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Bone marrow necrosis in a patient with advanced Hodgkin's lymphoma after G-CSF and Plerixafor treatment during harvesting for autologous bone marrow transplantation: is it possible? Hematol Transfus Cell Ther 2020; 43:512-514. [PMID: 32536531 PMCID: PMC8572987 DOI: 10.1016/j.htct.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/22/2022] Open
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2
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Noureldine MHA, Khamashta MA, Merashli M, Sabbouh T, Hughes GRV, Uthman I. Musculoskeletal manifestations of the antiphospholipid syndrome. Lupus 2016; 25:451-62. [DOI: 10.1177/0961203316636467] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/01/2016] [Indexed: 11/17/2022]
Abstract
The scope of clinical and laboratory manifestations of the antiphospholipid syndrome (APS) has increased dramatically since its discovery in 1983, where any organ system can be involved. Musculoskeletal complications are consistently reported in APS patients, not only causing morbidity and mortality, but also affecting their quality of life. We reviewed all English papers on APS involvement in the musculoskeletal system using Google Scholar and Pubmed; all reports are summarized in a table in this review. The spectrum of manifestations includes arthralgia/arthritis, avascular necrosis of bone, bone marrow necrosis, complex regional pain syndrome type-1, muscle infarction, non-traumatic fractures, and osteoporosis. Some of these manifestations were reported in good quality studies, some of which showed an association between aPL-positivity and the occurrence of these manifestations, while others were merely described in case reports.
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Affiliation(s)
- M H A Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - M A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College University, London, UK
| | - M Merashli
- Division of Rheumatology, The Royal London Hospital, London, UK
| | - T Sabbouh
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - G R V Hughes
- London Lupus Center, London Bridge Hospital, London, UK
| | - I Uthman
- Division of Rheumatology, American University of Beirut, Beirut, Lebanon
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Pan Y, Wang X, Wang C, Zhang Q, Xi R, Bai J, Bai H. Extensive bone marrow necrosis resolved by allogeneic umbilical cord blood mesenchymal stem cell transplantation in a chronic myeloid leukemia patient. Bone Marrow Transplant 2015; 50:1265-8. [PMID: 25961769 DOI: 10.1038/bmt.2015.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Y Pan
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - X Wang
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - C Wang
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - Q Zhang
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - R Xi
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - J Bai
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
| | - H Bai
- Department of Hematology, Lanzhou General Hospital, Lanzhou, China
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Elgamal BM, Rashed RA, Raslan HN. Prevalence of bone marrow necrosis in Egyptian cancer patients referring to the National Cancer Institute. J Egypt Natl Canc Inst 2012; 23:95-9. [PMID: 22776813 DOI: 10.1016/j.jnci.2011.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 08/08/2011] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Bone marrow necrosis is a relatively rare entity which has been associated with a poor prognosis. It is most commonly found in patients with neoplastic disorders and severe infections. METHODS The study comprised examination of 5043 bone marrow biopsy specimens performed at the National Cancer Institute, Cairo University, over 7 years period (March 2004-March 2011). It included 5 years retrospective (2867 archived samples) and 2 years prospective (2176 samples). RESULTS Bone marrow necrosis was diagnosed in fifteen out of 5043 examined specimens with a percentage of 0.3% and ranged from mild to massive according to semiquantitative estimation. Prognosis of all patients was poor with survival not exceeding 6 months from the date of marrow necrosis diagnosis. CONCLUSION In Egyptian patients, bone marrow necrosis in association with malignancy is a rare disorder which is accompanied by a poor outcome.
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Affiliation(s)
- Basma M Elgamal
- Hematology Unit, Clinical Pathology Department, National Cancer Institute, Cairo University, Egypt.
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G-CSF-Associated Bone Marrow Necrosis in AML after Induction Chemotherapy. Case Rep Hematol 2012; 2012:314278. [PMID: 22937323 PMCID: PMC3420589 DOI: 10.1155/2012/314278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/28/2012] [Indexed: 11/28/2022] Open
Abstract
Bone marrow necrosis (BMN) is defined as necrosis of the myeloid tissues and stroma without involvement of the cortical bone. We report a case of 66-year-old male with AML-M4 (FAB classification) who was given induction chemotherapy with cytarabine and daunorubicin. Filgrastim at 480 micrograms was administered on days 15–19 to shorten the duration of neutropenia. Consequently patient developed severe pelvic bone pain, leukoerythroblastosis, and severe leukocytosis. Repeat bone marrow aspiration and biopsy on day 21 confirmed bone marrow necrosis. These manifestations responded quickly to discontinuation of filgrastim. Subsequently, he recovered full myelopoiesis. We suggest that there may be more cases of BMN associated with G-CSF that are undiagnosed.
