#diffuse large B-cell lymphoma

[jcsmicasereports]

Primary dural-based parafalcine diffuse large b-cell lymphoma mimicking meningioma by Amr El Mohamad in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Background: Primary dural-based diffuse large B-cell lymphoma is very rare. Only few cases were reported in the literature. Case presentation: Herein, we present a case of an immunocompetent patient with primary dural-based diffuse large B-cell lymphomas mimicking meningioma associated with ghost tumor phenomenon without any evidence of a systemic lymphoma. Conclusion: Primary central nervous system lymphomas are rare. Clinicians should always consider this lesion as a differential diagnosis if radiological findings are not indicative of typical one meningiomas.

Key words: Dural-based tumor, diffuse large B-cell lymphoma, ghost tumor, MATRIX regimen, central nervous system.

Introduction

Primary central nervous system lymphomas (CNSLs) (PCNSLs) are rare and account for 2%–5% of all brain tumor cases, whereas secondary CNSLs are more common [1,2]. One study has shown that the most common intraparenchymal histological type is diffuse large B-cell lymphoma, as among 26 patients with PCNSL, 25 had diffuse large B-cell lymphoma [3]. Although primary dural-based lymphomas are rare, the most common area of involvement is the cerebral hemispheres. Most dural-based lymphomas are secondary and present as extra-nodal systemic diffuse large B-cell lymphomas. Primary dural-based lymphomas are usually histologically marginal-zone lymphomas, representing a group of lymphomas that have been historically classified together because they appear to arise from post-germinal center and marginal-zone B cells and share a similar immunophenotype, and few cases were reported to be diffuse large B lymphomas [4]. Here, we present a case of an immunocompetent patient with primary dural-based diffuse large B-cell lymphomas mimicking meningioma associated with ghost tumor phenomenon without any evidence of systemic disease.

Case Presentation

A 58-year-old male individual previously healthy and immunocompetent presented with headache, recurrent vomiting, and memory problems lasting for 3 days. No loss of consciousness, seizure, subjective weakness, or fever was observed. On physical examination, the patient’s Glasgow coma scale score was 15; his pupils were 3 mm in diameter, equal, and reactive; and the patient had nominal aphasia without motor and sensory deficit. He had normal cerebellar functions, and cranial nerve exams revealed no deficit. Head computed tomography (CT) (Fig. 1) showed a 2.2 × 3.8 cm (transverse × anteroposterior) iso-dense lesion with internal hypodensity in the left parasagittal frontal region extending to the right frontal region. Extensive perilesional edema was observed with effacement of the sulci and mass effect on bilateral frontal horns, associated with 3-mm midline shift. Head magnetic resonance imaging (MRI) showed an isointense parasagittal lesion on T1 and heterogeneous intense on T2, with redemonstration of perifocal edema (Fig. 2). Head T1-weighted imaging with contrast enhancement (Fig. 3) showed a large, left frontal, parafalcine, irregular-shaped mass located below the superior sagittal sinus level. It measured 4 × 3 × 3.3 cm in anteroposterior, mediolateral, and craniocaudal, respectively. It showed diffusion restriction (Fig. 4). There was central hyperintensity on T2-weighted imaging, without post-contrast enhancement area representing cyst formation. It exerts a mass effect characterized by effacement of the adjacent sulci, compression of the left lateral ventricle, and a 3-mm shift of the midline structures to the right side, and the impression of our neuroradiologist was atypical meningioma. Regarding extensive edema, dexamethasone was started at a dose of 4 mg, thrice a day, and the patient was planned for craniotomy and resection of the tumor. Initially, the patient was reluctant to undergo surgery; however, subsequently, the patient agreed to undergo surgery after approximately 10 days. During surgery, parasagittal craniotomy was performed; however, to our surprise, no definite mass lesion was found at the proposed site, in contrast to the findings described on imaging. The falx was thinned out and partly deficient. A biopsy sample was obtained from this abnormally appearing falx. Moreover, we obtained biopsy samples under neuronavigation guidance from abnormally appearing tissue, which was completely intra-axial, deep down in the lesion visualized on navigation. On postoperative day 1, MRI head with contrast enhancement (Fig. 5) showed that the previously seen lesion had a significant regression in size. Its right frontal extension and adjacent enhanced meningeal tail showed size reduction. Moreover, some regression in the perilesional vasogenic edema was observed. A significant regression in the previously described enhancement was noted at the left-side lentiform nucleus and external capsule. The MR spectroscopy study showed an increased choline/N-acetyl aspartate ratio and elevated lactate level within the lesion.

The histopathology results of the first brain biopsy samples (Figs.6–7) obtained from the falx cerebri showed meningothelial hyperplasia with calcification and focal perivascular lymphocytic infiltrate composed of small and large, atypical lymphocytes. Immunohistochemical staining was performed; however, the area of interest disappeared. The pathology team recommended another fresh biopsy to have the final diagnosis and flowmetry studies. So, the patient underwent redo craniotomy using the same incision, and multiple biopsy samples were taken. The second fresh brain biopsy (Figs. 8–9) showed multiple brain fragments with predominant perivascular atypical lymphoid infiltrates. Most cells were medium to large with moderate cytoplasm, atypical irregular nuclei having vesicular chromatin, variably prominent nucleoli, and several mitoses, including atypical one. Necrotic areas were also seen. Immunohistochemistry of the second biopsy (Fig.10 A-D) showed that atypical perivascular cells were positive for CD45, CD20, CD79a, BCl2, BCl6, MUM1, OCT2, and C-MYC, and negative for CD10, CD21, TDT, ALK1, EBV-LMP1, CD3, and CD5; however, few reactive/residual lymphocytes were positive for these enzymes. Moreover, 80% of lymphoid cellular nuclei were positive for Ki67. These findings were consistent with diffuse large B-cell lymphoma, not otherwise specified.

Whole-body positron emission tomography (PET) showed intense fluorodeoxyglucose (FDG) uptake higher than that in the healthy brain cortex, without evidence of coexisting systemic disease. In addition to PET scan, contrast-enhanced chest, abdomen, pelvis CT did not show any other lesions in the body; furthermore, workup for viral markers and autoimmune conditions were all unremarkable, thus confirming the diagnosis of “primary dural-based diffuse large B-cell lymphoma,” distinguishing it from secondary CNSL. The patient was transferred to the Oncology Department and started on three cycles of the methotrexate, cytarabine, thiotepa, and rituximab (MATRIX) protocol, which is the current standard treatment regimen for PCNSLs [5]. Three months after the diagnosis and after receiving two cycles of the MATRIX protocol, brain MRI with contrast enhancement (Fig. 11A, B) showed regression of the lesion, and PET scan showed complete metabolic resolution in terms of decreased FDG activity of the previously seen PCNSL without signs of lymphoma activity elsewhere. Subsequently, the patient received the third cycle of the MATRIX protocol without specific complications. Two weeks later, autologous stem cell transplantation (50 × 106/kg) was performed as part of the consolidation phase of treatment. Six weeks later, conditioning chemotherapy with carmustine–thiotepa was administered, followed by stem cell infusion (CD34 = 12 million/kg). The post-transplant course was complicated with mucositis, folliculitis, diarrhea, febrile neutropenia, and prolonged thrombocytopenia. Two months after transplantation, PET scan was repeated and showed complete metabolic resolution of initially seen PCNSL involvement. Currently, the patient is being followed by the hematology team; the patient is in good health and remission. The last outpatient follow-up was 8 months after the first surgery. The patient was seen by the vascular surgery (for permcath removal) and oncology teams. At this time, the patient was stable with complete remission; then, the patient was lost to follow-up. Another head MRI was performed and showed almost total regression of the lesion.

