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Hartsough EM, Foreman RK, Martinez-Lage M, Branda J, Sohani AR, Zukerberg L. Dematiaceous fungal infections: clinical and pathologic conundrums. J Clin Pathol 2024; 77:352-357. [PMID: 38272660 DOI: 10.1136/jcp-2023-209239] [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: 10/16/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
Dematiaceous fungi are defined by pigment within their cell walls. They are increasingly recognised human pathogens, causing a wide range of clinical presentations, from localised subcutaneous infections to disseminated disease in rare cases. We report our institutional experience with diagnosis of dematiaceous fungal infections from 2005 to 2022 and highlight four instructive cases that clinically and pathologically mimicked other diseases for which the diagnosis was confirmed by fungal culture (one case) or supported by PCR with 28S rRNA and internal transcribed spacer primers (three cases). Two patients were immunocompromised and two had presumed exposure to the organism. In each highlighted case, fungal infection was not clinically suspected, and the pathologist was critical in making the diagnosis and ensuring appropriate clinical management, which was supplemented by fungal stains and novel molecular methods.
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Affiliation(s)
- Emily Mae Hartsough
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruth K Foreman
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Martinez-Lage
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Branda
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aliyah R Sohani
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lawerence Zukerberg
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Fitzpatrick MJ, Sohani AR, Ly A. Uses and limitations of small-volume biopsies for the diagnosis of lymphoma. Cytopathology 2024. [PMID: 38462899 DOI: 10.1111/cyt.13372] [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: 01/04/2024] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
Although surgical biopsy remains the gold standard for the diagnosis of lymphoma, small-volume biopsies including fine-needle aspiration and core needle biopsy are increasingly being used as a first line diagnostic tool. Small-volume biopsies are safe, rapid and cost effective; however, diagnostic utility varies by lymphoma subtype. It is important for pathologists and clinicians to recognize both the strengths and limitations of such biopsies.
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Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Medeiros LJ, Marques-Piubelli ML, Sangiorgio VFI, Ruiz-Cordero R, Vega F, Feldman AL, Chapman JR, Clemens MW, Hunt KK, Evans MG, Khoo C, Lade S, Silberman M, Morkowski J, Pina EM, Mills DC, Bates CM, Magno WB, Sohani AR, Sieling BA, O'Donoghue JM, Bacon CM, Patani N, Televantou D, Turner SD, Johnson L, MacNeill F, Wotherspoon AC, Iyer SP, Malpica LE, Patel KP, Xu J, Miranda RN. Corrigendum to "Epstein-Barr-virus-positive large B-cell lymphoma associated with breast implants: an analysis of eight patients suggesting a possible pathogenetic relationship." [Modern Pathology 34 (2021) 2154-2167]. Mod Pathol 2023; 36:100355. [PMID: 37948938 DOI: 10.1016/j.modpat.2023.100355] [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: 11/12/2023]
Affiliation(s)
- L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mario L Marques-Piubelli
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valentina F I Sangiorgio
- Division of Hematopathology, Department of Cellular Pathology, The Royal London Hospital. Barts Health NSH Trust, London, United Kingdom
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Francisco Vega
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew L Feldman
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jennifer R Chapman
- Department of Pathology and Laboratory Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark G Evans
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christine Khoo
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephen Lade
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | - Edward M Pina
- Pina Cosmetic Surgery, Department of Surgery, HCA Houston Healthcare Southeast, Houston, Texas
| | - Daniel C Mills
- Aesthetic Plastic Surgical Institute, Laguna Beach, California
| | | | | | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Beth A Sieling
- Department of Surgery, St. Mary's Hospital, Trinity Health of New England, Waterbury, Connecticut
| | - Joseph M O'Donoghue
- Department of Plastic Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Chris M Bacon
- Department of Cellular Pathology, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Neill Patani
- Department of Breast Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Despina Televantou
- Department of Cellular Pathology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Laura Johnson
- Department of Surgery, Barts Health NHS Trust, London, United Kingdom
| | - Fiona MacNeill
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Andrew C Wotherspoon
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Swaminathan P Iyer
- Department of Myeloma and Lymphoma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Luis E Malpica
- Department of Myeloma and Lymphoma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jie Xu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Ly A, Balassanian R, Alperstein S, Donnelly A, McGrath C, Sohani AR, Stelow EB, Thrall MJ, Zhang ML, Pitman MB. One procedure-one report: the Re-Imagine Cytopathology Task Force position paper on small tissue biopsy triage in anatomic pathology. J Am Soc Cytopathol 2023; 12:395-406. [PMID: 37270328 DOI: 10.1016/j.jasc.2023.04.007] [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: 03/28/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Endoscopic biopsy procedures increasingly generate multiple tissue samples from multiple sites, and frequently retrieve concurrent cytologic specimens and small core needle biopsies. There is currently lack of consensus in subspecialized practices as to whether cytopathologists or surgical pathologists should review such samples, and whether the pathology findings should be reported together or separately. MATERIALS AND METHODS In December 2021, the American Society of Cytopathology convened the Re-Imagine Cytopathology Task Force to examine various workflows that would facilitate unified pathology reporting of concurrently obtained biopsies and improve clinical care. RESULTS AND CONCLUSIONS This position paper summarizes the key points and highlights the advantages, challenges, and resources available to support the implementation of such workflows that result in "one procedure-one report".
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Affiliation(s)
- Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Susan Alperstein
- Department of Pathology, Weill Cornell Medical College, New York, New York
| | - Amber Donnelly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska
| | - Cindy McGrath
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward B Stelow
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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5
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Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, de Oliveira Araujo IB, Berti E, Bhagat G, Borges AM, Boyer D, Calaminici M, Chadburn A, Chan JKC, Cheuk W, Chng WJ, Choi JK, Chuang SS, Coupland SE, Czader M, Dave SS, de Jong D, Di Napoli A, Du MQ, Elenitoba-Johnson KS, Ferry J, Geyer J, Gratzinger D, Guitart J, Gujral S, Harris M, Harrison CJ, Hartmann S, Hochhaus A, Jansen PM, Karube K, Kempf W, Khoury J, Kimura H, Klapper W, Kovach AE, Kumar S, Lazar AJ, Lazzi S, Leoncini L, Leung N, Leventaki V, Li XQ, Lim MS, Liu WP, Louissaint A, Marcogliese A, Medeiros LJ, Michal M, Miranda RN, Mitteldorf C, Montes-Moreno S, Morice W, Nardi V, Naresh KN, Natkunam Y, Ng SB, Oschlies I, Ott G, Parrens M, Pulitzer M, Rajkumar SV, Rawstron AC, Rech K, Rosenwald A, Said J, Sarkozy C, Sayed S, Saygin C, Schuh A, Sewell W, Siebert R, Sohani AR, Suzuki R, Tooze R, Traverse-Glehen A, Vega F, Vergier B, Wechalekar AD, Wood B, Xerri L, Xiao W. Correction: "The 5th edition of The World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms" Leukemia. 2022 Jul;36(7):1720-1748. Leukemia 2023; 37:1944-1951. [PMID: 37468552 PMCID: PMC10457187 DOI: 10.1038/s41375-023-01962-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | - Catalina Amador
- Department of Pathology, University of Miami, Miami, FL, USA
| | | | | | | | - Emilio Berti
- University of Milan, Fondazione Cà Granda, IRCCS, Ospedale Maggiore Policlinico, Milan, Italy
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Daniel Boyer
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Mariarita Calaminici
- Centre for Haemato-Oncology, Barts Cancer Institute, QMUL and SIHMDS Barts Health NHS Trust, London, UK
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Wee-Joo Chng
- National University Cancer Institute, Singapore, Singapore
| | - John K Choi
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Sarah E Coupland
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Magdalena Czader
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, USA
| | - Sandeep S Dave
- Center for Genomic and Computational Biology and Department of Medicine, Duke University, Durham, NC, USA
| | - Daphne de Jong
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Pathology, Amsterdam, The Netherlands
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sapienza University, School of Medicine and Psychology, Sant' Andrea Hospital, Rome, Italy
| | - Ming-Qing Du
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK.
| | - Kojo S Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Judith Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Julia Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg Medical School, Chicago, IL, USA
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - Marian Harris
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
| | - Christine J Harrison
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Patty M Jansen
- Leiden University Medical Center, Department of Pathology, Leiden, The Netherlands
| | | | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik Zurich, and Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Joseph Khoury
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hiroshi Kimura
- Department of Virology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Wolfram Klapper
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - Alexandra E Kovach
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Alexander J Lazar
- Departments of Pathology & Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stefano Lazzi
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Nelson Leung
- Division of Nephrology and Hypertension, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Vasiliki Leventaki
- Department of Pathology, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | - Xiao-Qiu Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Megan S Lim
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wei-Ping Liu
- Department of Pathology, West-China Hospital, Sichuan University, Chengdu, PR China
| | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Marcogliese
- Department of Pathology & Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Michal
- Department of Pathology, Charles University in Prague, Faculty of Medicine in Plzen, Plzen, Czech Republic
| | - Roberto N Miranda
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Santiago Montes-Moreno
- Anatomic Pathology Department and Translational Hematopathology Lab, Valdecilla/IDIVAL University Hospital, Santander, Spain
| | - William Morice
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kikkeri N Naresh
- Section of Pathology, Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Yasodha Natkunam
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ilske Oschlies
- Department of Pathology, Hematopathology Section and Lymph Node Registry, University Hospital Schleswig-Holstein, University of Kiel, Kiel, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany.
| | - Marie Parrens
- Department of Pathology, Bordeaux University Hospital, Bordeaux, France
| | - Melissa Pulitzer
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Vincent Rajkumar
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, Rochester, MN, USA
| | - Andrew C Rawstron
- HMDS, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Karen Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andreas Rosenwald
- Institute of Pathology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Jonathan Said
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Shahin Sayed
- Department of Pathology-Aga Khan University Hospital-Nairobi, Nairobi, Kenya
| | - Caner Saygin
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - William Sewell
- Immunology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany.
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ritsuro Suzuki
- Department of Hematology & Oncology, Shimane University School of Medicine, Shimane, Japan
| | - Reuben Tooze
- Division of Haematology and Immunology, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Alexandra Traverse-Glehen
- Hospices Civils de Lyon/Department of Pathology/Université Lyon 1/Centre International de Recherche en Infectiologie (CIRI) INSERM U1111-CNRS UMR5308, Lyon, France
| | - Francisco Vega
- Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beatrice Vergier
- Department of Pathology, Hopital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | | | - Brent Wood
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Luc Xerri
- Department of Pathology, Institut Paoli-Calmettes and Aix-Marseille University, Marseille, France
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Sohani AR. Hodgkin Lymphoma and Its Differential Diagnosis: New Twists on an Old Challenge. Surg Pathol Clin 2023; 16:287-346. [PMID: 37149361 DOI: 10.1016/j.path.2023.02.002] [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] [Indexed: 05/08/2023]
Abstract
Hodgkin lymphoma is a B-cell neoplasm that typically presents with localized, nodal disease. Tissues are characterized by few large neoplastic cells, usually comprising less than 10% of tissue cellularity, present in a background of abundant nonneoplastic inflammatory cells. This inflammatory microenvironment, although key to the pathogenesis, can make diagnosis a challenge because reactive conditions, lymphoproliferative diseases, and other lymphoid neoplasms may mimic Hodgkin lymphoma and vice versa. This review provides an overview of the classification of Hodgkin lymphoma, its differential diagnosis, including emerging and recently recognized entities, and strategies to resolve challenging dilemmas and avoid diagnostic pitfalls.
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Affiliation(s)
- Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA 02114, USA.
