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Pakjoo M, Ahmadi SE, Zahedi M, Jaafari N, Khademi R, Amini A, Safa M. Interplay between proteasome inhibitors and NF-κB pathway in leukemia and lymphoma: a comprehensive review on challenges ahead of proteasome inhibitors. Cell Commun Signal 2024; 22:105. [PMID: 38331801 PMCID: PMC10851565 DOI: 10.1186/s12964-023-01433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
The current scientific literature has extensively explored the potential role of proteasome inhibitors (PIs) in the NF-κB pathway of leukemia and lymphoma. The ubiquitin-proteasome system (UPS) is a critical component in regulating protein degradation in eukaryotic cells. PIs, such as BTZ, are used to target the 26S proteasome in hematologic malignancies, resulting in the prevention of the degradation of tumor suppressor proteins, the activation of intrinsic mitochondrial-dependent cell death, and the inhibition of the NF-κB signaling pathway. NF-κB is a transcription factor that plays a critical role in the regulation of apoptosis, cell proliferation, differentiation, inflammation, angiogenesis, and tumor migration. Despite the successful use of PIs in various hematologic malignancies, there are limitations such as resistant to these inhibitors. Some reports suggest that PIs can induce NF-κB activation, which increases the survival of malignant cells. This article discusses the various aspects of PIs' effects on the NF-κB pathway and their limitations. Video Abstract.
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Affiliation(s)
- Mahdi Pakjoo
- Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
- ATMP department, Breast cancer research center, Motamed cancer institute, ACECR, P.O. BOX:15179/64311, Tehran, Iran
| | - Seyed Esmaeil Ahmadi
- Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zahedi
- Department of Medical Biotechnology, School of Allied Medicine, Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Jaafari
- Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reyhane Khademi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Amini
- Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Majid Safa
- Department of Hematology and Blood Banking, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran.
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2
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Hoffmann E, Böke S, De-Colle C, Lengerke C, Niyazi KM, Gani C. Ulcerating skin lesions from blastic plasmacytoid dendritic cell neoplasm responding to low-dose radiotherapy-a case report and literature review. Strahlenther Onkol 2024:10.1007/s00066-024-02200-2. [PMID: 38285172 DOI: 10.1007/s00066-024-02200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy that can manifest with skin nodules and erythematous plaques. In most cases BPDCN progresses rapidly, causing multiple skin lesions and also affecting internal organs and bone marrow, warranting initiation of systemic therapies or hematopoietic stem cell transplantation (HCT). Although not curative, radiotherapy for isolated lesions might be indicated in case of (imminent) ulceration and large or symptomatic lesions. To this end, doses of 27.0-51.0 Gy have been reported. Here, we present the case of an 80-year-old male with BPDCN with multiple large, nodular, and ulcerating lesions of the thorax, abdomen, and face. Low-dose radiotherapy of 2 × 4.0 Gy was administered to several lesions, which resolved completely within 1 week with only light residual hyperpigmentation of the skin in affected areas and reliably prevented further ulceration. Radiotoxicity was not reported. Therefore, low-dose radiotherapy can be an effective and low-key treatment in selected cases of BPDCN, especially in a palliative setting, with a favorable toxicity profile.
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Affiliation(s)
- Elgin Hoffmann
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany.
| | - Simon Böke
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Chiara De-Colle
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Claudia Lengerke
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Karim-Maximilian Niyazi
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Cihan Gani
- University Hospital for Radiotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
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Mehra S, Taylor J. Blastic Plasmacytoid Dendritic Cell Neoplasm: A Comprehensive Review of the Disease, Central Nervous System Presentations, and Treatment Strategies. Cells 2024; 13:243. [PMID: 38334635 PMCID: PMC10854688 DOI: 10.3390/cells13030243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematologic malignancy with poor outcomes. The World Health Organization (WHO) redefined BDCN as a distinct disease entity in 2016. BPDCN arises from plasmacytoid dendritic cells, manifesting primarily in the skin, bone marrow, and lymph nodes, occasionally involving the central nervous system (CNS). This presents challenges in diagnosis and treatment, with CNS involvement often overlooked in standard diagnostic workups due to BPDCN's rarity and patients often being neurologically asymptomatic at diagnosis. CNS involvement typically emerges during relapse, yet clinical trials often exclude such cases, limiting our understanding of its development and treatment. Treatment options for CNS involvement include intrathecal (IT) chemotherapies like methotrexate and cytarabine, often in combination with systemic agents. Tagraxofusp and traditional regimens for acute myeloid leukemia show limited success at preventing CNS relapse, prompting exploration of combined therapies like hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (HyperCVAD) with venetoclax and adding IT chemotherapy to other backbones. Ongoing clinical trials investigating emerging therapies offer hope despite limited focus on CNS implications. Trials incorporating CNS-involved patients aim to pioneer novel treatment approaches, potentially reshaping BPDCN management. Understanding CNS involvement's complexities in BPDCN remains crucial for tailored treatments and better patient outcomes.
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Affiliation(s)
| | - Justin Taylor
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
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Zanotta S, Galati D, De Filippi R, Pinto A. Breakthrough in Blastic Plasmacytoid Dendritic Cell Neoplasm Cancer Therapy Owing to Precision Targeting of CD123. Int J Mol Sci 2024; 25:1454. [PMID: 38338733 PMCID: PMC10855071 DOI: 10.3390/ijms25031454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic cancer originating from the malignant transformation of plasmacytoid dendritic cell precursors. This malignancy progresses rapidly, with frequent relapses and a poor overall survival rate, underscoring the urgent need for effective treatments. However, diagnosing and treating BPDCN have historically been challenging due to its rarity and the lack of standardized approaches. The recognition of BPDCN as a distinct disease entity is recent, and standardized treatment protocols are yet to be established. Traditionally, conventional chemotherapy and stem cell transplantation have been the primary methods for treating BPDCN patients. Advances in immunophenotyping and molecular profiling have identified potential therapeutic targets, leading to a shift toward CD123-targeted immunotherapies in both clinical and research settings. Ongoing developments with SL-401, IMGN632, CD123 chimeric antigen receptor (CAR) T-cells, and bispecific antibodies (BsAb) show promising advancements. However, the therapeutic effectiveness of CD123-targeting treatments needs improvement through innovative approaches and combinations of treatments with other anti-leukemic drugs. The exploration of combinations such as CD123-targeted immunotherapies with azacitidine and venetoclax is suggested to enhance antineoplastic responses and improve survival rates in BPDCN patients. In conclusion, this multifaceted approach offers hope for more effective and tailored therapeutic interventions against this challenging hematologic malignancy.
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Affiliation(s)
- Serena Zanotta
- Hematology-Oncology and Stem-Cell Transplantation Unit, Department of Onco-Hematology and Innovative Diagnostics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (S.Z.); (A.P.)
| | - Domenico Galati
- Hematology-Oncology and Stem-Cell Transplantation Unit, Department of Onco-Hematology and Innovative Diagnostics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (S.Z.); (A.P.)
| | - Rosaria De Filippi
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy;
| | - Antonio Pinto
- Hematology-Oncology and Stem-Cell Transplantation Unit, Department of Onco-Hematology and Innovative Diagnostics, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (S.Z.); (A.P.)
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5
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Aran BM, Duran J, Whittemore D, Gru AA. A CD56- immunoblastoid variant of blastic plasmacytoid dendritic cell neoplasm. J Cutan Pathol 2024; 51:40-44. [PMID: 37612885 DOI: 10.1111/cup.14517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive malignant hematologic neoplasm arising from plasmacytoid dendritic cells. It is a very rare tumor that constitutes less than 0.1% of all hematologic malignancies. Most patients with BPDCN present clinically with cutaneous lesions as the first sign of disease. Immunophenotypic variability with aberrant marker profiles has been reported. We report a case of a transcription factor 4 (TCF-4) + BPDCN, with negative CD56 expression in an 85-year-old woman with multiple skin nodules. A punch biopsy revealed a diffuse, monomorphous, and non-epidermotropic cell infiltrate involving the entire dermis. The infiltrate was composed of intermediate-sized cells with immunoblastoid morphology, which is an unusual morphologic variant. The neoplastic cells were strongly positive for CD45 and co-expressed CD4, CD123, TCF-4, BCL-2, and CD10. The Ki-67 proliferative rate was very high (90%). Negative immunostains included CD56, an unusual finding in BPDCN. This case illustrates the challenges encountered in the diagnosis of this entity, particularly in unusual morphologic variants and phenotypes. The elucidation of molecular signatures and development of targeted therapies for its management have been recently introduced and differ from acute myeloid leukemias. Hence, accurate diagnosis of BPDCN is critical for dermatopathologists.
