S-553 Primary low grade duodenal-type follicular lymphoma : A study of 10 cases in South Korea

( Haerim Chung ),( Jung Yeon Lee ),( June-won Cheong ),( Yu Ri Kim ),( Soo-jeong Kim ),( Cheolwon Suh ),( Dok Hyun Yoon ),( Soon Il Lee ),( Woo Ick Yang ),( Jin Seok Kim ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

In the revised 2016 World Health Organization (WHO) classification, the duodenal-type follicular lymphoma (FL) was newly added. It is a low grade B-cell lymphoma characterized by indolent clinical course. For the rarity of disease, little is known about optimal treatment. We described clinical characteristics of 10 patients with primary low grade duodenal-type FL. A total of 10 patients who diagnosed with duodenal-type FL at 3 hospitals in South Korea from 2009 to 2016 were retrospectively reviewed. The low tumor burden (LTB) criteria by the Groupe D’Etude des Lymphomes Folliculaires (GELF) was assessed for all patients. All patients were clinical stage IE and scored 0 by GELF criteria. Preferential segment was 2nd portion of duodenum (n=8, 80.0%). 9 patients (90.0%) found incidentally the disease during routine health examination. Fold swelling and thickening (n=4, 40.0%) was the most common endoscopic finding. All patients were positive for CD20, CD10, and Bcl-2 in immunohistochemical analysis. Treatment strategies including watch and wait (n=5, 50.0%) and radiotherapy (n=5, 50.0%) were performed. Of the 5 patients who did not receive any treatment, only 1 patient underwent progression of disease with median time of 19.4 months. All patients are still alive with median follow-up duration of 32.7 months (range, 2.5-63.9 months). Primary duodenal-type FL is characterized a remarkable indolent disease. The watch and wait policy may be an acceptable initial strategy for LTB duodenal-type FL. Further prospective investigations are needed to determine the optimal treatment.

S-567 The role and significance of MDSC-like myeloid blasts in immune-tolerance of AML

( Haerim Chung ),( Jung Yeon Lee ),( Yundeok Kim ),( Soo Jeong Kim ),( Jin Seok Kim ),( June-won Cheong ),( Yoo Hong Min ),( Shin Young Hyun ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Myeloid-derived suppressor cells (MDSCs) is a heterogenous cell population, consisting of myeloid progenitor cells and immature myeloid cells and having an ability to suppress T-cell function. Due to their suppressive effects on immunity, MDSCs can lead to facilitate tumor development and growth, and has been known to be associated with poor prognosis in various solid cancers. However, the role of MDSC in myeloid neoplasm are unclear. So, we elucidated the role of leukemic subpopulation showing CD11b+CD33+HLA-DR- immunophenotype, which resembles MDSCs. CD11b+CD33+HLA-DR- blast were isolated using flow-cytometry from bone marrow mononuclear cell sample, which were collected at the time of diagnosis by Acute Leukemia Cohort Study in Severance. The clinical impact of MDSC-like blasts was retrospectively reviewed in 63 patients. CD33+HLA-DR- leukemic cells from each patients showed various range of expression for CD11b (Mean±SD, 21.02±22.19%). MDSCs can be divided into two subtypes, monocytic MDSC expressing CD14 and granulocytic MDSC expressing CD15, and CD14 expression on MDSC-like blast expression was more frequent than CD15 expression (67.5% vs. 39.3%). To figure out the immunosuppressive activity in MDSC-like blasts, Arg1 and iNOS expression were checked, and MDSC-like blasts showed significantly higher expression of Ara1(77.1% vs. 38.5%, p<0.001) and iNOS (33.0% vs. 1.1%, p<0.0001) compared to non-MDSC-like blasts. Compared to ‘Lower MDSC group’, WBC count, serum LDH, fraction of blasts in bone marrow, and frequency of adverse cytogenetics were significantly higher in ‘Higher MDSC group’. Patients in ‘High MDSC group’ had significantly shorter overall survival (331±42 vs. 758±114 days, p=0.027). On multivariate analysis, higher fraction of CD11b+CD33+HLA-DR- leukemic cells (HR 2.966, 95%CI 1.086-8.095, p=0.034), old age (p=0.001), adverse cytogenetics (p=0.013), and FAB classification (p=0.035) were poor prognosis factors. CD33+HLA-DR- MDSC-like blasts subgroup is existed in myeloid leukemic blasts with various range. Because they suppressed T cell immunity, also showed adverse prognostic effect on survival, MDSC-like blasts might play a certain role in immune-tolerance in leukemia.

