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D'Sa S, Matous JV, Advani R, Buske C, Castillo JJ, Gatt M, Kapoor P, Kersten MJ, Leblond V, Leiba M, Palomba ML, Paludo J, Qiu L, Sarosiek S, Shadman M, Talaulikar D, Tam CS, Tedeschi A, Thomas SK, Tohidi-Esfahani I, Trotman J, Varettoni M, Vos J, Garcia-Sanz R, San-Miguel J, Dimopoulos MA, Treon SP, Kastritis E. Report of consensus panel 2 from the 11th international workshop on Waldenström's macroglobulinemia on the management of relapsed or refractory WM patients. Semin Hematol 2023; 60:80-89. [PMID: 37147252 DOI: 10.1053/j.seminhematol.2023.03.003] [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: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
The consensus panel 2 (CP2) of the 11th International Workshop on Waldenström's macroglobulinemia (IWWM-11) has reviewed and incorporated current data to update the recommendations for treatment approaches in patients with relapsed or refractory WM (RRWM). The key recommendations from IWWM-11 CP2 include: (1) Chemoimmunotherapy (CIT) and/or a covalent Bruton tyrosine kinase (cBTKi) strategies are important options; their use should reflect the prior upfront strategy and are subject to their availability. (2) In selecting treatment, biological age, co-morbidities and fitness are important; nature of relapse, disease phenotype and WM-related complications, patient preferences and hematopoietic reserve are also critical factors while the composition of the BM disease and mutational status (MYD88, CXCR4, TP53) should also be noted. (3) The trigger for initiating treatment in RRWM should utilize knowledge of patients' prior disease characteristics to avoid unnecessary delays. (4) Risk factors for cBTKi related toxicities (cardiovascular dysfunction, bleeding risk and concurrent medication) should be addressed when choosing cBTKi. Mutational status (MYD88, CXCR4) may influence the cBTKi efficacy, and the role of TP53 disruptions requires further study) in the event of cBTKi failure dose intensity could be up titrated subject to toxicities. Options after BTKi failure include CIT with a non-cross-reactive regimen to one previously used CIT, addition of anti-CD20 antibody to BTKi, switching to a newer cBTKi or non-covalent BTKi, proteasome inhibitors, BCL-2 inhibitors, and new anti-CD20 combinations are additional options. Clinical trial participation should be encouraged for all patients with RRWM.
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Affiliation(s)
- S D'Sa
- UCLH Centre for Waldenström Macroglobulinaemia and Related Conditions, University College London Hospitals NHS Foundation Trust, London, UK.
| | - J V Matous
- Colorado Blood Cancer Institute, Sarah Cannon Research Institute, Denver, CO
| | - R Advani
- Stanford University Medical Center, Stanford, CA
| | - C Buske
- University Hospital Ulm, Ulm, Germany
| | - J J Castillo
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - M Gatt
- Hadassah University Medical Center, Jerusalem, Israel
| | | | - M J Kersten
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - V Leblond
- Groupe Hospitalier Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - M Leiba
- Assuta Ashdod University Hospital; Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel Memorial Sloan Kettering Cancer Center, New York, NY
| | - M L Palomba
- Memorial Sloan Kettering Cancer Center, New York NY US
| | | | - L Qiu
- National Clinical Medical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - S Sarosiek
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - D Talaulikar
- ANU College of Health and Medicine, Canberra, Australia
| | - C S Tam
- Alfred Health, Monash University, Melbourne, Australia
| | - A Tedeschi
- A. O. Ospedale Niguarda Ca' Granda, Milan, Italy
| | - S K Thomas
- University of Texas, MD Anderson Cancer Center, Houston TX USA
| | - I Tohidi-Esfahani
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - J Trotman
- Concord Repatriation General Hospital, University of Sydney, Sydney, Australia
| | - M Varettoni
- Division of Hematology, Fondazione iRCCS Policlinico, San Matteo, Italy
| | - Jmi Vos
- Amsterdam UMC, University of Amsterdam, Department of Hematology, Cancer Center Amsterdam/LYMMCARE, Amsterdam, Netherlands
| | - R Garcia-Sanz
- Hematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca, CIBERONC and Center for Cancer Research-IBMCC (University of Salamanca-CSIC), Salamanca, Spain
| | - J San-Miguel
- Clínica Universidad de Navarra, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Centro de Investigación Biomédica en Red Cáncer, Pamplona, Spain
| | - M A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - S P Treon
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - E Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
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2
