Blastic plasmacytoid dendritic cell neoplasm: a short review and update


Published: 11 August 2023
Abstract Views: 606
PDF: 145
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematologic neoplasm (less than 1% of primary cutaneous lymphomas and acute leukemia) with a highly aggressive clinical course and frequent skin, bone marrow and central nervous system involvement. Even though there is often an early response to chemotherapy, leukemic dissemination relapses are very common and result in poor outcomes, with a median overall survival of 8 to 14 months in the first-line setting using standard combination chemotherapy regimens. Almost 90% of patients experience skin involvement as their initial site of infection, where BPDCN may stay restricted for weeks or even months until a swift secondary phase involving multiple organs takes place. Consequently, it is crucial to suspect and identify early skin lesions, as well as to conduct and report a skin biopsy as soon as possible. In order to diagnose and treat BPDCN, a multidisciplinary strategy involving collaboration between pathologists, hematologists, and dermatologists is unquestionably essential.


Pagano L, Valentini CG, Grammatico S, Pulsoni A. Blastic plasmacytoid dendritic cell neoplasm: diagnostic criteria and therapeutical approaches. Br J Haematol 2016;174:188-202. DOI: https://doi.org/10.1111/bjh.14146

Pileri A, Delfino C, Grandi V, et al. Blastic plasmacytoid dendritic cell neoplasm (BPDCN): the cutaneous sanctuary. G Ital Dermatol Venereol 2012;147:603-8.

Lennert K, Remmele W. Karyometrische untersuchungen an lymphknotenzellen des menschen. Acta Haematol 1958;19:99-113. DOI: https://doi.org/10.1159/000205419

Reizis B, Bunin A, Ghosh HS, et al. Plasmacytoid dendritic cells: recent progress and open questions. Annu Rev Immunol 2011;29:163. DOI: https://doi.org/10.1146/annurev-immunol-031210-101345

Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization classification of haematolymphoid tumours: myeloid and histiocytic/dendritic neoplasms. Leukemia 2022;36: 1703-19. DOI: https://doi.org/10.1038/s41375-022-01613-1

Pagano L, Zinzani PL, Pileri S, et al. Unmet clinical needs and management recommendations for blastic plasmacytoid dendritic cell neoplasm: a consensus-based position paper from an ad hoc international expert panel. Hemasphere 2023;7:e841. DOI: https://doi.org/10.1097/HS9.0000000000000841

Massone C, Chott A, Metze D, et al. Subcutaneous, plastic natural killer (NK), NK/T-cell, and other cytotoxic lymphomas of the skin: a morphologic, immunophenotypic, and molecular study of 50 patients. Am J Surg Pathol 2004;28:719-35. DOI: https://doi.org/10.1097/01.pas.0000126719.71954.4f

Massone C, Raiola AM, Dominietto A, et al. Blastic Plasmacytoid Dendritic Cell Neoplasm: Underlining the importance of an early diagnosis and the use of tagraxofusp therapy before wide dissemination. Australas J Dermatol 2021;62:e316-e318. DOI: https://doi.org/10.1111/ajd.13399

Laribi K, Baugier de Materre A, Sobh M, et al. Blastic plasmacytoid dendritic cell neoplasms: results of an international survey on 398 adult patients. Blood Adv 2020;4:4838-48. DOI: https://doi.org/10.1182/bloodadvances.2020002474

NCCN guidelines, version 3.2021. Blastic plasmacytoid dendritic cell neoplasm (Age ≥18 years)

Facchetti F, Cigognetti M, Fisogni S, et al. Neoplasms derived from plasmacytoid dendritic cells. Mod Pathol 2016;29:98-111. DOI: https://doi.org/10.1038/modpathol.2015.145

Facchetti F, Jones D, Petrella T. Blastic plasmacytoid dendritic cell neoplasm. In: WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Swerdlow, S.H., Campo, E., Harris, N.L., Jaffe, E.S., Pileri, S.A., Stein, H., Thiele, J. & Vardiman, J.W. (eds.), IARC press, Lyon, France; 2008:145-7.

Facchetti F, Pileri SA, Lorenzi L, et al. Histiocytic and dendritic cell neoplasms: what have we learnt by studying 67 cases. Virchows Arch 2017;471:467-89. DOI: https://doi.org/10.1007/s00428-017-2176-1

Brody JP, Allen S, Schulman P, et al. Acute agranular CD4-positive natural killer cell leukemia: comprehensive clinicopathologic studies including virologic and in vitro culture with inducing agents. Cancer 1995;75:2474-83. DOI: https://doi.org/10.1002/1097-0142(19950515)75:10<2474::AID-CNCR2820751013>3.0.CO;2-Y

Petrella T, Dalac S, Maynadie M, et al. CD4+ CD56+ cutaneous neoplasms: a distinct hematological entity? Groupe Francais d’Etude des Lymphomes Cutanes (GFELC). Am J Surg Pathol 1999;23:137-46. DOI: https://doi.org/10.1097/00000478-199902000-00001

Chan JKC, Jaffe ES, Ralfkiaer E. Blastic NK-cell lymphoma. In: WHO Classification. Tumors of Haematopoietic and Lymphoid Tissues. Jaffe ES, Harris NL, Stein H, Vardiman JW (eds.), IARC Press, Lyon, France; 2001;214-5.