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Affiliation(s)
- Brenna M Aran
- University of Virginia, Charlottesville, Virginia, USA
| | - Juanita Duran
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
- Department of Dermatology, University of Virginia, Charlottesville, Virginia, USA
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Oliveira B, Nogueira C, Dias L, Ribeiro T, Gomes G. Blastic Plasmacytoid Dendritic Cell Neoplasm: A Rare Entity in Clinical Practice. Cureus 2024; 16:e51860. [PMID: 38327956 PMCID: PMC10848875 DOI: 10.7759/cureus.51860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 02/09/2024] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an exceedingly rare and aggressive hematologic malignancy. In the current World Health Organization classification, it is classified among histiocytic/dendritic cell neoplasms. This report describes the case of an 85-year-old female with a complex medical history, including rheumatoid arthritis, who presented with a one-month history of low-grade fever, anorexia, and unexplained weight loss. The diagnosis of BPDCN was confirmed following an immunophenotyping analysis of a bone marrow aspirate. With this report, the authors intend to shed some light on BPDCN's clinical presentation, diagnostic journey, therapeutic approaches, and patient outcomes, and denote the significance of early detection and interdisciplinary collaboration in enhancing patient care.
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Affiliation(s)
| | | | - Luís Dias
- Internal Medicine, Hospital de Braga, Braga, PRT
- School of Medicine, University of Minho, Braga, PRT
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Peng J, He S, Yang X, Huang L, Wei J. Plasmacytoid dendritic cell expansion in myeloid neoplasms: A novel distinct subset of myeloid neoplasm? Crit Rev Oncol Hematol 2023; 192:104186. [PMID: 37863402 DOI: 10.1016/j.critrevonc.2023.104186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
Plasmacytoid dendritic cells (pDCs) are a specific dendritic cell type stemming from the myeloid lineage. Clinically and pathologically, neoplasms associated with pDCs are classified as blastic plasmacytoid dendritic cell neoplasm (BPDCN), mature plasmacytoid dendritic myeloid neoplasm (MPDMN) and pDC expansion in myeloid neoplasms (MNs). BPDCN was considered a rare and aggressive neoplasm in the 2016 World Health Organization (WHO) classification. MPDMN, known as mature pDC-derived neoplasm, is closely related to MNs and was first recognized in the latest 2022 WHO classification, proposing a new concept that acute myeloid leukemia cases could show clonally expanded pDCs (pDC-AML). With the advances in detection techniques, an increasing number of pDC expansion in MNs have been reported, but whether the pathogenesis is similar to that of MPDMN remains unclear. This review focuses on patient characteristics, diagnosis and treatment of pDC expansion in MNs to gain further insight into this novel and unique provisional subtype.
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Affiliation(s)
- Juan Peng
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei 430030, China
| | - Shaolong He
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China
| | - Xingcheng Yang
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei 430030, China
| | - Liang Huang
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei 430030, China.
| | - Jia Wei
- Department of Hematology, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan 430000, Hubei, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, Hubei 430030, China; Department of Hematology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China; Sino-German Joint Oncological Research Laboratory, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, 030032 Taiyuan, Shanxi, China.
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8
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Nagate Y, Nakaya A, Kamimura R, Hirose Y, Nojima S, Fujita J, Kiyohara E, Shibayama H. Venetoclax Combined with Azacytidine Can Be a First-line Treatment Option for Elderly Blastic Plasmacytoid Dendritic Cell Neoplasm. Intern Med 2023; 62:2547-2551. [PMID: 37661416 PMCID: PMC10518555 DOI: 10.2169/internalmedicine.0318-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/07/2022] [Indexed: 09/05/2023] Open
Abstract
An 84-year-old Japanese man was diagnosed with blastic plasmacytoid dendritic cell neoplasm (BPDCN). We administered combination therapy using venetoclax and azacytidine. We observed neutropenia (Grade 4), thrombocytopenia (Grade 2), and stomatitis (Grade 3). After six cycles of treatment, the BPDCN abnormal cells in the bone marrow specimen almost disappeared, and atypical cells were not detected in a skin biopsy. We propose venetoclax combined with azacytidine as a useful treatment approach in elderly patients, although clinicians should be mindful that therapeutic modifications may be essential to minimize and/or avoid adverse events.
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Affiliation(s)
- Yasuhiro Nagate
- Department of Hematology, National Hospital Organization Osaka National Hospital, Japan
| | - Aya Nakaya
- Department of Hematology, National Hospital Organization Osaka National Hospital, Japan
| | - Ren Kamimura
- Department of Hematology, National Hospital Organization Osaka National Hospital, Japan
| | - Yumiko Hirose
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization Osaka National Hospital, Japan
| | - Satoshi Nojima
- Department of Pathology, Osaka University Graduate School of Medicine, Japan
| | - Jiro Fujita
- Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Japan
| | - Eiji Kiyohara
- Department of Dermatology, Osaka University Graduate School of Medicine, Japan
| | - Hirohiko Shibayama
- Department of Hematology, National Hospital Organization Osaka National Hospital, Japan
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Chen J, Zhang X, Ma L, Gao Y, Fu Z, Liu M. 18F-FDG PET/CT findings in a patient with blastic plasmacytoid dendritic cell neoplasm and post-transplant lymphoproliferative disorder after hematopoietic stem cell transplantation: a case report. Front Med (Lausanne) 2023; 10:1258310. [PMID: 37663666 PMCID: PMC10469918 DOI: 10.3389/fmed.2023.1258310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an extremely rare hematopoietic malignancy, which originating from precursors of plasmacytoid dendritic cells. Allogeneic hematopoietic stem cell transplantation (HSCT) is normally considered in the treatment of BPDCN patients to acquire sustained remission. Post-transplant lymphoproliferative disorder (PTLD) is a group of conditions involving abnormal lymphoid cells proliferation in the context of extrinsic immunosuppression after solid organ transplantation (SOT) or HSCT. Herein, we report a patient with BPDCN, who suffered from PTLD after allogeneic HSCT. Case presentation A 66-year-old man was diagnosed with BPDCN, confirmed by pathologic examination after splenectomy. The post-surgery 18F-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (18F-FDG PET/CT) showed multifocal 18F-FDG avidity in the left cheek, lymph nodes and bone marrow. The patient started chemotherapy, followed by allogeneic HSCT and immunosuppressive therapy. Four months after the HSCT, the patient developed intermittent fever and recurrent lymphadenopathy, accompanied with progressively elevated Epstein-Barr virus (EBV)-DNA both in serum and lymphocytes. 18F-FDG PET/CT was performed again and found multiple new enlarged 18F-FDG-avid lymph nodes, while the previous hypermetabolic lesions all disappeared. The pathology of mesenteric lymph node indicated a monomorphic PTLD (diffuse large B-cell lymphoma). Then the immunosuppressive medications were stopped and two cycles of Rituximab were given, and the follow-up CT scan indicated a complete response. Conclusion When patients with BPDCN recurred new enlarged lymph nodes after allogeneic HSCT and immunosuppressive therapy, PTLD should be taken into consideration. 18F-FDG PET/CT may provide additional evidence for supporting or refuting the suspicion of PTLD, and suggest lesions accessible for biopsy.
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Affiliation(s)
| | | | | | | | - Zhanli Fu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Meng Liu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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10
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Liu F, Qi F, Zhang J, Tan Y, Zhang X. Blastic Plasmacytoid Dendritic Cell Neoplasm with Lung Involvement and Cytopenia: A Case Report and a Literature Review. Clin Cosmet Investig Dermatol 2023; 16:2211-2216. [PMID: 37588110 PMCID: PMC10426402 DOI: 10.2147/ccid.s414326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a hostile cutaneous malignancy with dismal prognosis and unknown etiology with rarity. Most patients received traditional chemotherapy only has one year of median survival time. This article reports an 81-year-old male patient with BPDCN who presented with skin manifestations and was diagnosed with positive CD4, CD56, and CD123 immunohistochemical results. Systematic examination revealed lung involvement and cytopenia.