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Li Y, Xu-Monette ZY, Abramson J, Sohani AR, Bhagat G, Tzankov A, Visco C, Zhang S, Dybkaer K, Pan Z, Xu M, Tam W, Zu Y, Hsi ED, Hagemeister FB, Go H, van Krieken JH, Winter JN, Ponzoni M, Ferreri AJM, Møller MB, Piris MA, Wang Y, Zhang M, Young KH. EBV-positive DLBCL frequently harbors somatic mutations associated with clonal hematopoiesis of indeterminate potential. Blood Adv 2023; 7:1308-1311. [PMID: 36399513 PMCID: PMC10119604 DOI: 10.1182/bloodadvances.2022008550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yong Li
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Zijun Y. Xu-Monette
- Hematopathology Division and Department of Pathology, Duke University Medical Centre, Durham, NC
| | - Jeremy Abramson
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Aliyah R. Sohani
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Govind Bhagat
- Columbia University Irving Medical Centre and New York Presbyterian Hospital, New York, NY
| | - Alexandar Tzankov
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Carlo Visco
- Department of Hematology, University of Verona, Verona, Italy
| | - Shanxiang Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Karen Dybkaer
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Zenggang Pan
- Department of Pathology, University of Colorado, Boulder, CO
| | - Min Xu
- Department of Pathology, Yale University, New Haven, CT
| | - Wayne Tam
- Department of Pathology, Weill Medical College of Cornell University, New York, NY
| | - Youli Zu
- Department of Pathology, The Methodist Hospital, Houston, TX
| | - Eric D. Hsi
- Department of Pathology, Wake Forest University, Winston-Salem, NC
| | - Fredrick B. Hagemeister
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Heounjeong Go
- Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | | | - Jane N. Winter
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Maurilio Ponzoni
- Department of Hematology and Pathology, San Raffaele H. Scientific Institute, Milan, Italy
| | - Andrés J. M. Ferreri
- Department of Hematology and Pathology, San Raffaele H. Scientific Institute, Milan, Italy
| | - Michael B. Møller
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Miguel A. Piris
- Department of Pathology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Yingjun Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingzhi Zhang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ken H. Young
- Department of Medicine, Baylor College of Medicine, Houston, TX
- Duke Cancer Institute, Durham, NC
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8
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Sohani AR. Evolving Concepts in Diagnostic Hematopathology. Surg Pathol Clin 2023; 16:xi. [PMID: 37149369 DOI: 10.1016/j.path.2023.02.003] [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: 03/29/2023]
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9
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Lopez AR, Sohani AR, O’Shea A, Ng TS. Neurolymphomatosis in Recrudescent Diffuse Large B-cell Lymphoma. Asia Ocean J Nucl Med Biol 2023; 11:89-92. [PMID: 36619186 PMCID: PMC9803627 DOI: 10.22038/aojnmb.2022.66666.1464] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 01/10/2023]
Abstract
Neurolymphomatosis is an uncommon manifestation of lymphoma, often presenting with painful polyneuropathy or polyradiculopathy and concomitant distal extremity weakness. Differentiation from other etiologies resulting in similar neuropathic symptoms such as compressive or inflammatory pathologies can be difficult and often results in delayed diagnosis. Here we describe a case of neurolymphomatosis affecting a 64-year-old man with a history of diffuse large B-cell lymphoma (DLBCL) in remission presenting with a right-sided foot drop following a gunshot wound. MRI at that time demonstrated thickening and enhancement of the cauda equina nerve roots. Over the course of the subsequent eight months, he developed left lower extremity sensory symptoms, left-sided foot drop and signs of upper motor neuron involvement, including left facial weakness, dysphonia, and dysphagia. 18F-FDG PET/CT revealed intensely avid left lumbosacral nerve roots, bilateral lower extremity and left upper extremity neurovascular bundles. Left sural nerve biopsies showed infiltration of DLBCL and confirmed neurolymphomatosis. We highlight the role of 18F-FDG PET/CT, with histological verification, for the diagnosis of an extended course of neurolymphomatosis occurring in the absence of typical painful neuropathy but with cranial and peripheral neuropathies.
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Affiliation(s)
| | - Aliyah R. Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Aileen O’Shea
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas S.C. Ng
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, MA, USA,Corresponding author: Thomas S.C. Ng. Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, White 4, 55 Fruit St, Boston MA 02114. Tel: (617) 732-5938; Fax: (617) 726 6165;
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10
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Soumerai JD, Takvorian RW, Sohani AR, Abramson JS, Ferry JA. Venetoclax activity in a patient with central nervous system involvement by chronic lymphocytic leukaemia. Lancet Haematol 2022; 9:e796. [PMID: 36174642 DOI: 10.1016/s2352-3026(22)00098-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 06/16/2023]
Affiliation(s)
| | | | - Aliyah R Sohani
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | - Judith A Ferry
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
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11
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Xia D, Sayed S, Moloo Z, Gakinya SM, Mutuiri A, Wawire J, Okiro P, Courville EL, Hasserjian RP, Sohani AR. Geographic Variability of Nodular Lymphocyte-Predominant Hodgkin Lymphoma. Am J Clin Pathol 2022; 157:231-243. [PMID: 34542569 DOI: 10.1093/ajcp/aqab113] [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: 04/09/2021] [Accepted: 05/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) differs from classic Hodgkin lymphoma (CHL) in terms of clinicopathologic features, including Epstein-Barr virus (EBV) association. CHL geographic variability is well known, with higher frequencies of mixed-cellularity subtype and EBV positivity in low/middle-income countries (LMICs), but there are few well-characterized series of NLPHL from LMICs. METHODS We detail clinicopathologic findings of 21 NLPHL cases received in consultation from Kenya and summarize reports of NLPHL with EBV testing published since 2000. RESULTS Median age of consultation cases was 36 years, and male/female ratio was 3.2. All cases involved peripheral lymph nodes and showed at least some B-cell-rich nodular immunoarchitecture, with prominent extranodular lymphocyte-predominant (LP) cells and T-cell-rich variant patterns most commonly seen. LP cells expressed pan-B-cell markers, including strong OCT2; lacked CD30 and CD15 expression in most cases; and were in a background of expanded/disrupted follicular dendritic cell meshworks and increased T-follicular helper cells. LP cells were EBV negative in 18 cases. Historical cases showed a low rate of EBV positivity with no significant difference between LMICs and high-income countries. CONCLUSIONS Unlike CHL, NLPHL shows few geographic differences in terms of clinicopathologic features and EBV association. These findings have implications for diagnosis, prognostication, and treatment of patients with NLPHL in LMICs.
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Affiliation(s)
- Daniel Xia
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, Canada
| | | | - Zahir Moloo
- Aga Khan University Hospital, Nairobi, Kenya
| | | | | | | | | | | | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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12
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Fitzpatrick MJ, Nardi V, Sohani AR. Plasma cell myeloma: role of histopathology, immunophenotyping, and genetic testing. Skeletal Radiol 2022; 51:17-30. [PMID: 33687521 DOI: 10.1007/s00256-021-03754-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 02/02/2023]
Abstract
Myeloma is a malignant neoplasm of plasma cells with complex pathogenesis. Diagnosis and risk stratification require the integration of histology, radiology, serology, and genetic data. Bone marrow biopsies are essential for myeloma diagnosis by providing material for histologic and cytologic assessment as well as immunophenotypic and genetic studies. Flow cytometry and genetic studies are, in particular, becoming increasingly important for diagnosis, risk stratification, and assessment of treatment response. Myeloma has traditionally been characterized by recurrent cytogenetic abnormalities that can be divided into two subtypes: hyperdiploid, characterized by trisomies, and non-hyperdiploid, characterized by translocations involving chromosome 14. These abnormalities are thought to be primary events, initiating a premalignant state, which progresses to myeloma through the acquisition of secondary mutations. The emergence of next-generation sequencing has led to the discovery of numerous mutations and gene fusions that comprise the heterogenous genomic landscape of myeloma. As the underlying pathogenesis of myeloma continues to be delineated, possible therapeutic targets have also emerged. Herein, we describe the importance of histology, immunophenotype, and mutational analysis in the assessment of myeloma.
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Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WRN 219, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WRN 219, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WRN 219, Boston, MA, 02114, USA.
- Department of Pathology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
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13
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Chipidza FE, Kayembe MKA, Nkele I, Efstathiou JA, Chabner BA, Abramson J, Dryden-Peterson SL, Sohani AR. Accuracy of Pathologic Diagnosis in Patients With Lymphoma and Survival: A Prospective Analysis From Botswana. JCO Glob Oncol 2021; 7:1620-1632. [PMID: 34860565 PMCID: PMC8654434 DOI: 10.1200/go.21.00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE With intense HIV epidemics, southern African countries have a high burden of classic Hodgkin lymphoma (CHL) and non-Hodgkin lymphoma (NHL). However, suboptimal access to pathology resources limits subtype classification. We sought to assess the diagnostic accuracy of specimens classified as lymphoma and to determine association between discordant pathologic diagnosis and overall survival. METHODS Seventy patients with CHL or NHL and treated at three Botswana hospitals from 2010 to 2016 were analyzed. Local pathologic assessment relied primarily on morphology. All cases underwent secondary US hematopathology review, which is considered gold standard. RESULTS The median follow-up was 58 months. The overall reclassification rate was 20 of 70 cases (29%). All 20 CHL cases were correctly classified in Botswana, and mixed cellularity was the most common subtype, diagnosed in 11 (55%) cases. Of 47 confirmed NHL cases, diffuse large B-cell lymphoma was the final US diagnosis in 28 cases (60%), another aggressive B-cell NHL in nine (19%), an indolent B-cell NHL in six (13%), and T-cell NHL in four (9%). Common types of diagnostic discordance included NHL subtype reclassification (11 of 20, 55%) and CHL reclassified as NHL (7 of 20, 35%). Concordant versus discordant diagnosis after secondary review was associated with improved 5-year overall survival (60.1% v 26.3%, P = .0066). Discordant diagnosis was independently associated with increased risk of death (adjusted hazard ratio 2.733; 95% CI, 1.102 to 6.775; P = .0300) even after stratifying results by CHL versus NHL. CONCLUSION In this single prospective cohort, discordant pathologic diagnosis was associated with a nearly three-fold increased risk of death. Limited access to relatively basic diagnostic techniques impairs treatment decisions and leads to poor patient outcomes in low-resource countries.
