1
|
Horna P, Weybright MJ, Ferrari M, Jungherz D, Peng Y, Akbar Z, Tudor Ilca F, Otteson GE, Seheult JN, Ortmann J, Shi M, Maciocia PM, Herling M, Pule MA, Olteanu H. Dual T-cell constant β chain (TRBC)1 and TRBC2 staining for the identification of T-cell neoplasms by flow cytometry. Blood Cancer J 2024; 14:34. [PMID: 38424120 PMCID: PMC10904869 DOI: 10.1038/s41408-024-01002-0] [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: 12/01/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
The diagnosis of leukemic T-cell malignancies is often challenging, due to overlapping features with reactive T-cells and limitations of currently available T-cell clonality assays. Recently developed therapeutic antibodies specific for the mutually exclusive T-cell receptor constant β chain (TRBC)1 and TRBC2 isoforms provide a unique opportunity to assess for TRBC-restriction as a surrogate of clonality in the flow cytometric analysis of T-cell neoplasms. To demonstrate the diagnostic utility of this approach, we studied 164 clinical specimens with (60) or without (104) T-cell neoplasia, in addition to 39 blood samples from healthy donors. Dual TRBC1 and TRBC2 expression was studied within a comprehensive T-cell panel, in a fashion similar to the routine evaluation of kappa and lambda immunoglobulin light chains for the detection of clonal B-cells. Polytypic TRBC expression was demonstrated on total, CD4+ and CD8+ T-cells from all healthy donors; and by intracellular staining on benign T-cell precursors. All neoplastic T-cells were TRBC-restricted, except for 8 cases (13%) lacking TRBC expression. T-cell clones of uncertain significance were identified in 17 samples without T-cell malignancy (13%) and accounted for smaller subsets than neoplastic clones (median: 4.7 vs. 69% of lymphocytes, p < 0.0001). Single staining for TRBC1 produced spurious TRBC1-dim subsets in 24 clinical specimens (15%), all of which resolved with dual TRBC1/2 staining. Assessment of TRBC restriction by flow cytometry provides a rapid diagnostic method to detect clonal T-cells, and to accurately determine the targetable TRBC isoform expressed by T-cell malignancies.
Collapse
Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA.
| | | | | | - Dennis Jungherz
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - YaYi Peng
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | | | | | | | | | - Janosch Ortmann
- Centre de Recherches Mathematiques, Universite du Quebec a Montreal, Montreal, Canada
| | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | - Marco Herling
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - Martin A Pule
- Autolus Ltd, London, UK
- Cancer Institute, University College London, London, UK
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
2
|
Seheult JN, Weybright MJ, Jevremovic D, Shi M, Olteanu H, Horna P. Computational Flow Cytometry Accurately Identifies Sezary Cells Based on Simplified Aberrancy and Clonality Features. J Invest Dermatol 2024:S0022-202X(24)00019-8. [PMID: 38237727 DOI: 10.1016/j.jid.2023.12.020] [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: 10/11/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 03/09/2024]
Abstract
Flow cytometric identification of circulating neoplastic cells (Sezary cells) in patients with mycosis fungoides and Sezary syndrome is essential for diagnosis, staging, and prognosis. Although recent advances have improved the performance of this laboratory assay, the complex immunophenotype of Sezary cells and overlap with reactive T cells demand a high level of analytic expertise. We utilized machine learning to simplify this analysis using only 2 predefined Sezary cell-gating plots. We studied 114 samples from 59 patients with Sezary syndrome/mycosis fungoides and 66 samples from unique patients with inflammatory dermatoses. A single dimensionality reduction plot highlighted all TCR constant β chain-restricted (clonal) CD3+/CD4+ T cells detected by expert analysis. On receiver operator curve analysis, an aberrancy scale feature computed by comparison with controls (area under the curve = 0.98) outperformed loss of CD2 (0.76), CD3 (0.83), CD7 (0.77), and CD26 (0.82) in discriminating Sezary cells from reactive CD4+ T cells. Our results closely mirrored those obtained by exhaustive expert analysis for event classification (positive percentage agreement = 100%, negative percentage agreement = 99%) and Sezary cell quantitation (regression slope = 1.003, R squared = 0.9996). We demonstrate the potential of machine learning to simplify the accurate identification of Sezary cells.
Collapse
Affiliation(s)
- Jansen N Seheult
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
3
|
Vossen C, Im R, Horna P. Iron-laden blasts in refractory acute myeloid leukemia. J Hematop 2023; 16:187-188. [PMID: 38175403 PMCID: PMC10766746 DOI: 10.1007/s12308-023-00555-6] [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: 06/26/2023] [Accepted: 07/19/2023] [Indexed: 01/05/2024] Open
Abstract
We report a case of refractory acute myeloid leukemia with DEK-NUP214 rearrangement showing circulating monocytic blasts with abundant green cytoplasmic granules on the Wright-Giemsa stain. The granules were strongly positive for Perls' Prussian blue, consistent with hemosiderin deposits. This previously unreported finding is suggestive of siderophage activity by leukemic blasts, likely associated with monocytic differentiation.
Collapse
Affiliation(s)
- Christopher Vossen
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, 200 1st St SW, MN, 55905, Rochester, USA.
| | - Roeun Im
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, 200 1st St SW, MN, 55905, Rochester, USA
| | - Pedro Horna
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, 200 1st St SW, MN, 55905, Rochester, USA
| |
Collapse
|
4
|
Seheult JN, Otteson GE, Jevremovic D, Horna P, Timm MM, Yuan J, Morice WG, Olteanu H, Shi M. Establishing NK-Cell Receptor Restriction by Flow Cytometry and Detecting Potential NK-Cell Clones of Uncertain Significance. Mod Pathol 2023; 36:100255. [PMID: 37385341 DOI: 10.1016/j.modpat.2023.100255] [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: 03/29/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Abstract
Natural killer (NK) cells develop a complex inhibitory and/or activating NK-cell receptor system, including killer cell immunoglobulin-like receptors (KIRs or CD158) and CD94/NKG2 dimers, which are variably combined to generate the individual's NK-cell receptor repertoire. Establishing NK-cell receptor restriction by flow cytometric immunophenotyping is an important step in diagnosing NK-cell neoplasms, but reference interval (RI) data for interpreting these studies are lacking. Specimens from 145 donors and 63 patients with NK-cell neoplasms were used to identify discriminatory rules based on 95% and 99% nonparametric RIs for CD158a+, CD158b+, CD158e+, KIR-negative, and NKG2A+ NK-cell populations to establish NK-cell receptor restriction. These 99% upper RI limits (NKG2a >88% or CD158a >53% or CD158b >72% or CD158e >54% or KIR-negative >72%) provided optimal discrimination between NK-cell neoplasm cases and healthy donor controls with an accuracy of 100% compared with the clinicopathologic diagnosis. The selected rules were applied to 62 consecutive samples received in our flow cytometry laboratory that were reflexed to an NK-cell panel due to an expanded NK-cell percentage (exceeding 40% of total lymphocytes). Twenty-two (35%) of 62 samples were found to harbor a very small NK-cell population with restricted NK-cell receptor expression based on the rule combination, suggestive of NK-cell clonality. A thorough clinicopathologic evaluation for the 62 patients did not reveal diagnostic features of NK-cell neoplasms; therefore, these potential clonal populations of NK cells were designated as NK-cell clones of uncertain significance (NK-CUS). In this study, we established decision rules for NK-cell receptor restriction from the largest published cohorts of healthy donors and NK-cell neoplasms. The presence of small NK-cell populations with restricted NK-cell receptors does not appear to be an uncommon finding, and its significance requires further exploration.
Collapse
Affiliation(s)
- Jansen N Seheult
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Gregory E Otteson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Pedro Horna
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Michael M Timm
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Ji Yuan
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - William G Morice
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Horatiu Olteanu
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Min Shi
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
5
|
Patra-Kneuer M, Chang G, Xu W, Augsberger C, Grau M, Zapukhlyak M, Ilieva K, Landgraf K, Mangelberger-Eberl D, Yousefi K, Berning P, Kurz KS, Ott G, Klener P, Khandanpour C, Horna P, Schanzer J, Steidl S, Endell J, Heitmüller C, Lenz G. Activity of tafasitamab in combination with rituximab in subtypes of aggressive lymphoma. Front Immunol 2023; 14:1220558. [PMID: 37600821 PMCID: PMC10433160 DOI: 10.3389/fimmu.2023.1220558] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Background Despite recent advances in the treatment of aggressive lymphomas, a significant fraction of patients still succumbs to their disease. Thus, novel therapies are urgently needed. As the anti-CD20 antibody rituximab and the CD19-targeting antibody tafasitamab share distinct modes of actions, we investigated if dual-targeting of aggressive lymphoma B-cells by combining rituximab and tafasitamab might increase cytotoxic effects. Methods Antibody single and combination efficacy was determined investigating different modes of action including direct cytotoxicity, antibody-dependent cell-mediated cytotoxicity (ADCC) and antibody-dependent cellular phagocytosis (ADCP) in in vitro and in vivo models of aggressive B-cell lymphoma comprising diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma (BL). Results Three different sensitivity profiles to antibody monotherapy or combination treatment were observed in in vitro models: while 1/11 cell lines was primarily sensitive to tafasitamab and 2/11 to rituximab, the combination resulted in enhanced cell death in 8/11 cell lines in at least one mode of action. Treatment with either antibody or the combination resulted in decreased expression of the oncogenic transcription factor MYC and inhibition of AKT signaling, which mirrored the cell line-specific sensitivities to direct cytotoxicity. At last, the combination resulted in a synergistic survival benefit in a PBMC-humanized Ramos NOD/SCID mouse model. Conclusion This study demonstrates that the combination of tafasitamab and rituximab improves efficacy compared to single-agent treatments in models of aggressive B-cell lymphoma in vitro and in vivo.
