characteristic constellation of symptoms. The emergence of PAs and novel targeted agents have improved the likelihood and durability of responses for these patients.
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Affiliation(s)
- Amber C King
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Sarah E Stump
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryan J Daley
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
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29
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Zheng G, Chattopadhyay S, Sud A, Sundquist K, Sundquist J, Försti A, Houlston R, Hemminki A, Hemminki K. Second primary cancers in patients with acute lymphoblastic, chronic lymphocytic and hairy cell leukaemia. Br J Haematol 2019; 185:232-239. [DOI: 10.1111/bjh.15777] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/12/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Guoqiao Zheng
- Division of Molecular Genetic Epidemiology German Cancer Research Centre (DKFZ) Heidelberg Germany
- Faculty of Medicine University of Heidelberg Heidelberg Germany
| | - Subhayan Chattopadhyay
- Division of Molecular Genetic Epidemiology German Cancer Research Centre (DKFZ) Heidelberg Germany
- Faculty of Medicine University of Heidelberg Heidelberg Germany
| | - Amit Sud
- Division of Molecular Genetic Epidemiology German Cancer Research Centre (DKFZ) Heidelberg Germany
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
| | - Kristina Sundquist
- Centre for Primary Health Care Research Lund University Malmö Sweden
- Department of Family Medicine and Community Health Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York NY USA
- Centre for Community‐based Healthcare Research and Education (CoHRE) Department of Functional Pathology School of Medicine Shimane University Matsue Japan
| | - Jan Sundquist
- Centre for Primary Health Care Research Lund University Malmö Sweden
- Department of Family Medicine and Community Health Department of Population Health Science and Policy Icahn School of Medicine at Mount Sinai New York NY USA
- Centre for Community‐based Healthcare Research and Education (CoHRE) Department of Functional Pathology School of Medicine Shimane University Matsue Japan
| | - Asta Försti
- Division of Molecular Genetic Epidemiology German Cancer Research Centre (DKFZ) Heidelberg Germany
- Centre for Primary Health Care Research Lund University Malmö Sweden
| | - Richard Houlston
- Division of Genetics and Epidemiology The Institute of Cancer Research London UK
- Division of Molecular Pathology The Institute of Cancer Research London UK
| | - Akseli Hemminki
- Cancer Gene Therapy Group Faculty of Medicine University of Helsinki Helsinki Finland
- Comprehensive Cancer Centre Helsinki University Hospital Helsinki Finland
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology German Cancer Research Centre (DKFZ) Heidelberg Germany
- Centre for Primary Health Care Research Lund University Malmö Sweden
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30
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Concurrent Hairy Cell Leukemia and Metastatic Merkel Cell Carcinoma. Case Rep Oncol Med 2018; 2018:1736854. [PMID: 30538875 PMCID: PMC6261234 DOI: 10.1155/2018/1736854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022] Open
Abstract
Hairy cell leukemia (HCL) and Merkel cell carcinoma (MCC) are two rare malignancies with distinct cells of origin. HCL is a lymphoid malignancy of mature B cells, and MCC derives from neuroendocrine cell origin. HCL has a favorable prognosis with most patients achieving long-term remission and potential cure. In contrast, MCC is an aggressive malignancy affecting the skin and can metastasize quickly with a dismal prognosis. Immunocompromised patients, such as those with AIDS, posttransplant, and the elderly, have higher incidences than the general population, suggesting a possible immune mechanism. We report a case where a patient presented with HCL and metastatic MCC synchronously. This is the first reported case of these two rare malignancies occurring concurrently at initial presentation and may represent a role of immunosuppression in the pathogenesis of MCC.
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31
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Roider T, Falini B, Dietrich S. Recent advances in understanding and managing hairy cell leukemia. F1000Res 2018; 7:F1000 Faculty Rev-509. [PMID: 29770206 PMCID: PMC5931274 DOI: 10.12688/f1000research.13265.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/15/2023] Open
Abstract
Hairy cell leukemia is a rare B-cell malignancy that is characterized by an indolent course. It was initially described as a distinct entity in 1958. Before the establishment of modern treatment, median survival was only 4 years. Since then, major advances in the treatment and understanding of the biology and genomic landscape of hairy cell leukemia have been made. This review summarizes the present understanding of hairy cell leukemia with particular focus on the development of novel and targeted approaches to treatment.