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Affiliation(s)
- Fallon E Chipidza
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA.,Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Mukendi K A Kayembe
- University of Botswana, Gaborone, Botswana.,Ministry of Health, Gaborone, Botswana
| | - Isaac Nkele
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | | | | | - Scott L Dryden-Peterson
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA
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14
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Medeiros LJ, Marques-Piubelli ML, Sangiorgio VFI, Ruiz-Cordero R, Vega F, Feldman AL, Chapman JR, Clemens MW, Hunt KK, Evans MG, Khoo C, Lade S, Silberman M, Morkowski J, Pina EM, Mills DC, Bates CM, Magno WB, Sohani AR, Sieling BA, O'Donoghue JM, Bacon CM, Patani N, Televantou D, Turner SD, Johnson L, MacNeill F, Wotherspoon AC, Iyer SP, Malpica LE, Patel KP, Xu J, Miranda RN. Epstein-Barr-virus-positive large B-cell lymphoma associated with breast implants: an analysis of eight patients suggesting a possible pathogenetic relationship. Mod Pathol 2021; 34:2154-2167. [PMID: 34226673 DOI: 10.1038/s41379-021-00863-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 03/08/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/08/2022]
Abstract
Breast implant anaplastic large cell lymphoma (ALCL) is a T-cell neoplasm arising around textured breast implants that was recognized recently as a distinct entity by the World Health Organization. Rarely, other types of lymphoma have been reported in patients with breast implants, raising the possibility of a pathogenetic relationship between breast implants and other types of lymphoma. We report eight cases of Epstein-Barr virus (EBV)-positive large B-cell lymphoma associated with breast implants. One of these cases was invasive, and the other seven neoplasms were noninvasive and showed morphologic overlap with breast implant ALCL. All eight cases expressed B-cell markers, had a non-germinal center B-cell immunophenotype, and were EBV+ with a latency type III pattern of infection. We compared the noninvasive EBV+ large B-cell lymphoma cases with a cohort of breast implant ALCL cases matched for clinical and pathologic stage. The EBV+ large B-cell lymphoma cases more frequently showed a thicker capsule, and more often were associated with calcification and prominent lymphoid aggregates outside of the capsule. The EBV+ B-cell lymphoma cells were more often arranged within necrotic fibrinoid material in a layered pattern. We believe that this case series highlights many morphologic similarities between EBV+ large B-cell lymphoma and breast implant ALCL. The data presented suggest a pathogenetic role for breast implants (as well as EBV) in the pathogenesis of EBV+ large B-cell lymphoma. We also provide some histologic findings useful for distinguishing EBV+ large B-cell lymphoma from breast implant ALCL in this clinical setting.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/analysis
- Breast Implantation/adverse effects
- Breast Implantation/instrumentation
- Breast Implants/adverse effects
- Diagnosis, Differential
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/virology
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Lymphoma, Large-Cell, Anaplastic/etiology
- Lymphoma, Large-Cell, Anaplastic/immunology
- Lymphoma, Large-Cell, Anaplastic/pathology
- Middle Aged
- Neoplasm Staging
- Predictive Value of Tests
- Prosthesis Design
- Risk Factors
- Surface Properties
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Affiliation(s)
- L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mario L Marques-Piubelli
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valentina F I Sangiorgio
- Division of Hematopathology, Department of Cellular Pathology, The Royal London Hospital. Barts Health NSH Trust, London, UK
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Francisco Vega
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew L Feldman
- Division of Hematopathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jennifer R Chapman
- Department of Pathology and Laboratory Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark G Evans
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christine Khoo
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephen Lade
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | - Edward M Pina
- Pina Cosmetic Surgery, Dpt Surgery HCA Houston Healthcare Southeast, Houston, TX, USA
| | - Daniel C Mills
- Aesthetic Plastic Surgical Institute, Laguna Beach, CA, USA
| | | | | | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Beth A Sieling
- Department of Surgery, St. Mary's Hospital, Trinity Health of New England, Waterbury, CT, USA
| | - Joseph M O'Donoghue
- Department of Plastic Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Chris M Bacon
- Department of Cellular Pathology, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Neill Patani
- Department of Breast Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Despina Televantou
- Department of Cellular Pathology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Laura Johnson
- Department of Surgery, Barts Health NHS Trust, London, UK
| | - Fiona MacNeill
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew C Wotherspoon
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Swaminathan P Iyer
- Department of Myeloma and Lymphoma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luis E Malpica
- Department of Myeloma and Lymphoma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jie Xu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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15
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Flerlage JE, Hiniker SM, Armenian S, Benya EC, Bobbey AJ, Chang V, Cooper S, Coulter DW, Cuglievan B, Hoppe BS, Isenalumhe L, Kelly K, Kersun L, Lamble AJ, Larrier NA, Magee J, Oduro K, Pacheco M, Price AP, Roberts KB, Smith CM, Sohani AR, Trovillion EM, Walling E, Xavier AC, Burns JL, Campbell M. Pediatric Hodgkin Lymphoma, Version 3.2021. J Natl Compr Canc Netw 2021; 19:733-754. [PMID: 34214968 DOI: 10.6004/jnccn.2021.0027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hodgkin lymphoma (HL) is a highly curable form of cancer, and current treatment regimens are focused on improving treatment efficacy while decreasing the risk of late effects of treatment. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for pediatric HL provide recommendations on the workup, diagnostic evaluation, and treatment of classic HL, including principles of pathology, imaging, staging, systemic therapy, and radiation therapy. This portion of the NCCN Guidelines focuses on the management of pediatric classic HL in the upfront and relapsed/refractory settings.
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Affiliation(s)
- Jamie E Flerlage
- 1St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Ellen C Benya
- 4Ann & Robert H. Lurie Children's Hospital of Chicago/Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Adam J Bobbey
- 5The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Stacy Cooper
- 7The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Kara Kelly
- 12Roswell Park Comprehensive Cancer Center
| | - Leslie Kersun
- 13Children's Hospital of Philadelphia/Abramson Cancer Center at the University of Pennsylvania
| | - Adam J Lamble
- 14Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Jeffrey Magee
- 16Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Kwadwo Oduro
- 17Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | | | | | | | - Ana C Xavier
- 25O'Neal Comprehensive Cancer Center at UAB; and
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16
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Fitzpatrick MJ, Sayed S, Moloo Z, Kayembe MKA, Roberts DJ, Pham TA, Xi L, Raffeld M, Louissaint A, Sohani AR. Clinicopathologic Features of Peripheral T-Cell Lymphoma in Sub-Saharan Africa. Am J Clin Pathol 2021; 156:42-55. [PMID: 33527979 DOI: 10.1093/ajcp/aqaa201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/28/2022] Open
Abstract
OBJECTIVES Peripheral T-cell lymphomas (PTCLs) are heterogeneous, clinically aggressive, and rare. Subtype distribution varies by geographic location; however, data from sub-Saharan Africa (SSA) are lacking. We sought to elucidate clinicopathologic features of PTCL in SSA. METHODS We reviewed PTCL consultation cases from three SSA countries. PTCL subtype was determined per 2017 World Health Organization classification. Cases with sufficient material were evaluated by polymerase chain reaction for human T-cell leukemia virus type 1 (HTLV-1) and T-cell receptor γ (TCRG) rearrangement. RESULTS Among 32 cases, median age was 45 years and male-to-female ratio was 1.7. Thirty (94%) of 32 cases required additional workup for subclassification. PTCL, not otherwise specified (PTCL-NOS) was the most common subtype (13/32, 41%), followed by PTCL with T-follicular helper phenotype (6/32, 19%) and systemic anaplastic large cell lymphoma (6/32, 19%). Four (16%) of 25 cases were Epstein-Barr virus positive (EBV+) (2/2 extranodal natural killer/T-cell lymphoma, 1/13 PTCL-NOS, and 1/4 angioimmunoblastic T-cell lymphoma with EBV+ immunoblasts). Two (15%) of 13 patients with PTCL-NOS were human immunodeficiency virus positive. No cases with evaluable DNA (0/15) were HTLV-1 positive, and 9 of 10 showed clonal TCRG rearrangements. CONCLUSIONS In comparison to Western studies, PTCLs from SSA show similar subtype distribution and male predominance but a younger age at diagnosis. Appropriate diagnosis of PTCL requires extensive ancillary testing not readily available in low-income countries, including much of SSA.
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Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shahin Sayed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Zahir Moloo
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thu-Anh Pham
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Liqiang Xi
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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17
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Harris CK, Shepherd DJ, Bland DK, Anim W, Sohani AR, Duncan LM, Nazarian RM. The diagonal technique for alopecia biopsies. J Am Acad Dermatol 2021; 86:1354-1356. [PMID: 33989696 DOI: 10.1016/j.jaad.2021.04.100] [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: 02/23/2021] [Revised: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Cynthia K Harris
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Daniel J Shepherd
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Denise K Bland
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - William Anim
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aliyah R Sohani
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lyn M Duncan
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rosalynn M Nazarian
- Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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18
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Crotty R, Hu K, Stevenson K, Pontius MY, Sohani AR, Ryan RJH, Rueckert E, Brauer HA, Hudson B, Berlin AM, Rodenbaugh M, Licon A, Haimes J, Iafrate AJ, Nardi V, Louissaint A. Simultaneous Identification of Cell of Origin, Translocations, and Hotspot Mutations in Diffuse Large B-Cell Lymphoma Using a Single RNA-Sequencing Assay. Am J Clin Pathol 2021; 155:748-754. [PMID: 33258912 DOI: 10.1093/ajcp/aqaa185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma with a heterogenous genetic landscape that can require multiple assays to characterize. We reviewed a 1-step RNA-based assay to determine cell of origin (COO), detect translocations, and identify mutations and to assess the role of the assay in diagnosis. METHODS Using a single custom Archer FusionPlex Lymphoma panel, we performed anchored multiplex polymerase chain reaction-based RNA sequencing on 41 cases of de novo DLBCL. Each case was subclassified by COO, and gene fusions and hotspot mutations were identified. The findings were then compared with COO classification by the Hans immunohistochemical algorithm and NanoString technology, cytogenetics, and fluorescence in situ hybridization results. RESULTS Concordant COO classification by the FusionPlex panel and NanoString was observed in 35 of 41 cases (85.3%), with NanoString and Hans concordant in 33 of 41 cases (80.5%) and FusionPlex and Hans concordant in 33 of 41 cases (80.5%). The FusionPlex assay also detected 6 of 11 BCL6 translocations (4 cryptic), 2 of 3 BCL2 translocations, and 2 of 4 MYC translocations. Mutations were detected in lymphoma-related genes in 24 of 41 cases. CONCLUSION This FusionPlex assay offers a single method for COO classification, mutation detection, and identification of important translocations in DLBCL. Although not replacing traditional testing, it could offer useful data when limited tissue is available.
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Affiliation(s)
- Rory Crotty
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Krista Hu
- Department of Pathology, Massachusetts General Hospital, Boston
| | | | | | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Russell J H Ryan
- Department of Pathology, University of Michigan Medical School, Ann Arbor
| | | | | | | | | | | | | | | | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Boston
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19
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Affiliation(s)
- Richelle C Charles
- From the Departments of Medicine (R.C.C., A.M.N.), Radiology (M.S.), Pediatrics (A.M.N.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.C.C., A.M.N.), Radiology (M.S.), Pediatrics (A.M.N.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Madeleine Sertic
- From the Departments of Medicine (R.C.C., A.M.N.), Radiology (M.S.), Pediatrics (A.M.N.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.C.C., A.M.N.), Radiology (M.S.), Pediatrics (A.M.N.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Anne M Neilan
- From the Departments of Medicine (R.C.C., A.M.N.), Radiology (M.S.), Pediatrics (A.M.N.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.C.C., A.M.N.), Radiology (M.S.), Pediatrics (A.M.N.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Aliyah R Sohani
- From the Departments of Medicine (R.C.C., A.M.N.), Radiology (M.S.), Pediatrics (A.M.N.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Medicine (R.C.C., A.M.N.), Radiology (M.S.), Pediatrics (A.M.N.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
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20
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Ma MCJ, Tadros S, Bouska A, Heavican T, Yang H, Deng Q, Moore D, Akhter A, Hartert K, Jain N, Showell J, Ghosh S, Street L, Davidson M, Carey C, Tobin J, Perumal D, Vose JM, Lunning MA, Sohani AR, Chen BJ, Buckley S, Nastoupil LJ, Davis RE, Westin JR, Fowler NH, Parekh S, Gandhi M, Neelapu S, Stewart D, Bhalla K, Iqbal J, Greiner T, Rodig SJ, Mansoor A, Green MR. Subtype-specific and co-occurring genetic alterations in B-cell non-Hodgkin lymphoma. Haematologica 2021; 107:690-701. [PMID: 33792219 PMCID: PMC8883549 DOI: 10.3324/haematol.2020.274258] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 11/09/2022] Open
Abstract
B-cell non-Hodgkin's lymphoma (B-NHL) encompasses multiple clinically and phenotypically distinct subtypes of malignancy with unique molecular etiologies. Common subtypes of B-NHL such as diffuse large B-cell lymphoma (DLBCL) have been comprehensively interrogated at the genomic level. But rarer subtypes such as mantle cell lymphoma (MCL) remain sparsely characterized. Furthermore, multiple B-NHL subtypes have thus far not been comprehensively compared using the same methodology to identify conserved or subtype-specific patterns of genomic alterations. Here, we employed a large targeted hybrid-capture sequencing approach encompassing 380 genes to interrogate the genomic landscapes of 685 B-NHL tumors at high depth; including DLBCL, MCL, follicular lymphoma (FL), and Burkitt lymphoma (BL). We identified conserved hallmarks of B-NHL that were deregulated in the majority of tumor from each subtype, including the frequent genetic deregulation of the ubiquitin proteasome system (UPS). In addition, we identified subtype-specific patterns of genetic alterations, including clusters of co-occurring mutations and DNA copy number alterations. The cumulative burden of mutations within a single cluster were more discriminatory of B-NHL subtypes than individual mutations, implicating likely patterns of genetic cooperation that contribute to disease etiology. We therefore provide the first cross-sectional analysis of mutations and DNA copy number alterations across major B-NHL subtypes and a framework of co-occurring genetic alterations that deregulate genetic hallmarks and likely cooperate in lymphomagenesis.