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Keane C, Hamad N, Barraclough A, Lee YY, Talaulikar D, Ku M, Wight J, Tatarczuch M, Swain F, Gregory GP. Diagnosis and management of primary central nervous system lymphoma: a Consensus Practice Statement from the Australasian Lymphoma Alliance. Intern Med J 2021; 52:1624-1632. [PMID: 34927329 DOI: 10.1111/imj.15658] [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: 05/15/2021] [Revised: 10/24/2021] [Accepted: 12/05/2021] [Indexed: 11/28/2022]
Abstract
Primary central nervous system lymphoma is a clinicopathological disease entity that accounts for 1 % of all non-Hodgkin lymphoma (NHL). Advanced patient age, adverse disease biology and complexities of diagnosis and treatment render outcomes markedly inferior to systemic NHL. Despite this, an increasing evidence base including limited randomised controlled clinical trial data is informing optimal therapeutic strategies with methotrexate-based induction chemotherapy schedules and intensified consolidation in selected patients. This practice statement represents an evidence-based review of the literature and has been devised to assist healthcare professionals in the diagnosis and management of this disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- C Keane
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - N Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Australia.,School of Medicine, Sydney, University of Notre Dame, Australia.,St Vincent's Clinical School, Sydney, University of New South, UK
| | - A Barraclough
- Department of Haematology, Fiona Stanley Hospital, Western Australia, Australia
| | - Y Y Lee
- Radiation Oncology, Division of Cancer Services, Princess Alexandra Hospital, Queensland, Australia
| | - D Talaulikar
- Department of Haematology, Canberra Hospital, ACT, Australia
| | - M Ku
- Department of Clinical Haematology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,University of Melbourne, Victoria, Australia
| | - J Wight
- Department of Haematology, Townsville Hospital, Australia
| | - M Tatarczuch
- Monash Haematology, Monash Health, Clayton, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - F Swain
- Division of Cancer Services, Princess Alexandra Hospital, Australia
| | - G P Gregory
- Monash Haematology, Monash Health, Clayton, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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3
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Wilson C, Lee WI, Cook MC, Smyth L, Talaulikar D. Correlation of haemophagocytosis with clinical criteria of haemophagocytic lymphohistiocytosis and recommendations for bone marrow reporting. Pathology 2021; 54:434-441. [PMID: 34711415 DOI: 10.1016/j.pathol.2021.07.015] [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: 02/08/2021] [Revised: 07/18/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a rare condition resulting from a dysregulated inflammatory response. Currently there are no guidelines on the reporting of haemophagocytosis on bone marrow biopsy (BM) and lack of evidence on correlation between haemophagocytosis with the clinical diagnostic criteria for HLH. We aimed to assess if the amount of haemophagocytosis identified in the BM correlates with HLH-2004 criteria. Secondary aims were to evaluate inter-observer variability in reporting haemophagocytosis, and to formulate recommendations for screening in bone marrow specimens. A retrospective review of bone marrow biopsies from adult patients under investigation for HLH was undertaken independently by two haematopathologists who were blinded to the original biopsy report. The average number of actively haemophagocytic cells in each slide were quantified. Cases with discordance pertaining to the degree of haemophagocytosis were reviewed by both assessors to reach a consensus. Sixty-two specimens from 59 patients were available for assessment. An underlying haematological condition was identified in 34 cases (58%). There was a significant association between the amount of haemophagocytosis identified on the aspirate samples and the number of HLH-2004 criteria met (p<0.0001). In patients where haemophagocytosis was present (n=31), there was a correlation between the amount of haemophagocytosis and ferritin (p=0.041). Based on our review, we have made recommendations for the reporting of BM haemophagocytosis. Our findings indicate that the amount of haemophagocytosis present on BM samples correlates with the number of HLH-2004 criteria. We found marked interobserver variability which we anticipate can be rectified with our recommendations for reporting.
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Affiliation(s)
- C Wilson
- Haematology Department, Canberra Hospital, Garran, ACT, Australia
| | - W I Lee
- Immunology Department, Canberra Hospital, Garran, ACT, Australia
| | - M C Cook
- Immunology Department, Canberra Hospital, Garran, ACT, Australia; Australian National University Medical School, Acton, ACT, Australia
| | - L Smyth
- Australian National University Medical School, Acton, ACT, Australia
| | - D Talaulikar
- Haematology Department, Canberra Hospital, Garran, ACT, Australia; Australian National University Medical School, Acton, ACT, Australia.