Discussion

Lymphomas in CNS are classified as primary, arising de novo from brain parenchyma, leptomeninges, eye, and spinal cord and as secondary to systemic lymphoma, which can be dural-based lesions. Secondary CNSLs are more common than PCNSLs. Most PCNSLs are intraparenchymal diffuse large B-cell lymphomas with a predilection to occur in the frontal lobe and then deep nucleic and periventricular locations; the infratentorial cerebellum is the most common location. However, primary dural-based lymphomas are rare, and even when found, they are histologically marginal-zone lymphomas. Few cases of primary dural-based diffuse large B-cell lymphoma have been reported in the literature [4,6]. Furthermore, PCNSLs are more common in immunocompromised patients with a mean age of 34 years, and they occur in immunocompetent individuals at an older age with a mean of 52 years [7]. The patient in this case report was 58 years old and immunocompetent without significant previous medical conditions. The latest review of the literature on primary dural-based lymphoma has been conducted by Quinn et al., who have found only 24 reported cases of primary dural-based diffuse large B-cell lymphoma, which confirms the rarity of the disease and subsequently the limited knowledge regarding this disease entity [8]. CNSLs have rapid response to steroids with shrinkage in size and initial remission [9]. Moreover, the initial response to steroids is associated with a better response to chemoradiotherapy and good prognosis [9]. In the patient in this case report, there was an unintentional delay of surgery for approximately 10 days, and the patient was on steroids (dexamethasone). In this case report, the failure to identify a discrete lesion of the size expected as perceived on initial imaging, despite proper surgical planning using neuronavigation, was probably due to the rapid regression of the tumor in response to steroids. This phenomenon agrees with the scientific literature reporting about the disappearance of lymphomas in response to steroids (ghost tumors) [10,11]. The pathogenesis of primary dural-based lymphoma remains unknown as there is no lymphoid tissue in the dura. It is hypothesized that it is related to chronic infection, autoimmune disease, or chronic inflammatory condition, which recruits polyclonal lymphocytes resulting in monoclonal lymphomas [6]. In contrast, the patient in this case report did not have any chronic conditions. All workups were negative, including the entire viral panel and autoimmune markers. Basic research is needed to determine the etiology of PCNSL, especially dural-based lymphomas. In the patient in this case report, the initial radiological findings were mimicking those of a meningioma: dural-based and uniformly enhanced. There was significant surrounding edema, significant diffusion restriction, and blooming in susceptibility-weighted image, which goes more with higher-grade meningioma or another high-grade lesion. One review has shown that primary dural-based lymphomas can display the “dural tail “sign, further confusing the preoperative diagnosis with meningioma [12], which did happen in the patient in this case report. Therefore, we suggest that in case of a dural-based lesion that has non-typical features of grade 1 meningioma, clinicians should consider lymphoma in the differential diagnosis and avoid steroids unless necessary due to edema and mass effect keeping in mind the ghost tumor phenomena of lymphoma.

The role of surgery in PCNSLs is limited mainly to histological diagnosis through biopsy or tumor debulking in case of increased intracranial pressure or impending brain herniation. Some studies have shown no benefit of complete surgical resection of PCNSLs; however, a recent systematic review of 244 articles has shown evidence in support of cytoreductive surgery [13]. Previously, whole-brain radiotherapy (WBRT) was the recommended treatment; however, this treatment modality resulted in a high rate of relapse and a decrease in performance status and cognitive impairment, and with the improvement in survival with high-dose methotrexate, WBRT is no longer recommended. Currently, newly diagnosed PCNSLs are initially treated with induction chemotherapy until complete radiological response, followed by consolidation therapy, to prolong the overall survival [14]. The International Extra Nodal Lymphoma Study Group-32 trial has shown that a methotrexate-based MATRIX regimen results in a good outcome and control rate in PCNSL [5], and it is the standard induction chemotherapy. Ferreri AJM, in his article “The role of autologous stem cell transplantation in PCNSL” has compared various consolidation phase treatment modalities, including beam radiation, carmustine–thiotepa regimens, and autologous stem cell transplantation, and the results showed that autologous stem cell transplantation resulted in good outcomes [15]. The patient in this case report showed a good response to treatment with almost total resolution of PCNSL with three cycles of MATRIX chemotherapy, followed by conditioning chemotherapy with stem cell infusion.

Conclusion

PCNSL is a rare entity. Clinicians should always consider it in differential diagnosis of meningioma if the radiological findings are not typical for meningioma. When there is a high index of suspicion of lymphoma, repeating neuroimaging, particularly MRI, before surgery, especially if the surgery is delayed while the patient is on steroids, may help develop a better management plan while dealing with this rare lesion. In case of lesion disappearance, falx biopsy can be an option. The aim of surgery in PCNSL is mainly biopsy or debulking to decrease intracranial pressure in case of significant mass effect.

List of abbreviation:

Primary central nervous system lymphomas (PCNSLs)

Central nervous system lymphomas (CNSLs)

Head computed tomography (CT)

magnetic resonance imaging (MRI)

positron emission tomography (PET)

fluorodeoxyglucose (FDG)

whole-brain radiotherapy (WBRT)

[ustechbog]

Report Overview: Summary of the clinical trial landscape for Diffuse Large B-Cell Lymphoma, including phase-wise analysis, sponsor type, regional distribution, trial status, and primary endpoints. Key Findings: Highlights of major clinical advancements, notable sponsors, promising treatment approaches, and regional activity hotspots.

[phoebesbridgers]

What’s His Age Again? Blink-182’s Mark Hoppus (Now 53) Looks Back.

The sometimes fraught relationship between Hoppus and DeLonge is what Ozzi described as the “real bromance” at the center of the memoir. Fellow skate punks and self-taught musicians with a penchant for phallus jokes, the pair first met in San Diego County in 1992. Hoppus — the son of a homemaker mother and an aerospace engineer father who split up when he was in the third grade — was 20 and drifting through college. DeLonge, three years his junior, was a high school miscreant.

FULL NY TIMES ARTICLE UNDER THE CUT

In early March, Mark Hoppus, the singer and bassist for the long-running pop-punk trio Blink-182, and his wife, Skye, were special guests at a Sotheby’s modern and contemporary art auction in London. The sale featured a piece from their collection, a rare Banksy titled “Crude Oil (Vettriano),” up alongside works by Yoshitomo Nara, Gerhard Richter and Vincent van Gogh.

“It was such rarefied air that we’ve never been a part of before,” Hoppus recalled at his home a week later, outfitted in chunky black glasses, a Dinosaur Jr. long-sleeve T-shirt, navy blue Dickies and Gucci Mickey Mouse sneakers. The painting sold for nearly $5.5 million, part of which will go to charity.

It would have been hard to predict such a highfalutin turn for Hoppus back in 1999, when Blink-182 released its magnum opus, “Enema of the State,” which catapulted the band to MTV “Total Request Live” stardom and sold five million copies domestically. The video for the album’s first single, the jocular “What’s My Age Again?,” famously features the band members running unclothed through the streets of Los Angeles. (“Naked dudes are so ridiculous,” Hoppus said. “It just looks comical to me.”) Blink-182 followed up that LP with its first No. 1 album, “Take Off Your Pants and Jacket,” two years later.