Collapse
Affiliation(s)
| | - Gaomei Chang
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Wendan Xu
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | | | - Michael Grau
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Myroslav Zapukhlyak
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | | | | | | | - Kasra Yousefi
- Translational Research, MorphoSys AG, Planegg, Germany
| | - Philipp Berning
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Katrin S. Kurz
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus and Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology, Stuttgart, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus and Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology, Stuttgart, Germany
| | - Pavel Klener
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University Prague, Prague, Czechia
- First Medical Department, Department of Hematology, Charles University General Hospital Prague, Prague, Czechia
| | - Cyrus Khandanpour
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
- Hematology and Oncology Clinic, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN, United States
| | | | - Stefan Steidl
- Translational Research, MorphoSys AG, Planegg, Germany
| | - Jan Endell
- Translational Research, MorphoSys AG, Planegg, Germany
| | | | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| |
Collapse
|
6
|
Panakkal V, Lakshman A, Shi M, Olteanu H, Horna P, Timm MM, Otteson GE, Baughn LB, Greipp PT, Gonsalves WI, Kapoor P, Gertz MA, Binder M, Buadi FK, Dispenzieri A, Rajkumar SV, Kumar SK, Jevremovic D. Utility of flow cytometry screening before MRD testing in multiple myeloma. Blood Cancer J 2023; 13:55. [PMID: 37080968 PMCID: PMC10119092 DOI: 10.1038/s41408-023-00832-8] [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: 01/23/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Vandana Panakkal
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arjun Lakshman
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Michael M Timm
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | - Linda B Baughn
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Wilson I Gonsalves
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Prashant Kapoor
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Moritz Binder
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francis K Buadi
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Angela Dispenzieri
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
7
|
Jevremovic D, Nanaa A, Geyer SM, Timm M, Azouz H, Hengel C, Reberg A, He R, Viswanatha D, Salama ME, Shi M, Olteanu H, Horna P, Otteson G, Greipp PT, Xie Z, Alkhateeb HB, Hogan W, Litzow M, Patnaik MM, Shah M, Al-Kali A, Nguyen PL. Abnormal CD13/HLA-DR Expression Pattern on Myeloblasts Predicts Development of Myeloid Neoplasia in Patients With Clonal Cytopenia of Undetermined Significance. Am J Clin Pathol 2022; 158:530-536. [PMID: 35938646 PMCID: PMC9535519 DOI: 10.1093/ajcp/aqac083] [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: 03/02/2022] [Accepted: 06/09/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with clonal cytopenia of undetermined significance (CCUS) are at increased risk of developing myeloid neoplasia (MN). We evaluated whether a simple flow cytometry immunophenotyping (FCIP) assay could differentiate the risk of development of MN in patients with CCUS. METHODS Bone marrow aspirates were assessed by FCIP panel in a cohort of 80 patients identified as having CCUS based on next-generation sequencing or cytogenetics from March 2015 to May 2020, with available samples. Flow cytometric assay included CD13/HLA-DR expression pattern on CD34-positive myeloblasts; CD13/CD16 pattern on maturing granulocytic precursors; and aberrant expression of CD2, CD7, or CD56 on CD34-positive myeloblasts. Relevant demographic, comorbidity, and clinical and laboratory data, including the type and extent of genetic abnormalities, were extracted from the electronic health record. RESULTS In total, 17 (21%) patients with CCUS developed MN over the follow-up period (median survival follow-up, 28 months [95% confidence interval, 19-31]). Flow cytometry immunophenotyping abnormalities, including the aberrant pattern of CD13/HLA-DR expression, as detected at the time of the diagnosis of CCUS, were significantly associated with risk of developing MN (hazard ratio, 2.97; P = .006). Additional FCIP parameters associated with the development of MN included abnormal expression of CD7 on myeloblasts and the presence vs absence of any FCIP abnormality. CONCLUSIONS A simple FCIP approach that includes assessment of CD13/HLA-DR pattern on CD34-positive myeloblasts can be useful in identifying patients with CCUS at higher risk of developing MN.
Collapse
Affiliation(s)
| | - Ahmad Nanaa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Susan M Geyer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Michael Timm
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Haya Azouz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Cynthia Hengel
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | - Rong He
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Gregory Otteson
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Patricia T Greipp
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA.,Division of Laboratory Genetics and Genomics, Mayo Clinic, Rochester, MN, USA
| | - Zhuoer Xie
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - William Hogan
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Mithun Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Phuong L Nguyen
- Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
8
|
Shi M, Timm MM, Howard MT, Jevremovic D, Yuan J, Greipp PT, Peterson JF, Roh DJ, Horna P, Olteanu H. Spurious CD34 expression in B-cell lymphoma due to nonspecific binding to PerCP-Cy5.5 fluorochrome conjugates: A rare phenomenon and a diagnostic pitfall. Cytometry B Clin Cytom 2022; 102:326-328. [PMID: 35652321 DOI: 10.1002/cyto.b.22079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Min Shi
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael M Timm
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew T Howard
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ji Yuan
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia T Greipp
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jess F Peterson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dana J Roh
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pedro Horna
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
9
|
Horna P, King RL, Jevremovic D, Fajgenbaum DC, Dispenzieri A. The lymph node transcriptome of unicentric and idiopathic multicentric Castleman disease. Haematologica 2022; 108:207-218. [PMID: 35484648 PMCID: PMC9827154 DOI: 10.3324/haematol.2021.280370] [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: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
Castleman disease is a polyclonal lymphoproliferative disorder characterized by unicentric or multicentric lymphadenopathy with characteristic histomorphological features, in addition to variable inflammatory symptomatology. The molecular mechanisms and etiologies of unicentric Castleman disease (UCD) and idiopathic multicentric Castleman disease (iMCD) are poorly understood, and identification of targetable disease mediators remains an unmet clinical need. We performed whole exome sequencing on lymph node biopsies from patients with UCD and iMCD and compared the transcriptomic profiles to that of benign control lymph nodes. We identified significantly upregulated genes in UCD (n=443), iMCD (n=316) or both disease subtypes (n=51) and downregulated genes in UCD (n=321), iMCD (n=105) or both (n=10). The transcriptomes of UCD and iMCD showed enrichment and upregulation of elements of the complement cascade. By immunohistochemistry, C4d deposits indicative of complement activation were found to be present in UCD and iMCD, mostly within abnormally regressed germinal centers, but also in association with plasma cell clusters, endothelial cells and stroma cell proliferations. Other enriched gene sets included collagen organization, S1P3 pathway and VEGFR pathway in UCD; and humoral response, oxidative phosphorylation and proteosome in iMCD. Analysis of cytokine transcripts showed upregulation of CXCL13 but not IL6 in UCD and iMCD. Among angiogenic mediators, the VEGFR1 ligand placental growth factor (PGF) was upregulated in both disease subtypes. We hereby report for the first time the whole lymph node transcriptomes of UCD and iMCD, underscoring findings that could aid in the discovery of targetable disease mediators.
Collapse
Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN,P. Horna
| | | | | | - David C. Fajgenbaum
- Center for Cytokine Storm Treatment & Laboratory, University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
10
|
Horna P, Pearce KE, Ketterling RP, Shi M, Peterson JF. Recurrent Chromosomal Abnormalities in Tissues Involved by Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Am J Clin Pathol 2022; 157:286-292. [PMID: 34528680 DOI: 10.1093/ajcp/aqab128] [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: 03/08/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Prognostically relevant chromosomal abnormalities in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) are routinely identified by fluorescence in situ hybridization (FISH) on peripheral blood or bone marrow specimens. We studied the prevalence of chromosomal abnormalities on extramedullary tissues involved by CLL/SLL and evaluated their association with prominent proliferation centers (PPCs). METHODS FISH for recurrent abnormalities in CLL/SLL was performed on formalin-fixed, paraffin-embedded biopsy sections. PPCs were identified on H&E-stained sections. Available FISH results on peripheral blood or bone marrow specimens were also reviewed. RESULTS Recurrent FISH abnormalities were detected in 69% of 320 CLL/SLL biopsy specimens studied, including +12 (35%), 13q- (24%), 11q- (15%), 17p- (6%), 6q- (2%), and IGH/BCL2 (0.9%). Forty-three patients had abnormal blood or bone marrow FISH analyses, of whom 7 (16%) had discordant +12 and/or 13q-, and 3 (7%) had discordant 17p- or 11q-. Morphology was positive (17%), negative (78%), or equivocal (6%) for PPCs on 247 evaluable biopsy specimens, a finding not significantly associated with FISH results (P = .7). CONCLUSIONS Trisomy 12 is overrepresented in tumoral CLL/SLL involvement, compared with the known predominance of 13q- in blood. Discrepancies between leukemic and tissue FISH findings are occasionally encountered. FISH results do not correlate with the presence of PPCs.
Collapse
Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Rochester, MN, USA
| | - Kathryn E Pearce
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rhett P Ketterling
- Division of Hematopathology, Rochester, MN, USA
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Division of Hematopathology, Rochester, MN, USA
| | - Jess F Peterson
- Division of Laboratory Genetics and Genomics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
11
|
Horna P, Otteson GE, Shi M, Jevremovic D, Yuan J, Olteanu H. Flow Cytometric Evaluation of Surface and Cytoplasmic TRBC1 Expression in the Differential Diagnosis of Immature T-Cell Proliferations. Am J Clin Pathol 2022; 157:64-72. [PMID: 34302330 DOI: 10.1093/ajcp/aqab098] [Citation(s) in RCA: 4] [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: 01/19/2021] [Accepted: 05/06/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Flow cytometric detection of T-cell clonality is challenging, particularly in differential diagnosis of immature T-cell proliferations. Studies have shown utility of TRBC1, in conjunction with other T-cell markers, as reliable means to identify T-cell clonality by flow cytometry. One limitation of surface TRBC1 (sTRBC1) evaluation is it cannot be detected in surface CD3 (sCD3)-negative T cells, such as normal or abnormal immature T-cell precursors. Here, we assess surface and cytoplasmic TRBC1 expression patterns in the differential diagnosis of T-lymphoblastic leukemia/lymphoma (T-ALL) vs normal thymocyte expansions. METHODS Forty-three samples containing T-ALL, thymoma, normal thymus, and/or indolent T-lymphoblastic proliferation (i-TLBP), were evaluated. RESULTS All 24 cases with normal thymocytes or i-TLBPs revealed a characteristic and reproducible sCD3/sTRBC1 expression pattern indicative of polytypic T-cell maturation. In contrast, all 19 T-ALLs lacked this polytypic maturation pattern and were either completely negative for sCD3/sTRBC1 or showed a minor sCD3-positive subset with a monotypic TRBC1 expression pattern. Cytoplasmic TRBC1 evaluation in 9 T-ALLs demonstrated a monotypic intracellular TRBC1-positive (n = 4) or TRBC1-negative (n = 5) expression, indicative of clonality. CONCLUSIONS Our findings demonstrate flow cytometric evaluation of surface and cytoplasmic TRBC1 expression can aid detection of T-cell clonality and differential diagnosis of immature T-cell proliferations.
Collapse
Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gregory E Otteson
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Min Shi
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ji Yuan
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
12
|
Horna P, Olteanu H, Jevremovic D, Otteson GE, Corley H, Ding W, Parikh SA, Shah MV, Morice WG, Shi M. Single-Antibody Evaluation of T-Cell Receptor β Constant Chain Monotypia by Flow Cytometry Facilitates the Diagnosis of T-Cell Large Granular Lymphocytic Leukemia. Am J Clin Pathol 2021; 156:139-148. [PMID: 33438036 DOI: 10.1093/ajcp/aqaa214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The diagnosis of T-cell large granular lymphocytic leukemia (T-LGLL) is challenging because of overlapping immunophenotypic features with reactive T cells and limitations of T-cell clonality assays. We studied whether adding an antibody against T-cell receptor β constant region 1 (TRBC1) to a comprehensive flow cytometry panel could facilitate the diagnosis of T-LGLL. METHODS We added TRBC1 antibody to the standard T-cell and natural killer (NK) cell panel to assess T-cell clonality in 56 T-LGLLs and 34 reactive lymphocytoses. In addition, 20 chronic lymphoproliferative disorder of NK cells (CLPD-NKs) and 10 reactive NK-cell lymphocytoses were analyzed. RESULTS Clonal T cells were detected in all available T-LGLLs by monotypic TRBC1 expression and clonal/equivocal T-cell receptor gene rearrangement (TCGR) studies, compared with only 27% of T-LGLLs by killer-cell immunoglobulin-like receptor (KIR) restriction. Overall, 85% of T-LGLLs had a blood tumor burden greater than 500 cells/µL. Thirty-four reactive cases showed polytypic TRBC1 expression, except for 5 that revealed small T-cell clones of uncertain significance. All CLPD-NKs showed expected clonal KIR expression and negative TRBC1 expression. CONCLUSIONS Addition of TRBC1 antibody to the routine flow cytometry assay could replace the TCGR molecular study and KIR flow cytometric analysis to assess clonality, simplifying the diagnosis of T-LGLL.
