Τίτλος:
Clinical considerations about the coexistence of melanoma and chronic lymphocytic leukemia in the era of targeted therapies, triggered by rare clinical scenarios. A case series and review of the literature
Περίληψη:
The epidemiologic correlation of melanoma and chronic lymphocytic leukemia (CLL) has been the subject of several population studies. In the present article, through the presentation of five illustrative cases of patients with melanoma and CLL, several aspects of this complex relationship are highlighted, with a focus on the increased incidence of melanoma in patients with CLL, its speculated etiology, and the impact of CLL stage and disease duration on the incidence and prognosis of melanoma. Furthermore, the rare entity of the synchronous diagnosis of melanoma and CLL in biopsied lymph nodes is discussed, along with its implications on the diagnostic and therapeutic procedures. In addition, the available data on the treatment choices in patients with melanoma and CLL are presented and the efficacy and safety of fludarabine, anti-CD20 monoclonal antibodies, new targeted therapies for CLL, and checkpoint inhibitors are further discussed. Finally, since no formal guidelines are available for the management of this group of patients, guidelines are proposed for skin-cancer screening in patients with CLL, for the correct interpretation of BRAF mutation analysis in lymph-node specimens with ‘collision of tumors,’ and for the optimal use of imaging studies in the diagnosis of metastatic disease in patients with CLL and melanoma, while a treatment approach for such patients is also suggested. The information and proposed guidelines provided in the present article comprise a useful guide for physicians managing such patients, focusing on diagnostic challenges and therapeutic dilemmas posed by the coexistence of the two disease entities. © The Author(s), 2020.
Συγγραφείς:
Diamantopoulos, P.T.
Ziogas, D.
Viniou, N.-A.
Anastasopoulou, A.
Kyriakakis, G.
Frangia, K.
Gogas, H.
Λέξεις-κλειδιά:
B Raf kinase; CD20 antigen; CD23 antigen; CD5 antigen; CD79 antigen; chlorambucil; common acute lymphoblastic leukemia antigen; cyclin D; dabrafenib; fludarabine; fluorodeoxyglucose f 18; ibrutinib; immunoglobulin antibody; interferon; interferon regulatory factor 4; ipilimumab; leukosialin; melan A; monoclonal antibody HMB 45; nivolumab; pembrolizumab; protein kinase ZAP 70; protein S 100; trametinib, adjuvant therapy; aged; Article; cancer prognosis; cancer staging; chronic lymphatic leukemia; clinical article; clinical assessment; computer assisted tomography; correlation analysis; disease duration; disease exacerbation; drug substitution; female; fine needle aspiration biopsy; hepatosplenomegaly; human; human tissue; immunophenotyping; inguinal lymph node; liver metastasis; lung metastasis; lymph node biopsy; lymphadenopathy; lymphocytic lymphoma; lymphocytosis; lymphoproliferative disease; male; maximum standardized uptake value; melanoma; molecularly targeted therapy; nuclear magnetic resonance imaging; positron emission tomography-computed tomography; practice guideline; scalp tumor; sentinel lymph node; skin defect; species coexistence; survival analysis; tumor associated leukocyte