Despite Blink-182’s reputation for high jinks, naughty puns and charmingly adolescent hits like “All the Small Things,” Hoppus is remarkably thoughtful in person. Jim Adkins, whose group, Jimmy Eat World, supported Blink-182 and Green Day on a 2002 tour, said in an interview that Hoppus exhibited “human empathy.”

“I know ‘Mark from Blink-182 is emotionally mature’ might seem like an oxymoron if you don’t know him,” Adkins admitted, “but I would say that.”

That maturity translates to the page. In his memoir, “Fahrenheit-182,” written with the music journalist Dan Ozzi and out April 8, Hoppus details Blink-182’s turbulent history and contemplates his own mortality with grace and good humor. The band’s “Behind the Music”-worthy history includes near-death experiences, bitter splits and world-conquering tours. In 2021, Hoppus was diagnosed with Stage 4A diffuse large B-cell lymphoma and underwent an arduous course of chemotherapy. (“I was all decay and poison,” he writes. “Everyone I talked to cried. Every conversation felt like goodbye.”) He now has a clean bill of health.

Hoppus, a 53-year-old California native, was sitting cross-legged on a chair in the round sunken den at the heart of his exquisite midcentury modern house, which was designed by the architect Harold Levitt. “This room is where I’ve suffered the most,” said the musician, who wore his hair, which he had lost during chemo, in a towering front spike. “This room is where I’ve had the most difficult self-reflection and conversations of my whole life.” He compared it to Superman’s Fortress of Solitude.

“When the band broke up, I sat right here on our couch and just despaired,” he said, referring to the first of two times the singer and guitarist Tom DeLonge walked away from Blink-182, only to eventually return. “I was so filled with animosity and hatred and rage, and I just wanted to get back in our band,” he continued, dropping a number of expletives.

But “Fahrenheit-182” never turns meanspirited or dour. “The book has no demons in it,” Hoppus said. He mentioned that he’d discussed his memoir on the phone with his psychiatrist — Hoppus is treated for obsessive-compulsive disorder, intrusive thoughts, depression and anxiety — earlier that day. “I think that writing the book helped solve a lot of ongoing issues in my life, because I was trying to write it with an even hand,” he said.

The sometimes fraught relationship between Hoppus and DeLonge is what Ozzi described as the “real bromance” at the center of the memoir. Fellow skate punks and self-taught musicians with a penchant for phallus jokes, the pair first met in San Diego County in 1992. Hoppus — the son of a homemaker mother and an aerospace engineer father who split up when he was in the third grade — was 20 and drifting through college. DeLonge, three years his junior, was a high school miscreant.

“Our musical styles fit exactly, and his humor was just as abrasive and as offensive as mine was,” DeLonge, 49, recalled in an interview. “We both came from broken families and saw the world the same way.”

The fast friends formed a band, originally known simply as Blink, with an even younger drummer, Scott Raynor. Blink’s first studio album, “Cheshire Cat” from 1995, did surprisingly well for the independent Cargo Music, and the band leaped to a major label, MCA. In 1997, Blink-182 released the LP “Dude Ranch,” scoring a hit with “Dammit,” a boisterous track with an indelible refrain, delivered by Hoppus: “Well, I guess this is growing up.” Hoppus and DeLonge ended up firing a troubled Raynor and replacing him with the tattooed powerhouse Travis Barker, of another California band, the Aquabats, before recording “Enema of the State.”

It was easy to dismiss Blink-182 in the early days. “When we first came on the scene, the gatekeepers and the people in charge were so focused on Blink’s comedy side, our silliness, that it prevented them from looking deeper,” Hoppus said. “But we did it to ourselves. We played naked. We do mom jokes, Tom and I, back-and-forth onstage, nonstop.” If it weren’t for the many hits Blink-182 scored in the wake of “What’s My Age Again?,” Barker said in an interview, “We very well could have been pigeonholed as the naked band.”

Over the years, Blink-182 only grew in stature among fellow musicians, inspiring emo bands in the 2000s — Fall Out Boy, Panic! at the Disco, Paramore — and the latest generation of pop-punk acts, including MGK (formerly Machine Gun Kelly) and Meet Me @ the Altar. “Look how big Blink-182 is now,” said the Meet Me @ the Altar drummer Ada Juarez, 26, who pointed out she was born the year “Enema of the State” came out. “You can listen to it today, and it still fits. A lot of it has to do with Tom and Mark’s parts and the way that their voices just fit so well together.”

The band’s sphere of influence extends to less-expected genres. “There are emo rappers who say, ‘I grew up listening to Blink-182,’” Hoppus said. “There are dudes playing in the shreddiest heavy metal bands saying, ‘I grew up listening to Blink-182.’ The Chainsmokers are like, ‘We grew up listening to Blink-182.’ I love that celebration and that connection.”

Readers coming to “Fahrenheit-182” for gossip will be disappointed for the most part. There is, for instance, barely a mention that Barker is married to a Kardashian. “It’s not ‘The Dirt,’” Hoppus said, referring to Mötley Crüe’s debauched tell-all. “It’s a PG-13 book.” The memoir does, however, provide insight into strife within Blink. After DeLonge’s 2005 departure broke up the group for the first time, he and Hoppus didn’t talk for several years. “It was awful,” Hoppus said. “I felt like my world had been rugged.”

DeLonge called that rupture “a tale as old as time.”

“When you start a band, it’s just you guys,” he said. “You all have the same dream, same aspirations, same work schedule, same passion, same drive. Then each person finds a spouse, might have kids, might start extracurricular activities.” (DeLonge, who formed the alternative rock band Angels & Airwaves in 2005, is a well-known U.F.O. researcher.) “That just creates issues amongst the band members that I wasn’t even emotionally intelligent enough to communicate or understand or be able to remedy.”

Barker’s near death in 2008 — he survived a plane crash that killed four of the six people onboard — precipitated a Blink reunion, but after five years and just one album, DeLonge bailed again. “I don’t think we were all healed, and we didn’t fully trust each other,” he said. This time, Hoppus and Barker replaced him with Matt Skiba, the singer and guitarist for the Chicago punk band the Alkaline Trio.

“I remember that first Roxy show being mildly terrified and looking over at Mark cracking jokes,” said Skiba, who went on to record two albums with Blink. “His joy would just bring me back into the moment.”

Just as the world was beginning to emerge from the pandemic, Hoppus learned he had cancer. “It got really dark,” he said, recounting a conversation with Skye, with whom he has a 22-year-old son, Jack, a video game designer. “We were sitting in our kitchen and I was dying — the medication, the chemo, was just so gnarly,” he recalled. “Felt like I was being crushed between two trucks. I was like, ‘I don’t know if I can do this.’

“My wife goes, ‘What are you saying? Are you going to kill yourself?’” he continued. “And that moment really crystallized the fight for me. That was when I was like, ‘This is a losing battle, but I have to fight the fight. I can’t just give up in front of my wife and son.’”

When DeLonge found out about Hoppus’s illness, the resentments dropped away. “I was very quick to say, ‘I’m all in, Mark,’” DeLonge said. “‘When — not if — you’re done with these treatments, the north star is we’re going to play again. Let’s do that for each other.’”

Hoppus was cleared of cancer in September 2021, and a year later, he, DeLonge and Barker announced that they were reuniting again. In 2023, Blink released its ninth studio album, “One More Time…,” which became the group’s third record to hit No. 1 on the Billboard 200.

“I don’t think the band’s relationship has ever been as healthy or as strong as it is now,” Barker said. “We love this version of our band.” DeLonge marveled at Blink’s longevity: “Plane crash, cancer, top of the charts, breakups. It’s absolutely bananas that we’re still here.”

