Hodgkin lymphoma with symptomatic osseous involvement can have a similar presentation to osteomyelitis. Common findings in symptoms, laboratory workup, and imaging can make it very difficult to distinguish between the two diseases. Excisional biopsy should be pursued if fine-needle biopsy is equivocal and suspicion of lymphoma is high. We report a case of a 40-year-old man who presented with a history of marine animal sting on his neck and later developed erythema in the area, chest pain, constitutional symptoms, adenopathy, and imaging classic for sternal osteomyelitis. Fortunately, initial biopsy prompted the possibility of lymphoma, and further workup was initiated, which confirmed Hodgkin lymphoma. This case is a good reminder that malignancies and infections can share many common features, and keeping a broad differential diagnosis can be lifesaving. Proper staging and risk stratification of Hodgkin lymphoma help determine the optimal treatment. (C) 2017 The Author(s) Published by S. Karger AG, Basel

Class of 2017 Abstract / This project is related to the article that was later published, available at this link: https://doi.org/10.1016/j.critrevonc.2016.11.009 / Objectives: Brentuximab vedotin (BV) is an antibody-drug conjugate comprising a CD30-directed antibody conjugated to the microtubule-disrupting agent MMAE via a protease cleavable linker. BV is FDA approved for use in relapsed classical Hodgkin lymphoma and relapsed systemic Methods: primary study outcomes being objective response rate. PubMed (1946-2015), EMBASE (1947-2015), and Cochrane Central Register of Controlled Trials (1898-2015). Inclusion criteria included all studies and case reports of NHLs in which BV therapy was administered. Twenty-eight articles met these criteria. Results: Utilizing the twelve clinical subtypes, we found clinical evidence of BV and stratified the study populations into three groups: B-cell malignancies (group A), T-cell malignancies (group B), and non-B or non-T-cell hematological malignancies (group C). Across the group A malignancies, there were 87 patients. 48% experienced an objective response (OR). Across the group B malignancies, there were 274 patients. 74% experienced an OR. Across the group C malignancies, there were 9 patients. 44% experienced an OR. Conclusions: Our findings indicate that BV induces a variety of responses, largely positive and variable between NHL subtypes. With properly powered prospective studies, BV may prove to be a strong candidate in the treatment of CD30+ malignancies.

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Made available in DSpace on 2014-06-11T19:27:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2004Bitstream added on 2014-06-13T20:36:39Z : No. of bitstreams: 1 silva_gn_me_botfm.pdf: 467036 bytes, checksum: 3b9fa526eae390b7ae86bf47c5bcf731 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O linfoma de Hodgkin (LH) tem características clínicas e anátomo-patológicas distintas dos linfomas não-Hodgkin. Seu componente neoplásico, as células células de Hodgkin/Reed-Sternberg (H-RS), corresponde a cerca de 2% do tumor. As células H-RS apresentam imunofenótipo peculiar e sua origem ainda é objeto de estudo. O LH é classificado em LH clássico (que inclui os subtipos celularidade mista, esclerose nodular, depleção linfocítica e LH rico em linfócitos) e LH predominância linfocítica nodular. A associação do vírus de Epstein-Barr (EBV) com LH é conhecida e acredita-se que este vírus desempenha importante papel no desenvolvimento de parcela significativa dos casos de LH. No LH, o acúmulo de células reativas como linfócitos, plasmócitos, eosinófilos, histiócitos e fibroblastos ocorre em resposta a citocinas secretadas pelas células H-RS. A interleucina 10 (IL-10), importante citocina antiinflamatória da resposta imunitária, tem sido encontrada em grande quantidade em indivíduos com LH. É possível que essa elevada expressão de IL-10 esteja vinculada a determinados polimorfismos de nucleotídeos simples (SNP) na seqüência promotora do gene da IL-10, que podem se associar a características anátomoclínicas do LH. O presente trabalho avaliou a freqüência dos polimorfismos da IL-10 nas posições promotoras -1082, -819/-592 e estudou a correlação destes polimorfismos em LH com subtipos histológicos, infecção pelo EBV, faixa etária e, em alguns casos, estadiamento clínico da doença. Os resultados demonstram que os diferentes fenótipos para produção de IL-10, genótipos na posição -1082 e genótipos nas posições -592/-819 não têm relação com subtipos do LH e idade dos pacientes. Por outro lado, verificou-se que o genótipo GG na posição -1082 e a combinação de haplótipos GCC/GCC para alta... / Clinical and pathologic features of Hodgkin’s lymphoma (HL) reflect an abnormal immune response, which is in part due to the elaboration of a variety of cytokines. It was reported that interleukin 10 (IL -10), which may be produced by the malignant Hodgkin/Reed-Sternberg (H-RS) cells, is an important prognostic factor in HL, and it could play a role in the pathogenesis of this neoplasm. It is well established that genetic factors affect protein expression and function. In this regard, polymorphisms in the promoter region of IL-10 gene may cause different phenotypes for IL- 10 synthesis and activity. Three dimorphic single nucleotide polymorphisms (SNPs) have been identified at positions -1082, -819 and -519 within the IL-10 promoter region (SNPs/IL-10). These polymorphisms are in close proximity to several transcription factors binding-sites, and may interfere with IL-10 gene transcription. The aim of this study was to evaluate whether is there a particular distribution of SNPs at positions -1082, -819 and -519 in the IL-10 gene promoter in patients with HL, as well as to access the differences in the SNPs/IL10 frequency regarding HL subtype, patient age, EBV infection status, and clinical staging of the disease. For these purposes, sixty-five cases of HL and fifty cases of reactive follicular lymphoid hyperplasia (RFLH) were evaluated for SNPs/IL-10 by polymerase chain reaction amplification plus restriction fragment length polymorphism analysis (PCR-RFLP). Compared to HL EBV-negative cases, in HL EBV-positive cases it was observed a significant increase in the frequency of GG genotype at position -1082 of IL-10 gene promoter region, which is associated to high level of IL -10 production. No differences were observed in the frequency of different SNPs/IL-10 concerning patient age, HL subtype, and clinical stage of the disease. These results... (Complete abstract, click electronic address below)