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4
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Trotman J, Tedeschi A, Linton K, McKay P, Hu B, Chan H, Jin J, Sobieraj‐Teague M, Zinzani PL, Coleman M, Browett P, Ke X, Sun M, Marcus R, Portell C, Thieblemont C, Zhou K, Liberati AM, Bachy E, Cavallo F, Costello R, Iyengar S, Marasca R, Mociková H, Kim JS, Talaulikar D, Co M, Zhou W, Huang J, Opat S. SAFETY AND EFFICACY OF ZANUBRUTINIB IN PATIENTS WITH RELAPSED/REFRACTORY MARGINAL ZONE LYMPHOMA (MAGNOLIA PHASE 2 STUDY). Hematol Oncol 2021. [DOI: 10.1002/hon.19_2880] [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] [Indexed: 11/11/2022]
Affiliation(s)
- J. Trotman
- Concord Repatriation General Hospital University of Sydney Oncology Concord Australia
| | - A. Tedeschi
- ASST Grande Ospedale Metropolitano Niguarda Hematology Milan Italy
| | - K. Linton
- The Christie Hematology Manchester UK
| | - P. McKay
- Beatson West of Scotland Cancer Centre Oncology Glasgow UK
| | - B. Hu
- Levine Cancer Institute/Atrium Health Oncology Charlotte USA
| | - H. Chan
- North Shore Hospital Haematology Auckland New Zealand
| | - J. Jin
- The First Affiliated Hospital Zhejiang University Hematology Hangzhou China
| | | | - P. L. Zinzani
- Institute of Hematology “Seràgnoli” University of Bologna Hematology Bologna Italy
| | - M. Coleman
- Clinical Research Alliance Hematology Lake Success USA
| | - P. Browett
- Auckland City Hospital Haematology Grafton New Zealand
| | - X. Ke
- Peking University Third Hospital Hematology Beijing China
| | - M. Sun
- Institute of Hematology & Blood Diseases Hospital Chinese Academy of Medical Sciences Peking Union Medical College Hematology Tianjin China
| | - R. Marcus
- Sarah Cannon Research Institute UK Oncology London UK
| | - C. Portell
- University of Virginia Health System Hematology/Oncology Charlottesville USA
| | - C. Thieblemont
- APHP, Hôpital Saint‐Louis, Hemato‐oncology Paris University Diderot Hematology/Oncology Paris France
| | - K. Zhou
- Henan Cancer Hospital Oncology Zhengzhou China
| | - A. M. Liberati
- Azienda Ospedaliera Santa Maria Di Terni Oncology Terni Italy
| | - E. Bachy
- Centre Hospitalier Lyon Sud Pierre Bénite Hematology Rhone Italy
| | - F. Cavallo
- Azienda Ospedaliera Città della Salute e della Scienza di Torino Hematology Torino Italy
| | - Rég. Costello
- Hôpital de la Conception – APHM Hematology Marseille France
| | - S. Iyengar
- Royal Marsden Hospital Haematology London UK
| | - R. Marasca
- AOU Policlinico di Modena Hematology Modena Italy
| | - H. Mociková
- Fakultní nemocnice Královské Vinohrady Hematology Praha 10 Czech Republic
| | - J. S. Kim
- Severance Hospital Hematology Seoul Korea
| | - D. Talaulikar
- The Canberra Hospital Haematology Canberra Australia
| | - M. Co
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc Hematology San Mateo USA
| | - W. Zhou
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc Hematology San Mateo USA
| | - J. Huang
- BeiGene (Beijing) Co., Ltd. Beijing, China and BeiGene USA, Inc Hematology San Mateo USA
| | - S. Opat
- Monash Health Monash University Haematology Clayton Australia
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5
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Nath K, Law S, Talaulikar D, Sabdia MB, Gunawardana J, Long LM, Shanavas M, Tsang H, Tobin JW, Halliday S, Hernandez A, Cross D, Bird R, Jain S, Keane C, Trotman J, Law P, Gandhi MK. INTRATUMORAL T‐CELLS HAVE A DIFFERENTIAL IMPACT ON FDG‐PET PARAMETERS IN FOLLICULAR LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.76_2879] [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] [Indexed: 11/09/2022]
Affiliation(s)
- K. Nath
- Mater Research Institute University of Queensland Brisbane Australia
