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MALT1 Rearrangements in BAL FluidDetection of MALT1 Gene Rearrangements FREE TO VIEW

Raphael Borie, MD; Marie Wislez, MD, PhD; Jocelyne Fleury-Feith, MD, PhD; Marie-Helene Delfau-Larue, MD, PhD; Jacques Cadranel, MD, PhD
Author and Funding Information

From the Service de Pneumologie et Réanimation, Centre de Compétence Maladies Rares Pulmonaires (Drs Borie, Wislez, and Cadranel), the Service d’histologie et Biologie Tumorale (Dr Fleury-Feith), Hôpital Tenon, and the Service de Pneumologie A, Centre de Compétence Maladies Rares Pulmonaires, Hôpital Bichat (Drs Borie), Assistance Publique-Hôpitaux de Paris; the Faculté de Médecine Pierre et Marie Curie, Université Paris VI (Drs Wislez, Fleury-Feith, and Cadranel); and the Laboratoire d’Immunologie Biologique, Centre Hospitalier Henri Mondor and INSERM U955, UPEC, UFR de medecine (Dr Delfau-Larue).

Correspondence to: Raphael Borie, MD, Service de Pneumologie A, Hopital Bichat, 46 rue Henri Huchard 75877 Paris CEDEX 18, France; e-mail: raphael.borie@bch.aphp.fr

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(1):262. doi:10.1378/chest.12-0275
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To the Editor:

We read with great interest the article by Kido et al1 in an issue of CHEST (January 2012) demonstrating mucosa-associated lymphoid tissue (MALT) lymphoma translocation gene 1 rearrangements in BAL fluid (BALF) in four of five cases of pulmonary MALT lymphoma. The use of BALF is debated, but the authors elegantly demonstrate that BALF may be useful for the diagnosis of pulmonary disease, particularly when lymphoma is suspected.

The authors report an elevated number of lymphocytes, median 30%, in BALF from patients with pulmonary MALT lymphoma, which did not differ from control samples (23.6%). However, the authors did not report the phenotype of the lymphocytes or the results of clonality analysis. Indeed, we previously reported, for a series of 44 patients, an increased proportion of lymphocytes in BALF (31.5%) and a median B-lymphocyte proportion (CD19 or CD20) of total alveolar lymphocytes of 20% (normally<10%); moreover, clonality analysis of alveolar B cells showed a B-cell clone in 82% of the cases.2 In a prospective study, specificity and sensitivity of BALF clonality results were reported to be 97% and 95%, respectively.3

It would be interesting to know if some patients Kido et al1 describe had connective tissue disease (CTD), because patients without CTD showed a higher proportion of B lymphocytes (34%) than those with CTD (6.5%).2 Furthermore, we agree with Kido et al1 that pulmonary MALT lymphoma may be diagnosed without surgical biopsy. We previously reported on a series of 63 patients in which pulmonary MALT lymphoma could be diagnosed in 71.4% by minimally invasive procedures.4 The next step would be to confirm in a prospective larger series the feasibility of diagnosis of pulmonary MALT lymphoma by using BALF only.

Kido T, Yatera K, Noguchi S, et al. Detection ofMALT1gene rearrangements in BAL fluid cells for the diagnosis of pulmonary mucosa-associated lymphoid tissue lymphoma. Chest. 2012;141(1):176-182. [PubMed] [CrossRef]
 
Borie R, Wislez M, Antoine M, et al. Clonality and phenotyping analysis of alveolar lymphocytes is suggestive of pulmonary MALT lymphoma. Respir Med. 2011;105(8):1231-1237.
 
Zompi S, Couderc LJ, Cadranel J, et al. Clonality analysis of alveolar B lymphocytes contributes to the diagnostic strategy in clinical suspicion of pulmonary lymphoma. Blood. 2004;103(8):3208-3215.
 
Borie R, Wislez M, Thabut G, et al. Clinical characteristics and prognostic factors of pulmonary MALT lymphoma. Eur Respir J. 2009;34(6):1408-1416.
 

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References

Kido T, Yatera K, Noguchi S, et al. Detection ofMALT1gene rearrangements in BAL fluid cells for the diagnosis of pulmonary mucosa-associated lymphoid tissue lymphoma. Chest. 2012;141(1):176-182. [PubMed] [CrossRef]
 
Borie R, Wislez M, Antoine M, et al. Clonality and phenotyping analysis of alveolar lymphocytes is suggestive of pulmonary MALT lymphoma. Respir Med. 2011;105(8):1231-1237.
 
Zompi S, Couderc LJ, Cadranel J, et al. Clonality analysis of alveolar B lymphocytes contributes to the diagnostic strategy in clinical suspicion of pulmonary lymphoma. Blood. 2004;103(8):3208-3215.
 
Borie R, Wislez M, Thabut G, et al. Clinical characteristics and prognostic factors of pulmonary MALT lymphoma. Eur Respir J. 2009;34(6):1408-1416.
 
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