Collapse
Affiliation(s)
- Pedro Horna
- Departments of Laboratory Medicine and Pathology, Rochester, MN
| | - Horatiu Olteanu
- Departments of Laboratory Medicine and Pathology, Rochester, MN
| | | | | | - Heidi Corley
- Departments of Laboratory Medicine and Pathology, Rochester, MN
| | - Wei Ding
- Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | - Min Shi
- Departments of Laboratory Medicine and Pathology, Rochester, MN
| |
Collapse
|
13
|
Rozenova KA, Jevremovic D, Reichard KK, Nguyen P, Otteson GE, Timm MM, Horna P, Olteanu H, Shi M. CD2 and CD7 are sensitive flow cytometry screening markers for T-lineage acute leukemia(s): a study of 465 acute leukemia cases. Hum Pathol 2021; 114:66-73. [PMID: 34019867 DOI: 10.1016/j.humpath.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
T-lymphoblastic leukemia/lymphoma (T-ALL/LBL) is a rare acute leukemia that expresses cytoplasmic CD3 (cCD3) and frequently lacks surface CD3. Given that routine flow cytometric testing for cCD3 may not be feasible and cCD3 interpretation may be difficult, we investigate if surface CD2 and/or CD7 expression on blasts can be used by flow cytometry to screen for T-lineage acute leukemia. We retrospectively reviewed flow cytometric data from 233 acute leukemias (36 T-ALL/LBL, 8 mixed-phenotype acute leukemia T/myeloid, 80 acute myeloid leukemia, 97 B-ALL/LBL, 8 mixed-phenotype acute leukemia B/myeloid, and 4 acute undifferentiated leukemia cases). Uniform expression (≥75% of blasts) of CD2 and/or CD7 was seen in all 44 cCD3-positive cases but in only 11% (20/189) of cCD3-negative acute leukemias, thus demonstrating 100% sensitivity and 89% specificity in the identification of cCD3-positive (T-lineage) acute leukemia. To avoid selection bias, we prospectively studied 232 consecutive acute leukemias for which cCD3, CD2, and CD7 were automatically performed in all cases. Similar to the retrospective study, uniform expression of CD2 and/or CD7 on blasts showed 100% sensitivity and 88% specificity in the screening for cCD3-positive (T-lineage) acute leukemia. Therefore, acute leukemias with uniform expression of CD2 and/or CD7 warrant further testing for cCD3 to evaluate for T-lineage acute leukemia. Blasts that lack both uniform CD2 and CD7 expression do not require additional cCD3 testing. We propose that CD2 and CD7 could be utilized in a limited antibody flow cytometry panel as a sensitive, robust, and cost-effective way to screen for T-lineage acute leukemia.
Collapse
Affiliation(s)
- Krasimira A Rozenova
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, 55905, USA
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, 55905, USA
| | - Kaaren K Reichard
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, 55905, USA
| | - Phuong Nguyen
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, 55905, USA
| | - Gregory E Otteson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, 55905, USA
| | - Michael M Timm
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, 55905, USA
| | - Pedro Horna
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, 55905, USA
| | - Horatiu Olteanu
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, 55905, USA
| | - Min Shi
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, MN, 55905, USA.
| |
Collapse
|
14
|
Horna P, Shi M, Olteanu H, Johansson U. Emerging Role of T-cell Receptor Constant β Chain-1 (TRBC1) Expression in the Flow Cytometric Diagnosis of T-cell Malignancies. Int J Mol Sci 2021; 22:ijms22041817. [PMID: 33673033 PMCID: PMC7918842 DOI: 10.3390/ijms22041817] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 01/15/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023] Open
Abstract
T-cell clonality testing is integral to the diagnostic work-up of T-cell malignancies; however, current methods lack specificity and sensitivity, which can make the diagnostic process difficult. The recent discovery of a monoclonal antibody (mAb) specific for human TRBC1 will greatly improve the outlook for T-cell malignancy diagnostics. The anti-TRBC1 mAb can be used in flow cytometry immunophenotyping assays to provide a low-cost, robust, and highly specific test that detects clonality of immunophenotypically distinct T-cell populations. Recent studies demonstrate the clinical utility of this approach in several contexts; use of this antibody in appropriately designed flow cytometry panels improves detection of circulating disease in patients with cutaneous T-cell lymphoma, eliminates the need for molecular clonality testing in the context of large granular lymphocyte leukemia, and provides more conclusive results in the context of many other T-cell disorders. It is worth noting that the increased ability to detect discrete clonal T-cell populations means that identification of T-cell clones of uncertain clinical significance (T-CUS) will become more common. This review discusses this new antibody and describes how it defines clonal T-cells. We present and discuss assay design and summarize findings to date about the use of flow cytometry TRBC1 analysis in the field of diagnostics, including lymph node and fluid sample investigations. We also make suggestions about how to apply the assay results in clinical work-ups, including how to interpret and report findings of T-CUS. Finally, we highlight areas that we think will benefit from further research.
Collapse
Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA; (P.H.); (M.S.); (H.O.)
| | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA; (P.H.); (M.S.); (H.O.)
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA; (P.H.); (M.S.); (H.O.)
| | - Ulrika Johansson
- SI-HMDS, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
- Correspondence:
| |
Collapse
|
15
|
Almeida J, Pulitzer MP, Horna P. Authors reply to the letter to editor with regard to the article titled "Sézary syndrome and mycosis fungoides: An overview, including the role of immunophenotyping". Cytometry B Clin Cytom 2020; 100:141. [PMID: 33166040 DOI: 10.1002/cyto.b.21967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Julia Almeida
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL), Salamanca, Spain.,Cytometry Service (NUCLEUS), Department of Medicine, University of Salamanca, Salamanca, Spain.,IBSAL and CIBERONC, Salamanca, Spain
| | - Melissa P Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
16
|
Illingworth A, Johansson U, Huang S, Horna P, Wang SA, Almeida J, Wolniak KL, Psarra K, Torres R, Craig FE. International guidelines for the flow cytometric evaluation of peripheral blood for suspected Sézary syndrome or mycosis fungoides: Assay development/optimization, validation, and ongoing quality monitors. Cytometry B Clin Cytom 2020; 100:156-182. [PMID: 33112044 DOI: 10.1002/cyto.b.21963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022]
Abstract
Introducing a sensitive and specific peripheral blood flow cytometric assay for Sézary syndrome and mycosis fungoides (SS/MF) requires careful selection of assay design characteristics, and translation into a laboratory developed assay through development/optimization, validation, and continual quality monitoring. As outlined in a previous article in this series, the recommended design characteristics of this assay include at a minimum, evaluation of CD7, CD3, CD4, CD8, CD26, and CD45, analyzed simultaneously, requiring at least a 6 color flow cytometry system, with both quantitative and qualitative components. This article provides guidance from an international group of cytometry specialists in implementing an assay to those design specifications, outlining specific considerations, and best practices. Key points presented in detail are: (a) Pre-analytic components (reagents, specimen processing, and acquisition) must be optimized to: (i) identify and characterize an abnormal population of T-cells (qualitative component) and (ii) quantitate the abnormal population (semi/quasi-quantitative component). (b)Analytic components (instrument set-up/acquisition/analysis strategy and interpretation) must be optimized for the identification of SS/MF populations, which can vary widely in phenotype. Comparison with expert laboratories is strongly encouraged in order to establish competency. (c) Assay performance must be validated and documented through a validation plan and report, which covers both qualitative and semi/quasi-quantitative assay components (example template provided). (d) Ongoing assay-specific quality monitoring should be performed to ensure consistency.
Collapse
Affiliation(s)
- Andrea Illingworth
- Flow Cytometry Division, Dahl-Chase Diagnostic Services, Bangor, Maine, USA
| | - Ulrika Johansson
- SI-HMDS, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sa A Wang
- Department of Hematopathology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Julia Almeida
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL); Cytometry Service (NUCLEUS) and Department of Medicine, IBSAL and CIBERONC, University of Salamanca, Salamanca, Spain
| | - Kristy L Wolniak
- Division of Hematopathology, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katherina Psarra
- Department of Immunology - Histocompatibility, "Evangelismos" Hospital, Athens, Greece
| | - Richard Torres
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Fiona E Craig
- Division of Hematopathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| |
Collapse
|
17
|
Shi M, Nguyen P, Timm MM, Otteson GE, Horna P, Olteanu H, Jevremovic D. Cytoplasmic Expression of CD3ε Heterodimers by Flow Cytometry Rapidly Distinguishes Between Mature T-Cell and Natural Killer-Cell Neoplasms. Am J Clin Pathol 2020; 154:683-691. [PMID: 32589191 DOI: 10.1093/ajcp/aqaa086] [Citation(s) in RCA: 2] [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] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Distinguishing between T-cell and natural killer (NK)-cell neoplasms could be difficult given their overlapping immunophenotype. In this study, we investigated whether a flow cytometry assay with cytoplasmic staining for CD3 could be used for this purpose. METHODS Flow cytometry immunophenotyping was performed on 19 surface CD3 (sCD3)-negative mature T-cell neoplasms, 10 sCD3-positive mature T-cell neoplasms, 13 mature NK-cell neoplasms, and 19 normal controls. In addition to routine antibody panels (CD2, sCD3, CD4, CD5, CD7, CD8, CD16, CD45, CD56, CD57, CD94, CD158a, CD158b, CD158e, NKG2A TCRγ/δ), cytoplasmic staining for a monoclonal CD3 antibody (clone SK7/Leu-4) was assessed in all cases. A molecular study for T-cell receptor (TCR) gene rearrangement and an immunohistochemical study for TCRβ were performed. RESULTS Our data showed all T-cell neoplasms were uniformly positive for cytoplasmic CD3 (cCD3) regardless of sCD3 expression, whereas 85% of NK-cell neoplasms completely lacked cCD3 expression. The 2 cases with classic NK-cell immunophenotype but partial cCD3 expression showed no molecular genetic features of T-cell lineage by TCR gene rearrangement studies. CONCLUSIONS Uniform cCD3 positivity and homogeneous cCD3 negativity highly suggest T-cell and NK lineage, respectively. When partial cCD3 expression is encountered, additional confirmatory studies should be pursued for the most accurate lineage assignment.