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Affiliation(s)
- Fang Liu
- Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fei Qi
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Jingya Zhang
- Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yaqi Tan
- Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiuying Zhang
- Department of Dermatology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
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Nasiri A, Lami A, Alhumaidi A, Madkhali A, Althaqib A, Aljarwan N, Alkharras R. Blastic Plasmacytoid Dendritic Cell Neoplasm: A Case Report. Cureus 2023; 15:e37016. [PMID: 37026111 PMCID: PMC10072177 DOI: 10.7759/cureus.37016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/03/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an uncommon hematological tumor originating from the precursor of plasmacytoid dendritic cells (pDCs) with a persistent and progressive course of illness. Despite being an aggressive disease BPDCN has an initial indolent course manifested as skin lesions. Alongside or following the skin lesion, the extra-cutaneous manifestation develops and includes lymphadenopathy, splenomegaly, and hepatomegaly. The BPDCN diagnosis is mainly based on the immunophenotype. Herein, we report the case of a 72-year-old male patient who presented with a history of left anterior chest wall painless skin lesions. Histology of skin biopsy of the left chest skin lesion showed diffuse dermal infiltration by monomorphic medium-sized blastic cells positive for cluster of differentiation (CD)4, CD45, CD7, CD56, CD43, CD123, T-cell leukemia-1 (TCL1), and B-cell leukemia/lymphoma 2 protein (BCL2). Given the rarity of the disease, standard chemotherapy regimens used in treating different leukemias and lymphomas have been adapted to treat BPDCN.
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12
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Pagano L, Zinzani PL, Pileri S, Quaglino P, Cuglievan B, Berti E, Pemmaraju N, Onida F, Willemze R, Orfao A, Barosi G. Unmet Clinical Needs and Management Recommendations for Blastic Plasmacytoid Dendritic Cell Neoplasm: A Consensus-based Position Paper From an Ad Hoc International Expert Panel. Hemasphere 2023; 7:e841. [PMID: 36844178 DOI: 10.1097/HS9.0000000000000841] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/03/2023] [Indexed: 02/23/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a hematological malignancy characterized by recurrent skin nodules, an aggressive clinical course with rapid involvement of hematological organs, and a poor prognosis with overall survival. The rarity of the disease results in a few large-scale studies, a lack of controlled clinical trials for its management, and a lack of evidence-based guidelines. Here, we present a review of unmet clinical needs on the management of BPDCN by a panel of eleven experts involved in the research and clinical practice of BPDCN. Recommendations and proposals were achieved by multiple-step formalized procedures to reach a consensus after a comprehensive analysis of the scientific literature. The panel analyzed the critical issues of diagnostic pathway, prognostic stratification, therapy for young and fit patients and elderly and unfit patients, indication for allotransplant and for autotransplant, indication for central nervous system prophylaxis, and management of pediatric BPDCN patients. For each of these issues, consensus opinions were provided and, when appropriate, proposals for advancement in clinical practice were addressed. The hope is that this comprehensive overview will serve to improve the practice of BPDCN and inform the design and implementation of new studies in the field.
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13
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Pemmaraju N, Kantarjian H, Sweet K, Wang E, Senapati J, Wilson NR, Konopleva M, Frankel AE, Gupta V, Mesa R, Ulrickson M, Gorak E, Bhatia S, Budak-Alpdogan T, Mason J, Garcia-Romero MT, Lopez-Santiago N, Cesarman-Maus G, Vachhani P, Lee S, Bhatt VR, Blum W, Walter RB, Bixby D, Gojo I, Duvic M, Rampal RK, de Lima M, Foran J, Fathi AT, Hall AC, Jacoby MA, Lancet J, Mannis G, Stein AS, Mims A, Rizzieri D, Olin R, Perl A, Schiller G, Shami P, Stone RM, Strickland S, Wieduwilt MJ, Daver N, Ravandi F, Vasu S, Guzman M, Roboz GJ, Khoury J, Qazilbash M, Aung PP, Cuglievan B, Madanat Y, Kharfan-Dabaja MA, Pawlowska A, Taylor J, Tallman M, Dhakal P, Lane AA. North American Blastic Plasmacytoid Dendritic Cell Neoplasm Consortium: position on standards of care and areas of need. Blood 2023; 141:567-78. [PMID: 36399715 DOI: 10.1182/blood.2022017865] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy with historically poor outcomes and no worldwide consensus treatment approach. Unique among most hematologic malignancies for its frequent cutaneous involvement, BPDCN can also invade other extramedullary compartments, including the central nervous system. Generally affecting older adults, many patients are unfit to receive intensive chemotherapy, and although hematopoietic stem cell transplantation is preferred for younger, fit individuals, not all are eligible. One recent therapeutic breakthrough is that all BPDCNs express CD123 (IL3Rα) and that this accessible surface marker can be pharmacologically targeted. The first-in-class agent for BPDCN, tagraxofusp, which targets CD123, was approved in December 2018 in the United States for patients with BPDCN aged ≥2 years. Despite favorable response rates in the frontline setting, many patients still relapse in the setting of monotherapy, and outcomes in patients with relapsed/refractory BPDCN remain dismal. Therefore, novel approaches targeting both CD123 and other targets are actively being investigated. To begin to formally address the state of the field, we formed a new collaborative initiative, the North American BPDCN Consortium (NABC). This group of experts, which includes a multidisciplinary panel of hematologists/oncologists, hematopoietic stem cell transplant physicians, pathologists, dermatologists, and pediatric oncologists, was tasked with defining the current standard of care in the field and identifying the most important research questions and future directions in BPDCN. The position findings of the NABC's inaugural meetings are presented herein.
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Michaelis S, Pichler A, Beham-Schmid C, Stelzer I, Schöffmann L, Tinchon C, Enko D. Early cerebrospinal fluid infiltration in TP53-mutated blastic plasmacytoid dendritic cell neoplasm. Ann Hematol 2023; 102:491-3. [PMID: 36525028 DOI: 10.1007/s00277-022-05078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
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Mayta-Tovalino F, Quispe-Vicuna C, Cabanillas-Lazo M, Barja-Ore J, Mauricio-Vilchez C, Guerrero M, Munive-Degregori A. Blastic Plasmacytoid Dendritic Cell Neoplasm: A 10-year Bibliometric Study. J Appl Hematol 2023. [DOI: 10.4103/joah.joah_81_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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16
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Malone C, Law R, Sargent J, Feighery C. Dramatic cutaneous eruption of nodular purpuric lesions in an otherwise well older man. Clin Exp Dermatol 2022; 47:2055-2058. [DOI: 10.1111/ced.15334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ciara Malone
- Department of Dermatology Our Lady of Lourdes Hospital Drogheda Louth Ireland
| | - Ruth Law
- Department of Pathology Our Lady of Lourdes Hospital Drogheda Louth Ireland
| | - Jeremy Sargent
- Department of Haematology Our Lady of Lourdes Hospital Drogheda Louth Ireland
| | - Clióna Feighery
- Department of Dermatology Our Lady of Lourdes Hospital Drogheda Louth Ireland
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Roussel X, Garnache Ottou F, Renosi F. Plasmacytoid Dendritic Cells, a Novel Target in Myeloid Neoplasms. Cancers (Basel) 2022; 14:cancers14143545. [PMID: 35884612 PMCID: PMC9317563 DOI: 10.3390/cancers14143545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023] Open
Abstract
Plasmacytoid dendritic cells (pDC) are the main type I interferon producing cells in humans and are able to modulate innate and adaptive immune responses. Tumor infiltration by plasmacytoid dendritic cells is already well described and is associated with poor outcomes in cancers due to the tolerogenic activity of pDC. In hematological diseases, Blastic Plasmacytoid Dendritic Cells Neoplasm (BPDCN), aggressive leukemia derived from pDCs, is well described, but little is known about tumor infiltration by mature pDC described in Myeloid Neoplasms (MN). Recently, mature pDC proliferation (MPDCP) has been described as a differential diagnosis of BPDCN associated with acute myeloid leukemia (pDC-AML), myelodysplastic syndrome (pDC-MDS) and chronic myelomonocytic leukemia (pDC-CMML). Tumor cells are myeloid blasts and/or mature myeloid cells from related myeloid disorders and pDC derived from a clonal proliferation. The poor prognosis associated with MPDCP requires a better understanding of pDC biology, MN oncogenesis and immune response. This review provides a comprehensive overview about the biological aspects of pDCs, the description of pDC proliferation in MN, and an insight into putative therapies in pDC-AML regarding personalized medicine.
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Affiliation(s)
- Xavier Roussel
- INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, 25000 Besancon, France;
- Department of Clinical Hematology, University Hospital of Besançon, 25000 Besançon, France
- Correspondence: (X.R.); (F.R.)
| | - Francine Garnache Ottou
- INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, 25000 Besancon, France;
- Etablissement Français du Sang Bourgogne Franche-Comté, Laboratoire d’Hématologie et d’Immunologie Régional, 25020 Besançon, France
| | - Florian Renosi
- INSERM, EFS BFC, UMR1098 RIGHT, University of Bourgogne Franche-Comté, 25000 Besancon, France;
- Etablissement Français du Sang Bourgogne Franche-Comté, Laboratoire d’Hématologie et d’Immunologie Régional, 25020 Besançon, France
- Correspondence: (X.R.); (F.R.)