Blink-182 will continue so long as it’s still fun, Hoppus said. “The one thing that we have all agreed on, and promised one another, is we have no desire to become a legacy band,” he said. “We don’t want to ride off into the sunset playing ‘All the Small Things’ at casinos ad nauseam. I want to play ‘All the Small Things’ forever, but I also want to keep creating new music that connects with people.”

[diagnosed-weird]

I've gotten several asks from you fine folks asking where I've been the last couple years.

Shortly after my last post, I had several family medical emergencies.

My grandfather (89 at the time) was in and out of the hospital.

Then when he got better, my dad was diagnosed with Diffuse Large B-Cell Lymphoma that started in his brain. I spent 10 months taking him back and forth to the hospital, taking my mom back and forth when my dad was admitted, or caring for him at home while he was on hospice. He spent 2 months at home on hospice when he passed in April 2024 at the age of 70.

The literal day after my dad died, my grandfather was diagnosed with another form of lymphoma, aged 90 at that point. Thankfully, his is slow moving and we're in an observe and monitor plan. I've been slowly caring for him more and more over the last 10 months and hopefully he'll get to see his 92nd birthday this July.

I've continued caring for my mom over all of this. I've had my very supportive fiance by my side. My son has grown so much and is becoming a fantastic person as he learns to navigate this world.

It's been a strange 2 years. Death and cancer are bitches. I'm still here. Doing the best I can.

[valiha]

Seven years ago on this day I was waiting to be wheeled into surgery for doctors to remove a growth and send it to pathohistology. A month later I got the results and a diagnosis of stage three diffuse large B-cell Non-Hodgkin lymphoma. Soon after they started me on chemotherapy.

It was a long and difficult fight, but I managed to pull through. They say passing a five-year mark is a good sign; I am now two years beyond that point and I intend to continue moving forward, one year after another.

[drforambhuta]

The decision to undergo bone marrow transplantation (BMT) in a lymphoma patient is highly personalized and depends on several key factors:

• Histological Subtype: The specific form of lymphoma greatly influences treatment choices. For example, aggressive diffuse large B-cell lymphoma (DLBCL) or refractory Hodgkin lymphoma may require BMT.

• Disease Stage: The stage at the time of diagnosis plays a crucial role. BMT is often considered for advanced-stage lymphomas or those that have recurred after initial treatments.

• Response to Previous Therapies: Patients who do not achieve remission or experience a recurrence after traditional therapies may explore BMT as a treatment option.

• Age and Overall Health: The patient's age and general health significantly impact their ability to withstand the demanding BMT process.

• Donor Availability: In the case of allogeneic stem cell transplantation (allo-SCT), locating a compatible donor, typically a sibling or a well-matched unrelated individual, can be a complex undertaking.

A bone marrow transplant can be recommended in other medical conditions besides lymphoma, like leukemia, aplastic anemia, thalassemia, myeloma, and sickle cell disease. You can choose to undergo a bone marrow transplant from some of the best hospitals in Delhi. The cost of bone marrow transplant in Delhi will vary depending on the type and severity of condition being treated and the type of bone marrow transplant being performed.

[ghdrhseyhet]

Diffuse Large B Cell Lymphoma: Symptoms, Diagnosis, and Treatment

Introduction to Diffuse Large B Cell Lymphoma

Diffuse Large B Cell Lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), accounting for about 30% of all cases. This aggressive cancer originates in the B cells, a type of white blood cell responsible for producing antibodies. DLBCL can develop in lymph nodes or other organs and spreads rapidly if left untreated.

Understanding the symptoms, diagnostic procedures, and treatment options for Diffuse Large B Cell Lymphoma is crucial for early detection and effective management.

Symptoms of Diffuse Large B Cell Lymphoma

The symptoms of DLBCL can vary depending on where the cancer is located. Some common signs include:

Swollen Lymph Nodes – Painless swelling in the neck, armpits, or groin.

B Symptoms – Fever, night sweats, and unexplained weight loss (more than 10% of body weight in six months).

Fatigue – Persistent tiredness due to the body’s immune response.

Abdominal Pain or Swelling – If the lymphoma affects the abdomen or digestive tract.

Shortness of Breath – If the tumor presses against the lungs or airways.

Neurological Symptoms – Confusion, weakness, or seizures if the central nervous system is involved.

Because these symptoms can mimic other conditions, proper medical evaluation is essential.

Causes and Risk Factors of DLBCL

The exact cause of Diffuse Large B Cell Lymphoma is unknown, but several risk factors have been identified:

Age – Most common in people over 60, though it can occur at any age.

Weakened Immune System – Individuals with HIV/AIDS, autoimmune diseases, or those taking immunosuppressive drugs are at higher risk.

Infections – Certain viruses, such as Epstein-Barr virus (EBV) and hepatitis C, have been linked to lymphoma development.

Genetic Mutations – Abnormalities in genes like MYC, BCL2, and BCL6 can contribute to aggressive lymphoma growth.

Environmental Factors – Exposure to pesticides, herbicides, or certain chemicals may increase risk.

Diagnosis of Diffuse Large B Cell Lymphoma

Accurate diagnosis of DLBCL involves multiple tests:

1. Physical Examination

Doctors check for swollen lymph nodes, liver, or spleen enlargement.

2. Blood Tests

Complete blood count (CBC) to detect abnormalities.

Lactate dehydrogenase (LDH) levels, which are often elevated in aggressive lymphomas.

3. Imaging Tests

CT Scan – Identifies enlarged lymph nodes or tumors.

PET Scan – Helps determine the cancer’s stage and spread.

MRI – Used if central nervous system involvement is suspected.

4. Biopsy

A lymph node or tissue sample is examined under a microscope to confirm DLBCL and classify its subtype.

5. Bone Marrow Biopsy

Determines if lymphoma has spread to the bone marrow.

6. Molecular and Genetic Testing

Tests like fluorescence in situ hybridization (FISH) detect genetic abnormalities that influence treatment choices.

Staging Diffuse Large B Cell Lymphoma

The Ann Arbor staging system is used to classify DLBCL:

Stage I – Cancer is in one lymph node region or a single organ.

Stage II – Two or more lymph node regions on the same side of the diaphragm are affected.

Stage III – Lymph nodes on both sides of the diaphragm are involved.

Stage IV – Cancer has spread to organs like the liver, lungs, or bone marrow.

The presence of B symptoms (fever, night sweats, weight loss) is also noted as "B" designation, indicating a more aggressive disease.

Treatment Options for DLBCL

Treatment for Diffuse Large B Cell Lymphoma depends on the stage, patient’s age, and overall health. Common approaches include:

1. Chemotherapy

The R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is the standard first-line treatment.

2. Immunotherapy

Rituximab (anti-CD20 antibody) targets B cells.

CAR T-cell therapy (e.g., axicabtagene ciloleucel) is used for relapsed/refractory cases.

3. Radiation Therapy

Used for localized disease or to relieve symptoms in advanced stages.

4. Stem Cell Transplant

High-dose chemotherapy followed by autologous stem cell transplant may be recommended for relapsed patients.

5. Targeted Therapy

Drugs like ibrutinib (BTK inhibitor) or lenalidomide are options for specific subtypes.

6. Clinical Trials

New treatments, such as bispecific antibodies and checkpoint inhibitors, are being studied.

Prognosis and Survival Rates

The prognosis for DLBCL varies based on factors like:

International Prognostic Index (IPI) score (age, stage, LDH levels, performance status).