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Affiliation(s)
- Man Chun John Ma
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Saber Tadros
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alyssa Bouska
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Tayla Heavican
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Haopeng Yang
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Qing Deng
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dalia Moore
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE
| | - Ariz Akhter
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB
| | - Keenan Hartert
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE
| | - Neeraj Jain
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jordan Showell
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sreejoyee Ghosh
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lesley Street
- Section of Hematology, Department of Medicine, University of Calgary, Calgary, AB
| | - Marta Davidson
- Section of Hematology, Department of Medicine, University of Calgary, Calgary, AB
| | - Christopher Carey
- Northern Institute for Research, Newcastle University, Newcastle upon Tyne, England
| | - Joshua Tobin
- Diamantina Institute, University of Queensland, QLD
| | - Deepak Perumal
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julie M Vose
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Matthew A Lunning
- Department of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Benjamin J Chen
- Department of Pathology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA
| | - Shannon Buckley
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE
| | - Loretta J Nastoupil
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R Eric Davis
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason R Westin
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nathan H Fowler
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Samir Parekh
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Maher Gandhi
- Diamantina Institute, University of Queensland, QLD
| | - Sattva Neelapu
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Douglas Stewart
- Section of Hematology, Department of Medicine, University of Calgary, Calgary, AB
| | - Kapil Bhalla
- Department of Pathology, Brigham and Womens Hospital, Boston, MA
| | - Javeed Iqbal
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Timothy Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Scott J Rodig
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Adnan Mansoor
- Section of Hematology, Department of Medicine, University of Calgary, Calgary, AB
| | - Michael R Green
- Department of Lymphoma and Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Center for Cancer Epigenetics, University of Texas MD Anderson Cancer Center, Houston, TX.
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21
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Zhang ML, Maglantay RJ, Cunningham VL, Goodwin MT, Feeney MW, Keefe J, Tambouret RH, Sohani AR. Improving Malignancy Detection Rates in Body Fluids Submitted to the Hematology Laboratory for Nucleated Cell Count and Differential: A Quality Improvement Study. Arch Pathol Lab Med 2021; 145:201-207. [PMID: 33501495 DOI: 10.5858/arpa.2019-0617-oa] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Body fluid specimens are regularly submitted to the hematology laboratory for cell count and differential. Unless there is high clinical suspicion for malignancy, most cases lack concurrent cytology review and may not benefit from more focused examination for malignancy. OBJECTIVE.— To compare rates of malignancy detection before and after fluid-focused training for hematology technologists as part of a quality improvement initiative. DESIGN.— During an 8-week pretraining period, body fluids submitted to the cytology laboratory were correlated with concurrent hematology specimens. After slide review and training sessions for the hematology technologists, the same data were collected for a 4-week period. Discrepant cases were reviewed by hematology laboratory supervisors and pathologists. RESULTS.— We collected 465 pretraining and 249 posttraining body fluids with concurrent cytology and hematology evaluation. In the pretraining cohort, 48 cases (10.3%) were diagnosed as malignant by cytology; of those, 33 were detected by hematology. In the posttraining cohort, 30 cases (12.0%) were diagnosed as malignant by cytology of which 27 were detected by hematology. Of the 18 discrepant cases (all carcinomas), hematology slide review showed definite features of malignancy in 15 and no tumor cells in 3. The malignancy detection rate by the hematology laboratory significantly improved after training (68.8% versus 90.0%, P = .01). CONCLUSIONS.— We demonstrate the comparatively lower malignancy detection rate for body fluid specimens processed in our hematology laboratory, particularly for carcinomas. Hematology technologist education/training improved the malignancy detection rate, an important quality improvement given the large proportion of body fluids undergoing hematology evaluation without concurrent cytology reviews.
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Affiliation(s)
- M Lisa Zhang
- From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Zhang, Maglantay)
| | - Remegio J Maglantay
- From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Zhang, Maglantay).,the Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Alberta, Canada (Maglantay)
| | - Vickie L Cunningham
- the Department of Pathology, Massachusetts General Hospital, Boston (Cunningham, Goodwin, Feeney, Keefe)
| | - Michele T Goodwin
- the Department of Pathology, Massachusetts General Hospital, Boston (Cunningham, Goodwin, Feeney, Keefe)
| | - Margaret W Feeney
- the Department of Pathology, Massachusetts General Hospital, Boston (Cunningham, Goodwin, Feeney, Keefe)
| | - Joan Keefe
- the Department of Pathology, Massachusetts General Hospital, Boston (Cunningham, Goodwin, Feeney, Keefe)
| | - Rosemary H Tambouret
- the Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston (Tambouret, Sohani)
| | - Aliyah R Sohani
- the Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston (Tambouret, Sohani)
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22
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Sohani AR, Maurer MJ, Giri S, Pitcher B, Chadburn A, Said JW, Bartlett NL, Czuczman MS, Martin P, Rosenbaum CA, Jung SH, Leonard JP, Cheson BD, Hsi ED. Biomarkers for Risk Stratification in Patients With Previously Untreated Follicular Lymphoma Receiving Anti-CD20-based Biological Therapy. Am J Surg Pathol 2021; 45:384-393. [PMID: 33136585 PMCID: PMC7878306 DOI: 10.1097/pas.0000000000001609] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 01/08/2023]
Abstract
Follicular lymphoma (FL) is an indolent B-cell neoplasm of germinal center origin. Standard treatment regimens consist of anti-CD20 therapy with or without chemotherapy. While high response rates to initial therapy are common, patients ultimately relapse or have progressive disease. Clinical risk factors such as the Follicular Lymphoma International Prognostic Index (FLIPI) have been identified, but there is a need for prognostic and predictive biomarkers. We studied markers of lymphoma cells and tumor microenvironment by immunohistochemistry in tissue samples from patients enrolled in 1 of 4 phase 2 trials of anti-CD20-based biological therapy for previously untreated grades 1 to 2 or 3A FL. Results were correlated with progression-free survival (PFS) and PFS status at 24 months. The 4 trials included 238 patients (51.1% male, median age: 55 y) with stage III, IV, or bulky stage II disease. By FLIPI, 24.6% had low-risk, 56.8% had intermediate-risk, and 18.6% had high-risk disease. The outcome differed significantly for patients treated with lenalidomide and rituximab (CALGB 50803) compared with the other 3 trials (median: PFS not reached vs. 3.0 y, hazard ratio=3.47, 95% confidence interval: 2.11-5.72); therefore, data were stratified by clinical trial (CALGB 50803 vs. all others) and adjusted for FLIPI risk group. Among 154 patients with available tissue, interfollicular BCL6 positivity, interfollicular CD10 positivity, and elevated Ki67 proliferation index ≥30% within neoplastic follicles were each associated with inferior PFS and a high risk of the early event by PFS status at 24 months. We identify promising biomarkers for FL risk stratification that warrant further validation in phase 3 trials.
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Affiliation(s)
- Aliyah R. Sohani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Sharmila Giri
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Brandelyn Pitcher
- The University of Texas MD Anderson Cancer Center, Houston, TX
- Alliance Statistics and Data Center, Duke University, Durham, NC
| | | | | | | | | | | | | | - Sin-Ho Jung
- Alliance Statistics and Data Center, Duke University, Durham, NC
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23
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Podberezin M, Sohani AR. CD30-positive lymphomatous (nonleukemic) variant of adult T-cell leukemia/lymphoma, HTLV-1 associated. Clin Case Rep 2020; 8:2395-2397. [PMID: 33363748 PMCID: PMC7752401 DOI: 10.1002/ccr3.3092] [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: 04/10/2020] [Revised: 06/12/2020] [Accepted: 06/25/2020] [Indexed: 11/07/2022] Open
Abstract
Nonleukemic variant of HTLV-1-associated adult T-cell leukemia lymphoma (ATLL) is a rare variant, and herein, we describe a case with strong and diffuse positivity of neoplastic cells for CD30. Even though ATLL is aggressive entity with poor prognosis, in our case, there was very good clinical response achieved with brentuximab-containing regimen. Therefore, HTLV-1-associated ATLL can be included in the differential diagnostic approach of CD30-positive lymphoproliferative disorders.
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Affiliation(s)
- Mark Podberezin
- Department of Anatomic PathologyLahey Hospital and Medical CenterBurlingtonMAUSA
| | - Aliyah R. Sohani
- Department of PathologyMassachusetts General HospitalBostonMAUSA
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24
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Machacek ME, Gogakos T, Fletcher MC, Lunderville KA, Swoboda KJ, Sohani AR. Unusual inclusions in cerebrospinal fluid macrophages of spinal muscular atrophy patients treated with nusinersen. Int J Lab Hematol 2020; 43:e104-e106. [PMID: 33201586 DOI: 10.1111/ijlh.13392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Miranda E Machacek
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Tasos Gogakos
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Kathryn J Swoboda
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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25
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Sadigh S, Massoth LR, Christensen BB, Stefely JA, Keefe J, Sohani AR. Peripheral blood morphologic findings in patients with COVID-19. Int J Lab Hematol 2020; 42:e248-e251. [PMID: 32730694 DOI: 10.1111/ijlh.13300] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/15/2020] [Accepted: 07/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sam Sadigh
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucas R Massoth
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bianca B Christensen
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan A Stefely
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joan Keefe
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aliyah R Sohani
- Pathology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
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26
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Abstract
PURPOSE Diffuse large B-cell lymphoma (DLBCL) is the most commonly diagnosed
non-Hodgkin lymphoma in adults in Kenya. Cell of origin (COO) and double
expression of MYC and BCL2 are two important prognostic factors for DLBCL. A
small subset (5% to 10%) of DLBCL cases show positivity for CD5 and are
associated with poor prognosis, whereas CD30 antigen, seen in up to 10% of
cases, may be a useful target for therapy. We sought to determine the
prevalence of MYC/BCL2 double expression, COO, and proportion of
Epstein-Barr virus positivity among patients with DLBCL diagnosed at a
tertiary referral laboratory in Kenya. PATIENTS AND METHODS All cases of DLBCL diagnosed from 2012 through 2015 in our pathology
department were analyzed. Tumor tissue microarray sections were stained with
CD20, CD3, CD5, CD30, BCL2, BCL6, CD10, MUM1, MYC, and Ki67, classified for
COO on the basis of the Hans algorithm, and subjected to Epstein-Barr
virus-encoded small RNAs in situ hybridization. RESULTS Among 165 DLBCL cases, the median age was 50 years, and there was no sex
predilection. Only 18 (10.9%) cases showed double expression for MYC and
BCL2. Germinal center B (GCB)-cell type DLBCL accounted for 67 cases (40.6%)
and 97 cases (59.4%) were classified as non-GCB. The mean Ki67 proliferation
index was significantly higher in the double-expressing (45%) and non-GCB
groups (36%) compared with the non–double-expressing group (29%) and
GCB group (26%). Sixteen cases (9.7%) were Epstein-Barr virus-encoded small
RNAs positive, 12 (75%) of which were non-GCB. CONCLUSION DLBCL in Kenya is seen in much younger patients with the poor prognostic
non–GCB-type accounting for 59.4% of cases. MYC and BCL2 double
expression was seen in fewer tumors than reported in the literature and in
significantly older patients.
