1
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Iori E, Mazzoli M, Ariatti A, Salviato T, Rispoli V, Valzania F, Galassi G. Myasthenia Gravis crossing Parkinson's disease: a 20 year study from single Italian center. Int J Neurosci 2024; 134:429-435. [PMID: 35917141 DOI: 10.1080/00207454.2022.2107517] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE The concomitant diagnosis of Parkinson's disease (PD) and Myasthenia Gravis (MG) is rare. The aim of the study was to report our experience of patients with both diagnoses. MATERIAL AND METHODS We performed a retrospective analysis of patients with MG and PD, seen at Neurology Department, Modena, Italy from 2000 to 2020. We encountered 12 patients with both diagnoses. All had late onset MG (LOMG) and low Myasthenia Gravis Foundation of America (MGFA) severity scores at baseline. In respect of PD assessement, clinical signs were followed and summarized with modified Hoehn and Yahr staging (mHY). Patients were ranked as progressive or non-progressive, according to any change in mHY staging. We compared characteristics and outcome of the patients with age matched myasthenic subjects without PD. RESULTS The male gender significantly prevailed (p < 0.01) as well as the presence of multiple comorbidities (p < 0.001) in patients with MG associated with PD. In respect of clinical course, MG was benign as most of cases remained stable (66.7%). Six cases showed worsening of mHY scores; only one subject became wheelchair bound by the end of follow up. This uneven progression, at least in our hands, might suggest that MG and PD can evolve independently. CONCLUSION Clinicians should be alert about the association of PD and MG since early diagnosis and treatment are essential.
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Affiliation(s)
- Erika Iori
- Department of Biomedical, Metabolic Neural Sciences, University of Modena, Modena, Italy
| | - Marco Mazzoli
- Department of Biomedical, Metabolic Neural Sciences, University of Modena, Modena, Italy
| | - Alessandra Ariatti
- Department of Biomedical, Metabolic Neural Sciences, University of Modena, Modena, Italy
| | - Tiziana Salviato
- Department of Anatomy Pathology and Legal Medicine, University of Modena, Modena, Italy
| | - Vittorio Rispoli
- Department of Biomedical, Metabolic Neural Sciences, University of Modena, Modena, Italy
| | - Franco Valzania
- Neuro-Motor Department, S. Maria Nuova Hospital, AUSL-IRCSS, Reggio Emilia, Italy
| | - Giuliana Galassi
- Department of Biomedical, Metabolic Neural Sciences, University of Modena, Modena, Italy
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Means RT. Pure red cell aplasia: The second hundred years. Am J Med Sci 2023; 366:160-166. [PMID: 37327996 DOI: 10.1016/j.amjms.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
Pure red cell aplasia (PRCA) is a rare hematologic syndrome, characterized by an isolated normocytic anemia with severe reticulocytopenia, and defined by absence or near absence of erythroid precursors in the bone marrow. First described in 1922, PRCA may be a primary autoimmune or clonal myeloid or lymphoid disorder, but may also be secondary to other disorders of immune dysregulation/autoimmunity, to infections, to neoplasms, or to drugs. Insights from the study of PRCA have helped illuminate the understanding of the regulation of erythropoiesis. This review summarizes the classification, diagnostic, and therapeutic approach to PRCA as it begins its second century, with a particular focus on opportunities and challenges provided by new developments in the role of T-cells and T-cell regulatory mutations; the role of clonal hematopoiesis; and new developments in therapy for refractory PRCA and PRCA associated with ABO incompatible stem cell transplantation.
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Affiliation(s)
- Robert T Means
- Departments of Internal Medicine, Medical Education, and Pathology, James H. Quillen College of Medicine, Johnson City, TN, USA.
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3
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Shimazu Y, Mizumoto C, Chonabayashi K, Hanyu Y, Kanda J, Takaori-Kondo A. Successful treatment with cyclosporine of pure red cell aplasia induced by obinutuzumab bendamustine therapy. Ann Hematol 2023; 102:2291-2292. [PMID: 37103614 DOI: 10.1007/s00277-023-05215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Yutaka Shimazu
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
| | - Chisaki Mizumoto
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan.
| | - Kazuhisa Chonabayashi
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
| | - Yuta Hanyu
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
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Li X, Zhu X, Zhang X, Wang W. Successful treatment of a pure red-cell aplasia patient with γδT cells and clonal TCR gene rearrangement: A case report. Front Immunol 2023; 13:1103448. [PMID: 36726982 PMCID: PMC9885080 DOI: 10.3389/fimmu.2022.1103448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Pure red-cell aplasia (PRCA) is a syndrome associated with reduced erythroid precursors. This report presents the case of an elderly PRCA patient with significantly proliferated γδT cells and clonal T-cell receptor (TCR) gene rearrangement. The cause of this patient's PRCA was confirmed to be an autoimmune disorder rather than malignancy on the basis of flow cytometry, TCR gene rearrangement, and positron emission tomography/computed tomography (PET/CT) findings. Moreover, the γδT cell group identified in this case was captured for the first time under the microscope; this CD4+/CD8- (extremely high CD4/CD8 ratio) population is rare in PRCA patients. Our patient with a monoclonal and polyclonal hybrid of TCR gene rearrangement was sensitive to cyclosporin A (CsA), despite previous reports suggesting that patients with TCR clonal rearrangement may respond poorly to this drug. Overall, this case presents valuable clinical findings for the future diagnosis and management of PRCA caused by autoimmune conditions and further research on γδT cells' autoimmune pathophysiology and gene rearrangement.