Cell of origin (germinal center vs. activated B-cell subtype).

With treatment, the 5-year survival rate is approximately:

60-70% for early-stage DLBCL.

30-40% for advanced or high-risk cases.

Relapse can occur, but newer therapies like CAR T-cell therapy offer hope for refractory patients.

Living with Diffuse Large B Cell Lymphoma

Managing DLBCL involves:

Regular follow-ups to monitor remission.

Managing side effects (fatigue, infections, neuropathy).

Nutritional support and physical activity to improve recovery.

Emotional and psychological support through counseling or support groups.

Conclusion

Diffuse Large B Cell Lymphoma is a fast-growing but treatable cancer. Early diagnosis and advances in immunotherapy have improved outcomes significantly. Patients should work closely with their healthcare team to determine the best treatment plan.

Ongoing research continues to explore novel therapies, offering hope for better survival and quality of life for those affected by DLBCL.

This article provides a comprehensive overview of Diffuse Large B Cell Lymphoma, covering symptoms, diagnosis, treatment, and prognosis. If you or a loved one are experiencing concerning symptoms, consult a hematologist or oncologist for evaluation.

[gireportstory]

Global CAR T-Cell Therapy End-Use Market Future Growth Forecast 2025-2031

On 2025-3-11 Global Info Research released【Global CAR T-Cell Therapy Market 2025 by Manufacturers, Regions, Type and Application, Forecast to 2031】. This report includes an overview of the development of the CAR T-Cell Therapy industry chain, the market status of Consumer Electronics (Nickel-Zinc Ferrite Core, Mn-Zn Ferrite Core), Household Appliances (Nickel-Zinc Ferrite Core, Mn-Zn Ferrite Core), and key enterprises in developed and developing market, and analysed the cutting-edge technology, patent, hot applications and market trends of CAR T-Cell Therapy. According to our (Global Info Research) latest study, the global CAR T-Cell Therapy market size was valued at US$ 4205 million in 2023 and is forecast to a readjusted size of USD 21660 million by 2030 with a CAGR of 25.4% during review period. CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is an innovative form of immunotherapy that involves genetically modifying a patient’s own T cells to express a specific chimeric antigen receptor (CAR) on their surface. This receptor enables the T cells to target and destroy cancer cells effectively. CAR-T therapy has shown significant success in treating hematological malignancies, such as acute lymphoblastic leukemia (ALL) and certain types of lymphomas, and is being explored for its potential applications in solid tumors. The CAR-T Cell Therapy market is primarily driven by its groundbreaking effectiveness in treating certain types of hematological malignancies, such as acute lymphoblastic leukemia (ALL) and diffuse large B-cell lymphoma (DLBCL), particularly in patients who are refractory to standard treatments. The rising incidence of cancer globally and the growing demand for personalized and targeted therapies have further fueled market growth. In addition, advancements in genetic engineering and manufacturing processes are making CAR-T therapies safer, more efficient, and increasingly accessible. The strong support from government initiatives and private investments in oncology research is also accelerating the development of next-generation CAR-T products, expanding their therapeutic potential to include solid tumors.However, the market faces significant challenges, including the high cost of CAR-T therapies, which can exceed hundreds of thousands of dollars per treatment, making it inaccessible to many patients. The complex and time-consuming manufacturing process, which involves extracting and engineering a patient’s T cells, further contributes to these high costs. Additionally, CAR-T therapy is associated with severe side effects, such as cytokine release syndrome (CRS) and neurotoxicity, which require specialized management and can limit its broader adoption. Regulatory hurdles and the need for improved scalability also present obstacles, particularly in developing regions where healthcare infrastructure may be inadequate to support this advanced therapy. The global top three CAR T-Cell therapy players include Novartis, Gilead Sciences, Bristol-Myers Squibb, with a total market share of more than 99%. The largest player is Gilead Sciences, with a market share of over 50%. North America is the global most important consumer market for CAR T-Cell therapy, with a market share of more than 65%. In terms of type, CD19-targeted CAR cell therapy has a market share of over 90%. In the field of application, the market share of lymphoma exceeds 90%. This report is a detailed and comprehensive analysis for global CAR T-Cell Therapy market. Both quantitative and qualitative analyses are presented by company, by region & country, by Type and by Application. As the market is constantly changing, this report explores the competition, supply and demand trends, as well as key factors that contribute to its changing demands across many markets. Company profiles and product examples of selected competitors, along with market share estimates of some of the selected leaders for the year 2024, are provided.

Market segment by Type： CD19 - Targeted、BCMA - Targeted Market segment by Application：Lymphoma、Multiple Myeloma Major players covered： Novartis、Gilead Sciences、Bristol-Myers Squibb、J & J、JW Therapeutics、FOSUNKite、CARsgen Therapeutics (Pipeline)、Autolus Therapeutics(Pipeline)、Sorrento Therapeutics(Pipeline)、Mustang Bio(Pipeline)、Bluebird Bio(Pipeline)、Cellectis(Pipeline)、Allogene Therapeutics(Pipeline)、Celyad(Pipeline)

Market segment by region, regional analysis covers: North America (United States, Canada and Mexico), Europe (Germany, France, United Kingdom, Russia, Italy, and Rest of Europe), Asia-Pacific (China, Japan, Korea, India, Southeast Asia, and Australia),South America (Brazil, Argentina, Colombia, and Rest of South America),Middle East & Africa (Saudi Arabia, UAE, Egypt, South Africa, and Rest of Middle East & Africa). The content of the study subjects, includes a total of 15 chapters: Chapter 1, to describe CAR T-Cell Therapy product scope, market overview, market estimation caveats and base year. Chapter 2, to profile the top manufacturers of CAR T-Cell Therapy, with price, sales, revenue and global market share of CAR T-Cell Therapy from 2020 to 2025. Chapter 3, the CAR T-Cell Therapy competitive situation, sales quantity, revenue and global market share of top manufacturers are analyzed emphatically by landscape contrast. Chapter 4, the CAR T-Cell Therapy breakdown data are shown at the regional level, to show the sales quantity, consumption value and growth by regions, from 2020 to 2031. Chapter 5 and 6, to segment the sales by Type and application, with sales market share and growth rate by type, application, from 2020 to 2031. Chapter 7, 8, 9, 10 and 11, to break the sales data at the country level, with sales quantity, consumption value and market share for key countries in the world, from 2020 to 2024.and CAR T-Cell Therapy market forecast, by regions, type and application, with sales and revenue, from 2025 to 2031. Chapter 12, market dynamics, drivers, restraints, trends and Porters Five Forces analysis. Chapter 13, the key raw materials and key suppliers, and industry chain of CAR T-Cell Therapy. Chapter 14 and 15, to describe CAR T-Cell Therapy sales channel, distributors, customers, research findings and conclusion.

Data Sources: Via authorized organizations:customs statistics, industrial associations, relevant international societies, and academic publications etc. Via trusted Internet sources.Such as industry news, publications on this industry, annual reports of public companies, Bloomberg Business, Wind Info, Hoovers, Factiva (Dow Jones & Company), Trading Economics, News Network, Statista, Federal Reserve Economic Data, BIS Statistics, ICIS, Companies House Documentsm, investor presentations, SEC filings of companies, etc. Via interviews. Our interviewees includes manufacturers, related companies, industry experts, distributors, business (sales) staff, directors, CEO, marketing executives, executives from related industries/organizations, customers and raw material suppliers to obtain the latest information on the primary market; Via data exchange. We have been consulting in this industry for 16 years and have collaborations with the players in this field. Thus, we get access to (part of) their unpublished data, by exchanging with them the data we have.

