Cost‐effective approach to the diagnostic workup of B cell lymphoproliferative disorders via optimal integration of flow cytometric data

Mason, Emily F.; Morgan, Elizabeth A.; Pinkus, Geraldine S.; Pozdnyakova, Olga

doi:10.1111/ijlh.12595

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…Our data suggest that the combination of the use of cyclophosphamide with the compound measurement of B cells, Th17 cells, and TLR2 expression in monocytes is useful as an infection predictive index in SLE patients. All of the parameters included in the index are readily available using conventional flow cytometry, a technique that has demonstrated diagnostic utility as a compound measurement tool (44) as well as a cost-effective strategy (45) in many other diseases in the clinical setting, particularly at third level referral centers. Also, this is the first study to emphasize the pathogenic autoimmune response in SLE as a pivotal risk factor for infections, which could explain the concomitant occurrence of high disease activity and infections at lupus diagnosis even in the absence of immunosuppressive therapy.…”

Section: Discussionmentioning

confidence: 99%

The Systemic Lupus Erythematosus Infection Predictive Index (LIPI): A Clinical-Immunological Tool to Predict Infections in Lupus Patients

et al. 2019

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Among autoimmune diseases, systemic lupus erythematosus (SLE) patients have a unique predisposition to develop infections, which represents one of their main causes of morbidity and mortality. Many infections occur at disease diagnosis in the absence of immunosuppressive therapy, suggesting that the immunological abnormalities in SLE patients might be fundamental for the development of this complication. The aim of this study was to address the main clinical and immunological features associated with the development of infection and to create and validate a compound clinical-immunological infection predictive index in a cohort of SLE patients. We included 55 SLE patients with < 5 years since diagnosis. The clinical and immunological features were evaluated periodically and patients were followed-up during 1 year, searching for the development of infection. Immunophenotyping was performed by multiparametric flow cytometry and neutrophil extracellular traps (NETs) were assessed by confocal microscopy. Eighteen patients (32.7%) presented 19 infectious events, 5 (26.3%) were severe. For the construction of the index, we performed a logistic regression analysis and the cutoff points were determined with ROC curves. Increased numbers of peripheral Th17 cells, B cell lymphopenia, and lower TLR2 expression in monocytes, as well as the use of cyclophosphamide were the major risk factors for the development of infection and thus were included in the index. Besides, patients that developed infection were characterized by increased numbers of low-density granulocytes (LDGs) and higher expression of LL-37 in NETs upon infection. Finally, we validated the index retrospectively in a nested case-control study. A score >1.5 points was able to predict infection in the following year (AUC = 0.97; LR– = 0.001, specificity 100%, P = 0.0003). Our index encompasses novel immunological features able to prospectively predict the risk of infection in SLE patients.

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Section: Discussionmentioning

confidence: 99%

The Systemic Lupus Erythematosus Infection Predictive Index (LIPI): A Clinical-Immunological Tool to Predict Infections in Lupus Patients

et al. 2019

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“…Flow cytometry performed 16 years previously when diagnosing the original DLBCL had shown CD19 (+), CD20 (+), CD10 (+), and IgG (+). In contrast, immunostaining of the biopsy specimen of the current cardiac tumor revealed CD20 (+), CD3 (−), suggesting that it was an isolated cardiac recurrence of stage 1 DLBCL presenting 16 years after achieving CR [ 4 ].…”

Section: Case Reportmentioning

confidence: 99%

Cardiac Recurrence of Diffuse Large B-cell Lymphoma More Than a Decade After Attaining Complete Remission

et al. 2018

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Patient: Female, 79Final Diagnosis: Cardiac recurrence of DLBCLSymptoms: Cardiogenic shockMedication: —Clinical Procedure: Biopsy specimenSpecialty: Cardiology/HematologyObjective:Unusual clinical courseBackground:Although diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in adults, isolated cardiac recurrence of DLBCL which can cause fatal heart failure via various mechanisms is extremely rare. Furthermore, the frequency of recurrence of DLBCL more than 5 years after attaining complete remission is as low as 3.6%. The rate of complete remission and partial remission of DLBCL that have recurred 5 or more years after attaining the initial remission are reported to be 61% and 29%, respectively.Case Report:A 79-year-old female with a history of DLBCL at the age of 63 years was transferred to our hospital because of cardiogenic shock. Although cardiac tamponade was suspected, her hemodynamics did not improve with pericardiocentesis. Thoracotomy showed an elastic to hard tumor occupying most of the right ventricular wall. Cytological examination of the pericardial effusion and histological examination of a biopsy of the tumor yielded a diagnosis of DLBCL; this information was available only post mortem. Immunostaining of a biopsy specimen suggested that her cardiac tumor was a recurrence of her lymphoma diagnosed 16 years previously. Bone marrow aspiration was not performed; no recurrences were detected in any other site. This patient thus appeared to have an isolated cardiac recurrence of DLBCL.Conclusions:When managing a patient with a cardiac tumor and a past history of DLBCL, albeit more than a decade previously, establishing a histological diagnosis as early as possible would facilitate possible successful treatment and a good prognosis.

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Cost‐effective approach to the diagnostic workup of B cell lymphoproliferative disorders via optimal integration of flow cytometric data

Cited by 2 publications

References 9 publications

The Systemic Lupus Erythematosus Infection Predictive Index (LIPI): A Clinical-Immunological Tool to Predict Infections in Lupus Patients

The Systemic Lupus Erythematosus Infection Predictive Index (LIPI): A Clinical-Immunological Tool to Predict Infections in Lupus Patients

Cardiac Recurrence of Diffuse Large B-cell Lymphoma More Than a Decade After Attaining Complete Remission

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