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Affiliation(s)
- Xian Li
- Department of Hematology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyi Zhu
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Xiaohong Zhang
- Department of Hematology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Weiqin Wang
- Department of Hematology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China,*Correspondence: Weiqin Wang,
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Kawakami T, Nakazawa H, Ishida F. Somatic mutations in acquired pure red cell aplasia. Semin Hematol 2022; 59:131-136. [DOI: 10.1053/j.seminhematol.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 12/12/2022]
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Wagh AN, Bhagvat SR, Bhandarwar AH, Harivelam C, Ganesan B, Sawardekar VM. Minimally invasive extended thymectomy for thymoma associated with pure red cell aplasia. Indian J Thorac Cardiovasc Surg 2022; 38:199-203. [PMID: 35221558 PMCID: PMC8857358 DOI: 10.1007/s12055-021-01273-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/01/2022] Open
Abstract
Anaemia characterised by near absence of red cell precursors in the bone marrow is referred to as "pure red cell aplasia (PRCA)." It has an unusual and intriguing association with thymoma and auto-immunity. Here, we report such a case which was successfully treated with extended thymectomy by minimally invasive approach. A 68-year-old anaemic lady presented to our institute with weakness and exertional dyspnoea for almost a year. She was transfused with blood for the same periodically but remained transfusion dependent. Apart from pallor, her systemic examination was unremarkable. Peripheral smear showed reduced haemoglobin (Hb) mass and reduced reticulocytes. Bone marrow biopsy implied PRCA. High-resolution computed tomography (HRCT) of thorax revealed a well-defined soft tissue lesion in the anterior mediastinum suggesting thymoma. Biopsy showed lymphocyte-rich type thymoma. Thymus along with fibrofatty tissue was resected completely using video-assisted thoracoscopic surgery (VATS) approach. Histopathological examination of the resected specimen revealed World Health Organisation (WHO) type B1-thymoma. Immediate post-operative period was uneventful. However, a fall in Hb which required blood transfusions necessitated initiation of immunosuppression with corticosteroids. Patient was given 6 weeks of adjuvant immunosuppression with corticosteroids. After 8 months post-thymectomy, she was leading a symptom-free life and no longer in need for blood transfusions. VATS thymectomy is a safe and feasible approach for the treatment of thymoma-induced PRCA with added advantage of minimal invasive approach. Long-term complete remission is possible with adjuvant immunosuppression.
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Affiliation(s)
- Amol N. Wagh
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Shirish R. Bhagvat
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Ajay H. Bhandarwar
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Chidananda Harivelam
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Balamurugan Ganesan
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Vinayak M. Sawardekar
- Department of General Medicine, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
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Lesire B, Durieux V, Grigoriu B, Girard N, Berghmans T. Management of thymoma associated autoimmune pure red cell aplasia: Case report and systematic review of the literature. Lung Cancer 2021; 157:131-146. [PMID: 34049719 DOI: 10.1016/j.lungcan.2021.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
Pure red cell aplasia (PRCA) is a rare paraneoplastic syndrome observed in 2-5 % of thymomas. Literature reports great variability in its management. Based on an illustrative clinical case, we present a systematic literature review whose main objective is to evaluate the therapeutic management of PRCA. The literature search was performed based on the PICO method in the Medline and Scopus databases. The reference clinical case concerns a 51-year-old woman with stage IVa thymoma. After initial response to chemotherapy, a locoregional progression occurred with PRCA development that responded favorably under second line chemotherapy. The patient finally died in a context of bicytopenia with febrile neutropenia. The systematic review covers 135 articles published between 1950 and 2019. Thymectomy alone or in combination with other therapies showed a 31 % complete remission (CR) rate for PRCA of, whereas none was reported with anti-tumor treatments without thymectomy. Among immunomodulatory therapies, cyclosporin gave the highest percentage of CR (74 %). Finally, the combination of thymectomy and immunomodulatory treatments showed a CR rate of 45 %. Thymectomy appeared to be the most effective anti-tumor treatment for PRCA. Immunomodulatory therapies, particularly cyclosporine, are shown effective, but the risk of infectious complications must be considered. The optimal place of anti-tumor and immunomodulatory therapies against PRCA has yet to be determined.
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Affiliation(s)
- Bastien Lesire
- Department of Internal Medecine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles, Belgium.
| | - Bogdan Grigoriu
- Department of Intensive Care and Oncological Emergencies & Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France.
| | - Thierry Berghmans
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Laboratoire Facultaire de Médecine Factuelle de l'Université Libre de Bruxelles, Belgium.
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8
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Xavier RD, Devaraj S, Sadasivam V, Prakasam O, Menon N, Hariharan A, Sundaramoorthi T. Thymoma associated with pure red cell aplasia: a case report and literature review. Indian J Thorac Cardiovasc Surg 2020; 36:404-408. [PMID: 33061149 DOI: 10.1007/s12055-019-00875-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/20/2019] [Accepted: 09/01/2019] [Indexed: 10/24/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare hematological complication associated with thymoma. Remission of PRCA occurs after thymectomy but can reappear after a latency period even without recurrence of thymoma. We report a case and we have reviewed the literature of thymoma associated with PRCA. Because of less number of reported cases, there have been no clinical trials investigating the immunosuppression regimen following thymectomy for thymoma associated with PRCA. After reviewing the literature, we came to a conclusion that thymectomy followed by immumosuppression with the cyclosporin-containing regimen is currently the most effective treatment.
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Affiliation(s)
- Reenus Demel Xavier
- Department of Cardiothoracic Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamilnadu 641044 India
| | - Sujith Devaraj
- Department of Cardiothoracic Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamilnadu 641044 India
| | - Vijay Sadasivam
- Department of Cardiothoracic Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamilnadu 641044 India
| | - Om Prakasam
- Department of Cardiothoracic Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamilnadu 641044 India
| | - Narendra Menon
- Department of Cardiothoracic Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamilnadu 641044 India
| | - Ashok Hariharan
- Department of Cardiothoracic Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamilnadu 641044 India
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9
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Wang W, Chen LY, Zhao W, Ren Y, Wang L, Li X, Jiang Y, Gao H. Coexistence of Pure Red Cell Aplasia and Autoimmune Haemolytic Anaemia Associated with Thymoma. Acta Haematol 2020; 143:491-495. [PMID: 31962320 DOI: 10.1159/000503376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022]
Abstract
Thymoma is an uncommon neoplasia derived from the epithelial cells of the thymus, which leads to immune dysregulation and is associated with a series of autoimmune diseases. However, the concurrence of these disease entities is rare, and the exact mechanisms of these diseases are still unclear. We have admitted several cases who were diagnosed with thymoma, autoimmune haemolytic anaemia, and pure red cell aplasia. These cases were the first to report the concurrence of these three disorders. After thymectomy, anaemia improved, haemolytic cells decreased, and haemoglobin was normalized.