From our partners.We have information agencies as partners and they are located worldwide, thus we get (or purchase) the latest data from them. Via our long-term tracking and gathering of data from this industry.We have a database that contains history data regarding the market.

Global Info Research is a company that digs deep into global industry information to support enterprises with market strategies and in-depth market development analysis reports. We provides market information consulting services in the global region to support enterprise strategic planning and official information reporting, and focuses on customized research, management consulting, IPO consulting, industry chain research, database and top industry services. At the same time, Global Info Research is also a report publisher, a customer and an interest-based suppliers, and is trusted by more than 30,000 companies around the world. We will always carry out all aspects of our business with excellent expertise and experience.

[impomed]

A breakthrough in lymphoma treatment, Glofitamab Injection in India is designed for adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL). This targeted therapy boosts the immune system to fight cancer cells effectively. Impomed Healthcare ensures easy access to this innovative medication, supporting patients in receiving advanced oncology care. With immunotherapy advancements, this treatment is redefining lymphoma management, providing new possibilities for those seeking effective and reliable cancer solutions. For more information visit: https://www.impomedhealthcare.com

[blackbiobiotech]

The Role of MYD88 and ROS1 Mutations in Cancer Diagnosis and Treatment

Molecular diagnostics have transformed cancer detection and treatment by identifying specific genetic mutations linked to various malignancies. Among these, MYD88 and ROS1 mutations play a crucial role in guiding targeted therapies for lymphoma and lung cancer. Early and accurate identification of these mutations helps clinicians make informed treatment decisions, improving patient outcomes. Advanced testing methods like the MYD88 PCR Kit, MYD88 Mutation Detection Kit, ROS1 Mutations Kit, and ROS1 PCR Kit provide precise detection of these alterations, allowing for personalized cancer care.

The MYD88 gene is essential for immune signaling, but mutations in this gene, particularly the MYD88 L265P mutation, have been strongly linked to Waldenström macroglobulinemia (WM), diffuse large B-cell lymphoma (DLBCL), and other B-cell malignancies. These mutations lead to uncontrolled cell growth and survival, making them key diagnostic markers for hematological cancers. Detecting MYD88 mutations through PCR-based assays ensures highly sensitive and specific results, helping oncologists diagnose and manage these cancers effectively. Traditional diagnostic methods often lack the accuracy required to detect low-frequency mutations, making molecular testing indispensable.

Similarly, the ROS1 gene is a receptor tyrosine kinase involved in cell growth and survival. Gene rearrangements or fusions in ROS1 are particularly significant in non-small cell lung cancer (NSCLC), affecting a small but critical subset of patients. ROS1 gene fusions lead to uncontrolled cancer progression, but they also present an opportunity for targeted therapy using ROS1 inhibitors, which have shown remarkable effectiveness in treating ROS1-positive lung cancer. Identifying these rearrangements early using ROS1 PCR-based kits allows for timely intervention, giving patients access to life-saving precision medicine.

Cancer treatment has shifted towards a personalized approach, where genetic profiling determines the most effective therapy for each patient. MYD88 and ROS1 mutations serve as key biomarkers in this approach, guiding treatment decisions and ensuring patients receive targeted therapies suited to their genetic profile. PCR-based diagnostic kits for these mutations have improved the speed and accuracy of cancer diagnosis, leading to earlier intervention and better disease management.

The MYD88 PCR Kit and MYD88 Mutation Detection Kit developed by 3B BlackBio Biotech are designed to accurately detect MYD88 mutations, providing essential insights for diagnosing hematological malignancies. Similarly, the ROS1 Mutations Kit and ROS1 PCR Kit enable the precise detection of ROS1 gene fusions, helping oncologists identify lung cancer patients eligible for targeted treatment. These advanced diagnostic tools have revolutionized molecular oncology by offering rapid, reliable, and highly sensitive testing solutions.

With continuous advancements in genetic testing, molecular diagnostics have become a cornerstone of modern oncology. The ability to detect MYD88 and ROS1 mutations with high accuracy has significantly improved patient outcomes, allowing for more effective and personalized treatment strategies.

[biotech-news-feed]

Columvi plus chemotherapy showed a 41% reduction in the risk of death in the pivotal phase III STARGLO study1,2 DLBCL—an aggressive disease with a high risk of progression—remains an area of high unmet need, especially for treatments that can be ini #BioTech #science

[delveinsight12]

CAR-T Market Size, Target Population, Competitive Landscape, and Market Forecast to 2034

Introduction to CAR-T Cell Therapy

Chimeric Antigen Receptor T-cell (CAR-T) therapy has revolutionized cancer treatment by using genetically modified T cells to target and destroy cancer cells. Its potential to offer durable remissions for patients with otherwise incurable malignancies, particularly hematologic cancers, has driven significant growth and interest in this market. By 2034, the CAR-T therapy market is anticipated to witness robust expansion, driven by technological advancements, expanded indications, and increased global accessibility.

CAR-T Market Size and Growth Projections

The global CAR-T therapy market is projected to grow at a compound annual growth rate (CAGR) exceeding 25% through 2034, reaching multi-billion-dollar valuations. This growth is fueled by the approval and commercialization of novel therapies, expansion into solid tumors, and increased adoption in both developed and emerging markets.

Regions such as North America and Europe currently dominate the market due to established healthcare systems and regulatory frameworks. However, significant growth is anticipated in Asia-Pacific regions, where unmet needs and rising healthcare investments present a lucrative opportunity for market players.

Read more about CAR-T Market @ https://www.delveinsight.com/report-store/car-t-market-forecast

Key factors influencing CAR-T market growth include:

1. Expanding Indications: Initially approved for specific hematologic cancers like acute lymphoblastic leukemia (ALL) and diffuse large B-cell lymphoma (DLBCL), CAR-T therapies are now being developed for solid tumors and autoimmune diseases.

2. Technological Advancements: Innovations in CAR design, such as dual-targeting CARs and allogeneic CAR-T cells, are addressing limitations like relapse and toxicity.

3. Supportive Policy Frameworks: Governments and healthcare agencies are increasing funding and policy support to expand access to CAR-T therapies.

CAR-T Target Population

The primary target population for CAR-T therapies comprises patients with refractory or relapsed hematologic malignancies. These include:

1. Hematologic Cancers: ALL, DLBCL, multiple myeloma (MM), and mantle cell lymphoma (MCL) dominate current indications.

2. Expanding to Solid Tumors: Despite challenges, CAR-T therapies targeting glioblastoma, colorectal cancer, and ovarian cancer are in various stages of clinical development.

3. Non-Cancer Indications: Early research into autoimmune diseases and chronic viral infections signals a broader patient base for CAR-T therapies.

As clinical trials expand the therapeutic scope, the addressable patient population is expected to rise significantly by 2034. This includes previously untreatable conditions and younger patients benefiting from safer, next-generation therapies.

Download sample pages @ https://www.delveinsight.com/sample-request/car-t-market-forecast

CAR-T Market Competitive Landscape

The CAR-T therapy market is highly competitive, with both established pharmaceutical giants and emerging biotechs driving innovation. Key players include:

1. Novartis: The first company to receive FDA approval for a CAR-T therapy (Kymriah) in 2017, Novartis continues to explore label expansions and optimize manufacturing.

2. Gilead Sciences: Through its Kite Pharma subsidiary, Gilead has gained approvals for Yescarta and Tecartus, cementing its position in the lymphoma treatment space.

