| Enteropathy-associated T-cell lymphoma |
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Micrograph of enteropathy-associated T cell lymphoma (upper right of image). H&E stain.
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| Classification and external resources |
| ICD-10 |
C86.2 |
| ICD-O: |
M9717/3 |
Enteropathy-associated T-cell Lymphoma (EATL), also enteropathy-type T-cell lymphoma (ETTL), is a type of T-cell lymphoma that affects the small intestine. It is the most common primary gastrointestinal T-cell lymphoma, arising from the T cells that are found between the cells that line the small intestinal (brush border cells or small intestinal epithelial cells).[1] These cancerous T-cells are a possible consequence of refractory cases of coeliac disease or in chronic, untreated cases in genetically susceptible individuals.
Contents
- 1 Epidemiology
- 2 Classification
- 3 Genetics
- 4 Staging
- 5 Treatment
- 6 Prognosis
- 7 See also
- 8 References
Epidemiology
EATL is most frequent in Europe, where it represents 9.4% of all peripheral T cell lymphomas. Association with celiac disease is consistently demonstrated in only 30% of patients. The global incidence of this lymphoma is rare, being about 0.5 to 1 per million.[2]
Classification
EATL can be classified as an extranodal peripheral T Cell lymphoma, category it shares with Hepatosplenic T cell lymphoma, and Panniculitic T Cell lymphoma. It can be further classified in type I and II EATL.[2]
Genetics
Enteropathy associated T-cell lymphoma (EATL) is environmentally induced as a result of the consumption of Triticeae glutens (e.g. wheat gluten). In gluten-sensitive individuals with EATL, 68% are homozygotes of the DQB1*02 subtype at the HLA-DQB1 locus.[3] (See Coeliac Disease, HLA-DQ, HLA DR3-DQ2) A DQ isoform that appears to be responsible for EATL in the overwhelming number of cases is highly effective at presenting a proteolytically protected region of α2-gliadin to T-cells, constant over-stimulation of T-cell eventually results in neoplastic growth.[4] EATL typically appears after the 4th decade of life, within 3 years of coeliac disease diagnosis or in undiagnosed coeliacs.[5][6] In treated coeliacs, EATL may be preceded by refractory coeliac disease 1(RCD1) or, prominently, refractory celiac disease 2 (RCD2), in which EATL is a frequent outcome.[7] Refractory coeliac disease is no longer favorably responsive to wheat-gluten abstinence. Beyond the RCD1 stage, many drugs are not effective, and undetected coeliac disease leading to de novo EATL generally has a poor outcome.
The genetic association with celiac disease and HLA loci defines type I EATL. Type II doesn´t show these associations and frequently presents with bulky disease.
Early recognition of coeliac disease, particularly with a focus on DQ2 homozygotes and in affected family members, is the only effective prevention, though bone marrow transplant was suggested as a treatment during early RCD2.[8]
Staging
Bone marrow involvement is rare in this disease.[citation needed]
Treatment
In certain eligible patients, a conditioning regimen of high-dose chemotherapy followed by an autologous stem cell transplant may be used to extend a period of first complete remission.[9] Likewise, a recent study suggests that high dose therapy and autologous stem cell transplantation results in favorable outcomes for elderly patients with Non-Hodgkin's Lymphoma.[10]
Prognosis
According to the Peripheral T cell lymphoma project, median overall survival is 10 months, while median failure free survival is only 6 months. The international prognostic index is not useful in defining prognosis in this entity, but Peripheral Index for T cell lymphoma is. Among the most influential prognostic factors is bulky disease, defined by a tumor mass >5 cm.[2]
Autologous Stem Cell Transplant is feasible in selected patients with EATL and can yield durable disease control in a significant proportion of these patients. One study states that there was a trend for better survival in patients transplanted in first complete or partial remission at 4 years (66% vs 36%; P = .062).[9]
See also
- Coeliac Disease
- Lymphoma
- Mucosa-associated lymphoid tissue
References
- ^ Isaacson PG (October 1994). "Gastrointestinal lymphoma". Hum. Pathol. 25 (10): 1020–9. doi:10.1016/0046-8177(94)90060-4. PMID 7927306.
- ^ a b c Delabie J, et al (July 2011). "Enteropathy-associated T-cell lymphoma: clinical and histological findings from the International Peripheral T-Cell Lymphoma Project". Blood 118 (148): 148. doi:10.1182/blood-2011-02-335216.
- ^ Al-Toma A, Verbeek WH, Hadithi M, von Blomberg BM, Mulder CJ (2007). "Survival in Refractory Coeliac Disease and Enteropathy associated T cell Lymphoma: Retrospective evaluation of single centre experience". Gut 56 (10): 1373–8. doi:10.1136/gut.2006.114512. PMC 2000250. PMID 17470479.
- ^ Jores RD, Frau F, Cucca F, et al. (2007). "HLA-DQB1*0201 homozygosis predisposes to severe intestinal damage in celiac disease". Scand. J. Gastroenterol. 42 (1): 48–53. doi:10.1080/00365520600789859. PMID 17190762.
- ^ Al-Toma A, Goerres MS, Meijer JW, et al. (2006). "Cladribine therapy in refractory celiac disease with aberrant T cells". Clin. Gastroenterol. Hepatol. 4 (11): 1322–7; quiz 1300. doi:10.1016/j.cgh.2006.07.007. PMID 16979946.
- ^ Al-Toma A, Goerres MS, Meijer JW, Peña AS, Crusius JB, Mulder CJ (2006). "Human leukocyte antigen-DQ2 homozygosity and the development of refractory celiac disease and enteropathy-associated T-cell lymphoma". Clin. Gastroenterol. Hepatol. 4 (3): 315–9. doi:10.1016/j.cgh.2005.12.011. PMID 16527694.