Collapse
Affiliation(s)
- Min Shi
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Phuong Nguyen
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Michael M Timm
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Gregory E Otteson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Pedro Horna
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Horatiu Olteanu
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| |
Collapse
|
18
|
Habermann TM, Khurana A, Lentz R, Schmitz JJ, von Bormann AG, Young JR, Hunt CH, Christofferson SN, Nowakowski GS, McCullough KB, Horna P, Wood AJ, Macon WR, Kurtin PJ, Lester SC, Stafford SL, Chamarthy U, Khan F, Ansell SM, King RL. Analysis and impact of a multidisciplinary lymphoma virtual tumor board. Leuk Lymphoma 2020; 61:3351-3359. [PMID: 32967496 DOI: 10.1080/10428194.2020.1817432] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The aim is to prospectively evaluate the impact of a multidisciplinary lymphoma virtual tumor board. The utility of multi-site interactive lymphoma-specific tumor boards has not been reported. The Mayo Clinic Lymphoma Tumor Board is a component of the International Mayo Clinic Care Network (MCCN). The format includes the clinical case presentation, presentation of radiology and hematopathology findings by the appropriate subspecialist, proposed treatment options, review of the literature pertinent to the case, pharmacy contributions, and discussion followed by recommendations. Three hundred and nine consecutive highly selected real-time cases with a diagnosis of lymphoma were presented at the Mayo Clinic Lymphoma Tumor Board from January 2014 to June 2018 and decisions were prospectively tracked to assess its impact on the treatment decisions. A total of 309 cases were prospectively evaluated. One hundred and forty (45.3%) cases had some changes made or recommended. The total changes suggested were 179, as some cases had more than one recommendation. There were 93 (30%) clinical management recommendations, 45 (14.6%) additional testing recommendations, 29 (9.4%) pathology changes, and 6 (1.9%) radiology changes. In an electronic evaluation process, 93% of the responders reported an improvement in knowledge and competence, and 100% recommended no change in format of the board. A multidisciplinary lymphoma tumor board approach was found to have a meaningful impact on lymphoma patients while enhancing interdisciplinary interactions and education for multiple levels of the clinical care team.
Collapse
Affiliation(s)
- Thomas M Habermann
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arushi Khurana
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ruth Lentz
- Division of Hematology, Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jason R Young
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Pedro Horna
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Adam J Wood
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Paul J Kurtin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Scott L Stafford
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Ushrasree Chamarthy
- Department of Medical Oncology and Hematology, Sparrow Cancer Center, Lansing, MI, USA
| | - Faraz Khan
- Department of Hematology-Oncology, American Hospital Dubai, Dubai, United Arab Emirates
| | - Stephen M Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rebecca L King
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
19
|
Vaughan JW, Shi M, Horna P, Olteanu H. Increased CD200 expression in post-transplant lymphoproliferative disorders correlates with an increased frequency of FoxP3(+) regulatory T cells. Ann Diagn Pathol 2020; 48:151585. [PMID: 32829067 DOI: 10.1016/j.anndiagpath.2020.151585] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
CD200 is a membrane protein with immunosuppressive function and is expressed in many hematopoietic neoplasms, including acute myeloid leukemia (AML), plasma cell myeloma (PCM), and B-cell lymphoproliferative disorders, but is mostly negative in diffuse large cell lymphoma (DLBCL). CD200 has been shown to be a poor prognostic marker in AML and PCM; in AML, its immunomodulatory effect was linked to its ability to induce FoxP3(+) regulatory T cells (Tregs). Post-transplant lymphoproliferative disorders (PTLDs) arise in the setting of immune dysregulation, and tumor-infiltrating T cells, including Tregs, have been shown to correlate with outcome in these disorders. Because there is no literature data and CD200 is a potentially useful diagnostic and prognostic marker, we studied the expression of CD200 in a series of 38 PTLDs by immunohistochemistry (ICH), and found that 23.7% PTLDs were CD200(+) and showed strong membrane and cytoplasmic positivity in the neoplastic cells. All CD200(+) monomorphic PTLDs were DLBCLs and the median FoxP3(+) Treg count/hpf was higher in CD200(+) than in CD200(-) PTLDs: 22.6 vs. 0.30 (p < 0.001). These results indicated that almost a quarter of PTLDs in our series are CD200(+) by IHC, and CD200 expression correlates with the frequency of immunosuppressive Tregs. This is novel data and supports a pathophysiologic link between CD200 activity and Tregs. In our series, the 5-year overall survival was shorter in CD200(+) PTLDs, compared to CD200(-) patients, although this difference did not reach statistical significance. In addition, we find a higher proportion of CD200(+) monomorphic PTLD-DLBCLs (31.0%), as compared to de novo DLBCLs (7-8%, as found here and in other studies). This may indicate differential expression of CD200 in B-cell lymphomas arising in the setting of immune dysregulation, and raises the possibility of anti-CD200 immunotherapy for these cases.
Collapse
Affiliation(s)
- James W Vaughan
- Department of Pathology, University of Tennessee Graduate School of Medicine, Knoxville, TN, United States of America
| | - Min Shi
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Pedro Horna
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Horatiu Olteanu
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, United States of America.
| |
Collapse
|
20
|
Pulitzer MP, Horna P, Almeida J. Sézary syndrome and mycosis fungoides: An overview, including the role of immunophenotyping. Cytometry B Clin Cytom 2020; 100:132-138. [PMID: 32516521 DOI: 10.1002/cyto.b.21888] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/16/2020] [Accepted: 04/27/2020] [Indexed: 01/11/2023]
Abstract
This review discusses the definition and major categories of cutaneous T-cell lymphoma, Sézary syndrome and mycosis fungoides, and the role of immunophenotyping in their diagnosis. The following key points are raised: (a) Sézary syndrome and mycosis fungoides cells most often have a characteristic CD3+ CD4+ CD7- and/or CD26- immunophenotype. (b) This immunophenotype is not specific, but can assist in the distinction from non-neoplastic T cells and other subtypes of mature T-cell neoplasm. (c) However, small subsets of normal and reactive T-cells can have an overlapping immunophenotype, and can be distinguished by evaluating for additional changes in antigen expression.
Collapse
Affiliation(s)
- Melissa P Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York, USA
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julia Almeida
- Cancer Research Center (IBMCC-CSIC/USAL), Cytometry Service (NUCLEUS) and Department of Medicine, University of Salamanca, IBSAL and CIBERONC, Salamanca, Spain
| |
Collapse
|
21
|
Berg H, Otteson GE, Corley H, Shi M, Horna P, Jevremovic D, Olteanu H. Flow cytometric evaluation of
TRBC1
expression in tissue specimens and body fluids is a novel and specific method for assessment of
T‐cell
clonality and diagnosis of
T‐cell
neoplasms. Cytometry 2020; 100:361-369. [DOI: 10.1002/cyto.b.21881] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/31/2020] [Accepted: 04/07/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Holly Berg
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Gregory E. Otteson
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Heidi Corley
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Min Shi
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Pedro Horna
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Horatiu Olteanu
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| |
Collapse
|
22
|
Horna P, Wang SA, Wolniak KL, Psarra K, Almeida J, Illingworth AJ, Johansson U, Craig FE, Torres R. Flow cytometric evaluation of peripheral blood for suspected Sézary syndrome or mycosis fungoides: International guidelines for assay characteristics. Cytometry B Clin Cytom 2020; 100:142-155. [PMID: 32319723 DOI: 10.1002/cyto.b.21878] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/22/2020] [Accepted: 03/23/2020] [Indexed: 12/25/2022]
Abstract
A peripheral blood flow cytometric assay for Sézary syndrome (SS) or circulating mycosis fungoides (MF) cells must be able to reliably identify, characterize, and enumerate T-cells with an immunophenotype that differs from non-neoplastic T-cells. Although it is also important to distinguish SS and MF from other subtypes of T-cell neoplasm, this usually requires information in addition to the immunophenotype, such as clinical and morphologic features. This article outlines the approach recommended by an international group with experience and expertise in this area. The following key points are discussed: (a) At a minimum, a flow cytometric assay for SS and MF should include the following six antibodies: CD3, CD4, CD7, CD8, CD26, and CD45. (b) An analysis template must reliably detect abnormal T-cells, even when they lack staining for CD3 or CD45, or demonstrate a phenotype that is not characteristic of normal T-cells. (c) Gating strategies to identify abnormal T-cells should be based on the identification of subsets with distinctly homogenous immunophenotypic properties that are different from those expected for normal T-cells. (d) The blood concentration of abnormal cells, based on any immunophenotypic abnormalities indicative of MF or SS, should be calculated by either direct enumeration or a dual-platform method, and reported.
Collapse
Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristy L Wolniak
- Division of Hematopathology, Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katherina Psarra
- Department of Immunology and Histocompatibility, "Evangelismos" Hospital, Athens, Greece
| | - Julia Almeida
- Cancer Research Center (IBMCC-CSIC/USAL-IBSAL), Cytometry Service (NUCLEUS) and Department of Medicine, IBSAL and CIBERONC, University of Salamanca, Salamanca, Spain
| | | | - Ulrika Johansson
- SI-HMDS University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Fiona E Craig
- Division of Hematopathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Richard Torres
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
23
|
Mirza AS, Horna P, Teer JK, Song J, Akabari R, Hussaini M, Sokol L. New Insights Into the Complex Mutational Landscape of Sézary Syndrome. Front Oncol 2020; 10:514. [PMID: 32373524 PMCID: PMC7186303 DOI: 10.3389/fonc.2020.00514] [Citation(s) in RCA: 8] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/23/2020] [Indexed: 12/28/2022] Open
Abstract
Sézary syndrome (SS) is a genetically and clinically distinct entity among cutaneous T-cell lymphomas (CTCL). SS is characterized by more aggressive disease compared to the most common indolent type of CTCL, mycosis fungoides. However, there are limited available genomic data regarding SS. To characterize and expand current mappings of the genomic landscape of CTCL, whole exome sequencing (WES) was performed on peripheral blood samples from seven patients with SS. We detected 21,784 variants, of which 21,140 were novel and 644 were previously described. Filtering revealed 551 nonsynonymous variants among 525 mutated genes−25 recurrent mutations and 1 recurrent variant. Several recurrently mutated genes crucial to pathogenesis pathways, including Janus kinase (JAK)/signal transducers and activators of transcription (STAT), peroxisome proliferator-activated receptors (PPAR), PI3K-serine/threonine protein kinases (AKT), and fibroblast growth factor receptors (FGFR), were identified. Furthermore, genetic mutations spanned both known and novel genes, supporting the idea of a long-tail distribution of mutations in lymphoma. Acknowledging these genetic variants and their affected pathways may inspire future targeted therapies. WES of a limited number of SS patients revealed both novel findings and corroborated complexities of the “long-tail” distribution of previously reported mutations.