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Affiliation(s)
| | | | | | - Aliyah R Sohani
- Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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27
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Affiliation(s)
- Elaine S Jaffe
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Andrew L Feldman
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Philippe Gaulard
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Roberto N Miranda
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Aliyah R Sohani
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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28
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Abstract
Lymphoma is the most common malignancy involving the mediastinum but can be challenging to diagnose on small biopsy specimens. This review provides a pattern-based approach to help triage small tissue samples for the diagnosis of mediastinal lymphoid proliferations, with focus on the main primary mediastinal lymphomas. The use of ancillary studies is highlighted, along with considerations to avoid misdiagnosis and scenarios to request additional tissue.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, MA.
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA
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29
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Jaffe ES, Ashar BS, Clemens MW, Feldman AL, Gaulard P, Miranda RN, Sohani AR, Stenzel T, Yoon SW. Best Practices Guideline for the Pathologic Diagnosis of Breast Implant-Associated Anaplastic Large-Cell Lymphoma. J Clin Oncol 2020; 38:1102-1111. [PMID: 32045544 PMCID: PMC7106983 DOI: 10.1200/jco.19.02778] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To provide guidelines for the accurate pathologic diagnosis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), the preoperative evaluation of the patient with suspected BIA-ALCL, and the pathologic evaluation of the capsulectomy specimen. METHODS To better inform patients and healthcare providers about BIA-ALCL, we convened to review diagnostic procedures used in the evaluation of patients with suspected BIA-ALCL. We focused on the processing of the seroma fluid/effusion surrounding the implant, the handling of capsulectomy specimens following removal of implant(s), and the preoperative evaluation of the patient with suspected BIA-ALCL. Recommendations were based on the published literature and our experience to optimize procedures to obtain an accurate diagnosis and assess for tumor invasion and the extent of the disease. RECOMMENDATIONS Early diagnosis of BIA-ALCL is important as the disease can progress and deaths have been reported. Because the most common presentation of BIA-ALCL is swelling of the breast with fluid collection, an accurate diagnosis requires cytologic evaluation of the effusion fluid surrounding the affected implant. The first priority is cytocentrifugation and filtration of fresh, unfixed effusion fluid to produce air-dried smears that are stained with Wright-Giemsa or other Romanowsky-type stains. Preparation of a cell block is desirable to allow for hematoxylin and eosin staining and immunohistochemical analysis of formalin-fixed, paraffin-embedded histologic sections. Cell block sections can be used for polymerase chain reaction-based investigation of T-cell receptor gene rearrangement to detect clonality. Fixation and mapping of the capsulectomy specimen to select multiple representative sections are advised to assess for microscopic tumor involvement and capsular invasion. It is appropriate to assess lymph node involvement by excisional biopsy material rather than fine needle aspiration, due to propensity for focal involvement.
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Affiliation(s)
- Elaine S. Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Binita S. Ashar
- Office of Surgical and Infection Control Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD
| | - Mark W. Clemens
- Department of Plastic Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Andrew L. Feldman
- Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Philippe Gaulard
- Department of Pathology, Hôpital Henri Mondor, Institut National de la Santé et de la Recherche Médicale U955, Université Paris-Est, Créteil, France
| | - Roberto N. Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aliyah R. Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Timothy Stenzel
- Office of In Vitro Diagnostics and Radiological Health, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
| | - Sung W. Yoon
- Office of Surgical and Infection Control Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD
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30
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Ahn JS, Al-Habib A, Vos JA, Sohani AR, Barboza-Quintana O, Flores JP, Wen S, Rosado FG. Plasmablastic Lymphomas: Characterization of Tumor Microenvironment Using CD163 and PD-1 Immunohistochemistry. Ann Clin Lab Sci 2020; 50:213-218. [PMID: 32366559 PMCID: PMC7439522] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aims to characterize the tumor microenvironment of plasmablastic lymphoma (PBL) in regard to the quantities of CD163(+) tumor associated macrophages (TAM) and PD1(+) tumor infiltrating lymphocytes (TIL). This article also reviews the existing knowledge of the role of PD-1/PD-L1 pathway in the tumor microenvironment of hematopoietic neoplasms, discusses potential mechanisms to explain our findings, and outlines areas for future studies. We performed CD163 and PD1 immunohistochemical studies in 11 cases classified as plasmablastic lymphoma, and recorded the percentages of positive TAMs and TILs. Based on previous studies, cut off values of ≥30% and >5% were used to classify the cases into high TAMs and TILs, respectively. We determined that the majority of cases (8 of 11, or 73%) had high percentage of TAMs, while only a minority had high percentage of TILs (3 of 11, or 27%). Our data shows a trend towards a negative correlation between TAMs and TILs (p=0.08), and a predominance of the pattern TAMhigh/TILlow (7 of 11, or 63%) compared to other patterns. The microenvironment of plasma-blastic lymphoma tends to show high percentage of TAMs (≥30%) combined with low percentage of TILs (≤5%). Additional studies are needed to determine the clinical significance of TILs and the influence of EBV and HIV infections on numbers of TILs in PBL. As high microenvironment TAMs have been associated with high microenvironment PD-L1 in other hematopoietic malignancies, our data supports the need for future studies on the expression of PD-L1 in PBL.
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Affiliation(s)
- Janice S Ahn
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - Ali Al-Habib
- Department of Pathology and Laboratory Medicine, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Jeffrey A Vos
- Department of Pathology, Anatomy and Laboratory Medicine, West Virginia University, Morgantown, WV, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Juan P Flores
- Department of Pathology, University Hospital Dr. Jose Eleuterio Gonzalez, Monterrey, Mexico
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, WV, USA
| | - Flavia G Rosado
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
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Murphy WS, Yeh JE, Nazarian RM, Sohani AR, Kvedar J, Kroshinsky D. A Case of Fever and Erythema Nodosum-Like Lesions Leading to a New Diagnosis of Gamma-Delta T-Cell Lymphoma Complicated by Hemophagocytic Lymphohistiocytosis. Dermatopathology (Basel) 2020; 6:266-270. [PMID: 32232033 PMCID: PMC7098367 DOI: 10.1159/000505471] [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: 10/15/2019] [Accepted: 12/16/2019] [Indexed: 11/19/2022] Open
Abstract
A 69-year-old Vietnamese female presented with fever and new-onset tender subcutaneous nodules on her trunk and lower extremities initially thought to be clinically consistent with erythema nodosum. A biopsy showed an atypical, predominantly lobular lymphocytic panniculitis with admixed neutrophils, karyorrhectic debris, and histiocytes with subcutaneous fat necrosis. Immunohistochemistry was consistent with gamma-delta T-cell lymphoma. The patient was initiated on a chemotherapy regimen of cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone (CHOEP) with partial remission, and is currently undergoing evaluation for bone marrow transplant. This case highlights the ability of cutaneous gamma-delta T-cell lymphoma to mimic more common cutaneous conditions such as erythema nodosum, and stresses the importance of a broad differential for new presentation of tender subcutaneous nodules with concomitant systemic symptoms.
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Affiliation(s)
- William S Murphy
- Harvard Medical School, Harvard Business School, Boston, Massachusetts, USA
| | - Jennifer E Yeh
- Harvard Combined Dermatology Residency Program, Boston, Massachusetts, USA
| | - Rosalynn M Nazarian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph Kvedar
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Zhang ML, Guo AX, Kadauke S, Dighe AS, Baron JM, Sohani AR. Machine Learning Models Improve the Diagnostic Yield of Peripheral Blood Flow Cytometry. Am J Clin Pathol 2020; 153:235-242. [PMID: 31603184 DOI: 10.1093/ajcp/aqz150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/02/2023] Open
Abstract
OBJECTIVES Peripheral blood flow cytometry (PBFC) is useful for evaluating circulating hematologic malignancies (HM) but has limited diagnostic value for screening. We used machine learning to evaluate whether clinical history and CBC/differential parameters could improve PBFC utilization. METHODS PBFC cases with concurrent/recent CBC/differential were split into training (n = 626) and test (n = 159) cohorts. We classified PBFC results with abnormal blast/lymphoid populations as positive and used two models to predict results. RESULTS Positive PBFC results were seen in 58% and 21% of training cases with and without prior HM (P < .001). % neutrophils, absolute lymphocyte count, and % blasts/other cells differed significantly between positive and negative PBFC groups (areas under the curve [AUC] > 0.7). Among test cases, a decision tree model achieved 98% sensitivity and 65% specificity (AUC = 0.906). A logistic regression model achieved 100% sensitivity and 54% specificity (AUC = 0.919). CONCLUSIONS We outline machine learning-based triaging strategies to decrease unnecessary utilization of PBFC by 35% to 40%.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Alan X Guo
- Independent Researcher, Boston, MA, Philadelphia
| | - Stephan Kadauke
- Department of Pathology, University of Pennsylvania, Philadelphia
| | - Anand S Dighe
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Jason M Baron
- Department of Pathology, Massachusetts General Hospital, Boston
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston
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Affiliation(s)
- Brian K Alverson
- From the Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI (B.K.A.); and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Aoife Kilcoyne
- From the Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI (B.K.A.); and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Alison M Friedmann
- From the Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI (B.K.A.); and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Aliyah R Sohani
- From the Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI (B.K.A.); and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (A.K.), Pediatrics (A.M.F.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
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Saleh M, Naik G, Mwirigi A, Shaikh AJ, Sayani S, Ghesani M, Asaria S, Sohani AR, Sayed S, Moloo Z, Budhwani KI, Talib Z. Bridging the Gap in Training and Clinical Practice in Sub-Saharan Africa. Curr Breast Cancer Rep 2019. [DOI: 10.1007/s12609-019-00322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Im H, Pathania D, McFarland PJ, Sohani AR, Degani I, Allen M, Coble B, Kilcoyne A, Hong S, Rohrer L, Abramson JS, Dryden-Peterson S, Fexon L, Pivovarov M, Chabner B, Lee H, Castro CM, Weissleder R. Design and clinical validation of a point-of-care device for the diagnosis of lymphoma via contrast-enhanced microholography and machine learning. Nat Biomed Eng 2018; 2:666-674. [PMID: 30555750 PMCID: PMC6291220 DOI: 10.1038/s41551-018-0265-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/15/2018] [Indexed: 11/21/2022]
Abstract
The identification of patients with aggressive cancer who require immediate therapy is a health challenge in low-income and middle-income countries. Limited pathology resources, high healthcare costs and large-case loads call for the development of advanced standalone diagnostics. Here, we report and validate an automated, low-cost point-of-care device for the molecular diagnosis of aggressive lymphomas. The device uses contrast-enhanced microholography and a deep-learning algorithm to directly analyse percutaneously obtained fine-needle aspirates. We show the feasibility and high accuracy of the device in cells, as well as the prospective validation of the results in 40 patients clinically referred for image-guided aspiration of nodal mass lesions suspicious for lymphoma. Automated analysis of human samples with the portable device should allow for the accurate classification of patients with benign and malignant adenopathy.