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Affiliation(s)
- Tobias Roider
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Brunangelo Falini
- Institute of Hematology and Center for Hemato-Oncology Research (CREO), University and Hospital of Perugia, Perugia, Italy
| | - Sascha Dietrich
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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32
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Relative survival reaches a plateau in hairy cell leukemia: a population-based analysis in The Netherlands. Blood 2018; 131:1380-1383. [PMID: 29382643 DOI: 10.1182/blood-2017-12-820381] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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33
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Troussard X, Cornet E. Hairy cell leukemia 2018: Update on diagnosis, risk-stratification, and treatment. Am J Hematol 2017; 92:1382-1390. [PMID: 29110361 PMCID: PMC5698705 DOI: 10.1002/ajh.24936] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 01/15/2023]
Abstract
Disease overview Hairy cell leukemia (HCL) and HCL‐like disorders, including HCL variant (HCL‐V) and splenic diffuse red pulp lymphoma (SDRPL), are a very heterogeneous group of mature lymphoid B‐cell disorders, characterized by the identification of hairy cells, a specific genetic profile, a different clinical course and the need for appropriate treatment. Diagnosis Diagnosis of HCL is based on morphological evidence of hairy cells, an HCL immunologic score of 3 or 4 based on the CD11C, CD103, CD123, and CD25 expression, the trephine biopsy which makes it possible to specify the degree of tumoral medullary infiltration and the presence of BRAF V600E somatic mutation. Risk stratification Progression of patients with HCL is based on a large splenomegaly, leukocytosis, a high number of hairy cells in the peripheral blood and the immunoglobulin heavy chain variable region gene mutational status. VH4‐34 positive HCL cases are associated with poor prognosis Risk adapted therapy Purine analogs (PNA) are indicated in symptomatic first line HCL patients. The use of PNA followed by rituximab represents an alternative option. Management of progressive or refractory disease It is based on the use of BRAF inhibitors associated or not with MEK inhibitors, recombinant immunoconjugates targeting CD22 or BCR inhibitors.
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Affiliation(s)
| | - Edouard Cornet
- Laboratoire Hématologie, CHU Caen, 14 033; Caen Cedex France
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34
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Mature lymphoid malignancies: origin, stem cells, and chronicity. Blood Adv 2017; 1:2444-2455. [PMID: 29296894 DOI: 10.1182/bloodadvances.2017008854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/10/2017] [Indexed: 12/15/2022] Open
Abstract
The chronic behavior of mature lymphoid malignancies, with relapses occurring years apart in many patients, has until recently been unexplained. Patterns of relapse also differ vastly between disease entities, with some being highly curable by chemotherapy whereas others are destined to reemerge after treatment. Lately, the use of next-generation sequencing techniques has revealed essential information on the clonal evolution of lymphoid malignancies. Also, experimental xenograft transplantation point to the possible existence of an ancestral (stem) cell. Such a malignant lymphoid stem cell population could potentially evade current therapies and be the cause of chronicity and death in lymphoma patients; however, the evidence is divergent across disease entities and between studies. In this review we present an overview of genetic studies, case reports, and experimental evidence of the source of mature lymphoid malignancy and discuss the perspectives.