Background: We characterized B-cell non-Hodgkin lymphoma (NHL) cases over ten years at a tertiary children's hospital to contribute to the body of knowledge on pediatric lymphoma in developing countries with a high human immunodeficiency virus (HIV) burden. Methods: A retrospective cohort study using clinical and laboratory records of children newly diagnosed with B-cell NHL from January 2005 to December 2014. Results: Seventy-five children ≤ 15 years were included. The majority had Burkitt lymphoma (n = 61). Twenty-five percent (n = 19) were HIV positive and 16% (n = 12) had concurrent active tuberculosis. Bulky disease was present in 65.7% (n = 46) and 30.1% (n = 22) were classified as Lymphomes Malins B (LMB) risk group C. The five year survival estimates for HIV-negative and HIV-positive children were similar in our cohort: 81% vs. 79% for eventfree survival and 85% vs. 83.9% for overall survival. Of three children with Burkitt lymphoma, HIV and LMB group C, two died within one year. Conclusions: Irrespective of HIV status, the survival of children in our B-cell NHL cohort compares favorably with cure rates in developed nations, although advanced disease remains associated with a poor prognosis. Characterization of childhood NHL cases contributes to accurate risk stratification and tailored treatment.

La progression des traitements dans le lymphome amène à s’intéresser à la qualité de vie des survivants. La fatigue chronique est le problème le plus fréquemment décrit par les survivant. Dans le cadre du lymphome hodgkinien, le niveau de fatigue revêt une importance particulière par les patients ont entre 20 et 40 ans et sont confronté aux problématiques de retour à l’emploi. Dans la première partie de cette thèse, nous traiterons des causes de la fatigue et de sont évolutions pour les lymphomes hodgkinien et les lymphomes non-hodgkinien. En particulier, nous mettrons en lumière l’impacte des comorbidités sur les niveaux de fatigue ainsi que les différences d’évolution de la fatigue entre les survivants d’un lymphome hodgkinien et d’un lymphome non-hodgkinien. Dans la deuxième partie, nous traiterons de l’intégration de la fatigue dans l’évaluation des traitement dans le cadre du lymphome hodgkinien avec les problématiques de faible inclusion et de fort taux de survie. / The progression of treatment in lymphoma leads to an interest in the quality of life ofsurvivors. Chronic fatigue is the most frequently described problem among survivors. Inhodgkin lymphoma, the level of fatigue is of particular importance to patients between20 and 40 years of age and faces problems of return to employment. In the first part of thisthesis, we will deal with the causes of fatigue and are evolutionary for hodgkin lymphomaand non-hodgkin lymphoma. In particular, we will highlight the impact of comorbiditieson fatigue levels as well as differences in fatigue patterns between survivors of hodgkinlymphoma and non-hodgkinian lymphoma. In Part Two, we will deal with the integrationof fatigue into the assessment of treatment in hodgkin lymphoma with low-inclusion andhigh survival problems.

While CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone), the current standard of care for non-Hodgkin lymphoma (NHL), kills tumor cells, the accumulation of tumor cell “debris” can stimulate inflammation and tumor growth. Thus, cytotoxic cancer therapies are a double-edged sword. Previous studies have shown that apoptotic debris stimulates tumor growth. We hypothesize that (1) CHOP-generated tumor cell debris can promote lymphoma progression via release of pro-inflammatory cytokines; (2) blocking phosphatidylserine (PS), which is presented on the surface of apoptotic cells, may inhibit debris-stimulated cancer progression. METHODS: Lymphoma EL4 debris was generated by treating tumor cells with CHOP chemotherapy. EL4 debris was isolated via Ficoll gradient and co-injected with living EL4 tumor cells into immunocompetent C57BL/6 mice. Macrophage-secreted cytokines were measured via array analysis. RESULTS: Flow cytometry confirmed CHOP chemotherapy generated apoptotic/necrotic debris. Vincristine-, mafosfamide-, and prednisolone-generated lymphoma EL4 debris stimulated tumor growth by over 100-fold in a dose-dependent manner. Debris alone did not induce tumors, even at 250 days post-injection. Doxorubicin-generated EL4 debris stimulated tumor growth at low dose (1x105), but inhibited growth at high dose (9x105). Systemic administration of doxorubicin-generated EL4 debris or blocking PS in the cell debris generated by doxorubicin using annexin V or an anti-PS neutralizing antibody inhibited doxorubicin-generated debris-stimulated tumor growth. Therapy-generated debris stimulated macrophage pro-inflammatory cytokine production. CONCLUSIONS: CHOP chemotherapy-generated debris regulates tumor growth via cytokine production. Thus, harnessing the anti-tumor activity of inhibitory debris or neutralizing PS on stimulatory debris may be a novel anti-cancer approach. / 2018-07-11T00:00:00Z

Busulfan, cyclophosphamide, and etoposide (BuCyE) is a commonly used conditioning regimen for autologous stem cell transplantation (ASCT). This multicenter, phase II study examined the safety and efficacy of BuCyE with individually adjusted busulfan based on preconditioning pharmacokinetics. The study initially enrolled Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients ages 18 to 80 years but was amended due to high early treatment-related mortality (TRM) in patients > 65 years. BuCyE outcomes were compared with contemporaneous recipients of carmustine, etoposide, cytarabine, and melphalan (BEAM) from the Center for International Blood and Marrow Transplant Research. Two hundred seven subjects with HL (n = 66) or NHL (n = 141) were enrolled from 32 centers in North America, and 203 underwent ASCT. Day 100 TRM for all subjects (n = 203), patients > 65 years (n = 17), and patients ≤ 65 years (n = 186) were 4.5%, 23.5%, and 2.7%, respectively. The estimated rates of 2-year progression-free survival (PFS) were 33% for HL and 58%, 77%, and 43% for diffuse large B cell lymphoma (DLBCL; n = 63), mantle cell lymphoma (MCL; n = 29), and follicular lymphoma (FL; n = 23), respectively. The estimated rates of 2-year overall survival (OS) were 76% for HL and 65%, 89%, and 89% for DLBCL, MCL, and FL, respectively. In the matched analysis rates of 2-year TRM were 3.3% for BuCyE and 3.9% for BEAM, and there were no differences in outcomes for NHL. Patients with HL had lower rates of 2-year PFS with BuCyE, 33% (95% CI, 21% to 46%), than with BEAM, 59% (95% CI, 52% to 66%), with no differences in TRM or OS. BuCyE provided adequate disease control and safety in B cell NHL patients ≤ 65 years but produced worse PFS in HL patients when compared with BEAM.

Mantle cell lymphoma (MCL) is an extremely difficult to treat subtype of non-Hodgkin lymphoma (NHL) with a low patient survival rate compared to most common cancers. Recently, nanoparticle delivery systems have received a great deal of interest for treating NHL. One of the more promising cargo options for these systems is short interfering RNA (siRNA). siRNA is a 18-23 nucleotide long double stranded RNA that is used to inhibit the protein expression of target mRNAs in a sequence specific manner. MCLs have several commonly overexpressed genes compared to normal cells making it an ideal candidate for siRNA therapies. For RNA interference to occur, A delivery vehicle is needed for the siRNA to reach the cytoplasm of the cell. In this thesis, ionizable lipid-like materials termed lipidoids are formulated into lipid nanoparticles (LNPs) to deliver siRNA. A new library of lipidoids is constructed to gain a better understanding of how the lipidoid tail-structure affects the silencing ability of LNPs. A novel tail precursor is identified as conferring potency to LNPs. Then, LNPs are used to silence genes within difficult to transfect MCL cells. LNPs targeting the anti-apoptotic protein Mcl-1 exhibit potent gene silencing and cause an increase in the fraction of cells undergoing apoptosis. This is important because there is no therapeutic that is FDA approved that targets this commonly overexpressed protein. Because of this LNP’s potency, siRNAs targeting multiple genes can be encapsulated into LNPs without causing unwanted toxicity. LNPs targeting several genes in multiple pathways cause a larger fraction of MCL cells to undergo apoptosis compared to cells treated with LNPs targeting only one gene. A major issue in cancer therapeutics is that the majority of nanoparticles accumulate in the liver. In an effort to improve the delivery of LNPs to target cells, changes to their formulations and administration methods are investigated as a means to improve LNP circulation time, biodistribution, and silencing ability. Overall, this work identifies lipidoid nanoparticles as potent siRNA delivery systems to treat MCL and investigates key properties for further improvement in LNP siRNA delivery to target cells.