Recent advances in cellular immunotherapy for lymphoid malignancies

Haerim Chung,Hyunsoo Cho 대한혈액학회 2023 Blood Research Vol.58 No.4

Cellular immunotherapy with chimeric antigen receptor (CAR) T-cells has revolutionized the treatment of lymphoid malignancies. This review addresses the need for CAR expression in our endogenous T-cells to kill tumor cells with a focus on the basic principles of T-cell receptor recognition of major histocompatibility complex-peptide complexes. We review the factors associated with CAR T-cell outcomes and recent efforts to employ CAR T-cells in earlier lines of therapy. We also discuss the value of bispecific T-cell engagers as off-the-shelf products with better toxicity profiles. Finally, natural killer cells are discussed as an important cellular immunotherapy platform with the potential to broaden immunotherapeutic applications beyond lymphoid malignancies.

Clinical characteristics and treatment outcomes of isolated myeloid sarcoma without bone marrow involvement: a single-institution experience

Lee, Jung Yeon,Chung, Haerim,Cho, Hyunsoo,Jang, Ji Eun,Kim, Yundeok,Kim, Soo-Jeong,Kim, Jin Seok,Hyun, Shin Young,Min, Yoo Hong,Cheong, June-Won Korean Society of Hematology; Korean Society of Bl 2017 Blood Research Vol.52 No.3

<P><B>Background</B></P><P>Isolated myeloid sarcoma (MS) is a rare extramedullary tumor mass composed of malignant myeloid precursor cells without any evidence of leukemia in the peripheral blood and bone marrow. We describe the clinical characteristics and outcomes of patients diagnosed with isolated MS at our institution.</P><P><B>Methods</B></P><P>We retrospectively reviewed 9 of 497 acute myeloid leukemia (AML) patients (1.8%) with isolated MS. Isolated MS patients were divided into 2 groups according to the first-line treatment strategy: systemic treatment only (S) or local treatment with or without systemic treatment (LS).</P><P><B>Results</B></P><P>The most common site of MS occurrence was the head and neck area (N=4, 44.4%), followed by the anterior mediastinum (N=2, 22.2%) and the gastrointestinal tract (N=2, 22.2%). The tumors of 4 patients (44.4%) eventually evolved to AML, in a median time of 13.4 months (range, 2.4–20.1 mo). The number of patients achieving complete remission after first-line treatment was higher in the LS group (N=5, 83.3%) than in the S group (N=1, 33.3%) (<I>P</I> =0.226). All patients in the LS group survived, but those in the S group died (<I>P</I>=0.012).</P><P><B>Conclusion</B></P><P>Accurate and rapid diagnosis using various modalities and the early initiation of intensive combined treatment may be the optimal strategies to reduce the risk of isolated MS subsequently evolving to AML. To fully understand the characteristics of isolated MS, a larger number of patients from a multinational study is necessary.</P>

Different roles of surveillance positron emission tomography according to the histologic subtype of non-Hodgkin’s lymphoma

( Yu Ri Kim ),( Soo-jeong Kim ),( June-won Cheong ),( Yundeok Kim ),( Ji Eun Jang ),( Hyunsoo Cho ),( Haerim Chung ),( Yoo Hong Min ),( Woo Ick Yang ),( Arthur Cho ),( Jin Seok Kim ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.0