3. Bristol Myers Squibb: With Breyanzi and Abecma in its portfolio, BMS is a leader in addressing hematologic malignancies.

4. Emerging Players: Companies like Allogene Therapeutics and Cellectis are advancing off-the-shelf, allogeneic CAR-T therapies, aiming to reduce costs and improve scalability.

Key Developments in CAR-T Market Competition:

- Biosimilars and Generics: While still nascent, the emergence of biosimilar CAR-T therapies could create pricing pressure and broaden accessibility.

- Manufacturing Innovations: The transition from autologous to allogeneic therapies is a game-changer, promising reduced costs, faster turnaround times, and broader applicability.

Read more about the key developments in the CAR-T market: https://www.delveinsight.com/sample-request/car-t-market-forecast

CAR-T Market Challenges and Opportunities

CAR-T Market Challenges:

1. Cost and Accessibility: CAR-T therapies remain prohibitively expensive, limiting access in low- and middle-income countries.

2. Manufacturing Complexities: Autologous therapies require personalized manufacturing, leading to logistical challenges.

3. Safety Concerns: Cytokine release syndrome (CRS) and neurotoxicity are significant adverse effects, necessitating advanced safety protocols.

CAR-T Market Opportunities:

1. Allogeneic Therapies: "Off-the-shelf" CAR-T products offer a scalable, cost-effective alternative to autologous treatments.

2. Global Expansion: Strategic collaborations and regulatory approvals in emerging markets could significantly expand the reach of CAR-T therapies.

3. Combination Therapies: Pairing CAR-T cells with immune checkpoint inhibitors or small-molecule drugs could enhance efficacy and broaden applications.

Request for a sample report @ https://www.delveinsight.com/report-store/car-t-market-forecast

CAR-T Market Forecast to 2034

The CAR-T market is expected to reach unprecedented heights by 2034, with the following key trends shaping its trajectory:

1. Wider Approval Landscape: More than 30 new CAR-T therapies are anticipated to receive regulatory approval for various indications by 2034.

2. Increased Patient Access: Advances in manufacturing and distribution are expected to make CAR-T therapies more affordable and accessible globally.

3. Technological Breakthroughs: Innovations such as CRISPR-edited CAR-T cells and novel targets like BCMA and GPRC5D will expand the scope and efficacy of CAR-T therapies.

North America will likely maintain its leadership position, while Asia-Pacific will emerge as the fastest-growing market due to favorable demographics and government support.

The CAR-T therapy market represents a transformative approach in cancer treatment, with significant growth expected over the next decade. Despite challenges such as cost and manufacturing complexities, the market is poised for expansion, driven by innovation, an expanding patient base, and increased global adoption. By 2034, CAR-T therapies are expected to become a cornerstone of oncology, offering hope to millions of patients worldwide.

For further insights, explore DelveInsight’s comprehensive report on the [CAR-T Market Forecast](https://www.delveinsight.com/report-store/car-t-market-forecast).

[myrawjcsmicasereports]

Rapid progression of angioimmunoblastic t cell lymphoma after Covid-19 vaccination by Iryna Abramenko, MD in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

We present the case of a 57-year-old male patient from Ukraine who developed tonsillitis and generalized lymphadenopathy approximately one week after receiving the first dose of the ChAdOx1 (AstraZeneca) anti-SARS-CoV-2 vaccine. A total body computerized tomography scan revealed pronounced lymphadenopathy above and below the diaphragm, and enlargement of the spleen. Histologic examination of the left inguinal lymph node revealed revealed lack of a clear separation of the cortical and paracortical areas. Expanded proliferation of vessels (postcapillary venules) around which atypical lymphoid cells of small and medium size were located. The most of atypical lymphoid cells expressed CD3, CD4, PD1, blc-6, and Ki-67 antigens, some cells also CD10-, CD30-positive. Diagnosis of angioimmunoblastic T-cell lymphoma (AITL), IVB Ann Arbor stage, was established. The patient received six courses of therapy CHOEP regimen. According to the results of treatment clinical and hematological remission is achieved. Thus, this article describes the second case of the development of AITL after vaccination. The accumulation of such data and their analysis will allow to make appropriate conclusions about the relationship of anti-SARS-CoV-2 vaccination with development of oncohematological diseases.

Introduction

SARS-Cov-2 virus infection is widespread throughout the world. By May 2023, the number of infected cases raised to 765,903,278 persons and a total 13,350,530,518 vaccine doses have been administered [1]. Vaccination is an effective mean of preventing infection and the development of severe forms of the disease. Eleven vaccines were recommended by World Health Organization for vaccination: Pfizer-BioNTech, Oxford-AstraZeneca, Sinopharm BIBP, Moderna, Janssen, CoronaVac, Covaxin, Novavax, CovoVax (Novavax formulation), Convidecia, Sanofi-GSK; a number of vaccines are under consideration [2]. Oxford-AstraZeneca, CoronaVac, Pfizer-BioNTech, and Moderna were used for vaccination against SARS-CoV-2 in Ukraine [3].

Vaccination leads to the development of protective antiviral immunity [4, 5]. In oncological patients, this may have ambivalent influence on tumor growth. Two cases of spontaneous tumor regression after SARS-Cov-2 vaccination have been described: shrinking of the cervical lymph node and resolution of the diffuse lung lesions in patient with a recurrent primary cutaneous anaplastic large-cell lymphoma one week after having received the first COVID-19 vaccination (BioNTech/Pfizer) [6]; and spontaneous regression of metastatic salivary gland myoepithelial carcinoma in patient one month after vaccination of mRNA-1273 COVID-19 (Moderna) vaccine [7]. Anti-cancer effect of COVID-19 vaccines (a decrease in tumor size, a decrease in the expression of tumor markers (VEGF, Ki-67, MMP-2/9), CD4/CD8 ratio, and metastasis to the vital organs) has been shown in 4T1 mice models [8].

On the other hand, cases of progression of oncohematological diseases after vaccination have also been described. Goldman et al. described rapid progression of angioimmunoblastic T cell lymphoma following BNT162b2 mRNA vaccine booster shot [9]. Cavanna et al. presented a case of anaplastic large-cell lymphoma that developed in a patient approximately 10 days after receiving the third dose of the BNT162b2 vaccine and summarized eight additional cases identified in the available literature [10]. There were four cases of diffuse large-B-cell lymphoma [11-13], one case of extranodal NK/T-cell lymphoma [12], one patient with subcutaneous panniculitis-like T-cell lymphoma [14], one case of marginal zone B-cell lymphoma [15] and one primary cutaneous anaplastic large-cell lymphoma  (developed at the SARS-CoV2 vaccine injection site) [16].

In this article, we report a case of angioimmunoblastic T-cell lymphoma developed shortly after SARS-CoV2 vaccination.

Case report

The patient is a 57-year-old Caucasian man with no previous history of disease. On May 6, 2021, he received the first dose of the ChAdOx1 (AstraZeneca). A few days later, he noted a flu-like syndrome and a sore throat. A diagnosis of tonsillitis was established. Antibacterial therapy was ineffective and within two weeks patient noted rapid increase of cervical, axillary, and inguinal lymph nodes. On May, 28, 2021, trephine biopsy of the left inguinal lymph node was performed.