Les cytokines sont d’importants médiateurs dans la physiopathologie des lymphomes hodgkiniens (LH). A partir d’une cohorte de 464 patients, nous avons évalué l’impact pronostique de onze SNPs parmi les gènes de cytokines : IL10 (rs1800890, rs1800896, rs1800871, rs1800872), TNFA (rs1800629) ; IL6 (rs1800795) ; IL1B (rs16944) ; ILRN (rs419598) ; INFG (rs2430561) ; IL12 (rs3212227) ; CCL17 (rs223828). Le génotypage du SNP de l’IL12 montre une distribution différente de celle attendue dans la population générale selon le test de Hardy-Weinberg. Ce résultat suggère que les variations génétiques de l’IL12 pourraient être impliquées dans la susceptibilité au LH. Les patients porteurs du génotype IL10-1082AA présentent un taux de rémission complète au traitement initial supérieur aux patients présentant un autre génotype (95% vs. 88% P = .02). Pour les patients de stade avancé III-IV, le taux de survie globale à 6 ans est statistiquement différent entre les génotypes IL10-592AA/CC/AC et IL10-819TT/CC/CT (100%, 94%, 78%, P = .03). Ce résultat est retrouvé pour les patients porteurs de LH n’exprimant pas l’EBV. Pour les LH EBV négatif, le taux de survie sans progression à 6 ans est différent en fonction du génotype du TNFA-308AA/GG/AG (100%, 84%, 68%, P = .03). Il n’a été pas retrouvé de corrélation entre les génotypes et les dosages plasmatiques de l’IL-10, TNFA, IL-1RA, IL-6. Cette étude montre que le ‘‘fond génétique immun’’ est important à prendre en considération pour définir le pronostic des patients. Le rôle des SNPs de l’IL10 et du TNFA dans les LH EBV négatif devra être confirmé ainsi que l’influence des variations génétiques de l’IL12 dans la susceptibilité au LH. / Cytokines are important immune mediators implicated in Hodgkin lymphoma (HL) pathogenesis but little is known on the role of immune gene variations. We assessed prospectively the prognostic role of cytokine gene single nucleotide polymorphisms (SNPs) in HL patients (pts) : IL10 (rs1800890, 448 pts; rs1800896, 459 pts ; rs1800871, 446 pts ; rs1800872, 447 pts), TNFA (rs1800629, 464 pts) ; IL6 (rs1800795, 201 pts) ; IL1B (rs16944, 198 pts) ; ILRN (rs419598, 199 pts) ; INFG (rs2430561, 200 pts) ; IL12 (rs3212227, 259 pts) ; CCL17 (rs223828, 198 pts). IL12 genotype distribution appears significantly different from what observed in general population according to Hardy-Weinberg test which was already observed in another published study. IL10-1082AA genotype was associated with better complete response than other IL10 genotypes (95% vs. 88% P = .02). For patients with stage III-IV HL, the 6-year overall survival was statistically different between IL10-592AA/CC/AC and IL10-819TT/CC/CT genotypes (100%, 94%, 78%, P = .03). This prognostic effect was observed in EBV-negative but not in EBV-positive HL. In EBV-negative HL, TNFA-308AA/GG/AG genotypes had a different 6-year progression-free survival (100%, 84%, 68%, P = .03). No correlation was observed between genotypes and IL-10, TNFA, IL-1RA, IL-6 cytokine levels. This exploratory study suggests an effect of IL10 and TNFA SNPs in predicting HL outcome but other studies are needed to decipher the role of the host immunogenetic background, in particular the relation with EBV. Regarding the IL12 genotyping results, whether IL12 polymorphism is implicated in HL susceptibility needs also to be clarify.