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18
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Zhang Y, Sokol L. Clinical Insights into the Management of Blastic Plasmacytoid Dendritic Cell Neoplasm. Cancer Manag Res 2022; 14:2107-2117. [PMID: 35789956 PMCID: PMC9250318 DOI: 10.2147/cmar.s330398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/01/2022] [Indexed: 12/02/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is aggressive hematologic malignancy derived from plasmacytoid dendritic cell precursors of myeloid cell lineage. Patients frequently present with bruise-like skin lesions, which typically are followed months later by progressive cytopenias. Historically, BPDCN prognosis has been dismal, with median overall survival ranging from 9 to 13 months. In the past 2 decades, our understanding of BPDCN pathogenesis has led to the successful development of novel therapeutics. In December 2018, the FDA approved tagraxofusp-erzs for adults and pediatric patients older than 2 years who have either treatment-naïve or relapsed/refractory BPDCN. Acute lymphoblastic leukemia (ALL)-based chemotherapy regimens also provide comparable outcomes to tagraxofusp. In our practice, for patients with good performance status, we use tagraxofusp, ALL-based chemotherapy regimens, or clinical trials as frontline induction therapy, followed by consolidation with allogeneic stem cell transplant once the first complete response has been achieved. Our induction regimen also includes intrathecal chemotherapy for central nervous system prophylaxis. Patients with poor performance status who are treatment-naïve or patients with relapsed/refractory disease have limited therapeutic options, and we strongly recommend enrollment in clinical trials; several novel agents and combinations are currently under clinical investigation for both treatment-naïve and relapsed/refractory BPDCN.
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Affiliation(s)
- Yumeng Zhang
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
| | - Lubomir Sokol
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, USA
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Sibuh BZ, Gahtori R, Al-Dayan N, Pant K, Far BF, Malik AA, Gupta AK, Sadhu S, Dohare S, Gupta PK. Emerging trends in immunotoxin targeting cancer stem cells. Toxicol In Vitro 2022; 83:105417. [PMID: 35718257 DOI: 10.1016/j.tiv.2022.105417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/30/2022]
Abstract
Cancer stem cells (CSCs) are self-renewing multipotent cells that play a vital role in the development of cancer drug resistance conditions. Various therapies like conventional, targeted, and radiotherapies have been broadly used in targeting and killing these CSCs. Among these, targeted therapy selectively targets CSCs and leads to overcoming disease recurrence conditions in cancer patients. Immunotoxins (ITs) are protein-based therapeutics with selective targeting capabilities. These chimeric molecules are composed of two functional moieties, i.e., a targeting moiety for cell surface binding and a toxin moiety that induces the programmed cell death upon internalization. Several ITs have been constructed recently, and their preclinical and clinical efficacies have been evaluated. In this review, we comprehensively discussed the recent preclinical and clinical advances as well as significant challenges in ITs targeting CSCs, which might reduce the burden of drug resistance conditions in cancer patients from bench to bedside.
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Affiliation(s)
- Belay Zeleke Sibuh
- Department of Biotechnology, School of Engineering and Technology (SET), Sharda University, Knowledge Park III, Greater Noida 201310, Uttar Pradesh, India
| | - Rekha Gahtori
- Department of Biotechnology, Sir J.C. Bose Technical Campus, Kumaun University, Bhimtal, Nainital 263136, Uttarakhand, India
| | - Noura Al-Dayan
- Department of Medical Lab Sciences, Prince Sattam bin Abdulaziz University, Alkharj 16278, Saudi Arabia
| | - Kumud Pant
- Department of Biotechnology, Graphic Era Deemed to be University, Dehradun 248002, Uttarakhand, India
| | - Bahareh Farasati Far
- Department of Chemistry, Iran University of Science and Technology, Tehran, Iran
| | - Asrar Ahmad Malik
- Department of Life Sciences, School of Basic Sciences and Research (SBSR), Sharda University, Knowledge Park III, Greater Noida 201310, Uttar Pradesh, India
| | - Ashish Kumar Gupta
- Department of Life Sciences, J.C. Bose University of Science and Technology, YMCA, Faridabad 121006, Haryana, India
| | - Soumi Sadhu
- Department of Life Sciences, School of Basic Sciences and Research (SBSR), Sharda University, Knowledge Park III, Greater Noida 201310, Uttar Pradesh, India
| | - Sushil Dohare
- Department of Epidemiology, Faculty of Public Health & Tropical Medicine, Jazan University, Jazan, Saudi Arabia
| | - Piyush Kumar Gupta
- Department of Biotechnology, Graphic Era Deemed to be University, Dehradun 248002, Uttarakhand, India; Department of Life Sciences, School of Basic Sciences and Research (SBSR), Sharda University, Knowledge Park III, Greater Noida 201310, Uttar Pradesh, India.
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Suárez EU, Cornago J, Piris MÁ, Rodriguez Pinilla SM, López‐Lorenzo JL, Soto C. Localized skin‐limited blastic plasmacytoid dendritic cell neoplasm. eJHaem 2022; 3:560-562. [PMID: 35846036 PMCID: PMC9175955 DOI: 10.1002/jha2.383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Edwin U. Suárez
- Department of Haematology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
| | - Javier Cornago
- Department of Haematology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
| | - Miguel Á. Piris
- Department of Pathology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
| | | | - José L. López‐Lorenzo
- Department of Haematology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
| | - Carlos Soto
- Department of Haematology Hospital Universitario Fundación Jiménez Díaz Madrid Spain
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21
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Cai T, Gouble A, Black KL, Skwarska A, Naqvi AS, Taylor D, Zhao M, Yuan Q, Sugita M, Zhang Q, Galetto R, Filipe S, Cavazos A, Han L, Kuruvilla V, Ma H, Weng C, Liu CG, Liu X, Konoplev S, Gu J, Tang G, Su X, Al-Atrash G, Ciurea S, Neelapu SS, Lane AA, Kantarjian H, Guzman ML, Pemmaraju N, Smith J, Thomas-Tikhonenko A, Konopleva M. Targeting CD123 in blastic plasmacytoid dendritic cell neoplasm using allogeneic anti-CD123 CAR T cells. Nat Commun 2022; 13:2228. [PMID: 35484100 PMCID: PMC9051102 DOI: 10.1038/s41467-022-29669-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/21/2022] [Indexed: 01/06/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy with poor outcomes with conventional therapy. Nearly 100% of BPDCNs overexpress interleukin 3 receptor subunit alpha (CD123). Given that CD123 is differentially expressed on the surface of BPDCN cells, it has emerged as an attractive therapeutic target. UCART123 is an investigational product consisting of allogeneic T cells expressing an anti-CD123 chimeric antigen receptor (CAR), edited with TALEN® nucleases. In this study, we examine the antitumor activity of UCART123 in preclinical models of BPDCN. We report that UCART123 have selective antitumor activity against CD123-positive primary BPDCN samples (while sparing normal hematopoietic progenitor cells) in the in vitro cytotoxicity and T cell degranulation assays; supported by the increased secretion of IFNγ by UCART123 cells when cultured in the presence of BPDCN cells. UCART123 eradicate BPDCN and result in long-term disease-free survival in a subset of primary patient-derived BPDCN xenograft mouse models. One potential challenge of CD123 targeting therapies is the loss of CD123 antigen through diverse genetic mechanisms, an event observed in one of three BPDCN PDX studied. In summary, these results provide a preclinical proof-of-principle that allogeneic UCART123 cells have potent anti-BPDCN activity. Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and highly aggressive hematologic malignancy derived from the precursors of plasmacytoid dendritic cells. Here the authors characterize the anti-tumor activity of allogeneic anti-CD123 CAR-T cells in preclinical models of BPDCN.