Pathological examination revealed lack of a clear separation of the cortical and paracortical areas. Expanded proliferation of vessels (postcapillary venules) around which atypical lymphoid cells of small and medium size were located. Mitotic figures, single plasma cells, macrophages, neutrophils and eosinophils were present. The most of atypical lymphoid cells expressed CD3, CD4, PD1, blc-6, and Ki-67 antigens, some cells also CD10-, CD30-positive. Small clusters of CD20-positive cells were found between tumor cells. CD21- and CD23-positive follicular dendritic cells wrapped around postcapillary venules. Conclusion (8.06.2021): morphological changes in the lymph node and the immunophenotype of tumor cells correspond to diagnosis of angioimmunoblastic T cell lymphoma.

CT scan (29.05.2021) revealed pronounced lymphadenopathy above and below the diaphragm (diameters of cervical lymph nodes 10-24 mm, paratracheal lymph nodes 8-18 mm, bifurcation lymph nodes 14-25 mm, right axillary lymph nodes up to 20 mm, left axillary lymph nodes up to 15 mm, inguinal lymph nodes 8-28 mm), enlargement of the spleen (5.8x12.0x11.3 cm).

On June, 11, 2021 patient referred to the hematological department of National Research Center for Radiation Medicine. Complaints of the patient upon admission: fever (up to 380C) in the second half of the day, weakness, severe fatigue, enlargement of tonsils and lymph nodes. At examination: ECOG2 performance status. Weight 72 kg. Height 174 cm. Skin is pale. Peripheral lymph nodes are palpable: submaxillary up to 6 cm, cervical 4-6 cm, axillary up to 4 cm, inguinal up to 4 cm in diameter. The liver is not enlarged. The spleen is not palpable. Breathing is vesicular. Systolic murmur over the cardiac apex. The heart rhythm is correct. Blood pressure is 115/75 mm Hg, heart rate is 80 per min. There are no edema.

Bone marrow aspiration (11.06.2021) showed hypercellular marrow, dysplasia in erythropoiesis and megakariocytopoiesis, absence of blast cells, 5.6% of lymphocytes, no cytological signs of leukemic involvement. Among all nuclear bone marrow cells 1.68% with phenotype CD45dim+CD34+CD7+CD5+CD1a-TdT- were quantified by flow cytometry.

Except high level of blood lactate dehydrogenase (1249 units/L), and C-reactive protein (29.8 mg|L) other results of laboratory test of blood and urine were unremarkable.

Diagnosis of angioimmunoblastic T-cell lymphoma (AITL), IVB Ann Arbor stage, was established, and CHOEP (cyclophosphamide, vincristine, doxorubicin, etoposide and prednisone) regimen was initiated. The patient received six courses of therapy CHOEP regimen. According to the results of treatment clinical and hematological remission is achieved: hemodynamic parameters are stable, peripheral lymph nodes are not palpable, the spleen is not enlarged, and the size of the tonsils has decreased significantly.  At the time of this report the patient continues to be in clinical and hematological remission.

Discussion

The most exciting, intriguing question is: can vaccines induce the development of tumors, in particular, lymphoproliferative diseases?

So far, only the development of fibrosarcomas in cats after vaccination is known. This has been proven for killed adjuvanted virus vaccines (vaccination against rabies and feline leukemia virus). An inflammatory process with the formation of granulomatous nodules, only 5% of which subsequently undergo transformation, preceded tumor development. The interval between vaccine administration and detection of sarcoma varied from 4 months to several years [17]. In human, we found three similar cases in the literature: the development of lymphoma and undifferentiated, pleiomorphic high-grade sarcoma at the site of anti-SARS-CoV-2 vaccine administration [16, 18], and peripheral T-cell lymphoma at the injection site of influenza vaccination [19]. However, the interval between vaccine administration and tumor development was short, which does not fit into the classical scheme for the development of the oncological process (initiation, promotion, progression). Thus, it is unclear whether there is a true association between vaccination and the development of malignancy.

For the case described in this article, progression of preceding lymphoma under the influence of the vaccine seems more likely. Anti-SARS-CoV-2 vaccines cause a powerful immune response and stimulation of T- and B-lymphocytes, as well as the production of numerous cytokines [20]. Cases of post vaccine benign lymphadenopathy are described [21]. Today, AITL is recognized as a neoplasm derived from T-follicular helper cells [22, 23]. Up to 75% of AITL patients had a mutation RHOA G17V that facilitates proliferation and activation of several signaling pathways [24]. Since T-follicular helper cells are one of the main targets of mRNA vaccines [25], the Goldman et al. suggested that their stimulation under the influence of the vaccine can accelerate the development of AITL. In their case the malignant cells of patient had a mutation RHOA G17V that could make them especially sensitive to anti-SARS-CoV-2 vaccines [9]. Unfortunately, molecular genetic studies have not been performed in our patient.

Thus, this article describes the second case of the development of AITL after vaccination. The accumulation of such data and their analysis will allow to make appropriate conclusions about the relationship of anti-SARS-CoV-2 vaccination with development of oncohematological diseases. It will contribute to our better understanding of the possible negative consequences of anti-SARS-CoV-2 vaccination and their prevention as well.

[lindabrown1812]

What are the different types of blood cancer and their symptoms?

Blood cancers, also known as hematologic cancers, affect the blood, bone marrow, and lymphatic system. The three primary types of blood cancer are leukemia, lymphoma, and multiple myeloma. These cancers interfere with the production and function of blood cells, leading to various health challenges. Here’s an overview of each type, its subtypes, and common symptoms, as highlighted by cancer organizations like the National Coalition for Cancer Survivorship (NCCS).

1. Leukemia

Leukemia originates in the blood and bone marrow, where it disrupts the formation of white blood cells. This type of cancer is categorized based on how quickly it progresses (acute or chronic) and the type of blood cell affected (lymphocytic or myeloid).

Subtypes of Leukemia:

Acute Lymphocytic Leukemia (ALL): More common in children, but adults can also develop it.

Acute Myeloid Leukemia (AML): Common among adults, particularly older individuals.

Chronic Lymphocytic Leukemia (CLL): Progresses slowly and usually affects older adults.

Chronic Myeloid Leukemia (CML): Progresses slowly and primarily affects adults.

Common Symptoms:

Fatigue and weakness

Frequent infections and fevers

Easy bruising or bleeding

Bone and joint pain

Swollen lymph nodes or spleen

2. Lymphoma

Lymphoma targets the lymphatic system, a crucial part of the immune system. This cancer starts in lymphocytes (a type of white blood cell) and can spread throughout the body. The two main types are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL).

Hodgkin Lymphoma (HL):

Recognized by the presence of Reed-Sternberg cells in the lymph nodes.

More treatable than non-Hodgkin lymphoma, with a high survival rate if caught early.

Non-Hodgkin Lymphoma (NHL):

Comprises a broad category of lymphatic cancers that develop in lymph nodes and other lymphoid tissues.

Includes various subtypes, such as diffuse large B-cell lymphoma and follicular lymphoma.

Common Symptoms:

Swollen lymph nodes, often painless

Unexplained weight loss

Persistent fatigue

Night sweats

Abdominal pain or swelling

3. Multiple Myeloma

Multiple myeloma affects plasma cells, a type of white blood cell in the bone marrow. This cancer disrupts the production of healthy blood cells and the immune system, leading to complications throughout the body.

Common Symptoms:

Bone pain, especially in the spine or chest

Frequent infections

Fatigue and weakness

High blood calcium levels, which can cause nausea and constipation

Anemia-related symptoms

Conclusion

Blood cancers present distinct symptoms but often overlap, making early detection challenging. The National Coalition for Cancer Survivorship and similar cancer organizations emphasize the importance of awareness and regular health screenings to help detect these cancers early.

To know more visit: https://canceradvocacy.org/