Abstract
Dasatinib, a second-generation tyrosine kinase inhibitor with activity against BCR-ABL1 and other Src family tyrosine kinases, is approved as a first-line treatment option for Philadelphia chromosome-positive chronic myelogenous leukemia (CML) in the chronic phase. Recently, lymphadenopathy with morphologic features of reactive follicular hyperplasia was described in a cohort of patients with CML on long-term dasatinib therapy. However, the complete morphologic and immunophenotypic features of this previously underappreciated adverse effect have not been fully described. Herein, we report 3 cases of unexplained lymphadenopathy resulting in multiple diagnostic procedures in patients with CML and a history of long-term dasatinib therapy. Morphologic examination demonstrated preserved nodal architecture showing hybrid features of progressive transformation of germinal centers and Castleman-type changes in a background of florid follicular hyperplasia. Large germinal centers were disrupted by complex infolding of IgD mantle zones arranged as cuffs surrounding perforating capillaries. Other abnormalities variably present included decreased CD20 expression among polytypic B cells and increased Epstein-Barr virus reactivity in scattered paracortical cells and/or individual germinal centers. B-cell clonality studies showed no predominant clonal rearrangements. Consideration of dasatinib-related lymphadenopathy may pre-empt unnecessary repeat diagnostic procedures in patients with CML or other dasatinib-susceptible malignancies and persistent lymphadenopathy.
摘要
第二代酪氨酸激酶抑制剂达沙替尼,具有抑制BCR-ABL1和其他Src家族酪氨酸激酶的活性,被批准为费城染色体阳性慢性髓性白血病(CML)慢性期治疗的一线药物。最近,在一组长期达沙替尼治疗的CML患者发现淋巴结肿大,具有与反应性淋巴滤泡增生相似的形态学特征。然而,这种未被认识的副作用,其完整的形态学和免疫表型没有得到充分的描述。在此,我们报告3例CML伴有长期达沙替尼治疗史的患者,出现不明原因淋巴结肿大导致反复采用多种程序诊断。形态学检查证实淋巴结结构保存,呈进行性生发中心转化与Castleman样改变背景上旺帜性滤泡增生相混合的特征。大的生发中心被穿入其中的毛细血管及其周围袖套状分布的IgD套区细胞组成的复杂折叠结构破坏。其他异常改变不一,包括多型性B细胞CD20阳性表达减少和散在的副皮质区细胞和/或单个生发中心EB病毒阳性增加。B细胞克隆性分析显示无显著的克隆性重排。CML或其他达沙替尼敏感性恶性肿瘤和持续性淋巴结肿大患者应首先想到达沙替尼相关性淋巴结肿大的可能,以避免不必要的重复检查。
共0条评论