Background/Aims: Although the use of surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is discouraged in patients with diffuse large B-cell lymphoma, its usefulness in different subtypes has not been thoroughly investigated. Methods: We retrospectively evaluated 157 patients who showed positive results on surveillance FDG-PET/CT every 6 months following complete response for up to 5 years. All of the patients also underwent biopsies. Results: Seventy-eight (49.6%) of 157 patients had true positive results; the remaining 79 (50.3%), including eight (5.1%) with secondary malignancies, were confirmed to yield false positive results. Among the 78 patients with true positive results, the disease in seven (8.9%) had transformed to a different subtype. The positive predictive value (PPV) of FDG-PET/CT for aggressive B-cell non-Hodgkin’s lymphoma (NHL) was lower than that for indolent B-cell or aggressive T-cell NHL (p = 0.003 and p = 0.018, respectively), especially in patients with a low/low-intermediate international prognostic index (IPI) upon a positive PET/CT finding. On the other hand, indolent B-cell and aggressive T-cell NHL patients showed PPVs of > 60%, including those with low/low-intermediate secondary IPIs. Conclusions: The role of FDG-PET/CT surveillance is limited, and differs according to the lymphoma subtype. FDG-PET/CT may be useful in detecting early relapse in patients with aggressive T-cell NHL, including those with low/low-intermediate risk secondary IPI; as already known, FDG-PET/CT has no role in aggressive B-cell NHL. Repeat biopsy should be performed to discriminate relapse or transformation from false positive findings in patients with positive surveillance FDG-PET/CT results.

Prognostic significance of interventricular septal thickness in patients with AL amyloidosis

Cho, Hyunsoo,Kim, Soo-Jeong,Shim, Chi Young,Hong, Geu-Ru,Ha, Jong-Won,Kim, Yu Ri,Yang, Woo Ick,Chung, Haerim,Jang, Ji Eun,Cheong, June-Won,Min, Yoo Hong,Kim, Jin Seok Elsevier 2017 Leukemia research Vol.60 No.-

<P><B>Abstract</B></P> <P>The major prognostic determinant of immunoglobulin light chain (AL) amyloidosis is cardiac involvement. However, the role of interventricular septal thickness (IVST), which reflects the extent of cardiac involvement, remains unclear. Therefore, we analyzed 77 patients with newly diagnosed AL amyloidosis and evaluated the prognostic role of IVST. Fifty patients (64.9%) had cardiac involvement and 17 patients (22.1%) showed IVST >15mm. Among all patients, the revised Mayo Clinic Stage III–IV and IVST >15mm were independently associated with inferior overall survival (OS) in a multivariable analysis. IVST >15mm was also adversely prognostic for OS in a subgroup of advanced-stage (revised Mayo Clinic stage III–IV) patients in a multivariable analysis (<I>P</I> <0.001). Furthermore, advanced-stage patients with IVST >15mm did not show survival benefit from treatment with bortezomib-based regimens and/or autologous stem-cell transplantation (ASCT). Our study demonstrated that IVST >15mm is adversely prognostic independent of the revised Mayo Clinic staging system in patients with AL amyloidosis. In addition, the degree of IVST might be used as a useful prognostic indicator that can guide the management of patients with AL amyloidosis especially at an advanced stage.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Cardiac involvement is the major prognostic determinant of AL amyloidosis. </LI> <LI> Interventricular septal thickness (IVST) >15mm was an important prognostic factor. </LI> <LI> IVST >15mm was also adversely prognostic in advanced stage patients. </LI> <LI> IVST might be used as a useful prognostic indicator in AL amyloidosis. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>Differences in overall survival (OS) according to the interventricular septal thickness (IVST) and the new four-factor model, incorporating IVST into the revised Mayo Clinic staging system; patients are grouped by the presence of 0–1 (low-risk), 2–3 (intermediate-risk), or 4 (high-risk) of the following risk factors: IVST >15mm, troponin-T≥0.025ng/mL, N-terminal pro-brain natriuretic peptide ≥1800pg/mL, and difference between involved and uninvolved free light chains≥18mg/dL.</P> <P>[DISPLAY OMISSION]</P>