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Affiliation(s)
- Wei Wang
- Department of Haematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China,
| | - Li-Yan Chen
- Department of Haematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Weiwei Zhao
- Department of Haematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuyue Ren
- Department of Haematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lianjie Wang
- Department of Haematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaoyun Li
- Department of Haematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yongfang Jiang
- Department of Haematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haiyan Gao
- Department of Haematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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10
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Moriyama S, Yano M, Haneda H, Okuda K, Kawano O, Sakane T, Oda R, Watanabe T, Nakanishi R. Pure red cell aplasia associated with thymoma: a report of a single-center experience. J Thorac Dis 2018; 10:5066-5072. [PMID: 30233881 DOI: 10.21037/jtd.2018.07.14] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pure red cell aplasia (PRCA) associated with thymoma is relatively rare, and relevant reports are limited. We investigated the clinical features and outcomes of PRCA associated with thymoma in this study. Methods A retrospective review of all PRCA patients who underwent surgical resection of thymoma from April 1, 2004, to December 31, 2015, was performed. Results We experienced eight patients with PRCA among 146 patients who underwent surgical resection of thymoma. Extended thymectomy (n=4) and thymectomy (n=4) were performed for thymoma. Regarding the WHO classification of thymoma, the subtypes were type B2 or B3 in seven patients, and the stage of thymoma was advanced in seven patients. Complete resection was achieved macroscopically in only five patients. Recurrence of thymoma occurred in four patients who underwent complete resection. PRCA was diagnosed after surgical resection of thymoma in six patients (range 1-101 months, median 56.5 months). Cyclosporine was used for PRCA in six patients. Pneumonia of treatment-related complications due to cyclosporine occurred in all patients. The follow-up period ranged from 13-147 months (median 54.5 months) after the PRCA diagnosis. Three patients obtained complete remission of anemia by cyclosporine. Although one patient was able to stop taking cyclosporine because of complete remission of anemia, transfusion was needed due to relapse of PRCA. Five patients died, with the main causes of death diagnosed as pneumonia (n=4) and cardiac failure (n=1). Conclusions PRCA associated with thymoma was diagnosed postoperatively in three-quarter of patients. We should be alert for the occurrence of PRCA even after resection of thymoma, especially in patients with incomplete resection or advanced disease. Cyclosporine was effective for PRCA, but treatment-related complications occurred, particularly pneumonia. As treatment for PRCA associated with thymoma and its complications were combined in a complex manner, treating PRCA associated with thymoma can be quite difficult.
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Affiliation(s)
- Satoru Moriyama
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoki Yano
- Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Hiroshi Haneda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Katsuhiro Okuda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Osamu Kawano
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadashi Sakane
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Risa Oda
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Watanabe
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryoichi Nakanishi
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Fu R, Zhang T, Liu B, Song J, Wang G, Li L, Wang H, Xing L, Wu Y, Guan J, Shao Z. The clinical characteristics and therapy response of patients with acquired pure red cell aplasia. Hematology 2018; 23:639-645. [PMID: 29754581 DOI: 10.1080/10245332.2018.1470068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- Rong Fu
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Tian Zhang
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Bingnan Liu
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Jia Song
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Guojin Wang
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Lijuan Li
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Huaquan Wang
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Limin Xing
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Yuhong Wu
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Jing Guan
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Zonghong Shao
- The Department of Hematology, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
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Chen JF, Kang JM, Zhang YF, Wang MF, Dong CX, Wang LY, Guo LP, Yang LH. [Clinical analysis of 32 patients with acquired pure red cell aplasia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:981-983. [PMID: 29224325 PMCID: PMC7342792 DOI: 10.3760/cma.j.issn.0253-2727.2017.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Indexed: 12/05/2022]
Affiliation(s)
- J F Chen
- Department of Hematology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
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Hirokawa M, Sawada K, Fujishima N, Teramura M, Bessho M, Dan K, Tsurumi H, Nakao S, Urabe A, Fujisawa S, Yonemura Y, Kawano F, Oshimi K, Sugimoto K, Matsuda A, Karasawa M, Arai A, Komatsu N, Harigae H, Omine M, Ozawa K, Kurokawa M. Long-term outcome of patients with acquired chronic pure red cell aplasia (PRCA) following immunosuppressive therapy: a final report of the nationwide cohort study in 2004/2006 by the Japan PRCA collaborative study group. Br J Haematol 2015; 169:879-86. [DOI: 10.1111/bjh.13376] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Makoto Hirokawa
- Department of General Internal Medicine and Clinical Laboratory Medicine; Akita University Graduate School of Medicine; Akita Japan
| | - Kenichi Sawada
- Department of Haematology, Nephrology and Rheumatology; Akita University Graduate School of Medicine; Akita Japan
| | - Naohito Fujishima
- Department of Haematology, Nephrology and Rheumatology; Akita University Graduate School of Medicine; Akita Japan
| | - Masanao Teramura
- Department of Haematology; Tokyo Women's Medical University; Tokyo Japan
| | - Masami Bessho
- Haematology Division; Department of Internal Medicine; Saitama Medical University; Saitama Japan
| | - Kazuo Dan
- Department of Haematology; Nippon Medical School; Tokyo Japan
| | - Hisashi Tsurumi
- First Department of Internal Medicine; Gifu University School of Medicine; Gifu Japan
| | - Shinji Nakao
- Department of Cellular Transplantation Biology; Kanazawa University Graduate School of Medicine; Kanazawa Japan
| | - Akio Urabe
- Division of Haematology; NTT Medical Centre; Tokyo Japan
| | - Shin Fujisawa
- Department of Haematology; Yokohama City University Medical Centre; Yokohama Kanagawa Japan
| | - Yuji Yonemura
- Department of Transfusion Medicine and Cell Therapy Blood Transfusion Service; Kumamoto University School of Medicine; Kumamoto Japan
| | - Fumio Kawano
- National Hospital Organization Kumamoto National Hospital Medical Centre; Kumamoto Japan