Collapse
Affiliation(s)
- Abu-Sayeef Mirza
- Department of Internal Medicine, University of South Florida, Tampa, FL, United States
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN, United States
| | - Jamie K Teer
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Jinming Song
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Ratilal Akabari
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Mohammad Hussaini
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| |
Collapse
|
24
|
Mirza AS, Dholaria BR, Hussaini M, Mushtaq S, Horna P, Ravindran A, Kumar A, Ayala E, Kharfan-Dabaja MA, Bello C, Chavez JC, Sokol L. High-dose Therapy and Autologous Hematopoietic Cell Transplantation as Consolidation Treatment for Primary Effusion Lymphoma. Clin Lymphoma Myeloma Leuk 2019; 19:e513-e520. [PMID: 31253594 DOI: 10.1016/j.clml.2019.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Primary effusion lymphoma (PEL) is a rare type of non-Hodgkin lymphoma. The limited disease-free survival after chemotherapy has resulted in a poor prognosis. The outcomes data for high-dose therapy followed by autologous hematopoietic cell transplantation (auto-HCT) for PEL are limited owing to the rarity of the disease. PATIENTS AND METHODS The present study included 9 patients with PEL from 2 major academic centers. Of these patients, 4 had received auto-HCT after high-dose therapy. Of the 9 patients, 8 (89%) had immunodeficiency (7 with human immunodeficiency virus seropositivity; 1, a solid organ transplant recipient) at the diagnosis. Human herpesvirus-8 by immunohistochemistry was positive in 8 patients. Anthracycline-based combination chemotherapy was used as first-line treatment in 7 patients; 4 underwent auto-HCT after attaining first complete remission. RESULTS The median follow-up of the surviving patients was 25 months (95% confidence interval [CI], 8%-29%). The 2-year progression-free and overall survival for the 8 patients who had received treatment was 58% (95% CI, 22%-95%) and 73% (95% CI, 41%-100%), respectively. The 2-year progression-free and overall survival for the patients who had received auto-HCT was 50% (95% CI, 1%-99%) and 75% (95% CI, 33%-100%), respectively. Of the 4 auto-HCT recipients, all had been in first complete remission at the time of autografting. The cumulative incidence of relapse was 50% (95% CI, 19%-100%). No deaths were attributable to auto-HCT at 2 years after autografting. CONCLUSION Despite the small sample size, our data have shown that consolidative auto-HCT is safe and effective and should be considered for eligible patients with PEL after demonstration of an objective response to induction chemotherapy. However, the high relapse rate remains a concern and warrants the development of new strategies to mitigate post-transplantation relapse.
Collapse
Affiliation(s)
- Abu-Sayeef Mirza
- Department of Internal Medicine, University of South Florida, Tampa, FL.
| | - Bhagirathbhai R Dholaria
- Department of Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Mohammad Hussaini
- Department of Hematopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Sarah Mushtaq
- Department of Internal Medicine, University of South Florida, Tampa, FL
| | - Pedro Horna
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Adharsh Ravindran
- Department of Internal Medicine, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY
| | - Ambuj Kumar
- Program for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine, Tampa, FL
| | - Ernesto Ayala
- Department of Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Mohamed A Kharfan-Dabaja
- Department of Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Celeste Bello
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Julio C Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| |
Collapse
|
25
|
Shi M, Jevremovic D, Otteson GE, Timm MM, Olteanu H, Horna P. Single Antibody Detection of T-Cell Receptor αβ Clonality by Flow Cytometry Rapidly Identifies Mature T-Cell Neoplasms and Monotypic Small CD8-Positive Subsets of Uncertain Significance. Cytometry B Clin Cytom 2019; 98:99-107. [PMID: 30972977 DOI: 10.1002/cyto.b.21782] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/07/2019] [Accepted: 03/26/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The diagnosis of T-cell neoplasms is often challenging, due to overlapping features with reactive T-cells and limitations of currently available T-cell clonality assays. The description of an antibody specific for one of two mutually exclusive T-cell receptor (TCR) β-chain constant regions (TRBC1) provide an opportunity to facilitate the detection of clonal TCRαβ T-cells based on TRBC-restriction. METHODS Twenty patients with mature T-cell neoplasms and 44 patients without evidence of T-cell neoplasia were studied. Peripheral blood (51), bone marrow (10), and lymph node (3) specimens were evaluated by 9-color flow cytometry including TRBC1 (CD2/CD3/CD4/CD5/CD7/CD8/CD45/TCRγδ/TRBC1 and/or CD2/CD3/CD4/CD5/CD7/CD8/CD26/CD45/TRBC1). Monophasic TRBC1 expression on any immunophenotypically distinct CD4-positive or CD8-positive/TCRγδ-negative T-cell subset was considered indicative of clonality. RESULTS Monophasic (clonal) TRBC1 expression was identified on immunophenotypically abnormal T-cells from all 20 patients with T-cell malignancies (100% sensitivity), including 17 cases with either >97% or <3% TRBC1-positive events, and three cases with monophasic homogenous TRBC1-dim expression. All immunophenotypically distinct CD4-positive and CD8-positive/TCRγδ-negative T-cell subsets from 44 patients without T-cell malignancies showed the expected mixture of TRBC1-positive and TRBC-1-negative subpopulations (non-clonal), except for seven patients (16%) with very small CD8-positive T-cell subsets exhibiting a monophasic (clonal) pattern. CONCLUSION Inclusion of a single anti-TRBC1 antibody into a diagnostic T-cell flow cytometry panel facilitates the rapid identification of T-cell neoplasms, in addition to small monotypic CD8-positive subsets of uncertain significance. © 2019 International Clinical Cytometry Society.
Collapse
Affiliation(s)
- Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Michael M Timm
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
26
|
Patnaik MM, Pophali PA, Lasho TL, Finke CM, Horna P, Ketterling RP, Gangat N, Mangaonkar AA, Pardanani A, Tefferi A. Clinical correlates, prognostic impact and survival outcomes in chronic myelomonocytic leukemia patients with the JAK2V617F mutation. Haematologica 2019; 104:e236-e239. [PMID: 30606787 DOI: 10.3324/haematol.2018.208082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | | | | | | | - Pedro Horna
- Division of Hematopathology, Department of Laboratory Medicine and Pathology
| | - Rhett P Ketterling
- Division of Cytogenetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | |
Collapse
|
27
|
Pophali P, Horna P, Lasho TL, Finke CM, Ketterling RP, Gangat N, Nagorney D, Tefferi A, Patnaik MM. Splenectomy in patients with chronic myelomonocytic leukemia: Indications, histopathological findings and clinical outcomes in a single institutional series of thirty-nine patients. Am J Hematol 2018; 93:1347-1357. [PMID: 30105755 PMCID: PMC6196105 DOI: 10.1002/ajh.25246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/13/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/13/2022]
Abstract
In a 28-year period, 39 (7%) patients with chronic myelomonocytic leukemia (CMML) (median age 66 years, 64% male) underwent a splenectomy at our institution. Primary indications for splenectomy were refractory thrombocytopenia (36%), progressive spleen related symptoms (33%), emergent splenectomy for splenic rupture (21%), refractory anemia (8%), and prior to allogeneic stem cell transplant (3%). Eleven (28%) patients had anemia at the time of splenectomy, of which 3 (27%) were autoimmune. The median time to splenectomy from CMML diagnosis was 6 months (0-40); perioperative morbidity and mortality rates were 43% and 13%, while the median postsplenectomy survival was 25 months (11-38). Durable remission in spleen related symptoms, thrombocytopenia, complications from splenic rupture, and anemia were achieved in 85%, 50%, 62%, and 21% of patients, respectively. Perioperative morbidity (n = 30) included infections/sepsis in 6 (20%), intraabdominal bleeding in 4 (13%), venous thromboembolism (VTE) in 3 (10%), and acute lung injury in 2 (7%) patients. The median duration of hospital stay was 6 days (1-25), with 5 deaths occurring secondary to respiratory failure (n = 2), multiorgan dysfunction (n = 2) and hemorrhagic shock (n = 1). There was no difference in overall survival between CMML patients that underwent splenectomy, in comparison to those that did not. Unlike in myelofibrosis, portal hypertension was not an indication for splenectomy and no patients developed post-splenectomy thrombocytosis. In conclusion, apart from being a lifesaving emergent modality in the event of splenic rupture, splenectomy has an important palliative role in patients with CMML, with significant and durable improvements in spleen related symptoms and refractory cytopenias.
Collapse
Affiliation(s)
- Prateek Pophali
- Division of Hematology, Department of Internal Medicine,
Mayo Clinic, Rochester, MN
| | - Pedro Horna
- Division of Hematopathology, Department of Laboratory
Medicine, Mayo Clinic, Rochester, MN
| | - Terra L. Lasho
- Division of Hematology, Department of Internal Medicine,
Mayo Clinic, Rochester, MN
| | - Christy M. Finke
- Division of Hematology, Department of Internal Medicine,
Mayo Clinic, Rochester, MN
| | - Rhett P. Ketterling
- Division of Hematopathology, Department of Laboratory
Medicine, Mayo Clinic, Rochester, MN
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine,
Mayo Clinic, Rochester, MN
| | - David Nagorney
- Department of General Surgery, Mayo Clinic, Rochester,
MN
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine,
Mayo Clinic, Rochester, MN
| | - Mrinal M. Patnaik
- Division of Hematology, Department of Internal Medicine,
Mayo Clinic, Rochester, MN
| |
Collapse
|
28
|
Horna P, Moscinski LC, Sokol L, Shao H. Naïve/memory T-cell phenotypes in leukemic cutaneous T-cell lymphoma: Putative cell of origin overlaps disease classification. Cytometry B Clin Cytom 2018; 96:234-241. [PMID: 30328260 DOI: 10.1002/cyto.b.21738] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Mycosis fungoides (MF) and Sézary Syndrome (SS) are clinically distinct cutaneous T-cell lymphomas with strikingly similar morphologic and phenotypic features. Prior studies have suggested phenotypic differences based on markers of antigen experience, suggesting a different cell of origin. METHODS Seventy-nine involved peripheral blood or bone marrow samples from 33 patients with SS and 19 patients with MF were studied by 10-color flow cytometry, including CD62L, CD45RA, CCR4, and PD-1. Gated tumor events were classified as naïve (TN ), central memory (TCM ), effector memory (TEM ), or effector memory with reacquired CD45RA (TEMRA ); based on CD62L+ /CD45RA+ , CD62L+ /CD45RA- , CD62L- /CD45RA- , or CD62L- /CD45RA+ phenotype, respectively. Sequential specimens were compared to assess for phenotypic stability. RESULTS The naïve/memory phenotype of the neoplastic T-cells was markedly heterogeneous, with a dominant TN , TCM , TEM , or TEMRA subset on 11 (14%), 32 (41%), 30 (38%), and 6 (8%) cases, respectively. There was no correlation between the diagnosis of MF or SS and putative cell of origin (P = 0.4). Overexpression of CCR4 and PD1 was observed in most cases, with higher intensity in SS compared to MF. The naïve/memory phenotype remained the same for 10 patients up to 273 days after the initial analysis; while on six patients, the naïve/memory phenotype was different from the original phenotype. CONCLUSIONS Both SS and MF can have phenotypic features of any of the major naïve/memory T-cell subsets, which questions the current principle of "cell-of-origin" distinction between SS and MF. Phenotypic shifts within these subsets are common, suggesting a functional state rather than a cell-of-origin surrogate. © 2018 International Clinical Cytometry Society.