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Affiliation(s)
- Tianyu Cai
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Kathryn L Black
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Anna Skwarska
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Ammar S Naqvi
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Deanne Taylor
- Department of Biomedical & Health Informatics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ming Zhao
- School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qi Yuan
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mayumi Sugita
- Department of Medicine, Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Qi Zhang
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | | | - Antonio Cavazos
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Lina Han
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Vinitha Kuruvilla
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Helen Ma
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Connie Weng
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Chang-Gong Liu
- Department of Experimental Therapeutics, The University of MD Anderson Cancer Center, Houston, TX, USA
| | - Xiuping Liu
- Department of Experimental Therapeutics, The University of MD Anderson Cancer Center, Houston, TX, USA
| | - Sergej Konoplev
- Department of Hematopathology, The University of MD Anderson Cancer Center, Houston, TX, USA
| | - Jun Gu
- School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guilin Tang
- Department of Hematopathology, The University of MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaoping Su
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gheath Al-Atrash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of MD Anderson Cancer Center, Houston, TX, USA
| | - Stefan Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, The University of MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, The University of MD Anderson Cancer Center, Houston, TX, USA
| | | | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Monica L Guzman
- Department of Medicine, Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Andrei Thomas-Tikhonenko
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Molina Castro D, Perilla Suárez O, Cuervo-Sierra J, Moreno A. Blastic Plasmacytoid Dendritic Cell Neoplasm With Central Nervous System Involvement: A Case Report. Cureus 2022; 14:e23888. [PMID: 35530883 PMCID: PMC9075687 DOI: 10.7759/cureus.23888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm is a rare hematologic neoplasm characterized by cutaneous, hematologic, and central nervous system (CNS) involvement with poor prognosis. Diagnosis is made by flow cytometry, although there are no specific markers, making its diagnosis challenging. So far, with the available evidence, acute lymphoid leukemia-type schemes and consolidation with allogeneic transplant seem to become the first-line therapy. With its characterization, new therapies directed toward CD123 and the anti-apoptotic protein Bcl-2 have appeared to prolong the survival of these patients. We present a case of a 27-year-old male patient diagnosed with blastic plasmacytoid dendritic cell neoplasm with unusual CNS manifestations and without skin involvement who achieved complete remission with venetoclax and improvement of neurological symptoms, making him a candidate for hematopoietic stem cell transplant.
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Alam H, Saeed N, Rashid A. Indispensable role of immunophenotyping in diagnosing leukemic phase of blastic plasmacytoid dendritic cell neoplasm without cutaneous manifestation. Leuk Res Rep 2022; 17:100317. [PMID: 35518189 PMCID: PMC9065302 DOI: 10.1016/j.lrr.2022.100317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm usually presents as skin lesions. Diagnostic error occurs when it primarily presents in leukemic phase without skin involvement. Triad of CD4, CD56 and CD123 immunophenotype expression is essential to avoid misdiagnosis of this rare hematological malignancy. Here we describe a patient who presented in overt leukemic phase of BPDCN highlighting diagnostic challenges encountered that resulted in delayed diagnosis and poor outcome.
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Affiliation(s)
- Hareem Alam
- Section of Hematology & Transfusion Medicine, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nabiha Saeed
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Anila Rashid
- Section of Hematology & Transfusion Medicine, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
- Corresponding author.
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Khanlari M, Yin CC, Takahashi K, Lachowiez C, Tang G, Loghavi S, Bah I, Wang W, Konoplev S, Medeiros LJ, Pemmaraju N, Khoury JD, Wang SA. Bone marrow clonal hematopoiesis is highly prevalent in blastic plasmacytoid dendritic cell neoplasm and frequently sharing a clonal origin in elderly patients. Leukemia. [DOI: 10.1038/s41375-022-01538-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/13/2022]
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Affiliation(s)
- Nathaniel R. Wilson
- Department of Internal Medicine, The University of Texas McGovern Medical School, Houston, Texas, United States
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Saraç G, Güneş P. Blastic Plasmacytoid Dendritic Cell Neoplasm: A Rare Hematological Entity with Common Skin Presentation. Indian J Dermatol 2022; 67:439-440. [PMID: 36578719 PMCID: PMC9792023 DOI: 10.4103/ijd.ijd_310_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Gonca Saraç
- From the Department of Dermatology and Venereology, Public Hospital of Şile, İstanbul, Turkey E-mail:
| | - Pembegül Güneş
- Department of Pathology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
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Markham A. Tagraxofusp in blastic plasmacytoid dendritic cell neoplasm: a profile of its use. Drugs Ther Perspect 2021; 37:557-562. [DOI: 10.1007/s40267-021-00870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
INTRODUCTION Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy with historically poor outcomes for patients, often refractory to traditional chemotherapy. Recent research has focused on targeted therapy to improve responses and limit potential toxicity. AREAS COVERED CD123 (also known as IL-3 Rα) is a cell surface marker and attractive therapeutic target for many myeloid malignancies, particularly BPDCN, whose cells ubiquitously overexpress CD123. We review the history of CD123 research regarding BPDCN, recent advances including FDA approval of tagraxofusp (formerly SL-401) for BPDCN, and ongoing clinical studies utilizing novel therapeutic strategies to target CD123. EXPERT OPINION The approval of tagraxofusp for the treatment of BPDCN in December 2018 drastically changed the treatment landscape for patients with this rare neoplasm. While tagraxofusp is better tolerated than traditional multi-agent chemotherapy regimens, it requires close monitoring and sound clinical judgment by providers to prevent and mitigate severe treatment-related complications with special attention to the recognition and management of capillary leak syndrome (CLS). Several other promising strategies for targeting CD123 in BPDCN are currently under investigation, including antibody-drug conjugates, T-cell engagers, and CAR-T cellular therapeutics. These CD123 targeted approaches may soon become standard of care for patients with this difficult to treat malignancy.
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Affiliation(s)
- Adam J DiPippo
- Clinical Pharmacy Specialist, Pharmacy Clinical Programs, The University of Texas Md Anderson Cancer Center, Houston,Texas US
| | - Nathaniel R Wilson
- Resident Physician, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, US
| | - Naveen Pemmaraju
- Associate Professor, Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, US
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29
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Uetz-von Allmen E, Samson GPB, Purvanov V, Maeda T, Legler DF. CAL-1 as Cellular Model System to Study CCR7-Guided Human Dendritic Cell Migration. Front Immunol 2021; 12:702453. [PMID: 34603281 PMCID: PMC8482423 DOI: 10.3389/fimmu.2021.702453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Dendritic cells (DCs) are potent and versatile professional antigen-presenting cells and central for the induction of adaptive immunity. The ability to migrate and transport peripherally acquired antigens to draining lymph nodes for subsequent cognate T cell priming is a key feature of DCs. Consequently, DC-based immunotherapies are used to elicit tumor-antigen specific T cell responses in cancer patients. Understanding chemokine-guided DC migration is critical to explore DCs as cellular vaccines for immunotherapeutic approaches. Currently, research is hampered by the lack of appropriate human cellular model systems to effectively study spatio-temporal signaling and CCR7-driven migration of human DCs. Here, we report that the previously established human neoplastic cell line CAL-1 expresses the human DC surface antigens CD11c and HLA-DR together with co-stimulatory molecules. Importantly, if exposed for three days to GM-CSF, CAL-1 cells induce the endogenous expression of the chemokine receptor CCR7 upon encountering the clinically approved TLR7/8 agonist Resiquimod R848 and readily migrate along chemokine gradients. Further, we demonstrate that CAL-1 cells can be genetically modified to express fluorescent (GFP)-tagged reporter proteins to study and visualize signaling or can be gene-edited using CRISPR/Cas9. Hence, we herein present the human CAL-1 cell line as versatile and valuable cellular model system to effectively study human DC migration and signaling.
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Affiliation(s)
- Edith Uetz-von Allmen
- Biotechnology Institute Thurgau (BITg) at the University of Konstanz, Kreuzlingen, Switzerland
| | - Guerric P B Samson
- Biotechnology Institute Thurgau (BITg) at the University of Konstanz, Kreuzlingen, Switzerland.,Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Bern, Switzerland
| | - Vladimir Purvanov
- Biotechnology Institute Thurgau (BITg) at the University of Konstanz, Kreuzlingen, Switzerland
| | - Takahiro Maeda
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Daniel F Legler
- Biotechnology Institute Thurgau (BITg) at the University of Konstanz, Kreuzlingen, Switzerland.,Theodor Kocher Institute, University of Bern, Bern, Switzerland.,Department of Biology, University of Konstanz, Konstanz, Germany
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30
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Oza N, Rathnam K, Sumeet G, Honey SR, Saju SV, Shubhada K. Blastic Plasmacytoid Dendritic Cell Neoplasm: A Rare Case Report with Literature Review. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1736432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractBlastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematopoietic neoplasm for which there are no effective therapies. We present a 70-year-old male patient with multiple reddish painless, nonpruritic, and nonpedunculated nodules over the trunk, forearm, and thighs for a duration of 3 months. The nodules measured 0.5 to 2 cm in diameter. The peripheral smear findings were within normal limits. Excision biopsy was performed. Histomorphology and immunohistochemistry (CD123, CD 56, CD4, HLA-DR, CD43, and CD68) confirmed the diagnosis of BPDCN. Findings of marrow aspiration, biopsy and imaging studies were within normal limits. Patient demonstrated a good response with complete disappearance of all nodules by initial 2 weeks of therapy with a modified Berlin–Frankfurt–Munster (BFM) acute lymphoblastic leukemia (ALL) protocol and has completed 8 doses (LSAP [lincosamides, streptogramins A and pleuromutilins chemotherapy], 5,000 units/m2). The patient tolerated protocol extremely well.
