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Frustaci AM, Rusconi C, Picardi P, Veronese S, Montillo M, Cairoli R, Tedeschi A. Bing Neel Syndrome in a Previously Untreated Patient With Waldenström's Macroglobulinemia: Contribution of MYD88 L265P Mutation on Cerebrospinal Fluid. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:e7-9. [DOI: 10.1016/j.clml.2015.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/27/2015] [Accepted: 11/11/2015] [Indexed: 11/25/2022]
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Simon L, Fitsiori A, Lemal R, Dupuis J, Carpentier B, Boudin L, Corby A, Aurran-Schleinitz T, Gastaud L, Talbot A, Leprêtre S, Mahe B, Payet C, Soussain C, Bonnet C, Vincent L, Lissandre S, Herbrecht R, Kremer S, Leblond V, Fornecker LM. Bing-Neel syndrome, a rare complication of Waldenström macroglobulinemia: analysis of 44 cases and review of the literature. A study on behalf of the French Innovative Leukemia Organization (FILO). Haematologica 2015; 100:1587-94. [PMID: 26385211 DOI: 10.3324/haematol.2015.133744] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/18/2015] [Indexed: 11/09/2022] Open
Abstract
Central nervous system involvement by malignant cells is a rare complication of Waldenström macroglobulinemia, and this clinicopathological entity is referred to as the Bing-Neel syndrome. There is currently no consensus on the diagnostic criteria, therapeutic approaches and response evaluation for this syndrome. In this series, we retrospectively analyzed 44 French patients with Bing-Neel syndrome. Bing-Neel syndrome was the first manifestation of Waldenström macroglobulinemia in 36% of patients. When Waldenström macroglobulinemia was diagnosed prior to Bing-Neel syndrome, the median time interval between this diagnosis and the onset of Bing-Neel syndrome was 8.9 years. This study highlights the possibility of the occurrence of Bing-Neel syndrome without any other evidence of progression of Waldenström macroglobulinemia. The clinical presentation was heterogeneous without any specific signs or symptoms. Biologically, the median lymphocyte count in the cerebrospinal fluid was 31/mm(3). Magnetic resonance imaging revealed abnormalities in 78% of the cases. The overall response rate after first-line treatment was 70%, and the overall survival rate after the diagnosis of Bing-Neel syndrome was 71% at 5 years. Altogether, these results suggest that Bing-Neel syndrome should be considered in the context of any unexplained neurological symptoms associated with Waldenström macroglobulinemia. The diagnostic approach should be based on cerebrospinal fluid analysis and magnetic resonance imaging of the brain and spinal axis. It still remains difficult to establish treatment recommendations or prognostic factors in the absence of large-scale, prospective, observational studies.
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Affiliation(s)
- Laurence Simon
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Aikaterini Fitsiori
- Department of Radiology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Richard Lemal
- Department of Cell Therapy and Clinical Hematology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | | | - Laurys Boudin
- Department of Medical Oncology, Hôpital d'Instruction des Armées, Toulon, France
| | - Anne Corby
- Department of Hematology, Centre Hospitalier Universitaire, Angers, France
| | | | - Lauris Gastaud
- Department of Onco-Hematology, Centre Antoine Lacassagne, Nice, France
| | - Alexis Talbot
- Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Sorbonne Paris Cité, France
| | | | - Béatrice Mahe
- Department of Hematology, Centre Hospitalier Universitaire, Nantes, France
| | - Camille Payet
- Department of Hematology, Centre Hospitalier Universitaire, Besançon, France
| | - Carole Soussain
- Department of Hematology, Institut Curie-Hôpital René Huguenin, Saint-Cloud, France
| | - Charlotte Bonnet
- Department of Neurosurgery, Centre Hospitalier Universitaire, Bordeaux, France
| | - Laure Vincent
- Department of Hematology, Centre Hospitalier Universitaire, Montpellier, France
| | - Séverine Lissandre
- Department of Hematology, Centre Hospitalier Universitaire, Tours, France
| | - Raoul Herbrecht
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Stéphane Kremer
- Department of Radiology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Véronique Leblond
- Department of Hematology, APHP Hôpital Pitié-Salpêtrière, UPMC Paris, GRECHY, France
| | - Luc-Matthieu Fornecker
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
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Van Cauwenberge MG, Depreter B, Dumoulin EN, Emmerechts J, Nollet F, Vanopdenbosch LJ. Bing-Neel syndrome: Two unexpected cases and a review of the literature. J Neurol Sci 2015; 356:19-26. [PMID: 26159625 DOI: 10.1016/j.jns.2015.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 06/01/2015] [Accepted: 06/13/2015] [Indexed: 10/23/2022]
Abstract
Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma characterized by the proliferation of small B-lymphocytes in the bone marrow that produce monoclonal immunoglobulin M (IgM). We describe two patients with WM who presented with neurological symptoms due to infiltration of lymphoplasmacytoid tumor cells in the central nervous system, a condition known as Bing-Neel syndrome. A literature review revealed that this syndrome is rare and commonly missed in clinical practice due to its variable presentation and a lack of awareness or knowledge. Brain and spinal magnetic resonance imaging may show a focal mass or diffuse infiltration. The diagnosis of Bing-Neel syndrome requires proof of IgM or lymphoplasmacytoid cells in cerebrospinal fluid or in a brain biopsy. Treatment with intravenous and/or intrathecal chemotherapy and cranial radiotherapy is described in literature with generally poor outcome, although a combination of these therapies seems to improve outcome. Nevertheless, insufficient data are currently available to make general treatment recommendations.
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Affiliation(s)
- M G Van Cauwenberge
- Department of Neurology, University Clinic RWTH Aachen, Germany; Department of Neurology, AZ Sint Jan Brugge Oostende, Belgium.
| | - B Depreter
- Department of Laboratory Hematology, University Hospital Ghent, Belgium
| | - E N Dumoulin
- Department of Laboratory Hematology, University Hospital Ghent, Belgium
| | - J Emmerechts
- Department of Laboratory Hematology, AZ Sint Jan Brugge Oostende, Belgium
| | - F Nollet
- Department of Laboratory Hematology, AZ Sint Jan Brugge Oostende, Belgium
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