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Affiliation(s)
- Hyungsoon Im
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Divya Pathania
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Philip J McFarland
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Ismail Degani
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Matthew Allen
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin Coble
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Engineering and Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aoife Kilcoyne
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Seonki Hong
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Lucas Rohrer
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Scott Dryden-Peterson
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lioubov Fexon
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Misha Pivovarov
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Bruce Chabner
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Cesar M Castro
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA.
- Massachusetts General Hospital Cancer Center, Boston, MA, USA.
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA.
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA.
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Milligan MG, Bigger E, Abramson JS, Sohani AR, Zola M, Kayembe MK, Medhin H, Suneja G, Lockman S, Chabner BA, Dryden-Peterson SL. Impact of HIV Infection on the Clinical Presentation and Survival of Non-Hodgkin Lymphoma: A Prospective Observational Study From Botswana. J Glob Oncol 2018; 4:1-11. [PMID: 30241264 PMCID: PMC6223476 DOI: 10.1200/jgo.17.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Botswana has a high prevalence of HIV infection. Currently, there are few data regarding the sociodemographic factors, clinical characteristics, and outcomes of non-Hodgkin lymphoma (NHL)-an AIDS-defining cancer-in the country. PATIENTS AND METHODS This study used a prospective cancer registry to identify patients with a new diagnosis of NHL reporting for specialty cancer care at three hospitals in Botswana between October 2010 and August 2016. Treatment patterns and clinical outcomes were analyzed. RESULTS One hundred four patients with a new diagnosis of NHL were enrolled in this study, 72% of whom had HIV infection. Compared with patients not infected with HIV, patients infected with HIV were younger (median age, 53.9 v 39.1 years; P = .001) and more likely to present with an aggressive subtype of NHL (65.5% v 84.0%; P = .008). All patients infected with HIV received combined antiretroviral therapy throughout the course of the study, and similar chemotherapeutic regimens were recommended for all patients, regardless of subtype or HIV status (six to eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone; or cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab). There was no difference in 1-year mortality among patients not infected with HIV and patients infected with HIV (unadjusted analysis, 52.9% v 37.1%; hazard ratio [HR], 0.73; P = .33; adjusted analysis, HR, 0.57; P = .14). However, when compared with a cohort of patients in the United States matched by subtype, stage, age, sex, and race, patients in Botswana fared worse (1-year mortality, 22.8% v 46.3%; HR, 1.89; P = .001). CONCLUSION Among patients with NHL reporting for specialty cancer care in Botswana, there is no association between HIV status and 1-year survival.
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Affiliation(s)
- Michael G. Milligan
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Elizabeth Bigger
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Jeremy S. Abramson
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Aliyah R. Sohani
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Musimar Zola
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Mukendi K.A. Kayembe
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Heluf Medhin
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Gita Suneja
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Shahin Lockman
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Bruce A. Chabner
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
| | - Scott L. Dryden-Peterson
- Michael G. Milligan, Jeremy S. Abramson,
Aliyah R. Sohani, Shahin Lockman, Bruce A.
Chabner, and Scott L. Dryden-Peterson, Harvard Medical
School; Elizabeth Bigger, Jeremy S. Abramson, and
Aliyah R. Sohani, Massachusetts General Hospital; Shahin
Lockman and Scott L. Dryden-Peterson, Brigham and
Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston,
MA; Michael G. Milligan, Elizabeth Bigger,
Shahin Lockman, Bruce A. Chabner, and Scott
L. Dryden-Peterson, Botswana Harvard AIDS Institute Partnership;
Musimar Zola, Princess Marina Hospital; Mukendi K.A. Kayembe and
Heluf Medhin, Botswana Ministry of Health, Gaborone, Botswana;
and Gita Suneja, Duke University, Durham, NC
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Herrera AF, Rodig SJ, Song JY, Kim Y, Griffin GK, Yang D, Nikolaenko L, Mei M, Bedell V, Dal Cin P, Pak C, Alyea EP, Budde LE, Chen R, Chen YB, Chan WC, Cutler CS, Ho VT, Koreth J, Krishnan A, Murata-Collins JL, Nikiforow S, Palmer J, Pihan GA, Pillai R, Popplewell L, Rosen ST, Siddiqi T, Sohani AR, Zain J, Kwak LW, Weisenburger DD, Weinstock DM, Soiffer RJ, Antin JH, Forman SJ, Nademanee AP, Armand P. Outcomes after Allogeneic Stem Cell Transplantation in Patients with Double-Hit and Double-Expressor Lymphoma. Biol Blood Marrow Transplant 2017; 24:514-520. [PMID: 29196080 DOI: 10.1016/j.bbmt.2017.11.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/18/2017] [Indexed: 01/22/2023]
Abstract
Double-hit lymphomas (DHLs) and double-expressor lymphomas (DELs) are associated with resistance to frontline and salvage immunochemotherapy, as well as autologous stem cell transplantation (SCT). We hypothesized that allogeneic SCT (alloSCT) could overcome the chemoresistance associated with DEL/DHL. We retrospectively studied the impact of DEL/DHL status in a multicenter cohort of patients who underwent alloSCT for relapsed/refractory (rel/ref) aggressive B cell non-Hodgkin lymphoma (B-NHL). Seventy-eight patients transplanted at 3 centers in whom tumor tissue was available for immunohistochemistry and fluorescence in situ hybridization were enrolled; 47% had DEL and 13% had DHL. There were no significant differences in 4-year progression-free (PFS) or overall survival (OS) between patients with DEL compared with patients without DEL (PFS 30% versus 39%, P = .24; OS 31% versus 49%, P = .17) or between patients with DHL compared with patients without DHL (PFS 40% versus 34%, P = .62; OS 50% versus 38%, P = .46). The lack of association between DEL or DHL and outcome was confirmed in multivariable models, although inadequate sample size may have limited our ability to detect significant differences. In our cohort alloSCT produced durable remissions in patients with rel/ref aggressive B-NHL irrespective of DEL and DHL status, justifying its consideration in the treatment of patients with rel/ref DEL/DHL.
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Affiliation(s)
- Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California.
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, California
| | - Young Kim
- Department of Pathology, City of Hope, Duarte, California
| | - Gabriel K Griffin
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dongyun Yang
- Department of Information Sciences, City of Hope, Duarte, California
| | - Liana Nikolaenko
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Matthew Mei
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | | | - Paola Dal Cin
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Pak
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edwin P Alyea
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lihua E Budde
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Yi-Bin Chen
- Division of Bone Marrow Transplantation, Massachusetts General Hospital, Boston, Massachusetts
| | - Wing C Chan
- Department of Pathology, City of Hope, Duarte, California
| | - Corey S Cutler
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vincent T Ho
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - John Koreth
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amrita Krishnan
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | | | - Sarah Nikiforow
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joycelynne Palmer
- Department of Information Sciences, City of Hope, Duarte, California
| | - German A Pihan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Raju Pillai
- Department of Pathology, City of Hope, Duarte, California
| | - Leslie Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Steven T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Tanya Siddiqi
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Larry W Kwak
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | | | - David M Weinstock
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert J Soiffer
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Auayporn P Nademanee
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Philippe Armand
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts
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LaCasce AS, Flores EJ, Goldstein RH, Sohani AR. Case 25-2017. N Engl J Med 2017; 377:677-688. [PMID: 28813220 DOI: 10.1056/nejmcpc1706099] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ann S LaCasce
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.S.L.), the Departments of Radiology (E.J.F.), Medicine (R.H.G.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Medicine (A.S.L., R.H.G.), Radiology (E.J.F.), and Pathology (A.R.S.), Harvard Medical School - all in Boston
| | - Efren J Flores
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.S.L.), the Departments of Radiology (E.J.F.), Medicine (R.H.G.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Medicine (A.S.L., R.H.G.), Radiology (E.J.F.), and Pathology (A.R.S.), Harvard Medical School - all in Boston
| | - Robert H Goldstein
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.S.L.), the Departments of Radiology (E.J.F.), Medicine (R.H.G.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Medicine (A.S.L., R.H.G.), Radiology (E.J.F.), and Pathology (A.R.S.), Harvard Medical School - all in Boston
| | - Aliyah R Sohani
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.S.L.), the Departments of Radiology (E.J.F.), Medicine (R.H.G.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Medicine (A.S.L., R.H.G.), Radiology (E.J.F.), and Pathology (A.R.S.), Harvard Medical School - all in Boston
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Kerr DA, Busarla SVP, Gimbel DC, Sohani AR, Nazarian RM. mTOR, VEGF, PDGFR, and c-kit signaling pathway activation in Kaposi sarcoma. Hum Pathol 2017; 65:157-165. [PMID: 28506734 DOI: 10.1016/j.humpath.2017.05.002] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/27/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
Abstract
Kaposi sarcoma (KS) is a locally progressive, intermediate-grade vascular neoplasm with no known cure, high recurrence rates, and potential for wide dissemination. Low efficacy and high toxicity limit current therapeutic options for advanced disease. Activation of mammalian target of rapamycin (mTOR), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and c-kit signaling pathways has been implicated in KS pathogenesis and may suggest a role for targeted inhibitors. KS cases were retrospectively retrieved (N=274), most (90%) associated with human immunodeficiency virus. Tissue microarray slides were stained with human herpes virus-8, Friend leukemia integration 1 transcription factor, CD117 (c-kit), phospho-S6 (pS6), PDGF receptor-β, VEGF, and phospho-mTOR. Both intensity and extent of staining were scored. Multiplying these scores for each core yielded total staining H-scores. Human herpes virus-8 was positive in 87% and Friend leukemia integration 1 transcription factor in 95.7% of cases. Most were also VEGF+ (97.6%), pS6+ (95.7%), CD117+ (92.5%), and PDGFRB+ (87.4%). Approximately half (55.6%) were phospho-mTOR+. There was no significant difference in staining among patients with low (<500 cells/mm3) or preserved CD4 T-cell counts. Immunohistochemistry confirms upregulation of the mTOR, PDGF, VEGF, and c-kit pathways in a large cohort of KS samples. Of proteins tested, pS6, downstream of mTOR, demonstrated the highest proportion of strong positivity (67.1%). These results support the possibility of using targeted inhibitors in KS. Overexpression was independent of CD4 count, suggesting that even patients with low counts may be targeted therapy candidates.
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Affiliation(s)
- Darcy A Kerr
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114.
| | | | - Devon C Gimbel
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114.
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114.
| | - Rosalynn M Nazarian
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114.
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Affiliation(s)
- Aliyah R. Sohani
- Department of PathologyMassachusetts General Hospital and Harvard Medical SchoolBoston Massachusetts
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Weinberg OK, Sohani AR, Bhargava P, Nardi V. Diagnostic work-up of acute myeloid leukemia. Am J Hematol 2017; 92:317-321. [PMID: 28066929 DOI: 10.1002/ajh.24648] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 12/19/2022]
Abstract
Acute myeloid leukemia (AML) is characterized by a clonal expansion of undifferentiated myeloid precursors resulting in impaired hematopoiesis and bone marrow failure. In 2016, the World Health Organization (WHO) published revisions to the classification of myeloid neoplasms and acute leukemias. Similar to the 2008 classification, the updated classification incorporates clinical features, morphology, immunophenotyping, and cytogenetics, with greater emphasis on molecular genetics, to define disease entities. This brief review addresses the various components of pathologic assessment to establish a diagnosis of AML and to help risk stratify patients, with an emphasis on newer techniques used in the detection of mutations with prognostic significance, as well as assays employed in the evaluation of minimal residual disease following treatment.