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Affiliation(s)
- Nikita Oza
- Department of Histopathology, SRL Diagnostics – Centre of Excellence, Goregaon West, Mumbai, Maharashtra, India
| | - Krishnakumar Rathnam
- Department of Medical Oncology, Meenakshi Mission Hospital & Research Centre, Madurai, Tamil Nadu, India
| | - Gujral Sumeet
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Susan R. Honey
- Department of Medical Oncology, Meenakshi Mission Hospital & Research Centre, Madurai, Tamil Nadu, India
| | - S. V. Saju
- Department of Medical Oncology, Meenakshi Mission Hospital & Research Centre, Madurai, Tamil Nadu, India
| | - Kane Shubhada
- Department of Histopathology, SRL Diagnostics – Centre of Excellence, Goregaon West, Mumbai, Maharashtra, India
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31
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Abstract
Plasmacytoid dendritic cells (pDCs) serve as immunoregulatory antigen-presenting cells that play a role in various inflammatory, viral, and malignant conditions. Malignant proliferation of pDCs is implicated in the pathogenesis of certain hematologic cancers, specifically blastic plasmacytoid dendritic cell neoplasm (BPDCN) and acute myelogenous leukemia with clonal expansion of pDC (pDC-AML). In recent years, BPDCN and pDC-AML have been successfully treated with targeted therapy of pDC-specific surface marker, CD123. However, relapsed and refractory BPDCN remains an elusive cancer, with limited therapeutic options. CD303 is another specific surface marker of human pDCs, centrally involved in antigen presentation and immune tolerance. Monoclonal antibodies directed against CD303 have been studied in preclinical models and have achieved disease control in patients with cutaneous lupus erythematosus. We performed a comprehensive review of benign and malignant disorders in which CD303 have been studied, as there may be a potential future CD303-directed therapy for many of these conditions.
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Affiliation(s)
- Nathaniel R Wilson
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Laura Bover
- Departments of Genomic Medicine and Immunology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Marina Konopleva
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Lina Han
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sattva Neelapu
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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32
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Porwit A, Béné MC. The Plasmacytoid Dendritic Cell CD123+ Compartment in Acute Leukemia with or without RUNX1 Mutation: High Inter-Patient Variability Disclosed by Immunophenotypic Unsupervised Analysis and Clustering. Hemato 2021; 2:572-85. [DOI: 10.3390/hemato2030036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Plasmacytoid dendritic cells (PDC) constitute a small subset of normal bone marrow (BM) cells but have also been shown to be present, sometimes in large numbers, in several hematological malignancies such as acute myeloid leukemia with RUNX1 mutation, chronic myelomonocytic leukemia or, obviously, blastic plasmacytoid dendritic cell neoplasms. These cells have been reported to display somewhat variable immunophenotypic features in different conditions. However, little is known of their plasticity within individual patients. Using an unsupervised clustering tool (FlowSOM) to re-visit flow cytometry results of seven previously analyzed cases of hematological malignancies (6 acute myeloid leukemia and one chronic myelomonocytic leukemia) with a PDC contingent, we report here on the unexpectedly high variability of PDC subsets. Although five of the studied patients harbored a RUNX1 mutation, no consistent feature of PDCs could be disclosed as associated with this variant. Moreover, the one normal single-node small subset of PDC detected in the merged file of six normal BM could be retrieved in the remission BM samples of three successfully treated patients. This study highlights the capacity of unsupervised flow cytometry analysis to delineate cell subsets not detectable with classical supervised tools.
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33
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Serio B, Giudice V, D'Addona M, Guariglia R, Gorrese M, Bertolini A, D'Alto F, Cuffa B, Pellegrino D, Langella M, Selleri C. A case series of blastic plasmacytoid dendritic cell neoplasia. Transl Med UniSa 2021. [PMID: 33457326 PMCID: PMC8370518 DOI: 10.37825/2239-9747.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN), an extremely rare and aggressive tumor, derives from plasmacytoid dendritic cell precursors and is characterized by CD4 and CD56 positivity accompanied by the expression of isolated myeloid, B- or T-cell lineage markers. Despite the recent introduction of specific targeted therapies, prognosis is still poor with a median overall survival of one year, and allogeneic bone marrow transplantation remains the only curative treatment in eligible patients. In this series, we described two cases of adult BPDCN treated with high dose cytarabine and methotrexate and autologous hematopoietic stem cell transplantation, or fludarabine, cytarabine, and idarubicin achieving the first a complete lasting remission, while the second only a transient improvement in skin lesions.
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Affiliation(s)
- B Serio
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy
| | - V Giudice
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy.,Clinical Pharmacology, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | - M D'Addona
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy
| | - R Guariglia
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy
| | - M Gorrese
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy
| | - A Bertolini
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | - F D'Alto
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy
| | - B Cuffa
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy
| | - D Pellegrino
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy
| | - M Langella
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy
| | - C Selleri
- Hematology and Transplant Center, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
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34
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Yoshioka K, Kurokawa R, Amemiya S, Koyamaa H, Matsuda K, Honda A, Kurokawa M, Shinozaki-Ushiku A, Abe O. Rapidly progressing blastic plasmacytoid dendritic cell neoplasm causing diffuse skin thickening: A case report with sequential computed tomography examinations. Radiol Case Rep 2021; 16:2929-2933. [PMID: 34401028 PMCID: PMC8350179 DOI: 10.1016/j.radcr.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/05/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm is a rare aggressive myeloid malignancy thought to be derived from precursor plasmacytoid dendritic cells. Rapid progression and poor prognosis have been known. We herein present a case of BPDCN in a previously healthy man who presented with suddenly developed multiple deep purple skin rashes, with sequential computed tomography examinations. The follow-up computed tomography demonstrated that multiple skin nodules observed in the initial MRI fused, resulting in a thickening of the entire skin, with some surface erosions and crusting. Blastic plasmacytoid dendritic cell neoplasm should be considered in the differentials in patients with a sudden onset and rapidly progressing skin rash or thickening.
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Affiliation(s)
- Kyohei Yoshioka
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiori Amemiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Koyamaa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kensuke Matsuda
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akira Honda
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Aya Shinozaki-Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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35
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Abstract
OBJECTIVES Ionized calcium binding adaptor molecule 1 (IBA1), a marker of microglia/macrophages, has not been investigated in human hematopathologic contexts. We evaluated its expression in mature and immature neoplasms of monocytic/histiocytic and dendritic cell (DC) origin. METHODS Immunohistochemistry for IBA1, CD14, CD68, and CD163 was performed on a total of 114 cases, including a spectrum of monocytic/histiocytic and DC neoplasms (20 tissue based and 59 bone marrow based) and several nonhistiocytic/monocytic/DC neoplasms as control groups (15 tissue based and 20 bone marrow based). RESULTS IBA1 expression was observed in all types of mature tissue-based histiocytic/DC neoplasms (20/20) but not in the corresponding control group (0/15). In bone marrow-based cases, IBA1 was expressed in most acute myeloid leukemias (AMLs) with monocytic differentiation (48/53), both blastic plasmacytoid dendritic cell neoplasms (2/2), and all chronic myelomonocytic leukemias (4/4), while it was positive in only one nonmonocytic AML (1/15) and none of the acute lymphoblastic leukemias (0/5). Collectively, IBA1 showed much higher sensitivity and specificity (93.7%, 97.1%) compared with CD14 (65.4%, 88.2%), CD68 (74.4%, 74.2%), and CD163 (52.6%, 90.6%). CONCLUSIONS IBA1 is a novel, highly sensitive, and specific marker for diagnosing neoplasms of monocytic/histiocytic and DC origin.
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Affiliation(s)
- Xiaoming Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Li-Ping Wang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Amy Ziober
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
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36
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Wilson NR, Konopleva M, Khoury JD, Pemmaraju N. Novel Therapeutic Approaches in Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN): Era of Targeted Therapy. Clin Lymphoma Myeloma Leuk 2021; 21:734-740. [PMID: 34226167 DOI: 10.1016/j.clml.2021.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/13/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic malignancy arising from the aberrant transformation of plasmacytoid dendritic cells (pDCs) and involving skin, bone marrow, lymph nodes, and central nervous system. Characteristically unique from other myeloid neoplasms, BPDCN cells express CD4, CD56, and CD123 as well as TCL-1 and TCF4 in almost all cases. Historically, this malignancy has exhibited a poor prognosis, with median survival of less than 2 years. Traditional treatment approaches have involved conventional cytotoxic chemotherapy followed by hematopoietic stem cell transplantation; however, patients frequently relapse with chemotherapy-resistant disease. We have recently entered a modern era of therapy with targeting of CD123, with first-in-class agent tagraxofusp, a CD123- targeted agent approved by the US Food and Drug Administration for therapy of patients with BPDCN ages 2 and older. Relapsed and refractory BPDCN remains an elusive therapeutic challenge, but better understanding of the underlying pathophysiology has led to the development of other CD123-targeted agents and combination therapy, as well as agents targeting beyond CD123. Specifically, the use of venetoclax in targeting BCL2 has been promising in BPDCN treatment. This review will focus on the underlying diagnostic markers of BPDCN which have led to novel targeted treatment strategies, as well as future directions in therapy we can expect in coming years.