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35
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Ronez E, Geara C, Coito S, Jacqmin H, Cornet E, Troussard X, Chatelain B, Mullier F. Usefulness of thresholds for smear review of neutropenic samples analyzed with a Sysmex XN-10 analyzer. Scand J Clin Lab Invest 2017; 77:406-409. [DOI: 10.1080/00365513.2017.1334129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emily Ronez
- Haematology Immunology and Transfusion Laboratory, University Hospital Ambroise Paré, Assistance Publique – Hôpitaux de Paris, Boulogne Billancourt, France
| | - Carole Geara
- Haematology Laboratory, University hospital CAEN, Caen, France
| | | | - Hugues Jacqmin
- Université catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Haemostasis Centre (NTHC), Namur Research Institute for Life Sciences (NARILIS), Namu, Belgium
| | - Edouard Cornet
- Haematology Laboratory, University hospital CAEN, Caen, France
| | | | - Bernard Chatelain
- Université catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Haemostasis Centre (NTHC), Namur Research Institute for Life Sciences (NARILIS), Namu, Belgium
| | - François Mullier
- Université catholique de Louvain, CHU UCL Namur, Hematology Laboratory, Namur Thrombosis and Haemostasis Centre (NTHC), Namur Research Institute for Life Sciences (NARILIS), Namu, Belgium
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36
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Divino V, Karve S, Gaughan A, DeKoven M, Gao G, Knopf KB, Lanasa MC. Characteristics and treatment patterns among US patients with hairy cell leukemia: a retrospective claims analysis. J Comp Eff Res 2017; 6:497-508. [PMID: 28485619 DOI: 10.2217/cer-2017-0014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Describe hairy cell leukemia (HCL) treatment patterns using a large, nationally representative US database. PATIENTS & METHODS Adults newly diagnosed with HCL (1 January 2006 to 30 June 2014) with continuous health plan enrollment ≥180 days pre- and 90 days post-diagnosis were identified from the QuintilesIMS PharMetrics Plus Health Plan Claims Database. Treatment patterns by line of therapy were assessed over the variable follow-up. RESULTS Among 749 HCL patients (77.4% male; mean age 55.6; mean 32.3 months follow-up), only 37.7% initiated first-line therapy during the available follow-up in a mean of 4.4 months following diagnosis; the majority (75.5%) received cladribine (mean duration 7.3 days). Thirty-eight patients (5.1%) received second-line treatment. CONCLUSION Over 2.7 years follow-up, more than a third of patients initiated first-line therapy which appeared to provide a long-lasting response.
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Affiliation(s)
| | | | | | | | | | | | - Mark C Lanasa
- Clinical Development, Oncology, MedImmune, Gaithersburg, MD 20878, USA
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Tessoulin B, Eveillard M, Lok A, Chiron D, Moreau P, Amiot M, Moreau-Aubry A, Le Gouill S, Pellat-Deceunynck C. p53 dysregulation in B-cell malignancies: More than a single gene in the pathway to hell. Blood Rev 2017; 31:251-259. [PMID: 28284458 DOI: 10.1016/j.blre.2017.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/02/2017] [Indexed: 12/31/2022]
Abstract
TP53 deletion or mutation is frequent in B-cell malignancies and is associated with a low response rate. We describe here the p53 landscape in B-cell malignancies, from B-Acute Lymphoblastic Leukemia to Plasma Cell Leukemia, by analyzing incidence of gain or loss of function of actors both upstream and within the p53 pathway, namely MYC, RAS, ARF, MDM2, ATM and TP53. Abnormalities are not equally distributed and their incidence is highly variable among malignancies. Deletion and mutation, usually associated, of ATM or TP53 are frequent in Diffuse Large B-Cell Lymphoma and Mantle Cell Lymphoma. MYC gain, absent in post-GC malignancies, is frequent in B-Prolymphocytic-Leukemia, Multiple Myeloma and Plasma Cell Leukemias. RAS mutations are rare except in MM and PCL. Multiple Factorial Analysis notes that MYC deregulation is closely related to TP53 status. Moreover, MYC gain, TP53 deletion and RAS mutations are inversely correlated with survival. Based on this landscape, we further propose targeted therapeutic approaches for the different B-cell malignancies.
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Affiliation(s)
- B Tessoulin
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Department of Hematology, Nantes University Hospital, Nantes, France.
| | - M Eveillard
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Hematology Biology Department, Nantes University Hospital, Nantes, France
| | - A Lok
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Department of Hematology, Nantes University Hospital, Nantes, France
| | - D Chiron
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France
| | - P Moreau
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Department of Hematology, Nantes University Hospital, Nantes, France
| | - M Amiot
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France
| | - A Moreau-Aubry
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France
| | - S Le Gouill
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France; Department of Hematology, Nantes University Hospital, Nantes, France
| | - C Pellat-Deceunynck
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Nantes, France.