| | - Soi‐C. Law
- Mater Research Institute University of Queensland Brisbane Australia
| | - D. Talaulikar
- Haematology Translational Research Unit Canberra Hospital Canberra Australia
| | - M. B. Sabdia
- Mater Research Institute University of Queensland Brisbane Australia
| | - J. Gunawardana
- Mater Research Institute University of Queensland Brisbane Australia
| | - L. M. Long
- Mater Research Institute University of Queensland Brisbane Australia
| | - M. Shanavas
- Mater Research Institute University of Queensland Brisbane Australia
| | - H. Tsang
- Mater Research Institute University of Queensland Brisbane Australia
| | - J. W. Tobin
- Mater Research Institute University of Queensland Brisbane Australia
| | - S.‐J. Halliday
- Princess Alexandra Hospital Department of Haematology Brisbane Australia
| | - A. Hernandez
- Princess Alexandra Hospital Department of Haematology Brisbane Australia
| | - D. Cross
- Princess Alexandra Hospital Department of Haematology Brisbane Australia
| | - R. Bird
- Princess Alexandra Hospital Department of Haematology Brisbane Australia
| | - S. Jain
- Canberra Hospital Department of Anatomical Pathology Canberra Australia
| | - C. Keane
- Mater Research Institute University of Queensland Brisbane Australia
| | - J. Trotman
- Concord Repatriation General Hospital Department of Haematology Sydney Australia
| | - P. Law
- Princess Alexandra Hospital Department of Medical Imaging Brisbane Australia
| | - M. K. Gandhi
- Mater Research Institute University of Queensland Brisbane Australia
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6
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Castillo J, Itchaki G, Paludo J, Varettoni M, Buske C, Eyre T, Chavez J, Shain K, Issa S, Palomba L, Pasvolsky O, Simpson D, Talaulikar D, Tam C, Tedeschi A, Ansell S, Nayak L, Treon S. IBRUTINIB FOR THE TREATMENT OF BING-NEEL SYNDROME: A RETROSPECTIVE, MULTICENTER STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.140_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. Castillo
- Bing Center for Waldenstrom Macroglobulinemia; Dana-Farber Cancer Institute; Boston United States
| | - G. Itchaki
- Hematology; Rabin Medical Center; Petah Tikva Israel
| | - J. Paludo
- Hematology and Oncology; Mayo Clinic; Rochester United States
| | - M. Varettoni
- Hematology; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - C. Buske
- Comprehensive Cancer Center; University Hospital Ulm; Ulm Germany
| | - T. Eyre
- Hematology; Churchill Hospital; Oxford United Kingdom
| | - J. Chavez
- Malignant Hematology; Moffitt Cancer Institute; Tampa United States
| | - K. Shain
- Malignant Hematology; Moffitt Cancer Institute; Tampa United States
| | - S. Issa
- Hematology; Middlemore Hospital; Auckland New Zealand
| | - L. Palomba
- Hematology and Oncology; Memorial Sloan Kettering Cancer Center; New York United States
| | - O. Pasvolsky
- Hematology; Rabin Medical Center; Petah Tikva Israel
| | - D. Simpson
- Hematology; North Shore Hospital; Auckland New Zealand
| | | | - C. Tam
- Hematology; Peter MacCallum Cancer Centre; Melbourne Australia
| | | | - S. Ansell
- Hematology and Oncology; Mayo Clinic; Rochester United States
| | - L. Nayak
- Center for CNS Lymphoma; Dana-Farber Cancer Institute; Boston United States
| | - S. Treon
- Bing Center for Waldenstrom Macroglobulinemia; Dana-Farber Cancer Institute; Boston United States
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7
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Gandhi M, Hoang T, Tobin J, Law S, Talaulikar D, Jain S, Vari F, Murigneux V, Fink L, Gunawardana J, Gould C, Oey H, Delecluse S, Trappe R, Merida de Long L, Sabdia M, Bhagat G, Hapgood G, Blyth E, Clancy L, Casey J, Wight J, Hawkes E, Keane C. EBV+ CNS LYMPHOMAS HAVE A DISTINCTIVE TUMOR MICROENVIRONMENT AND GENETIC PROFILE, WHICH IS AMENABLE TO COMBINATION 3 RD