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Affiliation(s)
- Nathaniel R Wilson
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX
| | - Marina Konopleva
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
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37
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Nagel S, Pommerenke C, Meyer C, Drexler HG. NKL Homeobox Gene VENTX Is Part of a Regulatory Network in Human Conventional Dendritic Cells. Int J Mol Sci 2021; 22:ijms22115902. [PMID: 34072771 PMCID: PMC8198381 DOI: 10.3390/ijms22115902] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 01/09/2023] Open
Abstract
Recently, we documented a hematopoietic NKL-code mapping physiological expression patterns of NKL homeobox genes in human myelopoiesis including monocytes and their derived dendritic cells (DCs). Here, we enlarge this map to include normal NKL homeobox gene expressions in progenitor-derived DCs. Analysis of public gene expression profiling and RNA-seq datasets containing plasmacytoid and conventional dendritic cells (pDC and cDC) demonstrated HHEX activity in both entities while cDCs additionally expressed VENTX. The consequent aim of our study was to examine regulation and function of VENTX in DCs. We compared profiling data of VENTX-positive cDC and monocytes with VENTX-negative pDC and common myeloid progenitor entities and revealed several differentially expressed genes encoding transcription factors and pathway components, representing potential VENTX regulators. Screening of RNA-seq data for 100 leukemia/lymphoma cell lines identified prominent VENTX expression in an acute myelomonocytic leukemia cell line, MUTZ-3 containing inv(3)(q21q26) and t(12;22)(p13;q11) and representing a model for DC differentiation studies. Furthermore, extended gene analyses indicated that MUTZ-3 is associated with the subtype cDC2. In addition to analysis of public chromatin immune-precipitation data, subsequent knockdown experiments and modulations of signaling pathways in MUTZ-3 and control cell lines confirmed identified candidate transcription factors CEBPB, ETV6, EVI1, GATA2, IRF2, MN1, SPIB, and SPI1 and the CSF-, NOTCH-, and TNFa-pathways as VENTX regulators. Live-cell imaging analyses of MUTZ-3 cells treated for VENTX knockdown excluded impacts on apoptosis or induced alteration of differentiation-associated cell morphology. In contrast, target gene analysis performed by expression profiling of knockdown-treated MUTZ-3 cells revealed VENTX-mediated activation of several cDC-specific genes including CSFR1, EGR2, and MIR10A and inhibition of pDC-specific genes like RUNX2. Taken together, we added NKL homeobox gene activities for progenitor-derived DCs to the NKL-code, showing that VENTX is expressed in cDCs but not in pDCs and forms part of a cDC-specific gene regulatory network operating in DC differentiation and function.
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Wang W, Khoury JD, Miranda RN, Jorgensen JL, Xu J, Loghavi S, Li S, Pemmaraju N, Nguyen T, Medeiros LJ, Wang SA. Immunophenotypic characterization of reactive and neoplastic plasmacytoid dendritic cells permits establishment of a 10-color flow cytometric panel for initial workup and residual disease evaluation of blastic plasmacytoid dendritic cell neoplasm. Haematologica 2021; 106:1047-1055. [PMID: 32241840 PMCID: PMC8017819 DOI: 10.3324/haematol.2020.247569] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 12/18/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematopoietic neoplasm whose immunophenotype remains incompletely characterized, particularly with regards to its distinction from reactive plasmacytoid dendritic cells (PDC). This limitation complicates detection of low-level involvement by BPDCN as well as minimal residual disease (MRD) assessment following therapy. We conducted the current study to characterize the immunophenotype of BPDCN in a cohort of 39 patients, and compared it to that of reactive PDC. We found that, in addition to CD56 expression (97%), BPDCN showed a number of aberrancies, including decreased/negative CD38 (82%), positive CD7 (64%), negative CD2 (81%), negative CD303 (56%), increased HLA-DR (69%) and decreased CD123 (78%) expression. Although BPDCN cells were characterized by CD56 expression, reactive PDC consistently included a CD56+ subset, ranging from 1.3%-20% (median 4.5%) of all PDC, challenging the detection of MRD. These CD56+ reactive PDC were, however, consistently positive for CD2 and CD303, brightly positive for CD38, and negative for CD7, distinctively different from BPDCN. Based on these findings, we set up a ten-color flow cytometry assay for BPDCN and validated it to a sensitivity of 0.01%. This panel was prospectively tested in 19 bone marrow samples from seven patients with BPDCN, and it effectively distinguished BPDCN cells from background reactive PDC in all cases. In summary, by understanding the immunophenotype of reactive and neoplastic PDC, BPDCN can be effectively detected by flow cytometry to a very low level using a panel of markers in addition to CD56. Such an assay could be used for initial bone marrow workup as well as MRD detection after therapy.
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Affiliation(s)
- Wei Wang
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Joseph D Khoury
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Roberto N Miranda
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jeffrey L Jorgensen
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jie Xu
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sanam Loghavi
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Shaoying Li
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Naveen Pemmaraju
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Than Nguyen
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - L Jeffrey Medeiros
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sa A Wang
- Dept. of Hematopathology1 and Leukemia2, University of Texas MD Anderson Cancer Center, Houston, USA
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39
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Dang X, Zhou D, Meng L, Bi L. Blastic plasmacytoid dendritic cell neoplasm with genetic mutations in multiple epigenetic modifiers: a case report. J Int Med Res 2021; 49:300060520982667. [PMID: 33530792 PMCID: PMC7871073 DOI: 10.1177/0300060520982667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematodermic malignancy derived from plasmacytoid dendritic cell precursors. Despite advances in our understanding of tumor cell surface markers, the pathogenesis of BPDCN remains largely unknown. No standard or optimal treatments are available for BPDCN, and the prognosis is usually poor. We report herein a case of BPDCN that harbored multiple genetic mutations in epigenetic modifiers such as TET2 and ZRSR2. Genetic studies in patients with BPDCN may provide insights into the underlying pathogenesis, prediction of clinical prognosis, and development of better targeted therapeutics for this rare clinical entity.
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Affiliation(s)
- Xinmei Dang
- Department of Hematology and Oncology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Di Zhou
- Department of Hematology and Oncology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Lingjun Meng
- Department of Hematology and Oncology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Lintao Bi
- Department of Hematology and Oncology, 74569China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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40
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Cangini D, Silimbani P, Cafaro A, Giannini MB, Masini C, Ghelli Luserna Di Rorà A, Simonetti G, Martinelli G, Cerchione C. Tagraxofusp and anti-CD123 in blastic plasmacytoid dendritic cell neoplasm: a new hope. Minerva Med 2020; 111:467-477. [PMID: 32955827 DOI: 10.23736/s0026-4806.20.07018-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy, characterized by poor prognosis if treated with conventional therapy. Allogenic hematologic stem cell transplant can improve survival and can be curative, but it is available in a small percentage of patients given that the median age at diagnosis is 70 years. In this scenario it is assumed that only the development of precision medicine-driven therapy will change BPDCN patient prognosis. CD123 (the α-subunit of interleukin (IL)-3 receptor) is over-expressed on BPDCN cells surface and seems to be the ideal marker to develop antibody-based therapies. Tagraxofusp (Elzonris<sup>®</sup>), a recombinant immunotoxin consisting of human interleukin-3 fused to a truncated diphtheria toxin, has been approved by FDA in December 2018 for the treatment of BPDCN in adult and pediatric patients. tagraxofusp has shown promising clinical activity, with a high overall response rate and quite manageable safety profile even in elderly patients. It seems to improve overall survival too, but comparative trials are necessary to confirm this. Adverse events are commonly reported and the most important are transaminitis, thrombocytopenia and capillary leak syndrome (CLS). Therefore, to prevent the onset of severe CLS is recommended to reserve tagraxofusp for patients with preserved hepatic and cardiac functions, and to strictly observe serum albumin level. Further studies are required to resolve many several unanswered questions about tagraxofusp. In this review, we will resume and discuss pharmacological characteristic of tagraxofusp, results of clinical trials leading to its approval by FDA in 2018 and future perspectives about its use in BPDCN and other hematological malignancies.