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Affiliation(s)
- Olga K. Weinberg
- Department of PathologyBoston Children's HospitalBoston Massachusetts
- Department of PathologyHarvard Medical SchoolBoston Massachusetts
| | - Aliyah R. Sohani
- Department of PathologyHarvard Medical SchoolBoston Massachusetts
- Department of PathologyMassachusetts General HospitalBoston Massachusetts
| | - Parul Bhargava
- Department of PathologyHarvard Medical SchoolBoston Massachusetts
- Department of PathologyBeth Israel Deaconess Medical CenterBoston Massachusetts
| | - Valentina Nardi
- Department of PathologyHarvard Medical SchoolBoston Massachusetts
- Department of PathologyMassachusetts General HospitalBoston Massachusetts
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Bogusz AM, Kovach AE, Le LP, Feng D, Baxter RHG, Sohani AR. Diffuse large B-cell lymphoma with concurrent high MYC and BCL2 expression shows evidence of active B-cell receptor signaling by quantitative immunofluorescence. PLoS One 2017; 12:e0172364. [PMID: 28212447 PMCID: PMC5315400 DOI: 10.1371/journal.pone.0172364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/04/2017] [Indexed: 01/07/2023] Open
Abstract
B-cell receptor (BCR)-mediated signaling plays an important role in the pathogenesis of a subset of diffuse large B-cell lymphoma (DLBCL), and novel agents targeting this pathway are now in clinical use. We have previously identified a signature of active BCR signaling on formalin-fixed paraffin-embedded specimens using quantitative immunofluorescence, allowing for identification of patients who might benefit from anti-BCR therapies. We sought to characterize the clinicopathologic significance of active BCR signaling in DLBCL by correlating measures of signaling intensity with clinical features and various tumor cell characteristics. High MYC and concurrent high MYC and BCL2 double-expression was positively correlated with individual markers of active BCR signaling and cases with MYC/BCL2 double-expression showed overall greater BCR activation compared to cases lacking double-expression. Our findings suggest that the BCR signaling pathway may be more active in MYC/BCL2 double-expressor DLBCL and may represent a rational therapeutic target in this aggressive DLBCL subgroup.
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Affiliation(s)
- Agata M. Bogusz
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Alexandra E. Kovach
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Long P. Le
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Derek Feng
- Department of Statistics, Yale University, New Haven, Connecticut, United States of America
| | - Richard H. G. Baxter
- Department of Chemistry, Yale University, New Haven, Connecticut, United States of America
- Department of Molecular Biophysics & Biochemistry, Yale University, New Haven, Connecticut, United States of America
| | - Aliyah R. Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Herrera AF, Mei M, Low L, Kim HT, Griffin GK, Song JY, Merryman RW, Bedell V, Pak C, Sun H, Paris T, Stiller T, Brown JR, Budde LE, Chan WC, Chen R, Davids MS, Freedman AS, Fisher DC, Jacobsen ED, Jacobson CA, LaCasce AS, Murata-Collins J, Nademanee AP, Palmer JM, Pihan GA, Pillai R, Popplewell L, Siddiqi T, Sohani AR, Zain J, Rosen ST, Kwak LW, Weinstock DM, Forman SJ, Weisenburger DD, Kim Y, Rodig SJ, Krishnan A, Armand P. Relapsed or Refractory Double-Expressor and Double-Hit Lymphomas Have Inferior Progression-Free Survival After Autologous Stem-Cell Transplantation. J Clin Oncol 2016; 35:24-31. [PMID: 28034071 DOI: 10.1200/jco.2016.68.2740] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose Double-hit lymphomas (DHLs) and double-expressor lymphomas (DELs) are subtypes of diffuse large B-cell lymphoma (DLBCL) associated with poor outcomes after standard chemoimmunotherapy. Data are limited regarding outcomes of patients with relapsed or refractory (rel/ref) DEL or DHL who undergo autologous stem-cell transplantation (ASCT). We retrospectively studied the prognostic impact of DEL and DHL status on ASCT outcomes in patients with rel/ref DLBCL. Methods Patients with chemotherapy-sensitive rel/ref DLBCL who underwent ASCT at two institutions and in whom archival tumor material was available were enrolled. Immunohistochemistry for MYC, BCL2, and BCL6 and fluorescence in situ hybridization (FISH) for MYC were performed. In cases with MYC rearrangement or copy gain, FISH for BCL2 and BCL6 was also performed. Results A total of 117 patients were included; 44% had DEL and 10% had DHL. DEL and DHL were associated with inferior progression-free survival (PFS), and DHL was associated with poorer overall survival (OS). The 4-year PFS in patients with DEL compared with those with non-DEL was 48% versus 59% ( P = .049), and the 4-year OS was 56% versus 67% ( P = .10); 4-year PFS in patients with DHL compared with those with non-DHL was 28% versus 57% ( P = .013), and 4-year OS was 25% versus 61% ( P = .002). The few patients with concurrent DEL and DHL had a poor outcome (4-year PFS, 0%). In multivariable models, DEL and DHL were independently associated with inferior PFS, whereas DHL and partial response ( v complete response) at transplant were associated with inferior OS. Conclusion DEL and DHL are both associated with inferior outcomes after ASCT in patients with rel/ref DLBCL. Although ASCT remains a potentially curative approach, these patients, particularly those with DHL, are a high-risk subset who should be targeted for investigational strategies other than standard ASCT.
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Affiliation(s)
- Alex F Herrera
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Matthew Mei
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Lawrence Low
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Haesook T Kim
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Gabriel K Griffin
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Joo Y Song
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Reid W Merryman
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Victoria Bedell
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Christine Pak
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Heather Sun
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Tanya Paris
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Tracey Stiller
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Jennifer R Brown
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Lihua E Budde
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Wing C Chan
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Robert Chen
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Matthew S Davids
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Arnold S Freedman
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - David C Fisher
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Eric D Jacobsen
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Caron A Jacobson
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Ann S LaCasce
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Joyce Murata-Collins
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Auayporn P Nademanee
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Joycelynne M Palmer
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - German A Pihan
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Raju Pillai
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Leslie Popplewell
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Tanya Siddiqi
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Aliyah R Sohani
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Jasmine Zain
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Steven T Rosen
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Larry W Kwak
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - David M Weinstock
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Stephen J Forman
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Dennis D Weisenburger
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Young Kim
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Scott J Rodig
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Amrita Krishnan
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
| | - Philippe Armand
- Alex F. Herrera, Matthew Mei, Lawrence Low, Joo Y. Song, Victoria Bedell, Lithua Budde, Wing C. Chan, Robert Chen, Joyce Murata-Collins, Auayporn P. Nademanee, Raju Pillai, Leslie Popplewell, Tanya Siddiqi, Jasmine Zain, Steven T. Rosen, Larry W. Kwak, Stephen J. Forman, Dennis D. Weisenburger, Young Kim, Amrita Krishnan, Tanya Paris, Tracey Stiller, Joycelynne M. Palmer, City of Hope National Medical Center, Duarte, CA; Haesook T. Kim, Jennifer R. Brown, Matthew S. Davids, Arnold S. Freedman, David C. Fisher, Eric D. Jacobsen, Caron A. Jacobson, Ann S. LaCasce, David M. Weinstock, Scott J. Rodig, Philippe Armand, Dana-Farber Cancer Institute; Gabriel K. Griffin, Reid W. Merryman, Christine Pak, Heather Sun, Brigham and Women's Hospital; German A. Pihan, Beth Israel Deaconess Medical Center; and Aliyah R. Sohani, Massachusetts General Hospital, Boston, MA
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Herrera AF, Kim HT, Kong KA, Faham M, Sun H, Sohani AR, Alyea EP, Carlton VE, Chen YB, Cutler CS, Ho VT, Koreth J, Kotwaliwale C, Nikiforow S, Ritz J, Rodig SJ, Soiffer RJ, Antin JH, Armand P. Next-generation sequencing-based detection of circulating tumour DNA After allogeneic stem cell transplantation for lymphoma. Br J Haematol 2016; 175:841-850. [PMID: 27711974 DOI: 10.1111/bjh.14311] [Citation(s) in RCA: 40] [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: 05/04/2016] [Accepted: 07/13/2016] [Indexed: 01/10/2023]
Abstract
Next-generation sequencing (NGS)-based circulating tumour DNA (ctDNA) detection is a promising monitoring tool for lymphoid malignancies. We evaluated whether the presence of ctDNA was associated with outcome after allogeneic haematopoietic stem cell transplantation (HSCT) in lymphoma patients. We studied 88 patients drawn from a phase 3 clinical trial of reduced-intensity conditioning HSCT in lymphoma. Conventional restaging and collection of peripheral blood samples occurred at pre-specified time points before and after HSCT and were assayed for ctDNA by sequencing of the immunoglobulin or T-cell receptor genes. Tumour clonotypes were identified in 87% of patients with adequate tumour samples. Sixteen of 19 (84%) patients with disease progression after HSCT had detectable ctDNA prior to progression at a median of 3·7 months prior to relapse/progression. Patients with detectable ctDNA 3 months after HSCT had inferior progression-free survival (PFS) (2-year PFS 58% vs. 84% in ctDNA-negative patients, P = 0·033). In multivariate models, detectable ctDNA was associated with increased risk of progression/death (Hazard ratio 3·9, P = 0·003) and increased risk of relapse/progression (Hazard ratio 10·8, P = 0·0006). Detectable ctDNA is associated with an increased risk of relapse/progression, but further validation studies are necessary to confirm these findings and determine the clinical utility of NGS-based minimal residual disease monitoring in lymphoma patients after HSCT.