PARTY EBV-SPECIFIC CTL AND IBRUTINIB THERAPY. Hematol Oncol 2019. [DOI: 10.1002/hon.91_2629] [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] [Indexed: 11/07/2022]
Affiliation(s)
- M.K. Gandhi
- Mater Research UQ; Brisbane Australia
- Haematology; Princess Alexandra Hospital; Brisbane Australia
| | - T. Hoang
- Blood Cancer Research; Diamantina Institute UQ; Brisbane Australia
| | | | - S.C. Law
- Mater Research UQ; Brisbane Australia
| | | | - S. Jain
- Pathology; Canberra Hospital; Canberra Australia
| | - F. Vari
- Blood Cancer Research; Diamantina Institute UQ; Brisbane Australia
| | - V. Murigneux
- Blood Cancer Research; Diamantina Institute UQ; Brisbane Australia
| | - L. Fink
- Blood Cancer Research; Diamantina Institute UQ; Brisbane Australia
| | | | - C. Gould
- Mater Research UQ; Brisbane Australia
| | - H. Oey
- Mater Research UQ; Brisbane Australia
| | - S. Delecluse
- DKFZ; German Cancer Research Centre; Heidelberg Germany
| | | | | | | | - G. Bhagat
- Pathology and Cell Biology; Institute for Cancer Genetics; New York United States
| | - G. Hapgood
- Haematology; Princess Alexandra Hospital; Brisbane Australia
| | - E. Blyth
- Westmead Institute for Medical Research; University of Sydney; Westmead Australia
| | - L. Clancy
- Cellular Therapies; NSW Government Health Pathology; Westmead Australia
| | - J. Casey
- Haematology; Townsville Hospital; Townsville Australia
| | - J. Wight
- Olivia Newton-John Cancer Research Institute; Heidelberg Australia
| | - E. Hawkes
- Olivia Newton-John Cancer Research Institute; Heidelberg Australia
| | - C. Keane
- Mater Research UQ; Brisbane Australia
- Haematology; Princess Alexandra Hospital; Brisbane Australia
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8
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Weber N, Mollee P, Augustson B, Brown R, Catley L, Gibson J, Harrison S, Ho PJ, Horvath N, Jaksic W, Joshua D, Quach H, Roberts AW, Spencer A, Szer J, Talaulikar D, To B, Zannettino A, Prince HM. Management of systemic AL amyloidosis: recommendations of the Myeloma Foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2016; 45:371-82. [PMID: 25169210 DOI: 10.1111/imj.12566] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 06/06/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
Systemic AL amyloidosis is a plasma cell dyscrasia with a characteristic clinical phenotype caused by multi-organ deposition of an amyloidogenic monoclonal protein. This condition poses a unique management challenge due to the complexity of the clinical presentation and the narrow therapeutic window of available therapies. Improved appreciation of the need for risk stratification, standardised use of sensitive laboratory testing for monitoring disease response, vigilant supportive care and the availability of newer agents with more favourable toxicity profiles have contributed to the improvement in treatment-related mortality and overall survival seen over the past decade. Nonetheless, with respect to the optimal management approach, there is a paucity of high-level clinical evidence due to the rarity of the disease, and enrollment in clinical trials is still the preferred approach where available. This review will summarise the Clinical Practice Guidelines on the Management of Systemic Light Chain (AL) Amyloidosis recently prepared by the Medical Scientific Advisory Group of the Myeloma Foundation of Australia. It is hoped that these guidelines will assist clinicians in better understanding and optimising the management of this difficult disease.