Willemze R, Jaffe ES, Burg G, et al. WHO-EORTC classification for cutaneous lymphomas. Blood 2005;105:3768-85. DOI: https://doi.org/10.1182/blood-2004-09-3502

Willemze R, Jansen PM, Cerroni L, et al. EORTC cutaneous lymphoma group. subcutaneous panniculitis-like T-cell lymphoma: definition, classification, and prognostic factors: an EORTC Cutaneous Lymphoma Group Study of 83 cases. Blood 2008;111:838-45. DOI: https://doi.org/10.1182/blood-2007-04-087288

Cota C, Vale E, Viana I, et al. Cutaneous manifestations of blastic plasmacytoid dendritic cell neoplasm-morphologic and phenotypic variability in a series of 33 patients. Am J Surg Pathol 2010;34:75-87. DOI: https://doi.org/10.1097/PAS.0b013e3181c5e26b

Massone C, Lozzi GP, Egberts F, et al. The protean spectrum of non-Hodgkin lymphomas with prominent involvement of subcutaneous fat. J Cutan Pathol 2006;33:418-25. DOI: https://doi.org/10.1111/j.0303-6987.2006.00493.x

Sapienza MR, Pileri A, Derenzini E, et al. Blastic plasmacytoid dendritic cell neoplasm: state of the art and prospects. Cancers (Basel) 2019;11:595.

Valentini CG, Piciocchi A, Facchetti F, et al. Blastic plasmocitoid dendritic cell neoplasm with leukemic spread: a GIMEMA survey. Blood Adv 2021;5:5608-11. DOI: https://doi.org/10.1182/bloodadvances.2021005802

Ascani S, Massone C, Ferrara G, et al. CD4-negative variant of CD4+/CD56+ hematodermic neoplasm: description of three cases. J Cutan Pathol 2008;35:911-5. DOI: https://doi.org/10.1111/j.1600-0560.2007.00915.x

Leukemia & Lymphoma Society. Facts about Blastic Plasmacytoid Dendritic Cell Neoplasm. 2019. Available from: https://www.lls.org/sites/default/files/2021-05/FSHP2_BPDCN_FINAL_2019.pdf

Garnache-Ottou F, Vidal C, Biichlé S, et al. How should we diagnose and treat blastic plasmacytoid dendritic cell neoplasm patients? Blood Adv 2019;3:4238-51.

Kharfan-Dabaja MA, Pemmaraju N, Mohty M, et al Therapeutic Approaches for Blastic Plasmacytoid Dendritic Cell Neoplasm: Allogeneic Hematopoietic Cell Transplantation and Novel Therapies. Clin Hematol Int 2019;1:2-9. DOI: https://doi.org/10.2991/chi.d.190218.001

Pagano L, Valentini CG Pulsoni, A, et al. Blastic plasmacytoid dendritic cell neoplasm with leukemic presentation: an Italian multicenter study. Haematologica 2013;98:239-46. DOI: https://doi.org/10.3324/haematol.2012.072645

Elzonris® (tagraxofusp). CHMP Assessment Report. 2020.

Pemmaraju N, Lane A, Sweet KL, et al. Tagraxofusp in Blastic Plasmacytoid Dendritic-Cell Neoplasm, N Engl J Med 2019;380:1628-37. DOI: https://doi.org/10.1056/NEJMoa1815105

Alfayez M, Konopleva M, Pemmaraju N. Role of tagraxofusp in treating blastic plasmacytoid dendritic cell neoplasm (BPDCN). Expert Opin Biol Ther 2020;20:115-23. DOI: https://doi.org/10.1080/14712598.2020.1701651

Pemmaraju N, Sweet KL, Stein AS, et al. Long-term benefits of tagraxofusp for patients with blastic plasmacytoid dendritic cell neoplasm. Lane J Clin Oncol 2022;26:3032-6. DOI: https://doi.org/10.1200/JCO.22.00034

Kharfan-Dabaja MA, Reljic T, Murthy HS, et al. Allogeneic hematopoietic cell transplantation is an effective treatment for blastic plasmacytoid dendritic cell neoplasm in first complete remission: systematic review and meta-analysis. Clin Lymphoma Myeloma Leuk 2018;18. DOI: https://doi.org/10.1016/j.clml.2018.07.295