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Grever MR, Abdel-Wahab O, Andritsos LA, Banerji V, Barrientos J, Blachly JS, Call TG, Catovsky D, Dearden C, Demeter J, Else M, Forconi F, Gozzetti A, Ho AD, Johnston JB, Jones J, Juliusson G, Kraut E, Kreitman RJ, Larratt L, Lauria F, Lozanski G, Montserrat E, Parikh SA, Park JH, Polliack A, Quest GR, Rai KR, Ravandi F, Robak T, Saven A, Seymour JF, Tadmor T, Tallman MS, Tam C, Tiacci E, Troussard X, Zent CS, Zenz T, Zinzani PL, Falini B. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood 2017; 129:553-560. [PMID: 27903528 PMCID: PMC5290982 DOI: 10.1182/blood-2016-01-689422] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 11/06/2016] [Indexed: 12/20/2022] Open
Abstract
Hairy cell leukemia is an uncommon hematologic malignancy characterized by pancytopenia and marked susceptibility to infection. Tremendous progress in the management of patients with this disease has resulted in high response rates and improved survival, yet relapse and an appropriate approach to re-treatment present continuing areas for research. The disease and its effective treatment are associated with immunosuppression. Because more patients are being treated with alternative programs, comparison of results will require general agreement on definitions of response, relapse, and methods of determining minimal residual disease. The development of internationally accepted, reproducible criteria is of paramount importance in evaluating and comparing clinical trials to provide optimal care. Despite the success achieved in managing these patients, continued participation in available clinical trials in the first-line and particularly in the relapse setting is highly recommended. The Hairy Cell Leukemia Foundation convened an international conference to provide common definitions and structure to guide current management. There is substantial opportunity for continued research in this disease. In addition to the importance of optimizing the prevention and management of the serious risk of infection, organized evaluations of minimal residual disease and treatment at relapse offer ample opportunities for clinical research. Finally, a scholarly evaluation of quality of life in the increasing number of survivors of this now manageable chronic illness merits further study. The development of consensus guidelines for this disease offers a framework for continued enhancement of the outcome for patients.
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Affiliation(s)
- Michael R Grever
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Omar Abdel-Wahab
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leslie A Andritsos
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Versha Banerji
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jacqueline Barrientos
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - James S Blachly
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | | | - Daniel Catovsky
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Claire Dearden
- Department of Haemato-Oncology, Royal Marsden Biomedical Research Centre, London, United Kingdom
| | - Judit Demeter
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Francesco Forconi
- Haematology Department, University Hospital Trust and Cancer Sciences Unit, Cancer Research UK and National Institute for Health Research Experimental Cancer Medicine Centres, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | - Anthony D Ho
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - James B Johnston
- Section of Hematology/Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Jeffrey Jones
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Gunnar Juliusson
- Department of Hematology, Skåne University Hospital and Stem Cell Center, Lund University, Lund, Sweden
| | - Eric Kraut
- Division of Hematology, Department of Internal Medicine, The Ohio State University James Cancer Hospital, Columbus, OH
| | - Robert J Kreitman
- Laboratory of Molecular Biology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Loree Larratt
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Francesco Lauria
- Hematology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gerard Lozanski
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Emili Montserrat
- Department of Hematology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Jae H Park
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Aaron Polliack
- Department of Hematology, Hadassah University Hospital and Hebrew University Medical School, Jerusalem, Israel
| | - Graeme R Quest
- Department of Laboratory Medicine and Pathology, University Health Network, Toronto, ON, Canada
| | - Kanti R Rai
- Department of Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, Hofstra University, Hempstead, NY
| | - Farhad Ravandi
- Section of Developmental Therapeutics, Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - Alan Saven
- Division of Hematology and Oncology, Scripps Clinic, La Jolla, CA
| | - John F Seymour
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Tamar Tadmor
- Hematology Unit, Bnai-Zion Medical Center, and the Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Martin S Tallman
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Constantine Tam
- Haematology Department, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Enrico Tiacci
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
| | - Xavier Troussard
- Department of Hematology, Centre Hospitalier Universitaire Côte de Nacre, Caen, France
| | - Clive S Zent
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Thorsten Zenz
- Department of Molecular Therapy in Hematology and Oncology, National Center for Tumor Diseases and German Cancer Research Center (DKFZ), Heidelberg, Germany; and
| | - Pier Luigi Zinzani
- Institute of Hematology "Seràgnoli," University of Bologna, Bologna, Italy