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Affiliation(s)
- N Weber
- Clinical Haematology and Bone Marrow Transplant Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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9
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Quach H, Joshua D, Ho J, Szer J, Spencer A, Harrison S, Mollee P, Roberts A, Horvath N, Talaulikar D, To B, Zannettino A, Brown R, Catley L, Augustson B, Jaksic W, Gibson J, Prince HM. Treatment of patients with multiple myeloma who are not eligible for stem cell transplantation: position statement of the myeloma foundation of Australia Medical and Scientific Advisory Group. Intern Med J 2015; 45:335-43. [DOI: 10.1111/imj.12688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- H. Quach
- Department of Haematology; St Vincent's Hospital; Melbourne Victoria Australia
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - D. Joshua
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Ho
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - J. Szer
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - A. Spencer
- Department of Haematology; The Alfred Hospital; Melbourne Victoria Australia
| | - S. Harrison
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - P. Mollee
- Amyloidosis Centre and Department of Haematology; Princess Alexandra Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - A. Roberts
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Clinical Haematology and BMT; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - N. Horvath
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - D. Talaulikar
- Department of Haematology; Canberra Hospital; Canberra Australian Capital Territory Australia
- Australian National University; Canberra Australian Capital Territory Australia
| | - B. To
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - A. Zannettino
- Department of Haematology; South Australia Pathology; Adelaide South Australia Australia
| | - R. Brown
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - L. Catley
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Haematology; Mater Public Hospital; Brisbane Queensland Australia
- Mater Medical Research Institute; Brisbane Queensland Australia
| | - B. Augustson
- Department of Haematology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - W. Jaksic
- Department of Haematology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - J. Gibson
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
- Department of Haematology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - H. M. Prince
- Faculty of Medicine; Dentistry and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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10
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Subramaniam K, Yeung D, Grimpen F, Joseph J, Fay K, Buckland M, Talaulikar D, Elijah J, Clarke AC, Pavli P, Moore J. Hepatosplenic T-cell lymphoma, immunosuppressive agents and biologicals: what are the risks? Intern Med J 2014; 44:287-90. [PMID: 24621284 DOI: 10.1111/imj.12363] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 04/27/2013] [Accepted: 09/14/2013] [Indexed: 11/28/2022]
Abstract
We present three cases of the rare hepatosplenic T-cell lymphoma (HSTCL); two patients suffering from Crohn disease who developed HSTCL on azathioprine without exposure to biologicals, and a third patient who had psoriasis treated using etanercept, cyclosporine and methotrexate. The evidence for an association between HSTCL and immunosuppressive drugs and biologicals is reviewed. We argue for improved pharmacovigilance processes to help determine the benefit to risk ratios for the use of these and other new agents.
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Affiliation(s)
- K Subramaniam
- Gastroenterology and Hepatology Unit, Therapeutic Goods Administration, Canberra, Australian Capital Territory, Australia
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Phillips DP, Talaulikar D, Hawkins CA, Hickman PE. Utilisation of sFLC assays - how well do we comply with guidelines? Int J Lab Hematol 2012; 35:200-10. [DOI: 10.1111/ijlh.12022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 09/25/2012] [Indexed: 12/22/2022]
Affiliation(s)
- D. P. Phillips
- Australian National University Medical School; Canberra; ACT; Australia
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Talaulikar D, Shadbolt B, Bell J, Khan K, Dahlstrom JE, McDonald A, Pidcock M, Broomfield A. Clinical role of flow cytometry in redefining bone marrow involvement in diffuse large B-cell lymphoma (DLBCL) - a new perspective. Histopathology 2008; 52:340-7. [PMID: 18269585 DOI: 10.1111/j.1365-2559.2007.02961.x] [Citation(s) in RCA: 13] [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: 11/28/2022]
Abstract
AIMS The clinical role of flow cytometry in staging bone marrow in diffuse large B-cell lymphoma (DLBCL), especially its impact on outcome, remains uncertain. The aim was to determine the contribution of flow cytometry to conventional staging, and to study the impact of this revised staging on survival. METHODS AND RESULTS One hundred and thirteen cases of DLBCL diagnosed at The Canberra Hospital from 1996 to 2005 were identified. Blinded analysis of bone marrow (BM) morphology and flow cytometric data showed involvement on morphology (M) in 25 (22.1%) cases, on flow cytometry (F) in 21 (18.6%) cases and overall (M + F) in 32 cases (28.3%); discordance was noted in 16 cases (16.1%). Cases with and without marrow involvement on conventional staging alone (M) had no significant difference in survival (P = NS). However, when BM involvement was defined as positivity on morphology and/or flow cytometry (M + F), the median survival of patients with involvement was significantly worse than patients without involvement (P = 0.026). CONCLUSIONS Flow cytometry-positive cases should be included with those positive on morphology in a summative model to define BM involvement in DLBCL, as it may have a potential impact on predicting outcome.
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Affiliation(s)
- D Talaulikar
- Department of Haematology, The Canberra Hospital, Canberra, ACT, Australia.