| | - Kazuo Oshimi
- Division of Haematology; Juntendo University School of Medicine; Tokyo Japan
| | - Koichi Sugimoto
- Division of Haematology; Juntendo University School of Medicine; Tokyo Japan
| | - Akira Matsuda
- Saitama International Medical Centre; Saitama Medical University; Saitama Japan
| | - Masamitsu Karasawa
- Blood Transfusion Service; Gunma University Hospital; Maebashi Gunma Japan
| | - Ayako Arai
- Department of Haematology; Tokyo Medical and Dental University; Tokyo Japan
| | - Norio Komatsu
- Division of Haematology; Juntendo University School of Medicine; Tokyo Japan
| | - Hideo Harigae
- Department of Haematology and Immunology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Mitsuhiro Omine
- Division of Haematology, Internal Medicine; Showa University Fujigaoka Hospital; Yokohama Japan
| | - Keiya Ozawa
- Division of Haematology; Department of Medicine; Jichi Medical School; Tochigi Japan
| | - Mineo Kurokawa
- Department of Haematology and Oncology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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14
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Deferasirox treatment improved hematopoiesis and led to complete remission in a patient with pure red cell aplasia. Int J Hematol 2013; 98:719-22. [DOI: 10.1007/s12185-013-1455-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 09/18/2013] [Accepted: 10/16/2013] [Indexed: 01/07/2023]
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15
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Herko A, Pophali P, Wallace PK, Sharma P, Loud P, Khoury T, Battiwalla M. T-cell large granular lymphocytosis associated with malignant thymoma. Leuk Res 2012; 36:e187-9. [PMID: 22475364 DOI: 10.1016/j.leukres.2012.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 02/27/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
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Nitta H, Harada Y, Okikawa Y, Fujii M, Arihiro K, Kimura A, Harada H. Good's syndrome-associated pure red cell aplasia with myelodysplastic syndrome. Intern Med 2011; 50:2011-4. [PMID: 21921387 DOI: 10.2169/internalmedicine.50.5709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of Good's syndrome-associated pure red cell aplasia (PRCA) with myelodysplastic syndrome (MDS). In this case, effector memory T (T(EM)) cells were expanded in the bone marrow. It remains uncertain whether the development of MDS was caused by the basic marrow defects or radiation therapy. However, since CD8(+) perforin(+) T(EM) cells expanded in the bone marrow, as was previously described for 3 of our patients with thymoma-associated PRCA, it is highly possible that the pathogenic mechanism of PRCA that is accompanied by thymoma is related to the expanded CD8(+) perforin(+) T(EM) cells in this MDS-complicated case.
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Affiliation(s)
- Hideaki Nitta
- Department of Hematology and Oncology, Division of Clinical Research, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan.
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17
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Nitta H, Mihara K, Sakai A, Kimura A. correspondence: Expansion of CD8+/perforin+ effector memory T cells in the bone marrow of patients with thymoma-associated pure red cell aplasia. Br J Haematol 2010; 150:712-5. [DOI: 10.1111/j.1365-2141.2010.08273.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Kelesidis T, Yang O. Good's syndrome remains a mystery after 55 years: A systematic review of the scientific evidence. Clin Immunol 2010; 135:347-63. [PMID: 20149753 DOI: 10.1016/j.clim.2010.01.006] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 01/17/2010] [Indexed: 11/17/2022]
Abstract
Good syndrome (GS) is a rare association of thymoma and immunodeficiency first described more than 50 years ago. However, this syndrome still remains a mystery to clinicians. We systematically reviewed all the clinical, laboratory and immunologic findings from 152 patients with Good syndrome. The syndrome has a worldwide distribution and approximately half of the cases (47%) have been described in Europe. The diagnosis of thymoma preceded the diagnosis of hypogammaglobulinemia, infection, or diarrhea in 42% of patients whereas in 38% of patients the diagnoses were made almost simultaneously within 2 months of each other. We found significant mortality in patients with this syndrome (44.5%). Astute clinical acumen and increased awareness about the clinical and immunological profile of this syndrome may increase early recognition of this syndrome and prevent mortality. Further studies are needed to elucidate this clinical entity.
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Affiliation(s)
- Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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19
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Sawada K, Hirokawa M, Fujishima N. Diagnosis and management of acquired pure red cell aplasia. Hematol Oncol Clin North Am 2009; 23:249-59. [PMID: 19327582 DOI: 10.1016/j.hoc.2009.01.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pure red cell aplasia is a syndrome characterized by a severe normocytic anemia, reticulocytopenia, and absence of erythroblasts from an otherwise normal bone marrow. Although the causes and natural course of this syndrome are variable and although the anemia in some patients can be managed by treatment of an underlying inflammatory or neoplastic disease, the pathogenesis of a large number of cases is autoimmune, including those associated with thymoma, and are best managed with immunosuppressive therapy.
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Affiliation(s)
- Kenichi Sawada
- Division of Hematology, Department of Medicine, Akita University School of Medicine, Hondo 1-1-1, Akita 018-8543, Japan.
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20
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Gonlugur U, Sahin E, Yildiz E, Gonlugur TE. Early autoimmune complications after thymomectomy in a patient with interstitial lung disease. Case report. Acta Microbiol Immunol Hung 2006; 53:105-11. [PMID: 16696554 DOI: 10.1556/amicr.53.2006.1.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Thymoma has been associated with a variety of autoimmune disorders. We report a case of myasthenia gravis and pancytopenia in a 53-year-old man with lymphoepithelial thymoma and interstitial lung disease. Preoperative examination revealed neither hematologic abnormality nor myasthenia gravis. The patient had enteritis prior to thymomectomy, sternal infection in the first month of operation, and urinary infection at the third month. About three months after thymomectomy, he required mechanical ventilation support due to myasthenia gravis-related respiratory failure. One month later, a rapidly progressing pancytopenia developed. The patient died within two weeks of overwhelming septicemia unresponsive to treatment with antibiotics and steroids. The possible onset of myasthenia gravis or pancytopenia after thymomectomy should be kept in mind during follow-up. Recurrent infections in the early stages of thymomectomy may suggest a lethal onset of pancytopenia.
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Affiliation(s)
- U Gonlugur
- Department of Chest Diseases, Cumhuriyet University Medical School, 58140, Sivas, Turkey.