Collapse
Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Lynn C Moscinski
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Haipeng Shao
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| |
Collapse
|
29
|
Higgins A, Mangaonkar AA, Hefazi M, Viswanatha D, Horna P, Foran J, Gangat N. Non-internal tandem duplication (ITD), non-tyrosine kinase domain (TKD) FLT3 mutations in myeloid malignancies: A brief report of 10 patients. Leuk Res 2018; 72:1-4. [PMID: 30055376 DOI: 10.1016/j.leukres.2018.07.018] [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] [Received: 06/20/2018] [Revised: 07/14/2018] [Accepted: 07/20/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Alexandra Higgins
- Department of Internal Medicine, Mayo Clinic, Rochester MN, United States
| | | | - Mehrdad Hefazi
- Division of Hematology, Mayo Clinic, Rochester MN, United States
| | - David Viswanatha
- Department of Pathology, Mayo Clinic, Rochester MN, United States
| | - Pedro Horna
- Department of Pathology, Mayo Clinic, Rochester MN, United States
| | - James Foran
- Department of Hematology & Medical Oncology, Mayo Clinic, Jacksonville FL, United States
| | - Naseema Gangat
- Division of Hematology, Mayo Clinic, Rochester MN, United States.
| |
Collapse
|
30
|
Betts BC, Veerapathran A, Pidala J, Yang H, Horna P, Walton K, Cubitt CL, Gunawan S, Lawrence HR, Lawrence NJ, Sebti SM, Anasetti C. Targeting Aurora kinase A and JAK2 prevents GVHD while maintaining Treg and antitumor CTL function. Sci Transl Med 2018; 9:9/372/eaai8269. [PMID: 28077684 DOI: 10.1126/scitranslmed.aai8269] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 08/17/2016] [Accepted: 10/10/2016] [Indexed: 12/12/2022]
Abstract
Graft-versus-host disease (GVHD) is a leading cause of nonrelapse mortality after allogeneic hematopoietic cell transplantation. T cell costimulation by CD28 contributes to GVHD, but prevention is incomplete when targeting CD28, downstream mammalian target of rapamycin (mTOR), or Aurora A. Likewise, interleukin-6 (IL-6)-mediated Janus kinase 2 (JAK2) signaling promotes alloreactivity, yet JAK2 inhibition does not eliminate GVHD. We provide evidence that blocking Aurora A and JAK2 in human T cells is synergistic in vitro, prevents xenogeneic GVHD, and maintains antitumor responses by cytotoxic T lymphocytes (CTLs). Aurora A/JAK2 inhibition is immunosuppressive but permits the differentiation of inducible regulatory T cells (iTregs) that are hyperfunctional and CD39 bright and efficiently scavenge adenosine triphosphate (ATP). Increased iTreg potency is primarily a function of Aurora A blockade, whereas JAK2 inhibition suppresses T helper 17 (TH17) differentiation. Inhibiting either Aurora A or JAK2 significantly suppresses TH1 T cells. However, CTL generated in vivo retains tumor-specific killing despite Aurora A/JAK2 blockade. Thus, inhibiting CD28 and IL-6 signal transduction pathways in donor T cells can increase the Treg/Tconv ratio, prevent GVHD, and preserve antitumor CTL.
Collapse
Affiliation(s)
- Brian C Betts
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL 33612, USA. .,Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA
| | - Anandharaman Veerapathran
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA
| | - Hua Yang
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA
| | - Pedro Horna
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA.,Department of Hematopathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Kelly Walton
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Steven Gunawan
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA
| | - Harshani R Lawrence
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA.,Department of Drug Discovery, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Nicholas J Lawrence
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA.,Department of Drug Discovery, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Said M Sebti
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA.,Department of Drug Discovery, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Claudio Anasetti
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA
| |
Collapse
|
31
|
Horna P, Shao H, Idrees A, Glass LF, Torres-Cabala CA. Indeterminate dendritic cell neoplasm of the skin: A 2-case report and review of the literature. J Cutan Pathol 2017; 44:958-963. [PMID: 28880462 DOI: 10.1111/cup.13017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 01/10/2017] [Revised: 06/29/2017] [Accepted: 08/06/2017] [Indexed: 11/27/2022]
Abstract
Indeterminate dendritic cell neoplasm (IDCN) is an exceedingly rare and mostly cutaneous histiocytosis, frequently associated with other hematopoietic malignancies. We report 2 cases of multilesional cutaneous IDCN. A 55-year-old male with no associated malignancy and complete response to ultraviolet phototherapy; and a 72-year-old male with chronic myelomonocytic leukemia (CMML). Both cases showed histiocytoid cytology, positivity for CD1a and no expression of langerin or BRAFV600E . With our patients, the literature describes 79 cases of IDCNs, including 65 (82%) with only skin involvement, 7 cases (9%) with involvement of skin and a second site, 5 cases (6%) involving lymph nodes only, 1 splenic lesion and 1 systemic disease. Seventeen cases (22%) were associated with other hematopoietic malignancies, most commonly CMML (6 cases), follicular lymphoma (4 cases) and acute myeloid leukemia (3 cases). All IDCNs associated with myeloid malignancies were limited to the skin, while most cases associated with lymphoma were limited to lymph nodes. Reported responses of cutaneous lesions to ultraviolet phototherapy are encouraging, while systemic chemotherapy is appropriate for clinically aggressive cases and treatment of associated malignancies. Recognition of the clinico-morphologic spectrum of IDCNs should prevent misdiagnoses and prompt investigation of possible associated neoplasms.
Collapse
Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Haipeng Shao
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Afshan Idrees
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - L Frank Glass
- Department of Dermatology, George Washington University, Washington, District of Columbia
| | - Carlos A Torres-Cabala
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
32
|
Sahakian E, Chen J, Powers JJ, Chen X, Maharaj K, Deng SL, Achille AN, Lienlaf M, Wang HW, Cheng F, Sodré AL, Distler A, Xing L, Perez-Villarroel P, Wei S, Villagra A, Seto E, Sotomayor EM, Horna P, Pinilla-Ibarz J. Essential role for histone deacetylase 11 (HDAC11) in neutrophil biology. J Leukoc Biol 2017; 102:475-486. [PMID: 28550123 DOI: 10.1189/jlb.1a0415-176rrr] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 04/28/2015] [Revised: 04/19/2017] [Accepted: 04/21/2017] [Indexed: 12/18/2022] Open
Abstract
Epigenetic changes in chromatin structure have been recently associated with the deregulated expression of critical genes in normal and malignant processes. HDAC11, the newest member of the HDAC family of enzymes, functions as a negative regulator of IL-10 expression in APCs, as previously described by our lab. However, at the present time, its role in other hematopoietic cells, specifically in neutrophils, has not been fully explored. In this report, for the first time, we present a novel physiologic role for HDAC11 as a multifaceted regulator of neutrophils. Thus far, we have been able to demonstrate a lineage-restricted overexpression of HDAC11 in neutrophils and committed neutrophil precursors (promyelocytes). Additionally, we show that HDAC11 appears to associate with the transcription machinery, possibly regulating the expression of inflammatory and migratory genes in neutrophils. Given the prevalence of neutrophils in the peripheral circulation and their central role in the first line of defense, our results highlight a unique and novel role for HDAC11. With the consideration of the emergence of new, selective HDAC11 inhibitors, we believe that our findings will have significant implications in a wide range of diseases spanning malignancies, autoimmunity, and inflammation.
Collapse
Affiliation(s)
- Eva Sahakian
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; .,Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jie Chen
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - John J Powers
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Xianghong Chen
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kamira Maharaj
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Susan L Deng
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Alex N Achille
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Maritza Lienlaf
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Hong Wei Wang
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Fengdong Cheng
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Andressa L Sodré
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Allison Distler
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Limin Xing
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, People's Republic of China
| | | | - Sheng Wei
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Alejandro Villagra
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Ed Seto
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Eduardo M Sotomayor
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Pedro Horna
- Department of Hematopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; and
| | - Javier Pinilla-Ibarz
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA; .,Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| |
Collapse
|
33
|
Hussaini MO, Rehman A, Chavez JC, Pinilla-Ibarz J, Horna P. EBV-positive Richter's syndrome with laboratory features of Burkitt's lymphoma, in Ibrutinib-treated chronic lymphocytic leukemia. Leuk Lymphoma 2016; 58:1753-1756. [PMID: 27852142 DOI: 10.1080/10428194.2016.1256482] [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: 10/20/2022]
Affiliation(s)
- Mohammad O Hussaini
- a Department of Hematopathology and Laboratory Medicine , H. Lee Moffitt Cancer Center , Tampa , FL , USA
| | - Alman Rehman
- b University of Central Florida , Orlando , FL , USA
| | - Julio C Chavez
- c Department of Malignant Hematology , H. Lee Moffitt Cancer Center , Tampa , FL , USA
| | - Javier Pinilla-Ibarz
- c Department of Malignant Hematology , H. Lee Moffitt Cancer Center , Tampa , FL , USA
| | - Pedro Horna
- d Division of Hematopathology , Mayo Clinic , Rochester , MN , USA
| |
Collapse
|
34
|
Salem KZ, Nishihori T, Kharfan-Dabaja MA, Horna P, Alsina M. Primary plasmacytoma involving mediastinal lymph nodes: A diagnostic mimicry of primary mediastinal lymphoma. Hematol Oncol Stem Cell Ther 2016; 9:26-9. [DOI: 10.1016/j.hemonc.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/09/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022] Open
|
35
|
Hussaini M, Shao H, Horna P, Markow M. Peripheral T-Cell Lymphoma Arising in a Patient With Prior T-Cell Acute Lymphoblastic Lymphoma: A Dyadic Case Series. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.151] [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: 11/14/2022] Open
|
36
|
Zimmerman A, Locke FL, Emole J, Rosa M, Horna P, Hoover S, Dayicioglu D. Recurrent Systemic Anaplastic Lymphoma Kinase–Negative Anaplastic Large Cell Lymphoma Presenting as a Breast Implant–Associated Lesion. Cancer Control 2015; 22:369-73. [DOI: 10.1177/107327481502200317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amanda Zimmerman
- Division of Plastic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Frederick L. Locke
- Departments of Blood & Marrow Transplantation, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Josephine Emole
- Hematology/Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Marilin Rosa
- Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Women's Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Pedro Horna
- Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Susan Hoover
- Breast Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Deniz Dayicioglu
- Plastic Surgery, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| |
Collapse
|
37
|
Abstract
BACKGROUND Kikuchi-Fujimoto disease (KFD) is a rare lymphohistiocytic disorder with an unknown etiopathogenesis. This disease is misdiagnosed as malignant lymphoma in up to one-third of cases and is associated with the development of systemic lupus erythematosus (SLE). METHODS The medical literature between the years 1972 and 2014 was searched for KFD, and the data were collected and analyzed regarding the epidemiology, clinical presentations, diagnosis, management, and suggested diagnostic and treatment algorithms. RESULTS Although KFD has been reported in other ethnic groups and geographical areas, it is more frequently diagnosed in young women of Asian descent. Patients with the disease typically present with rapidly evolving tender cervical lymphadenopathy, night sweats, fevers, and headache. Diagnosis is based on histopathological examination. Excisional lymph node biopsy is essential for a correct diagnosis. Apoptotic coagulation necrosis with karyorrhectic debris and the proliferation of histiocytes, plasmacytoid dendritic cells, and CD8(+) T cells in the absence of neutrophils are characteristic cytomorphology features. Interface dermatitis at the onset of KFD may be a marker for the subsequent evolution of SLE. The natural course of the disease is typically benign. Short courses of steroids, nonsteroidal anti-inflammatory drugs, or hydroxychloroquine can be administered to patients with more severe symptoms. CONCLUSIONS Although KFD was described more than 40 years ago, the etiology of this disease remains unsolved. Infectious or autoimmune processes were proposed but have not been definitively confirmed. Clinical presentation with systemic B symptoms and adenopathy may lead to an erroneous diagnosis of malignant lymphoma. The introduction of modern methods into hematopathology, including immunohistochemistry, flow cytometry, and molecular clonality studies, has decreased the probability of misdiagnosis. Until reliable prognostic markers are available, patients with KFD should have continued long-term follow-up care due to their increased risk of SLE.
