Clinicopathologic features and management of blastoid variant of mantle cell lymphoma.
The blastoid variant of mantle cell lymphoma (MCL), which accounts for less than one-third of MCL, may arise de novo or as a transformation from the classical form of MCL. Blastoid variant, which predominantly involves men in their sixth decade, has frequent extranodal involvement (40-60%), stage IV disease (up to 85%) and central nervous system (CNS) involvement. Diagnosis relies on morphological features and is challenging. Immunophenotyping may display CD23 and CD10 positivity and CD5 negativity in a subset. Genetic analysis demonstrates an increased number of complex genetic alterations. Blastoid variant responds poorly to conventional chemotherapy and has a short duration of response. Although the optimal therapy remains to be established, CNS prophylaxis and the use of aggressive immunochemotherapy followed by autologous stem cell transplant may prolong the remission rate and survival. Further studies are crucial to expand our understanding of this disease entity and improve the clinical outcome.
a Department of Internal Medicine , Memorial Hospital of Rhode Island , Pawtucket , RI , USA.
Rajesh
R
Shrestha
b Department of Internal Medicine , Division of Hematology-Oncology, University of Nebraska Medical Center , Omaha , NE , USA.
Vijaya Raj
VR
Bhatt
c Division of Internal Medicine, University of Arkansas for Medical Sciences , Little Rock , AR , USA.
Guru Subramanian
GS
Guru Murthy
b Department of Internal Medicine , Division of Hematology-Oncology, University of Nebraska Medical Center , Omaha , NE , USA.
James O
JO
Armitage
D001706:Biopsy; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D019468:Disease Management; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012008:Recurrence; D016896:Treatment Outcome
Mantle cell lymphoma; autologous stem cell transplant; blastoid variant; central nervous system involvement; genetic alteration; high dose chemotherapy; intensified chemotherapy