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21
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Ogata M, Ohtsuka E, Imamura T, Ikewaki J, Ogata Y, Kohno K, Nakayama T, Ono K, Saburi Y, Kikuchi H, Nasu M. Response to cyclosporine therapy in patients with myelodysplastic syndrome: a clinical study of 12 cases and literature review. Int J Hematol 2004; 80:35-42. [PMID: 15293566 DOI: 10.1532/ijh97.04051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cyclosporine (CyA) was administered to 12 patients with myelodysplastic syndrome (MDS), and a response (major erythroid response, according to International Working Group criteria) was observed in 7 patients (58.3%). The median duration of response was 18 months (range, 3-22 months). Two patients are still responding and continuing to take CyA. Three patients stopped because of malignancy complications. To identify variables associated with responsiveness to CyA therapy, we analyzed the treatments of 72 MDS patients, comprising the 12 new patients and 60 patients previously described in the literature. Responses were observed in 44 of the 72 patients (61.1%). Univariate analyses revealed that higher daily dose of CyA (P for trend test, .007) and shorter disease duration (median, 5 months versus 17.5 months, P = .04) were factors significantly associated with response. No significant associations were observed between response and bone marrow features such as erythroid hypoplasia or hypoplastic marrow. Multivariate analysis also demonstrated that high CyA dose (>5 mg/kg per day) was significantly associated with response (P = .02). The present study showed that CyA therapy is useful for MDS patients with any marrow cellularity. Shorter disease duration is a pretreatment variable correlated with response, and a higher CyA dose results in a higher response rate.
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Affiliation(s)
- Masao Ogata
- Second Department of Internal Medicine, Faculty of Medicine, Oita University Hasama-machi, Oita, Japan.
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22
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Suto Y, Araga S, Sakuma K, Nakano T, Ishiga K, Tajima F, Kowa H, Nakashima K. Myasthenia gravis with thymus hyperplasia and pure red cell aplasia. J Neurol Sci 2004; 224:93-5. [PMID: 15450777 DOI: 10.1016/j.jns.2004.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Revised: 06/08/2004] [Accepted: 06/09/2004] [Indexed: 10/26/2022]
Abstract
A case of myasthenia gravis (MG) with thymus hyperplasia and pure red cell aplasia (PRCA) is reported. A 57-year-old woman was diagnosed as having MG and was treated with thymectomy 26 years ago. The histology of the resected thymus was thymic lymphoid follicular hyperplasia. She developed rapidly progressive anemia and a bone marrow examination revealed PRCA. Her hematological results improved with oral administration of cyclosporine A. Cases of MG, thymoma and PRCA have been reported in the literature. We report the first case of MG without thymoma and PRCA.
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Affiliation(s)
- Yutaka Suto
- Department of Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, 36-1 Nishimachi, Yonago 683-8504, Japan
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23
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Domínguez-Gerpe L, Rey-Méndez M. Evolution of the thymus size in response to physiological and random events throughout life. Microsc Res Tech 2003; 62:464-76. [PMID: 14635139 DOI: 10.1002/jemt.10408] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During embryogenesis and in the early stages of life, the thymus is a crucial organ for the generation of the T cell repertoire. T cells are generated from hematopoietic stem cells already differentiated to precursor T cells in the bone marrow. These cells enter the thymus guided by chemotactic factors secreted by this organ. The complex maturation process takes place that ensures self-tolerance and homeostasis. Thymocytes that show autoreactivity do not leave the thymus, but rather die by apoptosis. The final percentage of mature T cells that survive to migrate from the thymus to the periphery is very low: at most 5%, under optimal conditions. The highest migration occurs in childhood and adulthood, at least in mice and humans; however, it declines throughout life and is minimal in the elderly. Under normal circumstances, the thymus commences involution soon after birth, and this involution correlates with the capacity to export mature T cells to the periphery. Hormones, cytokines, and neurotransmitters all play a role in this age-associated process, but the reasons for and mechanisms of this involution remain unknown. Apart from physiological conditions that change throughout life and govern age-related thymus evolution, random states and events provoked by intrinsic or extrinsic factors can induce either thymus involution, as in reversible transient thymic hypoplasias, or thymic hyperplasias. The age-associated involution, unlike transient involutions, follows a regular pattern for all individuals, though there are clear differences between the sexes. Nevertheless, even the age-associated involution seems to be reversible, raising the possibility of therapeutic strategies aimed at enhancing thymus function in the elderly.
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Affiliation(s)
- Lourdes Domínguez-Gerpe
- Departamento de Bioquímica y Biología Molecular, Facultad de Biología, Universidad de Santiago de Compostela, 15706 Santiago de Compostela, La Coruña, Spain.
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24
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Rameshwar P, Ramkissoon SH, Sundararajan S, Gascón P. Defect in the lymphoid compartment might account for CD8+-mediated effects in the pathophysiology of pure red cell aplasia. Clin Immunol 2003; 108:248-56. [PMID: 14499248 DOI: 10.1016/s1521-6616(03)00139-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pure red cell aplasia (PRCA) is a rare hematological syndrome characterized by the lack of red cell progenitors in an otherwise normocellular bone marrow. Many agents and mechanisms have been implicated in the pathophysiology of PRCA, including immune-mediated dysfunctions. This report describes three patients with PRCA with unknown underlying cause and showed that for each, increases in CD8+ cells blunted the maturation of early erythroid (BFU-E). Each patient subsequently responded to immunosuppressive therapy. Peripheral blood mononuclear cells from age- and sex-matched healthy controls showed comparable distribution of CD3, CD4 and CD16, but significant increase in CD8 and decreased CD19. The distribution of lymphocyte subsets correlated with mitogen responses, but showed no difference in allogeneic responses when compared to controls. The adherent population in PRCA is important for mediating the hyper-immune state of patients, when IL-2 levels were used as readout. There was a trend for decreased BFU-E in patients, but marked reduction for late erythroid progenitors (CFU-E). CD8+ cells from PRCA blunted the maturation of BFU-E, despite increasing erythropoietin concentrations. These results strongly suggest that there are defects in the lymphoid compartment that feedback on the erythroid lineage of PRCA.
