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Takashi Kido, MD, PhD; Kazuhiro Yatera, MD, PhD; Hiroshi Mukae, MD, PhD, FCCP
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From the Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan.

Correspondence to: Takashi Kido, MD, PhD, Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu City, Fukuoka 807-8555, Japan; e-mail: t-kido@med.uoeh-u.ac.jp

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):262-263. doi:10.1378/chest.12-0543
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To the Editor:

We thank Dr Borie and colleagues for their letter regarding our article in CHEST1 showing the diagnostic utility of the detection of mucosa-associated lymphoid tissue lymphoma translocation gene 1 (MALT1) gene rearrangements in BAL fluid (BALF) for primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma, a low-grade B-cell extranodal lymphoma.

They pointed out that we showed an elevated percentage of lymphocytes in BALF, while we did not show the phenotype and clonality of these lymphocytes in our study. We actually tried to evaluate the lymphocytes using flow cytometry in a couple of patients, but unfortunately we did not think that we had obtained sufficient results to include them in our report.

We believe that the detection of MALT1 gene rearrangements in BALF is specific and simple for the diagnosis of pulmonary MALT lymphoma and are very interested in the reports by Borie et al2 regarding phenotypic evaluation of lymphocytes in BALF in 33 patients with pulmonary MALT lymphoma without connective tissue diseases. They showed that 34% of the BALF cells were lymphocytes, and analyses of the cell-surface markers in the lymphocytes demonstrated 41% T cells and 34% B cells in these patients. In addition, they reported that B-cell clonality detected by complementarity determining region 3 was positive in 88% of these patients. None of the patients in our study had any connective tissue diseases, and they showed a median of 30% of lymphocytes in BALF. Additionally, 58% of these lymphocytes in BALF showed MALT1 gene rearrangement in the patients with MALT lymphoma.1 These results suggest that BALF lymphocytes in patients with MALT lymphoma include tumor cells (B cells) and reactive lymphocytes (possibly T cells), and our results were consistent with the report by Borie et al.2

We agree with Dr Borie and colleagues that it is necessary to confirm the utility of BALF for the diagnosis of pulmonary MALT lymphoma in a larger prospective study. MALT1 gene rearrangements are not always positive in patients with pulmonary MALT lymphoma, and the absence of the rearrangements does not exclude the diagnosis of pulmonary MALT lymphoma. We, therefore, think that a combination of detecting MALT1 gene rearrangements and other modalities, such as the detection of other chromosomal translocations, analyses of surface markers, and the detection of clonality in BALF lymphocytes may, thus, have a greater sensitivity and specificity for the diagnosis of pulmonary MALT lymphoma.

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.
 

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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.
 
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