Collapse
|
38
|
Riaz W, Zhang L, Horna P, Sokol L. Blastic plasmacytoid dendritic cell neoplasm: update on molecular biology, diagnosis, and therapy. Cancer Control 2015; 21:279-89. [PMID: 25310209 DOI: 10.1177/107327481402100404] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy with an aggressive clinical course. Most patients with BPDCN have skin lesions and simultaneous involvement of the peripheral blood, bone marrow, and lymph nodes. METHODS A search of PubMed and Medline was conducted for English-written articles relating to BPDCN, CD4(+)CD56(+) hematodermic neoplasm, and blastic natural killer cell lymphoma. Data regarding diagnosis, prognosis, and treatment were analyzed. RESULTS BPDCN is derived from precursor plasmacytoid dendritic cells. The diagnosis of BPDCN is based on the characteristic cytology and immunophenotype of malignant cells coexpressing CD4, CD56, CD123, blood dendritic cell antigens 2 and 4, and CD2AP markers. Multiple chromosomal abnormalities and gene mutations previously reported in patients with myeloid and selected lymphoid neoplasms were identified in approximately 60% of patients with BPDCN. Prospectively controlled studies to guide treatment decisions are lacking. The overall response rate with aggressive acute lymphoblastic leukemia-type induction regimens was as high as 90%, but the durability of response was short. Median survival rates ranged between 12 and 16 months. Patients with relapsed disease may respond to L-asparaginase-containing regimens. Allogeneic hematopoietic stem cell transplantation, particularly when performed during the first remission, may produce durable remissions in selected adults. CONCLUSIONS BPDCN is a rare aggressive disease that typically affects elderly patients. The most commonly affected nonhematopoietic organ is the skin. Although BPDCN is initially sensitive to conventional chemotherapy regimens, this response is relatively short and long-term prognosis is poor. In the near future, novel targeted therapies may improve outcomes for patients with BPDCN.
Collapse
Affiliation(s)
- Wasif Riaz
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL 33612, USA.
| | | | | | | |
Collapse
|
39
|
Horna P, Kurant D, Sokol L, Sotomayor EM, Moscinski L, Glass LF. Flow cytometric identification of immunophenotypically aberrant T-cell clusters on skin shave biopsy specimens from patients with mycosis fungoides. Am J Clin Pathol 2015; 143:785-96. [PMID: 25972320 DOI: 10.1309/ajcpwe2hbfcgdids] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To assess the ability of flow cytometry (FC) to detect putative neoplastic T-cell subsets on skin shave biopsy (SSB) specimens from patients with mycosis fungoides (MF) and to study the immunophenotype of skin-infiltrating tumor cells in MF. METHODS SSB specimens from patients with suspected MF were bisected and submitted for both FC and routine histopathology. Six-dimensional gating strategies were applied to identify putative neoplastic cells, independently from their expected immunophenotype. RESULTS Aberrant T cells were detected by FC in 18 of 33 SBB specimens, of which all had clinicomorphologic features of MF. Of the remaining 15 SSB specimens, six had clinicomorphologic features of MF and nine were diagnosed with benign inflammatory dermatoses. Unexpectedly, CD26 was aberrantly overexpressed in 11 (73%) and lost in three (20%) of 15 SSB specimens from patients with MF where this antigen was evaluated. Other detected aberrancies included CD3 dim- (13/18 [72%]), CD7 dim- (15/18 [83%]), and CD4-/CD8- (3/18 [17%]). CONCLUSIONS FC is capable of identifying putative neoplastic cells on SSB specimens from patients with MF. Bright homogeneous CD26 expression is a common and previously undescribed immunophenotypic aberrancy on MF skin infiltrates.
Collapse
Affiliation(s)
- Pedro Horna
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Danielle Kurant
- The Department of Pathology and Cell Biology, University of South Florida, Tampa
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | | | - Lynn Moscinski
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, FL
| | - L. Frank Glass
- Department of Dermatology, H. Lee Moffitt Cancer Center, Tampa, FL
| |
Collapse
|
40
|
Peker D, Padron E, Bennett JM, Zhang X, Horna P, Epling-Burnette PK, Lancet JE, Pinilla-Ibarz J, Moscinski L, List AF, Komrokji RS, Zhang L. A close association of autoimmune-mediated processes and autoimmune disorders with chronic myelomonocytic leukemia: observation from a single institution. Acta Haematol 2014; 133:249-56. [PMID: 25413011 DOI: 10.1159/000365877] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/10/2014] [Indexed: 12/14/2022]
Abstract
Chronic myelomonocytic leukemia (CMML), a clonal hematopoietic stem cell disease, may be linked to immune-mediated processes and/or autoimmune disorders (AID), although the exact pathogens are still elusive. We retrospectively analyzed 123 CMML patients in our institution. Twenty-four CMML patients (19.5%) had at least one immune-mediated disorder, most commonly idiopathic thrombocytopenic purpura, gout and psoriasis. Four of these 24 patients (15%) had more than one AID. We found that, in contrast to the general population with a prevalence rate of 3.2-5.2%, newly diagnosed CMML patients demonstrated a high prevalence and variety of immune-mediated processes and/or AID. When we compared the results with those of myelodysplastic syndromes published in the literature, the prevalence of AID in these two groups of patients is similar. Our results also showed that the presence of cytogenetic abnormalities was less in CMML patients with AID (6 of 21; 28.6%) than in those without AID (37 of 94; 39.4%), although there was no statistical significance (p = 0.334). A multicenter large cohort study of CMML with AID is recommended to illustrate the molecular relationship between the two distinct groups.
Collapse
MESH Headings
- Autoimmune Diseases/complications
- Autoimmune Diseases/epidemiology
- Autoimmune Diseases/genetics
- Autoimmune Diseases/pathology
- Chromosome Aberrations
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Prevalence
- Retrospective Studies
Collapse
Affiliation(s)
- Deniz Peker
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Fla., USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Lienlaf M, Perez-Villarroel P, Lee C, Cheng F, Canales J, Knox T, Marante D, Sarnaik A, Horna P, Seto E, Smalley K, Weber JS, Sotomayor EM, Villagra A. Abstract 4089: Histone deacetylase 6 (HDAC6) as a regulator of PD-L1 expression through STAT3 modulation in melanoma. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-4089] [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: 11/16/2022]
Abstract
Abstract
In spite of the progress made in the understanding of the cell biology, genetics and immunology of melanoma, the outcome for patients with advanced-stage disease has remained poor with a median survival ranging from 2-16 months. Some optimism was recently provided in metastatic melanoma by the improved clinical outcomes observed in patients receiving PD-L1 blocking antibodies. A better understanding of the environmental, genetic and epigenetic factors limiting the efficacy of melanoma immunotherapy will provide appropriate partner(s) for combination with Ipilimumab or PD1/PDL1 antibodies. Among the epigenetic factors, we have found that one member of the histone deacetylase family, HDAC6, plays a critical role not only in the regulation of survival/apoptosis of melanoma cells but also in limiting their immunogenicity and recognition by immune effector cells. Particularly, we found a major role of HDAC6 as a modulator of the immunosuppresive STAT3/IL-10 pathway and down-regulation of tolerogenic PD-L1 molecules in melanoma cells. By analyzing HDAC6 knock-down melanoma cell lines (HDAC6KD) we demonstrated the inactivation of the STAT3 pathway and the subsequent down-regulation of its target genes, including the expression of PD-L1. We also observed that the PD-L1 expression and phosphorylation of STAT3 was decreased in melanoma isolated from xenograph tumor growth models after in vivo treatment with specific HDAC6 inhibitors
Fortunately, there are multiple HDAC6-selective inhibitors available to mechanistically study the role of HDAC6 on these processes and provide a viable therapeutic avenue, which may minimize undesirable side effects that are characteristic of pan-HDACi such as SAHA. By building on our understanding of HDAC6 and applying these findings to novel experimental design, we hope to identify innovative therapeutic options to benefit cancer patients.
Citation Format: Maritza Lienlaf, Patricio Perez-Villarroel, Calvin Lee, Fengdong Cheng, Jorge Canales, Tessa Knox, Danay Marante, Amod Sarnaik, Pedro Horna, Ed. Seto, Keiran Smalley, Jeffrey S. Weber, Eduardo M. Sotomayor, Alejandro Villagra. Histone deacetylase 6 (HDAC6) as a regulator of PD-L1 expression through STAT3 modulation in melanoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4089. doi:10.1158/1538-7445.AM2014-4089
Collapse
Affiliation(s)
- Maritza Lienlaf
- 1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Calvin Lee
- 2All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL
| | - Fengdong Cheng
- 1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Jorge Canales
- 1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Tessa Knox
- 1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Danay Marante
- 1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Amod Sarnaik
- 1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Pedro Horna
- 1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Ed. Seto
- 1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Keiran Smalley
- 1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | | |
Collapse
|
42
|
Perez-Villarroel P, Lienlaf M, Lee C, Cheng F, Woods D, Barrios K, Woan K, Canales J, Knox T, Marante D, Wang H, Horna P, Smalley K, Celis E, Seto E, Weber JS, Sotomayor EM, Villagra A. Abstract 4086: Histone deacetylase 6 (HDAC6) as a new target modulating the proliferation and immune-related pathways in melanoma. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-4086] [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: 11/16/2022]
Abstract
Abstract
Histone deacetylases (HDACs), originally described as histone modifiers, have more recently been demonstrated to modify a variety of other proteins involved in diverse cellular processes unrelated to the chromatin environment. This includes the deacetylation of multiple non-histone targets, such as proteins involved in cell cycle/apoptosis and immune regulation. Specifically, HDACs have garnered significant interest due to the availability of drugs that selectively inhibits HDACs. We recently identified that the pharmacological or genetic abrogation of a single HDAC, HDAC6, modifies the immunogenicity and proliferation of melanoma in both in vitro and in vivo models.
Using specific HDAC6 inhibitors (HDAC6i) we observed decreased proliferation and G1 cell cycle arrest in all melanoma cell lines measured by MTS assay and flow cytometry. These results were also observed in stable HDAC6 knockdown melanoma cell lines (HDAC6KD) generated by specific lentiviral shRNA for HDAC6. In addition to the effects observed in proliferation and apoptosis after inhibiting HDAC6, we found important changes in the expression of immune-related pathways, including increased expression of MHC, co-stimulatory molecules, and specific melanoma tumor associated antigens such as gp100, MART-1, Tyrp1 and Tyrp2.