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Affiliation(s)
- Delia Cangini
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Paolo Silimbani
- Unit of Oncological Pharmacy, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Alessandro Cafaro
- Unit of Oncological Pharmacy, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Maria B Giannini
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Carla Masini
- Unit of Oncological Pharmacy, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Andrea Ghelli Luserna Di Rorà
- Laboratory of Biosciences, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Giorgia Simonetti
- Laboratory of Biosciences, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Giovanni Martinelli
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy
| | - Claudio Cerchione
- Unit of Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Forlì-Cesena, Italy -
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Mansoor N, Meraj F, Javed O, Rafiq N, Jabbar N. Blastic plasmacytoid dendritic cell neoplasm in a child: A case report of this rare entity. Human Pathology: Case Reports 2020. [DOI: 10.1016/j.ehpc.2020.200417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Trecourt A, Balme B, Lorton M, Fontaine J, Desormeaux P, Rossi C, Bastie J, Lafon I, Jeudy G, Dalac S, Huet S, Sujobert P, Mauduit C, Traverse-glehen A. Unusual presentation of blastic plasmacytoid dendritic cell neoplasm: Pitfalls in other hematolymphoid neoplasms. Human Pathology: Case Reports 2020; 21:200409. [DOI: 10.1016/j.ehpc.2020.200409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Massone C, Raiola AM, Dominietto A, Minetto P, Beltramini S, Cerroni L, Sola S, Angelucci E. Blastic Plasmacytoid Dendritic Cell Neoplasm: Underlining the importance of an early diagnosis and the use of tagraxofusp therapy before wide dissemination. Australas J Dermatol 2020; 62:e316-e318. [PMID: 32757292 DOI: 10.1111/ajd.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/16/2020] [Accepted: 06/15/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Anna Maria Raiola
- UO Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alida Dominietto
- UO Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Minetto
- UO Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Lorenzo Cerroni
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Simona Sola
- Surgical Pathology, Galliera Hospital, Genoa, Italy
| | - Emanuele Angelucci
- UO Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Abstract
INTRODUCTION Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive hematologic malignancy that previously lacked standardized therapeutic approaches. CD123 (interleukin-3 receptor alpha unit) is highly expressed in many hematologic malignancies, including BPDCN. Tagraxofusp-ezrs (tagraxofusp from herein) is an agent that consists of interleukin-3 fused to a truncated diphtheria toxin, targeting CD123. The Food and Drug Administration recently approved tagraxofusp as therapy for BPDCN for adults and children aged 2 years and older. AREAS COVERED We discuss the history and clinical background of BPDCN along with tagraxofusp as its first-line therapy. We review the clinical efficacy and safety profile of tagraxofusp in adults including proposed sensitivity and resistance. Finally, we summarize tagraxofusp use in the pediatric population. EXPERT OPINION Tagraxofusp is a newly approved therapy for BPDCN, a hematologic malignancy that has overall historically poor outcomes. With its significant efficacy, many patients were successfully bridged to stem cell transplantation in the clinical trial leading to its ultimate approval. Clinical awareness for major toxicities, including capillary leak syndrome will be a critical aspect of using this novel agent. In the future, investigation of its use in other hematologic malignancies and expansion of clinical trials in pediatric populations with BPDCN are warranted.
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Affiliation(s)
- Sophia S Lee
- Department of Internal Medicine, The University of Texas School of Health Sciences at Houston , Houston, TX, USA
| | - Deborah McCue
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - Naveen Pemmaraju
- Department of Leukemia, The University of Texas MD Anderson Cancer Center , Houston, TX, USA
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Beziat G, Ysebaert L. Tagraxofusp for the Treatment of Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN): A Brief Report on Emerging Data. Onco Targets Ther 2020; 13:5199-5205. [PMID: 32606740 PMCID: PMC7293389 DOI: 10.2147/ott.s228342] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare myeloid malignancy, for which conventional chemotherapy has poor outcomes. CD123, the α-subunit of interleukin (IL)-3 receptor, is constantly overexpressed at the surface of tumoral cells. Tagraxofusp (or SL-401) is a recombinant cytotoxin which consists of human interleukin-3 fused to a truncated diphtheria toxin. It is currently the only novel therapy with a prospective evaluation of efficacy and safety in the treatment of BPDCN and is also the only one to achieve FDA approval. In this short review, the results of tagraxofusp are summarized and perspectives of its use in BPDCN and in other malignancies are discussed. The safety profile is also summarized, since capillary leak syndrome is the main toxic effect of the drug, along with more common toxicities including an increase in transaminases and thrombocytopenia.
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Affiliation(s)
- Guillaume Beziat
- Hematology Department, University Hospitals of Toulouse, IUC Toulouse-Oncopole, Toulouse, France
| | - Loïc Ysebaert
- Hematology Department, University Hospitals of Toulouse, IUC Toulouse-Oncopole, Toulouse, France.,University Toulouse-3 Paul Sabatier, Toulouse, France
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Abstract
PURPOSE OF REVIEW The purpose of this review was to summarize the clinical, diagnostic, and therapeutic features of blastic plasmacytoid dendritic cell neoplasm (BPDCN). RECENT FINDINGS Several case reports and series revealed new clinical, molecular, diagnostic, and therapeutic aspects of the disease. The clinical presentation diversity has been confirmed, with frequent leukemic non-cutaneous or rare atypical manifestations. The clonal evolution in the development of BPDCN has not been sufficiently elucidated. Although certain immunophenotypic markers (CD4, TCL1, CD123, CD56, CD303) are indicative of BPDCN, the diagnosis remains in certain cases challenging. Adult (ALL)-type chemotherapy followed by hematopoietic stem cell transplantation (HSCT) is related to a favorable outcome, while chemotherapy alone seems enough in children. Future studies should continue to investigate whether CD123-directed therapies could be utilized. BPDCN is a rare aggressive malignancy that needs an aggressive induction therapy. Although a diagnostic consensus is still lacking, and large retrospective studies are also needed to obtain standardized treatment guidelines, the future perspectives are encouraging, because of novel therapeutic agents that are under investigation.
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Affiliation(s)
- Nikolaos J Tsagarakis
- Department of Immunology, "G. Gennimatas" General Hospital, Mesogion Avenue 154, 11527, Athens, Greece.
| | - Georgios Paterakis
- Department of Immunology, "G. Gennimatas" General Hospital, Mesogion Avenue 154, 11527, Athens, Greece
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Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) has to be considered an orphan tumoral disease. BPDCN is a good model concerning the structuring and the organization of a concerted medical program on a nation-based, transnational, or international level. In 2019 in France the diagnosis process for BPDCN was clearly established. Two prospective clinical trials are ongoing. Because of the difficulties in diagnostic procedures and the rarity of the disease it is important that European countries collaborate to build a real European network to ensure the best and equitable medical care to all BPDCN patients.
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Abstract
Clinical and biological presentation of patients with blastic plasmacytoid dendritic cell neoplasm (BPDCN) is depicted to highlight criteria that might alert physicians. Diagnosis of BPDCN is still challenging and requires (1) immunophenotyping of blood or bone marrow aspiration using several markers (CD4, CD56, HLA-DR, myeloid and lymphoid lineage markers) and should include pDC markers such as CD123, cTCL1, CD303, and CD304, and/or (2) pathologic analysis of cutaneous lesions, also with immunohistochemistry using markers specific to BPDCN.
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Affiliation(s)
- Eric Deconinck
- Service Hématologie, Université de Bourgogne Franche-Comté, INSERM Unite Mixte de Recherche (UMR) 1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Centre Hospitalier Universitaire de Besançon, 3 Boulevard Alexandre Fleming, Besançon Cedex 25030, France
| | - Tony Petrella
- Department of Pathology, University of Montréal, Hôpital Maisonneuve-Rosemont, 2900 Boulevard Edouard-Montpetit, Montréal QC H3T 1J4, Quebec, Canada
| | - Francine Garnache Ottou
- Université de Bourgogne Franche-Comté, INSERM Unite Mixte de Recherche (UMR) 1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Etablissement Français du sang Bourgogne Franche-Comté, 8 rue du Dr JFX Girod, Besançon 25000, France.
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Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive malignancy derived from the plasmacytoid dendritic cell that commonly involves the skin. Cutaneous involvement is often the initial presentation, with deep purple or red-brown macules, plaques, or tumors. As such, dermatologists may be the first to see these patients and, in addition to oncologists, should be familiar with its presentation to facilitate early diagnosis, helping to distinguish it from acute myelogenous leukemia cutis.
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Affiliation(s)
- Jesse P Hirner
- Department of Dermatology, The Center For Cutaneous Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 375 Longwood Avenue, Boston, MA 02115, USA
| | - John T O'Malley
- Department of Dermatology, The Center For Cutaneous Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 375 Longwood Avenue, Boston, MA 02115, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, The Center For Cutaneous Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 375 Longwood Avenue, Boston, MA 02115, USA.
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