Astrid Pavlovsky

T-Cell Lymphomas in South America and Europe

Peripheral T-cell lymphomas are a group of rare neoplasms originating from clonal proliferation of mature post-thymic lymphocytes with different entities having specific biological characteristics and clinical features. As natural killer cells are closely related to T-cells, natural killer-cell lymphomas are also part of the group. The current World Health Organization classification recognizes four categories of T/natural killer-cell lymphomas with respect to their presentation: disseminated (leukemic), nodal, extranodal and cutaneous. Geographic variations in the distribution of these diseases are well documented: nodal subtypes are more frequent in Europe and North America, while extranodal forms, including natural killer-cell lymphomas, occur almost exclusively in Asia and South America. On the whole, T-cell lymphomas are more common in Asia than in western countries, usually affect adults, with a higher tendency in men, and, excluding a few subtypes, usually have an aggressive course and poor prognosis. Apart from anaplastic lymphoma kinase-positive anaplastic large cell lymphoma, that have a good outcome, other nodal and extranodal forms have a 5-year overall survival of about 30%. According to the principal prognostic indexes, the majority of patients are allocated to the unfavorable subset. In the past, the rarity of these diseases prevented progress in the understanding of their biology and improvements in the efficaciousness of therapy. Recently, international projects devoted to these diseases created networks promoting investigations on T-cell lymphomas. These projects are the basis of forthcoming cooperative, large scale trials to detail biologic characteristics of each sub-entity and to possibly individuate targets for new therapies.

SOXC and MiR17-92 gene expression profiling defines two subgroups with different clinical outcome in mantle cell lymphoma.

Mantle cell lymphoma (MCL) is a heterogeneous B‐cell lymphoid malignancy where most patients follow an aggressive clinical course whereas others are associated with an indolent performance. SOX4, SOX11, and SOX12 belong to SOXC family of transcription factors involved in embryonic neurogenesis and tissue remodeling. Among them, SOX11 has been found aberrantly expressed in most aggressive MCL patients, being considered a reliable biomarker in the pathology. Several studies have revealed that microRNAs (miRs) from the miR‐17‐92 cluster are among the most deregulated miRNAs in human cancers, still little is known about this cluster in MCL. In this study we screened the transcriptional profiles of 70 MCL patients for SOXC cluster and miR17, miR18a, miR19b and miR92a, from the miR‐17‐92 cluster. Gene expression analysis showed higher SOX11 and SOX12 levels compared to SOX4 (P ≤ 0.0026). Moreover we found a negative correlation between the expression of SOX11 and SOX4 (P < 0.0001). miR17‐92 cluster analysis showed that miR19b and miR92a exhibited higher levels than miR17 and miR18a (P < 0.0001). Unsupervised hierarchical clustering revealed two subgroups with significant differences in relation to aggressive MCL features, such as blastoid morphological variant (P = 0.0412), nodal presentation (P = 0.0492), CD5+ (P = 0.0004) and shorter overall survival (P < 0.0001). Together, our findings show for the first time an association between the differential expression profiles of SOXC and miR17‐92 clusters in MCL and also relate them to different clinical subtypes of the disease adding new biological information that may contribute to a better understanding of this pathology.

Serum free light chains and oligoclonal bands in patients with multiple myeloma and autologous stem cell transplantation.

Abstract Background: To establish stringent complete remission (SCR) in patients with multiple myeloma (MM), it is currently recommended to obtain a normal serum free light chains (sFLC) ratio. The appearance of serum oligoclonal bands (OB) after autologous stem cell transplantation (ASCT) is considered a favorable prognostic factor. The objective of this study was to examine sFLC for assessing SCR in patients with MM, and ASCT with OB. We also examined how capillary electrophoresis (CE) compares with agarose gel electrophoresis (Aga) in identifying oligoclonal bands. Methods: Out of 238 patients studied in our institution between April 1992 and December 2008 a serum protein electrophoresis (SPE) was performed by means of CE and sFLC determination on 37 patients with MM in complete remission (CR), ASCT and OB presence were assigned by conventional Aga electrophoresis and IF. Results: Statistically significant differences (SSD) were found when comparing CE vs. Aga, regarding BO visualization in SPE, favoring the latter. In connection with sFLC, the group of patients with an abnormal ratio presented elevated values in the γ-globulin zone of the SPE, whereas the group of patients with a normal ratio of sFLC presented with normal values resulting in SSD between the groups. Conclusions: It is essential to perform immunofixation to certify the presence of OB, especially if CE is used as it is difficult to distinguish them using this method. A normal sFLC was observed in most of the patients with OB and normal values of the SPE γ-globulin zone. The above-mentioned information might demonstrate a limitation of sFLC test in SCR evaluation for patients with MM, ASCT and CR if OB has been detected.

Impact of Ibrutinib in Quality of Life (QoL) in Patients with Chronic Lymphocytic Leukemia (CLL): Preliminary Results of Real-World Experience

S218 association of several mutations is common. VAF is very variable, whether patients appear in clinical response or progressive. These results raise the question of the clinical significance of these mutations and a follow-up is required to determine if all these mutations are actually predictive of disease progression.

SAFETY AND EFFICACY ANALYSIS OF ELDERLY PATIENTS TREATED WITHIN THE GATLA HL-05 CLINICAL TRIAL: PET ADAPTED THERAPY AFTER 3 CYCLES OF ABVD FOR ALL STAGES OF HODGKIN LYMPHOMA

tomography (PET) is in the medium and long‐term follow‐up after complete response of Hodgkin lymphoma (HL) and aggressive non‐Hodgkin lymphoma (NHL) with mediastinal involvement at diagnosis. The aim of this study was to verify the reliability of positive PET scans of the mediastinum in following up patients with mediastinal lymphoma, using histological findings as comparison (gold standard). Methods: From January 2002 to February 2016, 483 patients with mediastinal lymphoma were followed after the end of front‐line treatment. Ninety‐six patients with a positive PET scan of the mediastinum underwent computed tomography scanning and surgical biopsy. Results: For 67 HL and 29 NHL, a suspicion of lymphoma relapse was raised based on positive mediastinal PET scanning. Histology confirmed relapse in 63 (48 HL and 15 NHL) of 96 patients (65.6%). In the remaining 33 (34,4%) cases, biopsy revealed: necrotic tissue in 7 patients, fibrosis in 7 patients, thymus in 7 patients, sarcoidosis in 4 patients, tuberculous granulomas in 2 patients, sarcoid‐like lymph node granulomatosis in 1 patient, tuberculosis lymph node granulomatosis in 1 patient, reactive inflammation lymph node in 3 patients, and thymoma in 1 patient. The maximum standardized uptake value was significantly higher among patients who had signs of relapse (63 true positive cases) than among those who stayed in remission (33 false positive cases), the median values being 10.30 (range, 3.2‐25.0) and 5.0 (range, 2.8‐12.6) respectively (P < .05). Conclusions: The analysis on this large series of 96 patients confirms the concept that patients with positive PET in the mediastinum during the follow‐up cannot be considered sufficient for final diagnostic purposes considering that at least one third of the patients can present only benign or, anyway, unrelated neoplastic pictures. Histological confirmation can be safely obtained by various biopsy techniques, the choice of which should be made on the basis of the clinical and imaging study findings case by case.

Communication with Patients with Hematological Malignancies in Argentina

Argentina is a country of immigrants and Buenos Aires, its capital city, one of the largest urban areas in the world. The country in which we live with all its cultural background together with the characteristics of the institution where we work, are important factors influencing our communication with patients.