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Affiliation(s)
- Pranela Rameshwar
- UMDNJ-New Jersey Medical School, Department of Medicine-Hematology, Newark, NJ 07103, USA
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25
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Matsutani T, Yoshioka T, Tsuruta Y, Shimamoto T, Ohyashiki JH, Suzuki R, Ohyashiki K. Determination of T-cell receptors of clonal CD8-positive T-cells in myelodysplastic syndrome with erythroid hypoplasia. Leuk Res 2003; 27:305-12. [PMID: 12531221 DOI: 10.1016/s0145-2126(02)00173-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We determined T-cell receptor alpha-chain variable (TCRAV) and T-cell receptor beta-chain variable (TCRBV) region repertoires in peripheral bloods from patients with myelodysplastic syndrome (MDS) with erythroid hypoplasia. T-cells bearing TCR ADV14S1/BV5S2, AV21S1/BV21S4, and AV2S2/BV7S2 segments were markedly increased in three of four MDS patients, respectively. In addition, there was a positive relationship between the increase in the number of CD8-positive T-cells and the expression levels of these TCR transcripts. These findings suggest that CD8-positive T-cells monoclonally or oligoclonally expanded in the peripheral blood. We also determined the nucleotide and amino acid sequences of the complementarity-determining region 3 (CDR3) of TCR alpha- and beta-chains of the expanded T-cells. Unique sequences were detected in a high percentage of the respective CDR3 clones. The gene segment of the variable and joining regions, however, varied among the patients. The deduced amino acid sequences of CDR3 were heterogeneous among the patients, and there was no common motif. These results indicate there is monoclonal or oligoclonal proliferation of CD8-positive T-cells in MDS patients with erythroid hypoplasia, and suggest that these proliferating T-cells are responsible for the pathogenesis of the MDS entity.
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Affiliation(s)
- Takaji Matsutani
- Department of Medical Science, Discovery Research Laboratories, Shionogi & Co. Ltd., Osaka 566-0022, Japan
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26
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Abstract
The myelodysplastic syndromes (MDS) comprise a heterogeneous group of clonal hematopoietic stem cell disorders, while, immunological abnormalities are frequently observed in patients with MDS. Several reports revealed that about 10% of MDS patients have clinical autoimmune disorders like skin vasculitis, rheumatic disease, or autoimmune hemolytic anemia. Furthermore, serological immunological abnormalities like hyper- or hypogammaglobulinemia, positivities of antinuclear antibody, positivities of direct Coombs test, or inverted CD4/8 ratios were found in 18-65% of patients with MDS. Recently immunosuppressive therapies including prednisolone, antithymocyte globulin, and cyclosporin A (CsA) are used to treat cytopenia in some patients with MDS. We examined the efficacy of CsA in 50 patients with MDS. Hematologic improvement was observed in 30 (60%) patients especially for erythroid lineage. There were significantly more responders with good karyotype or DRB1*1501 than with intermediate/poor karyotypes or with other HLA types. MDS with erythroid hypoplasia is a rare form of MDS, and has not yet been clearly defined. We reported four patients with MDS with erythroid hypoplasia who had morphological evidence of myelodysplasia and low percentage of erythroid precursors. Rearrangements of the TCR-beta and -gamma genes were seen in these patients using Southern blot and PCR analysis. Also they had skewed TCR usages using TCR repertoire analysis. Their anemia drastically improved with CsA therapy. We have to establish the clinical usefulness of immunosuppressive therapy in MDS patients and simple tools for revealing T-cell mediated myelosuppression in the individual patients for decision-making.
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Affiliation(s)
- Takashi Shimamoto
- First Department of Internal Medicine, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku Tokyo 160-0023, Japan.
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27
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Murakawa T, Nakajima J, Sato H, Tanaka M, Takamoto S, Fukayama M. Thymoma associated with pure red-cell aplasia: clinical features and prognosis. Asian Cardiovasc Thorac Ann 2002; 10:150-4. [PMID: 12079940 DOI: 10.1177/021849230201000213] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As information on the clinical features and prognosis of thymoma complicated by pure red-cell aplasia is limited, follow-up data on thymoma patients who had a thymectomy between 1954 and 1999 were analyzed retrospectively. Six of 166 cases were complicated by pure red-cell aplasia. In 3 of these, the pure red-cell aplasia appeared after surgical intervention. Remission was observed in 2 patients who underwent extended thymectomy. The other 4 patients subsequently died from pure red-cell aplasia. The outcome in patients with pure red-cell aplasia was poorer than that in the entire group of patients with thymoma and in those with thymoma complicated by myasthenia gravis. The possible onset of pure red-cell aplasia after thymectomy should be kept in mind during follow-up.
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Affiliation(s)
- Tomohiro Murakawa
- Department of Cardiothoracic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
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28
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Buckley C, Douek D, Newsom-Davis J, Vincent A, Willcox N. Mature, long-lived CD4+ and CD8+ T cells are generated by the thymoma in myasthenia gravis. Ann Neurol 2001; 50:64-72. [PMID: 11456312 DOI: 10.1002/ana.1017] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Antibodies to muscle acetylcholine receptors, to other muscle antigens, and to some cytokines are found in the majority of patients with thymic tumors (thymomas) and myasthenia gravis (MG). The role of the tumor in initiating autoimmunity, however, is unclear; in particular, it is not known whether the thymoma exports mature and long-lived T cells, which could provide help for antibody production in the periphery. Here, we quantified recently exported thymic T cells using the approach of measuring episomal DNA fragments [T-cell receptor excision circles (TRECs)], generated by T-cell receptor gene rearrangement. Compared to values in healthy individuals (n = 10) or in patients with late-onset MG (n = 8), TREC levels were significantly raised in both the CD4+ and CD8+ peripheral blood compartments of patients with thymoma and MG (n = 14, p = 0.002 and p = 0.0004 compared to healthy controls) but only in the CD8+ compartment of the three patients with thymoma without MG (p = 0.4 and p = 0.01 for CD4+ and CD8+). TREC levels decreased following thymectomy to values similar to controls but were substantially raised in patients who had developed tumor recurrence (n = 6, p = 0.04 and p = 0.02 for CD4+ and CD8+); this was associated with increased antibodies to interferon-alpha and interleukin-12 in the one case studied serially. Collectively, these results support the hypothesis that the neoplastic thymoma tissue itself can generate and export mature, long-lived T cells and that these T cells reflect the thymic pathology and are likely to be related to the associated autoimmune diseases. The results also provide a new approach for early diagnosis of thymoma recurrence.