| | - Brunangelo Falini
- Institute of Hematology, Department of Medicine, University and Hospital of Perugia, Perugia, Italy
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Chihara D, Kantarjian H, O'Brien S, Jorgensen J, Pierce S, Faderl S, Ferrajoli A, Poku R, Jain P, Thompson P, Brandt M, Luthra R, Burger J, Keating M, Ravandi F. Long-term durable remission by cladribine followed by rituximab in patients with hairy cell leukaemia: update of a phase II trial. Br J Haematol 2016; 174:760-6. [PMID: 27301277 DOI: 10.1111/bjh.14129] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/09/2016] [Indexed: 11/29/2022]
Abstract
Nucleoside analogues are highly active in patients with hairy cell leukaemia (HCL); however, patients continue to relapse. This phase II study evaluated the efficacy and safety of cladribine followed by rituximab in patients with untreated HCL (N = 59), relapsed HCL (N = 14) and HCL variant (HCLv, N = 7). Cladribine 5·6 mg/m(2) was given intravenously (IV) daily for 5 d and was followed approximately 1 month later with rituximab 375 mg/m(2) IV weekly for 8 weeks. Complete response rate in patients with untreated HCL, relapsed HCL and HCLv was 100%, 100% and 86%, respectively. With a median follow up of 60 months, 5-year failure-free survival (FFS) in patients with untreated HCL, relapsed HCL and HCLv was 95%, 100% and 64%, respectively. Median duration of response to the cladribine followed by rituximab was significantly longer than the first-line cladribine single agent in patients who received this treatment as second-line treatment (72 months vs not reached, P = 0·004). Almost all patients (94%) achieved negative minimal residual disease (MRD) after the treatment. Positive MRD during the follow up did not necessarily result in clinically relevant relapse. Cladribine followed by rituximab is highly effective even in patients with relapsed disease and HCLv, and can achieve durable remission.
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Affiliation(s)
- Dai Chihara
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan O'Brien
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Jorgensen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherry Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stefan Faderl
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Poku
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Preetesh Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Phillip Thompson
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Brandt
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jan Burger
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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40
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Senatore FJ, Dasanu CA. Synchronous gastric and ampullary adenocarcinomas in a hairy cell leukemia patient treated with pentostatin eight years prior. J Oncol Pharm Pract 2016; 22:543-7. [PMID: 25712625 DOI: 10.1177/1078155215574140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hairy cell leukemia patients are at increased risk for second malignancies, including both solid and lymphoid neoplasms. Along with other factors, multiple immune defects present in hairy cell leukemia likely contribute to subsequent carcinogenesis. We report herein a case of synchronous high-grade gastric and ampullary adenocarcinomas in a patient with a history of hairy cell leukemia treated eight years prior with pentostatin. We include a review of immune alterations induced by both hairy cell leukemia and its therapies, and link them with the occurrence of second cancers in these patients.
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Affiliation(s)
- Frank J Senatore
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Constantin A Dasanu
- Lucy Curci Cancer Center, Eisenhower Medical Center/University of Southern California, Rancho Mirage, CA, USA
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41
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Tadmor T, Polliack A. Hairy cell leukemia: Uncommon clinical features, unusual sites of involvement and some rare associations. Best Pract Res Clin Haematol 2015; 28:193-9. [DOI: 10.1016/j.beha.2015.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/22/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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Else M, Dearden CE, Catovsky D. Long-term follow-up after purine analogue therapy in hairy cell leukaemia. Best Pract Res Clin Haematol 2015; 28:217-29. [PMID: 26614900 PMCID: PMC5509559 DOI: 10.1016/j.beha.2015.09.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/11/2015] [Accepted: 09/28/2015] [Indexed: 11/30/2022]
Abstract
Since 2006 when we last reviewed the literature concerning the use of purine analogues in hairy cell leukaemia (HCL), results from several new and updated series have been published. Here we examine these reports and consider their implications for patient management. The two purine analogues pentostatin and cladribine remain the first-line treatments of choice for all patients with HCL. Although they have not been compared in randomised trials, they appear to be equally effective. A complete response is important for the long-term outcome and we look at how best this can be achieved. Evidence is emerging which supports the use of either purine analogue plus an anti-CD20 monoclonal antibody after relapse, though questions remain concerning the scheduling of the monoclonal antibody. Patients refractory to the purine analogues may require alternative agents.
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Affiliation(s)
- Monica Else
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.
| | - Claire E Dearden
- Department of Haemato-Oncology, Royal Marsden NHS Foundation Trust, London, UK.
| | - Daniel Catovsky
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.
