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Pembrolizumab in combination with epigenetic therapy is safe and active in heavily treated patients with peripheral T-cell lymphoma and cutaneous T-cell lymphoma T-cell subpopulation analysis ( I n i = 6) showed mean CD4:CD8 ratio of 0.5 in trial patients prior to treatment compared to 1.5 for healthy age and sex-matched controls ( I p i = 0.016). The proportion of PD1+CD8+ effector T cells was lower in trial patients relative to healthy controls both before and after treatment ( I p i = 0.04 and 0.001, respectively). [Extracted from the article]

Patients with double- and triple-hit lymphomas (DHL/THL) have inferior outcomes with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), and higher-intensity regimens such as dose-adjusted (DA)-EPOCH-R are standard. Dose-intensification of DA-EPOCH-R is guided by hematologic toxicity, without conclusive benefit for DHL/THL patients. To determine if cumulative doses of DA-EPOCH-R or compliance with dose adjustment impacts survival, we retrospectively evaluated detailed clinical data from 109 adult (age ≥18 years) patients with DHL/THL treated with ≥4 cycles of induction DA-EPOCH-R from 2014 to 2019 at six centers. A comprehensive multivariate analysis was performed. Survival outcomes for the entire cohort were comparable to historical estimates for DHL/THL treated with this regimen (median follow-up 27.9 months). Overall survival (OS) and progression-free survival (PFS) were not significantly associated with cumulative chemotherapy dose, dose escalation, or compliance with dose adjustment. Heterogeneous dosing practices were observed. Prospective investigation is warranted to evaluate the practice of dose adjustment of R-EPOCH for patients with DHL/THL.

Natural killer (NK) cell enteropathy is a lymphoproliferative disorder, initially described by Mansoor and colleagues, that presents in the gastrointestinal tract, and is often mistaken for extranodal NK/T-cell lymphoma on first assessment. This population of cells in this process have an NK-cell phenotype (CD3, CD56, CD2, CD7), lacks evidence of Epstein-Barr virus infection, has germline rearrangement of the T-cell receptor, and a very indolent clinical course. Indeed, many of such patients had been originally diagnosed as having an NK/T-cell lymphoma, and subsequently received chemotherapy. We report a unique case where an indolent lymphoproliferative disorder with features that resemble NK-cell enteropathy is encountered for the first time outside the gastrointestinal tract, specifically in the female genitourinary tract. We provide morphologic, immunophenotypic, and molecular documentation of such, in association with a completely indolent clinical behavior of this type of process.

Despite unprecedented clinical activity in mantle cell lymphoma (MCL), primary and acquired resistance to ibrutinib is common. The outcomes and ideal management of patients who experience ibrutinib failure are unclear. We performed a retrospective cohort study of all patients with MCL who experienced disease progression while receiving ibrutinib across 15 international sites. Medical records were evaluated for clinical characteristics, pathological and radiological data, and therapies used pre- and postibrutinib. A total of 114 subjects met eligibility criteria. The median number of prior therapies was 3 (range, 0-10). The Mantle Cell Lymphoma International Prognostic Index (MIPI) scores at the start of ibrutinib were low, intermediate, and high in 46%, 31%, and 23% of patients, respectively. Of patients with available data prior to ibrutinib and postibrutinib, 34 of 47 and 11 of 12 had a Ki67 >30%. The median time on ibrutinib was 4.7 months (range 0.7-43.6). The median overall survival (OS) following cessation of ibrutinib was 2.9 months (95% confidence interval [CI], 1.6-4.9). Of the 104 patients with data available, 73 underwent subsequent treatment an average of 0.3 months after stopping ibrutinib with a median OS of 5.8 months (95% CI, 3.7-10.4). Multivariate Cox regression analysis of MIPI before postibrutinib treatment, and subsequent treatment with bendamustine, cytarabine, or lenalidomide failed to reveal any association with OS. Poor clinical outcomes were noted in the majority of patients with primary or secondary ibrutinib resistance. We could not identify treatments that clearly improved outcomes. Future trials should focus on understanding the mechanisms of ibrutinib resistance and on treatment after ibrutinib., (© 2016 by The American Society of Hematology.)

Purpose: Thrombin and tryptase stimulation of human bladder microvascular endothelial cells (Cambrex Bioscience, Walkersville, Maryland) results in the production of multiple membrane phospholipid derived inflammatory mediators via the activation of a calcium independent phospholipase A2 that may have important implications in bladder inflammatory conditions, such as interstitial cystitis. We examined the effect of multiple phospholipase A2 and cyclooxygenase inhibitors on the immediate release of prostacyclin from human bladder microvascular endothelial cells., Materials and Methods: We stimulated confluent human bladder microvascular endothelial cell monolayers with thrombin or tryptase and measured the immediate release of prostacyclin. Human bladder microvascular endothelial cells were pretreated with several selective phospholipase A2 and cyclooxygenase inhibitors before thrombin or tryptase stimulation to determine which combination of phospholipase A2/cyclooxygenase isoforms was involved in this process. Phospholipase A2 activity was measured using (16:0, [3H]18:1) plasmenylcholine substrate in the absence of calcium. [3H] arachidonic acid release was measured in the surrounding medium from prelabeled human bladder microvascular endothelial cell monolayers. Prostacyclin release into the surrounding medium was measured using a commercially available immunoassay kit., Results: The immediate increase in prostacyclin release from thrombin or tryptase stimulated human bladder microvascular endothelial cells depended on the activation of membrane associated calcium independent phospholipase A2, resulting in an increase in arachidonic acid production. Constitutively active cyclooxygenase-1 was then responsible for further metabolism of free arachidonic acid to prostacyclin., Conclusions: These results show that the search for a suitable anti-inflammatory agent that selectively target specific phospholipase A2 isoforms requires rigorous testing in several cell types in response to various stimuli.

Increased mast cell numbers and mast cell activation represent one of the prevalent etiologic theories for interstitial cystitis, an inflammatory condition in the bladder. This study was designed primarily to determine whether increased mast cell tryptase in the bladder wall may play a role in activating bladder endothelial cell phospholipase A(2) (PLA(2)), leading to increased inflammatory phospholipid metabolite accumulation, which may propagate the inflammatory process. We stimulated human bladder microvascular endothelial cells with thrombin or tryptase and measured the activation of PLA(2) and the production of multiple membrane phospholipid-derived inflammatory mediators. Thrombin and tryptase stimulation resulted in activation of a Ca(2+)-independent PLA(2), leading to increased release of arachidonic acid and prostacyclin and increased production of platelet-activating factor. These responses were blocked completely by pretreatment of human bladder microvascular endothelial cells with the Ca(2+)-independent PLA(2)-selective inhibitor bromoenol lactone. The combination of increased prostacyclin and platelet-activating factor in the bladder circulation may result in vasodilation and increased polymorphonuclear leukocyte adherence to the endothelium and may facilitate recruitment of polymorphonuclear leukocytes to the bladder wall of patients with interstitial cystitis.