Dalle S, Beylot-Barry M, Bagot M, et al. Blastic plasmacytoid dendritic cell neoplasm: is transplantation the treatment of choice? Br J Dermatol 2010;162:74-9. DOI: https://doi.org/10.1111/j.1365-2133.2009.09373.x

Sullivan JM, Rizzieri DA. Treatment of blastic plasmacytoid dendritic cell neoplasm. Hematology Am Soc Hematol Educ Program 2016;2016:16-23. DOI: https://doi.org/10.1182/asheducation-2016.1.16

Aoki T, Suzuki R, Kuwatsuka Y, et al. Long-term survival following autologous and allogeneic stem cell transplantation for blastic plasmacytoid dendritic cell neoplasm. Blood 2015;125:3559-62. DOI: https://doi.org/10.1182/blood-2015-01-621268

Pemmaraju N, Wilson NR, Khoury JD, et al. Central nervous system involvement in blastic plasmacytoid dendritic cell neoplasm. Blood 2021;138:1373-7. DOI: https://doi.org/10.1182/blood.2021011817

Martın-Martın L, Almeida J, Pomares H, et al. Blastic plasmacytoid dendritic cell neoplasm frequently shows occult central nervous system involvement at diagnosis and benefits from intrathecal therapy. Oncotarget. 2016;7:10174-81. DOI: https://doi.org/10.18632/oncotarget.7101

Greenwell IB, Davis J, Li H, et al. Outcomes of CNS involvement in blastic plasmacytoid dendritic cell neoplasm (BPDCN). J Clin Oncol 2021;39:e19043-e19043. DOI: https://doi.org/10.1200/JCO.2021.39.15_suppl.e19043

Rivoli G, Beltrami G, Raiola A, et al. P:530: Tagraxofusp in blastic plasmacytoid dendritic cell neoplasm with/without central nervous system involvement and intrathecal chemotherapy as primary treatment or prophylaxis: an Italian experience. HemaSphere 2022;6:429-30. DOI: https://doi.org/10.1097/01.HS9.0000845008.01963.5f

Pemmaraju N, Cuglievan B, Lasky J, et al. Efficacy and manageable safety of tagraxofusp in pediatric and adolescent/young adult patients with blastic plasmacytoid dendritic cell neoplasm. Br J Haematol 2023;5:61-9. DOI: https://doi.org/10.1002/jha2.856

Montero J, Stephansky J, Cal T, et al. Blastic plasmacytoid dendritic cell neoplasm is dependent on BCL-2 and sensitive to venetoclax. Cancer Discov 2017;7:156-64. DOI: https://doi.org/10.1158/2159-8290.CD-16-0999

DiNardo CD, Rausch CR, Benton C, et al. Clinical experience with the BCL-2 inhibitor venetoclax in combination therapy for relapsed and refractory AML and related myeloid malignancies. AM J Hematol 2018;93:401-7. DOI: https://doi.org/10.1002/ajh.25000

Sapienza MR, Pileri A, Derenzini E, et al. Blastic plasmacytoid dendritic cell neoplasm: state of the art and prospects. Cancers (Basel) 2019;11:595. DOI: https://doi.org/10.3390/cancers11050595

Laribi K, Denizon N, Ghnaya H, et al. Blastic plasmacytoid dendritic cell neoplasm: the first report of two cases treated by 5-azacytidine. Eur J Haematol 2014;93;81-5. DOI: https://doi.org/10.1111/ejh.12294

Kovtun Y, Jones GE, Adams S, et al. A CD123-targeting antibody-drug conjugate, IMGN632, designed to eradicate AML while sparing normal bone marrow cells. Blood Adv 2018;2:848-58. DOI: https://doi.org/10.1182/bloodadvances.2018017517

Khwaja R, Daly A, Wong M, et al. Azacitidine in the treatment of blastic plasmacytoid dendritic cell neoplasm: a report of 3 cases. Leuk Lumphoma 2016;57:2720-2. DOI: https://doi.org/10.3109/10428194.2016.1160084

Marmouset V, Joris M, Merlusca L, et al. The lenalidomide/bortezomib/dexamethasone regimen for the treatment of blastic plasmacytoid dendritic cell neoplasm. Hematol Oncol 2019;37:487-89. DOI: https://doi.org/10.1002/hon.2671

Massone, C., Rivoli, G., Sola, S., & Angelucci, E. (2023). Blastic plasmacytoid dendritic cell neoplasm: a short review and update. Dermatology Reports, 16(s2). https://doi.org/10.4081/dr.2024.9781

Downloads

Download data is not yet available.

Citations