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Affiliation(s)
- C Buckley
- Neurosciences Group, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, United Kingdom
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29
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Abstract
Thymomas and thymic carcinomas are unique tumors of the anterior mediastinum. The association of a variety of different paraneoplastic syndromes with such lesions has fascinated physicians and researchers for years. Most recently, it has been demonstrated by numerous authors that thymomas are chemosensitive tumors. Their indolent nature and relative rarity have made evaluation through prospective randomized clinical trials extremely difficult. Further information regarding the molecular nature of these neoplasms and immunologic aspects is needed in future investigation.
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Affiliation(s)
- P J Loehrer
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
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30
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Kuo T, Shih LY. Histologic types of thymoma associated with pure red cell aplasia: a study of five cases including a composite tumor of organoid thymoma associated with an unusual lipofibroadenoma. Int J Surg Pathol 2001; 9:29-35. [PMID: 11469342 DOI: 10.1177/106689690100900106] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The histologic type of thymomas associated with pure red cell aplasia (PRCA) has generally been regarded to be predominantly the spindle cell type. The 5 thymomas associated with PRCA we studied showed various histologic types and none of them was a spindle cell thymoma. Some cases reported as spindle cell thymoma associated with PRCA in the literature might not be spindle cell type. The discrepancy could be due to the lack of consensus in the histologic classification of thymomas in the past. Our study showed that thymomas associated with PRCA lacked a strong correlation with a particular histologic type and the pathogenesis of PRCA associated with thymoma did not seem to be related to the histologic type. One of our cases was an unusual composite tumor of an organoid thymoma (WHO type B1) and a hitherto undescribed "lipofibroadenoma." The clinical outcome was influenced by the invasive character and the histologic type of the thymoma.
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Affiliation(s)
- T Kuo
- Department of Pathology, Chang Gung University School of Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
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31
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Zeidman A, Fradin Z, Barac Y, Bendayan D, Mittelman M, Orlin J. Splenic Lymphoma Presenting as Warm Autoimmune Hemolytic Anemia Associated with Pure Red Cell Aplasia. Vox Sang 2000. [DOI: 10.1046/j.1423-0410.2000.7820126.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Masuda M, Arai Y, Okamura T, Wada M, Mizoguchi H. Pure red cell aplasia (PRCA) with thymoma: a possible distinct clinical entity distinct from large granular lymphocyte (LGL) leukemia. Am J Hematol 2000; 63:102. [PMID: 10629578 DOI: 10.1002/(sici)1096-8652(200002)63:2<102::aid-ajh9>3.0.co;2-p] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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33
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Grumbeck E, Aiginger P, Gisslinger B, Geissler K, Thalhammer-Scherrer R, Gisslinger H. Macrocytic anemia and thrombocytosis associated with thymoma: a case report. Am J Hematol 2000; 63:38-41. [PMID: 10602167 DOI: 10.1002/(sici)1096-8652(200001)63:1<38::aid-ajh9>3.0.co;2-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Thymomas are often associated with autoimmune disorders. We report on a 45-year-old female patient with thymoma and hypogammaglobulinemia (Good's syndrome) who developed symptomatic macrocytic anemia (Hb 4.4 g/dl, MCV 112 fl) and thrombocytosis (Plt 442 G/l). Besides hypogammaglobulinemia (IgG 589 mg/dl), an inverted ratio of CD4(+)/CD8(+) cells was seen. The bone marrow biopsy showed a slightly hypercellular bone marrow with normal granulopoiesis, normal megakaryopoiesis and a mild dyserythropoiesis without any ring-sideroblasts. The in-vitro stem cell culture from the bone marrow revealed an atypical growth of macroclusters, reduced BFU-E and CFU-GEMM colony growth, whereas the CFU-GM colony growth was within the normal range. The chromosomal analysis showed a normal karyotype. The plasma vitamin B(12) and folate levels were within normal ranges, and we could not detect any autoantibodies. These findings excluded the differential diagnoses pure red cell aplasia (PRCA) and pernicious anemia. After resection of the thymoma of mixed cell type, the macrocytic anemia and thrombocytosis disappeared. The clinical course was complicated by a cerebral palsy and a life-threatening fungal septicemia after surgery. In the third year after thymectomy, hyporegenerative macrocytic anemia and thrombocytosis reappeared and an immunosuppressive treatment with prednisolone (1 mg/kg BW) was started. After initiation of the prednisolone therapy, reticulocyte counts increased and macrocytic anemia as well as thrombocytosis disappeared. The normalization of these laboratory parameters during glucocorticoid therapy suggests that in rare cases the constellation of macrocytic anemia, thrombocytosis and hypogammaglobulinemia may be due to an underlying immunologic mechanism.
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Affiliation(s)
- E Grumbeck
- Department of Internal Medicine I, Division of Hematology and Blood Coagulation, University of Vienna, Vienna, Austria
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34
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Abstract
Acquired primary pure red cell aplasia (PRCA) has frequently been shown to be associated with T cells that inhibit marrow erythropoiesis. A 41-year-old female presented with anemia in December 1985. Bone marrow examination revealed 1.8% erythroid cells. A diagnosis of PRCA was made. She received prednisolone, and her hemoglobin level recovered to 12 g/dl. In February 1995, her hemoglobin level decreased to 5.8 g/dl, and acquired primary PRCA recurred. Surface markers of peripheral blood mononuclear cells demonstrated CD4/8 ratio inversion. The T-cell receptor (TCR)-beta chain gene showed germ line configuration by Southern blot analysis of the mononuclear cells in peripheral blood. However, stepdown polymerase chain reaction analysis revealed that the TCR-beta gene of peripheral blood mononuclear cells was rearranged. With highly sensitive polymerase chain reaction analysis, clonality of T cells was confirmed. We propose that some acquired primary PRCA patients have a T-cell clonal disorder, similar to some PRCA patients with large granular lymphocytes leukemia or thymoma.
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Affiliation(s)
- M Masuda
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
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35
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Abstract
The following review is based on notes used in the teaching of clinical immunology to veterinary students. Immune diseases of the dog are placed into six different categories: (1) type I or allergic conditions; (2) type II or auto- and allo-antibody diseases; (3) type III or immune complex disorders; (4) type IV or cell-mediated immune diseases; (5) type V conditions or gammopathies; and (6) type VI or immunodeficiency disorders. Separate discussions of transplantation immunology and the use of drugs to regulate unwanted immune responses are also included.