Our in vitro results were further supported by in vivo tumor growth studies. We observed a delayed tumor growth of inoculated B16 melanoma cells in C57BL/6 mice treated with selective HDAC6i. A similar outcome was identified after inoculation of HDAC6KD B16 melanoma cells in C57BL/6 mice. Such an effect was reverted partially in CD4+ and CD8+ depleted C57BL/6 mice challenged with HDAC6KD cells, suggesting that the disruption of HDAC6 enhances immune system recognition of melanoma cells. This delay in tumor growth could be a reflection of their diminished proliferation and an increase in their immunogenicity leading to improved immune recognition and clearance. These studies provide critical insights into the molecular pathways that are involved in the regulatory role of HDAC6 in cell proliferation, survival, and cytokine signaling of human melanoma cells. Collectively, our data has identified HDAC6 as an attractive therapeutic target in melanoma.
Citation Format: Patricio Perez-Villarroel, Maritza Lienlaf, Calvin Lee, Fengdong Cheng, David Woods, Kelly Barrios, Karrune Woan, Jorge Canales, Tessa Knox, Danay Marante, Hongwei Wang, Pedro Horna, Keiran Smalley, Esteban Celis, Ed Seto, Jeffrey S. Weber, Eduardo M. Sotomayor, Alejandro Villagra. Histone deacetylase 6 (HDAC6) as a new target modulating the proliferation and immune-related pathways in melanoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4086. doi:10.1158/1538-7445.AM2014-4086
Collapse
Affiliation(s)
| | - Maritza Lienlaf
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Calvin Lee
- 2All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL
| | - Fengdong Cheng
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - David Woods
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Kelly Barrios
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Karrune Woan
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Jorge Canales
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Tessa Knox
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Danay Marante
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Hongwei Wang
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Pedro Horna
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Keiran Smalley
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Esteban Celis
- 3Georgia Regents University Cancer Center, Augusta, GA
| | - Ed Seto
- 1H.Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | | | | |
Collapse
|
43
|
Horna P, Zhang L, Sotomayor EM, Lancet JE, Moscinski LC. Diagnostic immunophenotype of acute promyelocytic leukemia before and early during therapy with all-trans retinoic acid. Am J Clin Pathol 2014; 142:546-52. [PMID: 25239423 DOI: 10.1309/ajcppokehbp53zhv] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To study the immunophenotypic changes of acute promyelocytic leukemia (APL) in patients who recently received all-trans retinoic acid (ATRA) and to assess the diagnostic utility of flow cytometry in this setting. METHODS Flow cytometry was performed on 29 newly diagnosed APLs and 93 other acute myeloid leukemias, including 25 HLA-DR- or CD34- cases. Clinical notes from referring institutions were reviewed to assess for recent ATRA administration. RESULTS Recent ATRA therapy was documented in 17 (59%) of 29 patients with APL. The main features of untreated APL were preserved with ATRA therapy, including CD34- (83% vs 82%), HLA-DR- (83% vs 100%), and CD117+ (100% vs 77%). CD11b and CD11c were negative in all untreated APLs but positive in 76% and 88% of ATRA-treated APLs, respectively. Optimal diagnostic criteria for untreated APL (CD34- or HLA-DR- and CD11b- and CD11c-) showed 100% sensitivity and 98% specificity but were not useful after ATRA administration. The best interpretative approach to ATRA-treated APL (CD34- or HLA-DR-) showed 100% sensitivity but limited specificity (73%). CONCLUSIONS Information about recent ATRA administration is critical for adequate interpretation of the flow cytometric findings in patients with suspected APL.
Collapse
Affiliation(s)
- Pedro Horna
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Ling Zhang
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, FL
| | | | - Jeffrey E. Lancet
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Lynn C. Moscinski
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, FL
| |
Collapse
|
44
|
Idrees A, Horna P, Sokol L, Zhang L. Clinical, Pathological, and Genetic Characteristics of T-Cell Prolymphocytic Leukemia (T-PLL) in a Less Aggressive Course: A Single Institutional Experience. Am J Clin Pathol 2014. [DOI: 10.1093/ajcp/142.suppl1.094] [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: 11/14/2022] Open
Affiliation(s)
- Afshan Idrees
- University of South Florida, H. Lee Moffitt Cancer Center, Tampa
| | - Pedro Horna
- University of South Florida, H. Lee Moffitt Cancer Center, Tampa
| | - Lubomir Sokol
- University of South Florida, H. Lee Moffitt Cancer Center, Tampa
| | - Ling Zhang
- University of South Florida, H. Lee Moffitt Cancer Center, Tampa
| |
Collapse
|
45
|
Dalia SM, Horna P, Zhang L. Tetraploidy acute promyelocytic leuemia with double t(15;17)/PML-RARA, a case report with review of literature. Int J Clin Exp Pathol 2014; 7:5363-5368. [PMID: 25197424 PMCID: PMC4152114] [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] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/29/2014] [Indexed: 06/03/2023]
Abstract
Acute promyelocytic leukemia (APL) with tetraploidy chromosome harboring t(15;17)(q23;a21) is extremely rare. To date, there are 14 such cases reports that describe this entity, mostly found in Eastern hemisphere. Herein we described a 51-year-old man with a diagnosis of tetraploid acute promyelocytic leukemia with double (15;17) translocations and compare the prototypically clinicopathologic, genetic and molecular findings with those reported in the literature.
Collapse
Affiliation(s)
- Samir M Dalia
- H. Lee Moffitt Cancer and Research Institute, Division of Hematological Malignancies and The University of South FloridaTampa, Florida, USA
| | - Pedro Horna
- H. Lee Moffitt Cancer and Research Institute, Department of Hematopathology and Laboratory MedicineTampa, Florida, USA
| | - Ling Zhang
- H. Lee Moffitt Cancer and Research Institute, Department of Hematopathology and Laboratory MedicineTampa, Florida, USA
| |
Collapse
|
46
|
Holdener SL, Harrington L, Nguyen J, Horna P, Sagatys E, Shah B, Zhang L. Therapy-related B lymphoblastic leukemia with t(4;11)(q21;q23)/AF4-MLL in a patient with mantle cell lymphoma after recent aggressive chemotherapy: a unique case report. Int J Clin Exp Pathol 2014; 7:1800-1804. [PMID: 24817983 PMCID: PMC4014267] [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] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/04/2014] [Indexed: 06/03/2023]
Abstract
Mantle cell lymphoma (MCL) is a mature B-cell lymphoma associated with the hallmark translocation t(11;14)(q13;32), which involves the cyclin D1 (CCND1) and immunoglobin heavy chain (IgH) genes. It may transform to a more aggressive blastoid or pleomorphic variant, with or without acquisition of chromosomal abnormalities. MCL could also present with a leukemic phase with marked lymphocytosis. A literature search did not reveal any prior reports of MCL transforming to or followed by a B-cell lymphoblastic leukemia (B-ALL).
Collapse
Affiliation(s)
- Stephanie L Holdener
- Department of Pathology, University of South Florida Morsani College of MedicineTampa, FL, USA
| | - Lacey Harrington
- Department of Pathology, University of South Florida Morsani College of MedicineTampa, FL, USA
| | - Johnny Nguyen
- Department of Pathology, University of South Florida Morsani College of MedicineTampa, FL, USA
| | - Pedro Horna
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research InstituteTampa, FL, USA
| | - Elizabeth Sagatys
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research InstituteTampa, FL, USA
| | - Bijal Shah
- Department of Hematological Malignancies, H. Lee Moffitt Cancer Center and Research InstituteTampa, FL, USA
| | - Ling Zhang
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research InstituteTampa, FL, USA
| |
Collapse
|
47
|
Dalia S, Brayer J, Horna P, Zhang H, Pinilla-Ibarz J. Transformation to Hodgkin lymphoma in chronic lymphocytic leukemia coexisting with Epstein-Barr viremia. Leuk Lymphoma 2014; 55:2660-2. [PMID: 24528217 DOI: 10.3109/10428194.2014.894193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Samir Dalia
- Division of Hematological Malignancies, H. Lee Moffitt Cancer Center and Research Institute, and the University of South Florida , Tampa, FL , USA
| | | | | | | | | |
Collapse
|
48
|
Horna P, Pantazopoulos P, Lancet JE, Moscinski LC, Zhang L. Prominent hematogone hyperplasia in BCR-ABL1-positive chronic myelogenous leukemia: mimicking recurrent B-lymphoid blast crisis. Leuk Lymphoma 2013; 55:1952-4. [PMID: 24304373 DOI: 10.3109/10428194.2013.869330] [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] [Indexed: 11/13/2022]
Affiliation(s)
- Pedro Horna
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center , Tampa, FL , USA
| | | | | | | | | |
Collapse
|
49
|
Horna P, Deaver DM, Qin D, Moscinski LC, Sotomayor EM, Glass LF, Sokol L. Quantitative flow cytometric identification of aberrant T cell clusters in erythrodermic cutaneous T cell lymphoma. Implications for staging and prognosis. J Clin Pathol 2013; 67:431-6. [PMID: 24319102 DOI: 10.1136/jclinpath-2013-201748] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS Assessment of peripheral blood tumour burden for staging of cutaneous T cells lymphoma is most often accomplished by flow cytometry (FC) using various non-standarised strategies. We report the results of calculating absolute Sezary cell counts (SCCs) by FC, based on the identification of aberrant T cell clusters on a virtual 6-dimensional space and independently of the expected immunophenotype (6D-FC SCC). METHODS 6D-FC SCCs were calculated on 65 peripheral blood specimens from 28 patients with erythrodermic cutaneous T cells lymphoma (stage III or IV). Comparisons were made with recommended FC strategies and correlations with overall mortality were studied. RESULTS At first visit, 17 of 28 patients (61%) had 6D-FC SCCs meeting current criteria for Stage IV disease (≥1000 SC/μL); while only 2 patients (7%) met Stage IV criteria on other tissues. As defined by comprehensive staging using clinicomorphological criteria and 6D-FC SCCs, Stage IV disease identified a subgroup of patients with worse overall survival (p=0.0227). Residual non-aberrant CD4 T cells were markedly decreased in Stage IV disease (p=0.018). Among 65 specimens, discrepancies were observed between 6D-FC SCCs and usual FC thresholds for Stage IV disease, namely a CD4:CD8 ratio ≥10:1 (9 discrepancies, 14%), and ≥40% aberrant CD4 T cells (4 discrepancies, 6%). Surprisingly, 8 cases (12%) from 6 patients exhibited two distinctively separate clusters of aberrant CD4 T cells with different CD7 and/or CD26 expression. CONCLUSIONS Visual 6-dimensional identification of aberrant T cell clusters by FC allows for the calculation of clinically significant SCCs. Simplified gating strategies and relative quantitative values might underestimate the immunophenotypical complexity of Sezary cells.
Collapse
Affiliation(s)
- Pedro Horna
- Department of Hematopathology and Labororatory Medicine, H. Lee Moffitt Cancer Center, , Tampa, Florida, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
Horna P, Hamill JR, Sokol L, Glass LF. Primary cutaneous plasmablastic lymphoma in an immunocompetent patient. J Am Acad Dermatol 2013; 69:e274-e276. [PMID: 24124865 DOI: 10.1016/j.jaad.2013.06.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/06/2013] [Accepted: 06/09/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Pedro Horna
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida.
| | | | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - L Frank Glass
- Department of Dermatology, H. Lee Moffitt Cancer Center, Tampa, Florida
| |
Collapse
|