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43
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Robak T, Matutes E, Catovsky D, Zinzani PL, Buske C. Hairy cell leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v100-7. [PMID: 26269205 DOI: 10.1093/annonc/mdv200] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- T Robak
- Department of Hematology, Medical University of Lodz, Lodz, Poland
| | - E Matutes
- Haematopathology Unit, Hospital Clinic, Barcelona University, Barcelona, Spain
| | - D Catovsky
- Haemato-Oncology Research Unit, The Institute of Cancer Research, Sutton, Surrey, UK
| | - P L Zinzani
- Seràgnoli Institute of Hematology, University of Bologna, Bologna, Italy
| | - C Buske
- Comprehensive Cancer Center Ulm, Institute of Experimental Cancer Research, University Hospital, Ulm, Germany
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44
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Cornet E, Damaj G, Troussard X. New insights in the management of patients with hairy cell leukemia. Curr Opin Oncol 2015; 27:371-6. [PMID: 26154707 DOI: 10.1097/cco.0000000000000214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although hairy cell leukemia (HCL) was identified in 1958 by Bouroncle and colleagues, HCL remains in 2015 a mysterious disease. Accurate diagnosis of HCL relies on the recognition of hairy cells by morphology and flow cytometry in blood and/or bone marrow. However, there are cases difficult to diagnose, particularly in variants of HCL. Furthermore, some diseases such as splenic diffuse red pulp small B-cell lymphoma are very close to HCL and may be misdiagnosed. Major advances in the management of patients who have HCL have been made following the use of purine nucleoside analogs. However, new treatment options can be available in relapsed/refractory HCL: monoclonal antibody therapy, BRAF inhibitors, or immunotoxins. RECENT FINDINGS The presence of the BRAFV600E mutation was recently identified in most cases of HCL and its absence in variants of HCL and in other B-cell chronic lymphoproliferative disorders. The precise cellular origin of HCL remains elusive but BRAF mutations were detected in hematopoietic stem cells of patients with HCL. Assessment for minimal residual disease is important in clinical trials. Minimal residual disease detection can clearly predict inferior long-term outcomes or early relapses in patients with HCL. Recent reports have shown that inhibition of BRAF kinase by drugs such as vemurafenib is effective in relapsed/refractory HCL. Immunotoxins offer new opportunities even in patients without BRAF mutations. SUMMARY All these findings have major implications for diagnosis, monitoring, and treatment of HCL and variant forms of HCL.
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Affiliation(s)
- Edouard Cornet
- aLaboratoire Hématologie bService Hématologie Clinique, CHU Côte de Nacre, Caen, France
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Rossi C, Jégu J, Mounier M, Dandoit M, Colonna M, Daubisse-Marliac L, Trétarre B, Ganry O, Guizard AV, Bara S, Bouvier V, Woronoff AS, Monnereau A, Casasnovas O, Velten M, Troussard X, Maynadié M. Risk assessment of second primary cancer according to histological subtype of non-Hodgkin lymphoma. Leuk Lymphoma 2015; 56:2876-82. [DOI: 10.3109/10428194.2015.1007505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The majority of patients with hairy cell leukemia (HCL) achieve a response to therapy with cladribine or pentostatin with or without rituximab. However, late relapses can occur. Treatment of relapsed HCL can be difficult due to a poor tolerance to chemotherapy, increased risk of infections and decreased responsiveness to chemotherapy. The identification of BRAFV600E mutations and the role of aberrant MEK kinase and Bruton's tyrosine kinase (BTK) pathways in the pathogenesis of HCL have helped to develop novel targeted therapies for these patients. Currently, the most promising therapeutic strategies for relapsed or refractory HCL include recombinant immunoconjugates targeting CD22 (e.g. moxetumomab pasudotox), BRAF inhibitors such as vemurafenib and B cell receptor signaling kinase inhibitors such as ibrutinib. Furthermore, the VH4-34 molecular variant of classic HCL has been identified to be less responsive to chemotherapy. Herein, we review the results of the ongoing clinical trials and potential future therapies for relapsed/refractory HCL.
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Affiliation(s)
- Preetesh Jain
- a Department of Leukemia , University of Texas M. D. Anderson Cancer Center , Houston , TX , USA
| | - Aaron Polliack
- b Department of Hematology , Hadassah University Hospital, Hebrew University Medical School , Jerusalem , Israel
| | - Farhad Ravandi
- a Department of Leukemia , University of Texas M. D. Anderson Cancer Center , Houston , TX , USA
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