Case report: High doses of intravenous immunoglobulins as a successful treatment for late onset immune agranulocytosis after rituximab plus bendamustine

Late onset neutropenia (LON) related to rituximab or rituximab plus chemotherapy is defined as an unexplained absolute neutrophil count of ≤1.5 × 109/L starting at least four weeks after the last rituximab administration. LON is infrequent and its pathophysiology remains unknown. There are no guidelines or consensus strategies for the optimal management of patients developing LON. The majority of the patients recover promptly with no specific treatment and only some cases need to be managed with granulocytic colony stimulating factor (G-CSF), usually with a rapid response. Here, we describe a 69-year-old patient with Waldenström's macroglobulinemia who presented a septic event in the context of severe LON after rituximab plus bendamustine. The diagnosed of agranulocytosis was established by bone marrow examination. Interestingly, anti-neutrophil antibodies bound to the patient's granulocytes were found suggesting an autoimmune mechanism. The patient did not respond to G-CSF but achieved a rapid response after high doses of intravenous immunoglobulins with full white blood cell recovery

Evaluation of routine CT scans in the follow-up of diffuse large B-cell lymphomas

Objective: Our aim was to retrospectively assess the role of routine CT scans within the first year of follow-up with a limited surveillance policy prior to Lugano recommendations in diffuse large B-cell lymphomas (DLBCL) achieving complete metabolic remission (CMR). We also evaluated the type of relapse detection and exposure to CT scans within the first five years. Methods: Patients diagnosed with DLBCL who achieved CMR after first-line immunochemotherapy were included. Imaging studies and medical records were thoroughly reviewed. Results: Among 101 DLBCL patients in the first CMR, a total of 19 relapses were identified in the study period (18.8% of DLBCL patients included). Nine patients relapsed within the first year (47.4% of all relapses) but only 3 of them were detected by the 202 surveillance CT scans performed during this first year of follow-up. Conclusions: Our real-world data provide clinically applicable results which are in agreement with the Lugano recommendations based on trial data, highlighting the lack of utility of routine CTs in DLBCL patients achieving CMR

Worse outcome and distinct mutational pattern in follicular lymphoma with anti-HBc positivity

Epidemiological studies have demonstrated the association between hepatitis B virus (HBV) infection and B-cell non-Hodgkin lymphoma (NHL), mainly for diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). We studied a cohort of 121 patients with FL for HBV infection status, clinical features, and gene mutational profile. Anti-HBc was detectable in 16 patients (13.2%), although all had undetectable HBV DNA. Anti-HBcore+ (anti-HBc+) cases presented with older age at diagnosis than anti-HBc- cases (68.1 vs 57.2 years; P = .007) and higher β2-microglobulin (56.3% vs 28.9%; P = .04). All patients included in the study fulfilled criteria for treatment and received therapy with rituximab or rituximab-containing chemotherapy. There were no episodes of HBV reactivation or HBV hepatitis during treatment and/or maintenance. Remarkably, anti-HBc+ patients had significantly lower 10-year progression-free survival (PFS; 12.9% vs 58.3%; P < .0001) and overall survival (OS; 22.0% vs 86.2%; P < .0001), that remained at multivariate analysis. Gene mutational profiling of all cases showed that anti-HBc+ cases had higher incidence of ARID1A mutations and absence of EP300 mutations, 2 key epigenetic regulators in FL. Overall, our study shows that FL patients with resolved HBV infection have a worse outcome independently of other well-known clinical risk factors and a distinct gene mutational profile

Evaluation of four prognostic indices in follicular lymphoma treated in first line with immunochemotherapy

[AHEAD] Data de publicació electrónica: 19-10-2022Several clinical risk models have been proposed to predict outcome in follicular lymphoma (FL). The development of Next Generation Sequencing (NGS) technologies has allowed the integration of somatic gene mutations in clinical scores to build genotyped-based risk models, such as m7-FLIPI. We explored four clinical or clinicogenetic risk models in patients with symptomatic FL who received frontline immunochemotherapy. Out of 191 patients with FL grade 1-3a, 109 were successfully genotyped. Treatment consisted on rituximab (R) plus CVP/CHOP (72.5%) or R-bendamustine (R-B) (27.5%). The proportion of cases classified as high-risk in FLIPI, FLIPI-2, PRIMA-PI or m7-FLIPI were 39.3%, 14%, 30.3%, 22%, respectively. No case with low-intermediate FLIPI was upgraded in m7-FLIPI, but 18 out of 42 higher-risk patients in FLIPI were downgraded to low-risk m7-FLIPI. Sensitivity and specificity for the prediction of POD24 was highest for FLIPI. The discrimination for progression free survival (PFS) and overall survival (OS) was best for FLIPI (c-index: 0.644 and 0.727, respectively). When analyzed only R-B patients, m7-FLIPI had higher discrimination for PFS and OS. Thus, FLIPI remains as the clinical risk score with higher discrimination in advanced FL patients treated with immunochemotherapy, but the performance of m7-FLIPI should be further investigated in patients treated with R-B