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Affiliation(s)
- N C Pedersen
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis 95616, USA
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36
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Fujisao S, Tsuda H. Th1/Th2 balance alteration in the clinical course of a patient with pure red cell aplasia and thymoma. Br J Haematol 1998; 103:308-10. [PMID: 9827897 DOI: 10.1046/j.1365-2141.1998.01011.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Peripheral T helper subsets in a patient with acquired pure red cell aplasia (PRCA) and thymoma were analysed by flow cytometry. Thymectomy resulted in a transient but definite improvement in anaemia. A continuous remission was attained by cyclosporin A (CsA) therapy. The changes in Th1/Th2 ratios corresponded with the haematological changes. Specifically, Th2 type lymphocytes were dominant during a haemopoietic suppression and elevation of the Th1/Th2 ratio was concomitant with haematological improvement. These observations suggest that polarization of Th subsets to Th2, induced by clonally expanded (gammadelta-type) T cells in thymoma, are involved in the pathogenesis of PRCA.
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Affiliation(s)
- S Fujisao
- Division of Clinical Haematology and Immunology, Kumamoto City Hospital, Kumamoto, Japan
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37
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Mizobuchi S, Yamashiro T, Nonami Y, Yamamoto A, Kume M, Nakaya H, Sawada T, Taguchi H, Moriki T, Ogoshi S. Pure red cell aplasia and myasthenia gravis with thymoma: a case report and review of the literature. Jpn J Clin Oncol 1998; 28:696-701. [PMID: 9861237 DOI: 10.1093/jjco/28.11.696] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A case of pure red cell aplasia (PRCA), myasthenia gravis (MG) and thymoma is reported. A 70-year-old woman presented with severe anemia. She had been diagnosed as having MG 8 years earlier and her symptoms were adequately controlled with ambenonium chloride. When she visited our hospital, her hematocrit was 13.7% with a hemoglobin concentration of 4.7 g/dl and her reticulocyte counts were persistently abnormal at 0.1%. Although both direct and indirect Coombs' tests were positive, there was no evidence of hemolysis. Routine screening tests for other etiologies of anemia were negative. Serological tests for anti-DNA and anti-acetylcholine receptor antibodies gave positive results. A bone marrow examination revealed severe erythroid hypoplasia. PRCA was diagnosed and the patient was treated with periodic transfusions. A lateral view chest roentgenogram and a computed tomography scan of the thorax showed the presence of an anterior mediastinal mass which was suspected to be thymoma. The patient underwent thymothymectomy and the tumor was diagnosed as a thymoma. Although the patient received no treatment for MG and PRCA after surgery, her hematological test results rapidly improved and she was discharged from the hospital on the 29th postoperative day. At that time, her hematocrit was 33.2%, her hemoglobin concentration was 10.0 g/dl, her peripheral reticulocyte level was 1.8% and her left partial ptosis had improved. She is doing well, 9 months after surgery. For a patient to remain in remission without treatment for PRCA and MG after thymothymectomy is extremely rare.
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Affiliation(s)
- S Mizobuchi
- Department of Surgery II, Kochi Medical School, Japan.
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Di Mario A, De Stefano V, Mele L, Musumeci V, Leone G. Successful treatment with cyclosporine A of pure red-cell aplasia occurring 11 years after thymectomy. Eur J Haematol 1998; 61:221-2. [PMID: 9753422 DOI: 10.1111/j.1600-0609.1998.tb01090.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Masuda M, Arai Y, Nishina H, Fuchinoue S, Mizoguchi H. Large granular lymphocyte leukemia with pure red cell aplasia in a renal transplant recipient. Am J Hematol 1998; 57:72-6. [PMID: 9423821 DOI: 10.1002/(sici)1096-8652(199801)57:1<72::aid-ajh13>3.0.co;2-b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Neoplastic disorders sometimes accompany a renal transplant. Herein, we report a large granular lymphocyte (LGL) leukemia patient with pure red cell aplasia (PRCA) after renal transplantation. A 36-year-old female was presented to our department with anemia in February 1996. She had undergone hemodialysis because of pregnancy in December 1981. She received a renal transplantation from her mother in April 1986. After the transplantation, she received cyclosporin A (CyA) at 2 mg/kg/day, mizoribine at 1 mg/kg/day, and methylprednisolone at 0.1 mg/kg/day for 8 years. In July 1995, her hemoglobin level dropped to 9.3 g/dl, and anemia developed gradually. In January 1996, her hemoglobin was 5.8 g/dl, and she was given a red blood cell transfusion. Laboratory findings were as follows: RBC 1.46 x 10(12)/L; hemoglobin 5.8 g/dl; hematocrit 17.8%; leucocytes 5.2 x 10(9)/L with 62.4% neutrophils, 34.1% lymphocytes, 2.6% monocytes; platelets 50.8 x 10(10)/L; reticulocytes 0.4%. Bone marrow aspirate smears and biopsy sections revealed normal myeloid and megakaryocyte differentiation with few erythroid precursors. The lymphocytes were of medium size with granules in the cytoplasm. More than 90% of lymphocytes were of the LGL type. Surface markers of peripheral blood mononuclear cells demonstrated increases in the CD2+, CD3+, CD4-, and CD8+ populations. A monoclonal rearrangement of T-cell receptor (TCR)-beta chain gene was found by Southern blot analysis of the mononuclear cells in peripheral blood. A diagnosis of LGL leukemia with PRCA was made. During the next 4 months, she received six red blood cell transfusions, a total of 12 U. In March 1996, the patient was treated with cyclophosphamide (1 mg/kg/day). After 1 month of treatment, serum GPT levels increased to 60 IU/l. The dose of cyclophosphamide was reduced to 0.5 mg/kg/day. Two months after initiation of the therapy, the patient developed reticulocytosis and blood transfusion was not needed thereafter. During remission, the number of CD2+, CD3+, CD4-, and CD8+ lymphocytes decreased. Large granular lymphocytes decreased to less than 10% of peripheral blood. The monoclonal rearrangement of the TCR-beta chain gene in peripheral blood disappeared.
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Affiliation(s)
- M Masuda
- Department of Hematology, Tokyo Women's Medical College, Japan
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