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Affiliation(s)
- Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA, USA
| | - Haesook T Kim
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Malek Faham
- Adaptive Biotechnologies Corp., South San Francisco, CA, USA
| | - Heather Sun
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Edwin P Alyea
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Yi-Bin Chen
- Division of Bone Marrow Transplantation, Massachusetts General Hospital, Boston, MA, USA
| | - Corey S Cutler
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Vincent T Ho
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - John Koreth
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Sarah Nikiforow
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jerome Ritz
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert J Soiffer
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joseph H Antin
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Philippe Armand
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA
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45
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Bledsoe JR, Redd RA, Hasserjian RP, Soumerai JD, Nishino HT, Boyer DF, Ferry JA, Zukerberg LR, Harris NL, Abramson JS, Sohani AR. The immunophenotypic spectrum of primary mediastinal large B-cell lymphoma reveals prognostic biomarkers associated with outcome. Am J Hematol 2016; 91:E436-41. [PMID: 27419920 DOI: 10.1002/ajh.24485] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/14/2016] [Accepted: 07/13/2016] [Indexed: 12/25/2022]
Abstract
Primary mediastinal large B-cell lymphoma (PMBL) is a distinct subtype of diffuse large B-cell lymphoma (DLBCL) that shows overlap with classical Hodgkin lymphoma (CHL) and a favorable prognosis compared to mediastinal gray-zone lymphoma (MGZL). We performed immunohistochemistry on initial diagnostic specimens of 49 cases of uniformly treated PMBL to determine the frequency and clinical significance of expression of antigens commonly seen in CHL and MGZL, along with markers previously shown to be prognostic in DLBCL, not otherwise specified. The median age was 37 years with a female:male ratio of 2.3. After a median follow-up of 78 months, 24% of patients had relapsed or refractory disease and 22% had died; the 5-year PFS was 70%. Variable CD15 expression was seen in 31% of cases, but was not associated with adverse outcome. Hans cell-of-origin, proliferation index, and MYC/BCL2 coexpression were not associated with outcome, while low PDL1 (P = 0.011) and high MUM1 (P = 0.065) staining were each associated with shorter PFS. A biologic risk score (one point each for low PDL1 and high MUM1) stratified patients into three prognostic risk groups for PFS (P = 0.001) and OS (P = 0.032). On separate multivariate models, low PDL1 was independent of R-IPI risk group for PFS (HR 6.0, P = 0.023), as was a biologic risk score of 2 (HR 5.6, P = 0.011). Incorporation of the biologic risk score sub-stratified patients within R-IPI groups for both PFS (P < 0.001) and OS (P < 0.001). In summary, we characterize the immunophenotypic spectrum of PMBL and identify PDL1 and MUM1 as prognostic biomarkers for high-risk disease. Am. J. Hematol. 91:E436-E441, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jacob R. Bledsoe
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Robert A. Redd
- Department of Biostatistics and Computational Biology; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Robert P. Hasserjian
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Jacob D. Soumerai
- Lymphoma Service; Memorial Sloan Kettering Cancer Center; New York New York
| | - Ha T. Nishino
- Department of Pathology; North Shore Medical Center; Salem Massachusetts
| | - Daniel F. Boyer
- Department of Pathology; University of Michigan; Ann Arbor Michigan
| | - Judith A. Ferry
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Lawrence R. Zukerberg
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Nancy Lee Harris
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Jeremy S. Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School; Boston Massachusetts
| | - Aliyah R. Sohani
- Department of Pathology; Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
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McKelvie PA, Climent F, Krings G, Hasserjian RP, Abramson JS, Pilch BZ, Harris NL, Ferry JA, Zukerberg LR, Sohani AR. Small-cell predominant extranodal NK/T cell lymphoma, nasal type: clinicopathological analysis of a series of cases diagnosed in a Western population. Histopathology 2016; 69:667-79. [DOI: 10.1111/his.12990] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Penelope A McKelvie
- The James Homer Wright Pathology Laboratories of the Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston MA USA
- Department of Anatomical Pathology; St Vincent's Hospital; Melbourne Australia
| | - Fina Climent
- Department of Pathology; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Gregor Krings
- Department of Pathology; University of California San Francisco School of Medicine; San Francisco CA USA
| | - Robert P Hasserjian
- The James Homer Wright Pathology Laboratories of the Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston MA USA
| | - Jeremy S Abramson
- Center for Lymphoma; Massachusetts General Hospital Cancer Center and Department of Medicine; Harvard Medical School; Boston MA USA
| | - Ben Z Pilch
- The James Homer Wright Pathology Laboratories of the Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston MA USA
| | - Nancy Lee Harris
- The James Homer Wright Pathology Laboratories of the Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston MA USA
| | - Judith A Ferry
- The James Homer Wright Pathology Laboratories of the Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston MA USA
| | - Lawrence R Zukerberg
- The James Homer Wright Pathology Laboratories of the Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston MA USA
| | - Aliyah R Sohani
- The James Homer Wright Pathology Laboratories of the Massachusetts General Hospital and Department of Pathology; Harvard Medical School; Boston MA USA
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Pathania D, Im H, Kilcoyne A, Sohani AR, Fexon L, Pivovarov M, Abramson JS, Randall TC, Chabner BA, Weissleder R, Lee H, Castro CM. Holographic Assessment of Lymphoma Tissue (HALT) for Global Oncology Field Applications. Am J Cancer Res 2016; 6:1603-10. [PMID: 27446494 PMCID: PMC4955059 DOI: 10.7150/thno.15534] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/09/2016] [Indexed: 11/05/2022] Open
Abstract
Low-cost, rapid and accurate detection technologies are key requisites to cope with the growing global cancer challenges. The need is particularly pronounced in resource-limited settings where treatment opportunities are often missed due to the absence of timely diagnoses. We herein describe a Holographic Assessment of Lymphoma Tissue (HALT) system that adopts a smartphone as the basis for molecular cancer diagnostics. The system detects malignant lymphoma cells labeled with marker-specific microbeads that produce unique holographic signatures. Importantly, we optimized HALT to detect lymphomas in fine-needle aspirates from superficial lymph nodes, procedures that align with the minimally invasive biopsy needs of resource-constrained regions. We equipped the platform to directly address the practical needs of employing novel technologies for "real world" use. The HALT assay generated readouts in <1.5 h and demonstrated good agreement with standard cytology and surgical pathology.
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Sohani AR, Abramson JS. MYC/BCL2 double-expression vs. cell-of-origin classification in diffuse large B-cell lymphoma: do we need to know both? Leuk Lymphoma 2015; 57:509-11. [PMID: 26693593 DOI: 10.3109/10428194.2015.1115046] [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)
- Aliyah R Sohani
- a Department of Pathology , Massachusetts General Hospital , Boston , MA , USA
| | - Jeremy S Abramson
- b Center for Lymphoma, Massachusetts General Hospital Cancer Center , Boston , MA , USA
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Clemens MW, Medeiros LJ, Butler CE, Hunt KK, Fanale MA, Horwitz S, Weisenburger DD, Liu J, Morgan EA, Kanagal-Shamanna R, Parkash V, Ning J, Sohani AR, Ferry JA, Mehta-Shah N, Dogan A, Liu H, Thormann N, Di Napoli A, DiNapoli A, Lade S, Piccolini J, Reyes R, Williams T, McCarthy CM, Hanson SE, Nastoupil LJ, Gaur R, Oki Y, Young KH, Miranda RN. Complete Surgical Excision Is Essential for the Management of Patients With Breast Implant-Associated Anaplastic Large-Cell Lymphoma. J Clin Oncol 2015; 34:160-8. [PMID: 26628470 DOI: 10.1200/jco.2015.63.3412] [Citation(s) in RCA: 289] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is a rare type of T-cell lymphoma that arises around breast implants. The optimal management of this disease has not been established. The goal of this study is to evaluate the efficacy of different therapies used in patients with BI-ALCL to determine an optimal treatment approach. PATIENTS AND METHODS In this study, we applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, including 50 previously reported in the literature and 37 unreported. A Prentice, Williams, and Peterson model was used to assess the rate of events for each therapeutic intervention. RESULTS The median and mean follow-up times were 45 and 30 months, respectively (range, 3 to 217 months). The median overall survival (OS) time after diagnosis of BI-ALCL was 13 years, and the OS rate was 93% and 89% at 3 and 5 years, respectively. Patients with lymphoma confined by the fibrous capsule surrounding the implant had better event-free survival (EFS) and OS than did patients with lymphoma that had spread beyond the capsule (P = .03). Patients who underwent a complete surgical excision that consisted of total capsulectomy with breast implant removal had better OS (P = .022) and EFS (P = .014) than did patients who received partial capsulectomy, systemic chemotherapy, or radiation therapy. CONCLUSION Surgical management with complete surgical excision is essential to achieve optimal EFS in patients with BI-ALCL.
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Affiliation(s)
- Mark W Clemens
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - L Jeffrey Medeiros
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Charles E Butler
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Kelly K Hunt
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Michelle A Fanale
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Steven Horwitz
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Dennis D Weisenburger
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Jun Liu
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Elizabeth A Morgan
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Rashmi Kanagal-Shamanna
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Vinita Parkash
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Jing Ning
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Aliyah R Sohani
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Judith A Ferry
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Neha Mehta-Shah
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Ahmed Dogan
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Hui Liu
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Nora Thormann
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | | | - Arianna DiNapoli
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Stephen Lade
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Jorge Piccolini
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Ruben Reyes
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Travis Williams
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Colleen M McCarthy
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Summer E Hanson
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Loretta J Nastoupil
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Rakesh Gaur
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Yasuhiro Oki
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Ken H Young
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO
| | - Roberto N Miranda
- Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Jun Liu, Rashmi Kanagal-Shamanna, Jing Ning, Summer E. Hanson, Loretta J. Nastoupil, Yasuhiro Oki, Ken H. Young, and Roberto N. Miranda, The University of Texas MD Anderson Cancer Center, Houston, TX; Steven Horwitz, Neha Mehta-Shah, Ahmed Dogan, and Colleen M. McCarthy, Memorial Sloan Kettering Cancer Center, New York, NY; Dennis D. Weisenburger, City of Hope National Medical Center, Duarte, CA; Elizabeth A. Morgan, Brigham and Women's Hospital and Harvard Medical School; Aliyah R. Sohani and Judith A. Ferry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Vinita Parkash, Yale School of Medicine, New Haven, CT; Hui Liu, Xuzhou Medical College, Xuzhou, People's Republic of China; Nora Thormann, Fundacao Universitaria Mario Martins, Porto Alegre, Brazil; Arianna DiNapoli, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Stephen Lade, University of Melbourne, Melbourne, Victoria, Australia; Jorge Piccolini, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Ruben Reyes, Kansas University Medical Center, Kansas City, KS; Travis Williams, St Luke's Mountain States Tumor Institute, Meridian, ID; and Rakesh Gaur, St Luke's Hospital, Kansas City, MO.
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Landsburg DJ, Petrich AM, Abramson JS, Sohani AR, Press O, Cassaday R, Chavez JC, Song K, Zelenetz AD, Gandhi M, Shah N, Fenske TS, Jaso J, Medeiros LJ, Yang DT, Nabhan C. Impact of oncogene rearrangement patterns on outcomes in patients with double-hit non-Hodgkin lymphoma. Cancer 2015; 122:559-64. [PMID: 26565895 DOI: 10.1002/cncr.29781] [Citation(s) in RCA: 50] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Double-hit lymphomas (DHLs) are collectively defined as B-cell non-Hodgkin lymphomas harboring rearrangements of MYC as well as B-cell lymphoma 2 (BCL2) and/or B-cell lymphoma 6 (BCL6). To the authors' knowledge, the impact of specific oncogene rearrangements on outcomes of patients with DHL who are treated with immunochemotherapy has not been previously described. METHODS The authors identified patients whose diagnostic tissue specimens underwent metaphase karyotyping or fluorescence in situ hybridization for MYC as well as both BCL2 and BCL6 rearrangements. Cohorts were defined by the presence (+) or absence (-) of rearrangements: MYC+/BCL2+/BCL6- (BCL2-DHL), MYC+/BCL2-/BCL6+ (BCL6-DHL), and MYC+/BCL2+/BCL6+ (triple-hit lymphoma; THL). RESULTS A total of 117 patients were included in the current analysis (76 BCL2-DHL patients, 16 BCL6-DHL patients, and 25 THL patients). Compared with patients with BCL2-DHL, those with BCL6-DHL were more likely to be classified as having a non-germinal center cell of origin, presented with extranodal disease, and appeared to achieve higher rates of complete response despite receiving intensive induction therapy less frequently. However, patients with BCL6-DHL experienced a shorter median overall survival if achieving an initial complete response compared with patients with BCL2-DHL. Patients with THL experienced survival outcomes similar to those of patients with BCL2-DHL. CONCLUSIONS Recognition of the specific oncogene rearrangements may be of prognostic value and potentially guide future therapeutic strategies for patients with DHL.
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Affiliation(s)
- Daniel J Landsburg
- Division of Hematology/Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adam M Petrich
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Oliver Press
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ryan Cassaday
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Julio C Chavez
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Kevin Song
- Leukemia/BMT Program of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Andrew D Zelenetz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mitul Gandhi
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.,Virginia Cancer Specialists, Fairfax, Virginia
| | - Namrata Shah
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy S Fenske
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jesse Jaso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - L Jeffrey Medeiros
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David T Yang
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Chadi Nabhan
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
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