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Talaulikar D, Gray JX, Shadbolt B, McNiven M, Dahlstrom JE. A comparative study of the quality of DNA obtained from fresh frozen and formalin-fixed decalcified paraffin-embedded bone marrow trephine biopsy specimens using two different methods. J Clin Pathol 2007; 61:119-23. [PMID: 17545562 DOI: 10.1136/jcp.2006.045294] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Given its prognostic value, there is renewed interest in molecular staging in non-Hodgkin's lymphoma (NHL) using immunoglobulin heavy and light chain (IgH, IgL) gene rearrangements. AIMS To compare the efficiency of DNA amplification from fresh frozen and formalin-fixed decalcified paraffin-embedded (FFDPE) bone marrow trephines for use in molecular staging using two methods. METHODS After manually extracting DNA from 13 FFDPE and 14 fresh frozen trephine biopsy specimens, two methods were used to test for amplifiability: use of the amplification control master mix supplied in the In Vivo Scribe immunoglobulin heavy chain (IgH) clonality kit, which creates 5 amplicons between 96-600 base pairs (bp); and real-time amplification of the beta-globin gene. RESULTS Using the first method, the mean maximum length of amplicons generated from FFDPE trephines was statistically lower at 300 bp compared to fresh frozen samples, all of which generated amplicons up to 600 bp in size (p<0.001). Real-time amplification of the beta-globin gene showed that the mean crossing threshold of fresh frozen samples was statistically lower than that of FFDPE samples (23.48 (95% CI 22.47 to 24.48) vs 33.64 (95% CI 32.15 to 35.12); p<0.001). CONCLUSIONS Although amplifiable DNA can be extracted from both fresh-frozen and FFDPE trephine samples for IgH/IgL analysis, freshly frozen specimens are superior as a source of template DNA, especially for higher base pair PCR products.
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Affiliation(s)
- D Talaulikar
- Department of Haematology, The Canberra Hospital, Garran, Australia.
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Abstract
Measurement of health-related quality of life (HR-QoL) is used in patients with haemophilia as a way of assessing the effectiveness of health care, especially as cure is not possible. We report the first such study on patients with chronic coagulation disorders in Australia, using The RAND 36-item Health Survey 1.0 (SF-36), a standardized validated questionnaire combined with a semistructured interview. The mean scores for the eight domains of the SF-36 ranged from 52.5 +/- 42.1 for physical role to 80.0 +/- 20.0 for social functioning. Comparison with normative data obtained from the Australian Bureau of Statistics (ABS) demonstrated a reduction in all domains in this population with statistically significant reductions in general health, physical role limitation and vitality. Comparison with other studies indicates that the HR-QoL of patients with haemophilia and von Willebrand's disorder in Australia is comparable with other Western countries, reflecting the overall similar quality of care available to these patients. This study also provides a good cross-sectional view of the psychosocial factors of life in patients in Australia and recognizes the positive family support available to this population, while raising relevant shortcomings in schools and at the workplace that need to be studied further in a controlled manner.
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Affiliation(s)
- D Talaulikar
- Department of Haematology, The Canberra Hospital, Canberra, Australia.
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Talaulikar D, Tymms KE, Prosser I, Smith R. Autologous peripheral blood stem cell transplantation with in vivo T-cell depletion for life threatening refractory systemic lupus erythematosus. Lupus 2005; 14:159-63. [PMID: 15751821 DOI: 10.1191/0961203305lu2041cr] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report the first Australian application of autologous haemopoietic stem cell transplantation in a 39-year old woman with severe systemic lupus erythematosus (SLE) and multiple life threatening complications, refractory to conventional therapy including intravenous cyclophosphamide. Our transplant technique, although not unique, differs from most published reports, in which an unmanipulated peripheral stem cell graft was used with in vivo lymphocyte depletion using rabbit antithymocyte globulin (ATG). Successful stem cell mobilization was achieved using granulocytecolony stimulating factor mobilization with methylprednisolone cover, after an initial attempt at mobilization was curtailed by respiratory arrest from upper airway obstruction due to cricoarytenoiditis, requiring tracheostomy. Conditioning regimen for the transplantation was cyclophosphamide 50 mg/kg on days -5 to -2 and rabbit ATG 2.2 mg/kg on days -3 and -2. An unmanipulated autograft was infused, with in vivo T-cell depletion achieved through a further dose of ATG given on day +2 postinfusion. The autologous transplant was well tolerated without fever or other serious complication. At 12 months follow-up post-transplantation, there is an objective evidence of near-complete response with SLE disease activity index scores falling from 40 pretransplant to 2. We conclude that HSCT with unmanipulated peripheral stem cell graft and in vivo lymphocyte depletion with ATG is safe and effective therapy for cyclophosphamide refractory SLE.
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Affiliation(s)
- D Talaulikar
- Department of Haematology, The Canberra Hospital, Australia
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