- ^ Al-Toma A, Verbeek WH, Mulder CJ (2007). "Update on the management of refractory coeliac disease". Journal of gastrointestinal and liver diseases : JGLD 16 (1): 57–63. PMID 17410290.
- ^ Meijer JW, Mulder CJ, Goerres MG, Boot H, Schweizer JJ (2004). "Coeliac disease and (extra)intestinal T-cell lymphomas: definition, diagnosis and treatment". Scand. J. Gastroenterol. Suppl. 39 (241): 78–84. doi:10.1080/00855920410014605. PMID 15696854.
- ^ a b Jantunen, E; Boumendil, A; Finel, H; Luan, J. J.; Johnson, P; Rambaldi, A; Haynes, A; Duchosal, M. A.; Bethge, W; Biron, P; Carlson, K; Craddock, C; Rudin, C; Finke, J; Salles, G; Kroschinsky, F; Sureda, A; Dreger, P; Lymphoma Working Party of the EBMT (2013). "Autologous stem cell transplantation for enteropathy-associated T-cell lymphoma: A retrospective study by the EBMT". Blood 121 (13): 2529–32. doi:10.1182/blood-2012-11-466839. PMID 23361910. edit
- ^ https://synapse.mskcc.org/synapse/works/39346
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Hematological malignancy/leukemia histology (ICD-O 9590–9989, C81–C96, 200–208)
Lymphoid/Lymphoproliferative, Lymphomas/Lymphoid leukemias (9590–9739, 9800–9839)
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B cell
(lymphoma,
leukemia)
(most CD19
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By development/
marker
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TdT+
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- ALL (Precursor B acute lymphoblastic leukemia/lymphoma)
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CD5+
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mantle zone (Mantle cell)
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CD22+
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- Prolymphocytic
- CD11c+ (Hairy cell leukemia)
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CD79a+
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- germinal center/follicular B cell (Follicular
- Burkitt's
- GCB DLBCL
- Primary cutaneous follicular lymphoma)
marginal zone/marginal-zone B cell (Splenic marginal zone
- MALT
- Nodal marginal zone
- Primary cutaneous marginal zone lymphoma)
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RS (CD15+, CD30+)
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- Classic Hodgkin's lymphoma (Nodular sclerosis)
- CD20+ (Nodular lymphocyte predominant Hodgkin's lymphoma)
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PCDs/PP
(CD38+/CD138+)
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- see immunoproliferative immunoglobulin disorders
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By infection
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- KSHV (Primary effusion)
- EBV (Lymphomatoid granulomatosis
- Post-transplant lymphoproliferative disorder)
- HIV (AIDS-related lymphoma)
- Helicobacter pylori (MALT lymphoma)
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Cutaneous
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- Diffuse large B-cell lymphoma
- Intravascular large B-cell lymphoma
- Primary cutaneous marginal zone lymphoma
- Primary cutaneous immunocytoma
- Plasmacytoma
- Plasmacytosis
- Primary cutaneous follicular lymphoma
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T/NK
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T cell
(lymphoma,
leukemia)
(most CD3
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By development/
marker
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- TdT+: ALL (Precursor T acute lymphoblastic leukemia/lymphoma)
- prolymphocyte (Prolymphocytic)
- CD30+ (Anaplastic large-cell lymphoma
- Lymphomatoid papulosis type A)
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Cutaneous
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MF+variants
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- indolent: Mycosis fungoides
- Pagetoid reticulosis
- Granulomatous slack skin
aggressive: Sézary disease
- Adult T-cell leukemia/lymphoma
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Non-MF
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- CD30-: Non-mycosis fungoides CD30− cutaneous large T-cell lymphoma
- Pleomorphic T-cell lymphoma
- Lymphomatoid papulosis type B
CD30+: CD30+ cutaneous T-cell lymphoma
- Secondary cutaneous CD30+ large cell lymphoma
- Lymphomatoid papulosis type A
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Other peripheral
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- Hepatosplenic
- Angioimmunoblastic
- Enteropathy-associated T-cell lymphoma
- Peripheral T-cell lymphoma-Not-Otherwise-Specified (Lennert lymphoma)
- Subcutaneous T-cell lymphoma
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By infection
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- HTLV-1 (Adult T-cell leukemia/lymphoma)
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NK cell/
(most CD56)
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- Aggressive NK-cell leukemia
- Blastic NK cell lymphoma
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T or NK
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- EBV (Extranodal NK-T-cell lymphoma/Angiocentric lymphoma)
- Large granular lymphocytic leukemia
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Lymphoid+myeloid
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- Acute biphenotypic leukaemia
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Lymphocytosis
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- Lymphoproliferative disorders (X-linked lymphoproliferative disease
- Autoimmune lymphoproliferative syndrome)
- Leukemoid reaction
- Diffuse infiltrative lymphocytosis syndrome
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| Cutaneous lymphoid hyperplasia |
- Cutaneous lymphoid hyperplasia
- with bandlike and perivascular patterns
- with nodular pattern
- Jessner lymphocytic infiltrate of the skin
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Index of the immune system
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| Description |
- Physiology
- cells
- autoantigens
- autoantibodies
- complement
- surface antigens
- IG receptors
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| Disease |
- Allergies
- Immunodeficiency
- Immunoproliferative immunoglobulin disorders
- Hypersensitivity and autoimmune disorders
- Neoplasms and cancer
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| Treatment |
- Procedures
- Drugs
- immunostimulants
- immunosuppressants
- monoclonal antibodies
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