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D'Souza A, Jaiyesimi I, Trainor L, Venuturumili P. Granulocyte colony-stimulating factor administration: adverse events. Transfus Med Rev 2008; 22:280-90. [PMID: 18848155 DOI: 10.1016/j.tmrv.2008.05.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recombinant human granulocyte colony-stimulating factor (G-CSF) has been in clinical use for approximately 2 decades. In healthy donors, it has been used to mobilize peripheral blood progenitor cells for hematopoietic stem cell transplantation and granulocytes for apheresis collection. In patients, it has been used to decrease the duration of neutropenia after chemotherapy and to offset the neutropenia due to myelodysplasia, acquired immunodeficiency syndrome, and genetic disorders of granulocyte production. As the number of uses of G-CSF in clinical practice grows, more side effects of this generally safe pharmaceutical agent are being recognized. Our objective in this article is to provide an in-depth review of the reported adverse events associated with the use of G-CSF.
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Affiliation(s)
- Anita D'Souza
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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7
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Pain syndromes in the setting of haematopoietic stem cell transplantation for haematological malignancies. Bone Marrow Transplant 2008; 41:757-64. [DOI: 10.1038/bmt.2008.3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Niscola P, Piccioni D, Scaramucci L, Fratoni S, Tendas A, Cupelli L, Dentamaro T, Giovannini M, Pio Perrotti A, Del Poeta G, de Fabritiis P. Bone marrow necrosis as a terminal complication of a very long-lasting polycythemia vera. Int J Hematol 2007; 86:377-8. [PMID: 18055349 DOI: 10.1532/ijh97.e0726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Ishitsuka K, Shirahashi A, Iwao Y, Shishime M, Takamatsu Y, Takatsuka Y, Utsunomiya A, Suzumiya J, Hara S, Tamura K. Bone marrow necrosis in a patient with acute promyelocytic leukemia during re-induction therapy with arsenic trioxide. Eur J Haematol 2004; 72:280-4. [PMID: 15089767 DOI: 10.1111/j.0902-4441.2003.00206.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arsenic trioxide (As2O3) therapy at a daily dose of 0.15 mg/kg was given to a 60-yr-old Japanese male with refractory acute promyelocytic leukemia. White blood cell (WBC) of 6.6 x 10(3)/microl increased to 134 x 10(3)/microl following the administration of As2O3. Daily hydroxyurea (HU), and 6-mercaptopurine (6-MP) were added on days 7 and 19, respectively. Both HU and 6-MP were discontinued on day 28, when WBC declined to 54.0 x 10(3)/microl. He developed unexplained fever and profound cytopenia requiring multiple blood products transfusions. Bone marrow examination on day 42 revealed massive necrosis. Pharmacokinetics confirmed a mean maximum plasma arsenic concentration (Cpmax) and a half-life time (t1/2) of 6.9 microm and 3.2 h, respectively, in the therapeutic range. This is the first case of bone marrow necrosis after standard-dose As2O3 therapy.
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Affiliation(s)
- Kenji Ishitsuka
- 1st Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
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Strauss RG. Safety of donating multiple products in a single apheresis collection: Are we expecting too much? J Clin Apher 2003; 18:135-40. [PMID: 14569607 DOI: 10.1002/jca.10069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Modern blood separators rapidly process many liters of donor blood and efficiently collect vast quantities of blood components from donors, who may be stimulated with potent recombinant hematopoietic growth factors or cytokines. Accordingly, the potential risks of modern multiple product/unit apheresis donations and recombinant growth factors is analyzed in this report. As is true for all medical procedures, risks are associated with apheresis donations. Risks of a "standard" apheresis donation, in which one unit of PLTs or plasma is collected, are comparable to the risks of whole blood donation. Risks of multiple unit apheresis donations, in which either vast quantities of a single blood component or multiple units of various components are collected, are incompletely understood, particularly, when donors are stimulated with recombinant hematopoietic growth factors to increase component yields. To minimize donor risks and to increase knowledge of multiple component apheresis donations, both short-term problems (e.g., donor reactions accompanying apheresis procedures and pre- vs. post-procedure changes in results of donor laboratory studies) and long-term problems (e.g., medical diagnoses/problems and abnormalities of donor blood counts and laboratory test results) should be monitored, ideally, by a repeat donor registry. When recombinant hematopoietic growth factors are prescribed, donors should give informed consent, and blood center professionals must be aware of 1) the effects of these drugs given at pharmacologic, rather than physiologic, doses; 2) the differences between the molecular structure of recombinant vs. natural/endogenous growth factors; 3) the fact that recombinant growth factors have both narrow/focused and broad biological activities; and 4) the probability that results of studies in sick/immunosuppressed patients may not be applicable to healthy/immunocompetent donors.
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Affiliation(s)
- Ronald G Strauss
- Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa, USA.
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Paydas S, Ergin M, Baslamisli F, Yavuz S, Zorludemir S, Sahin B, Bolat FA. Bone marrow necrosis: clinicopathologic analysis of 20 cases and review of the literature. Am J Hematol 2002; 70:300-5. [PMID: 12210811 DOI: 10.1002/ajh.10114] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone marrow necrosis (BMN) is a relatively uncommon clinicopathologic entity. The etiology is diverse, and malignancy, especially hematopoietic in origin, is the most common underlying disease of BMN. In this retrospective analysis, cases with BMN were re-evaluated for etiology, histopathologic details, and clinical manifestations. In the last 8 years, 23 cases of BMN were detected among the 1,083 bone marrow (BM) biopsies, and the prevalence was found to be 2.2%. Three of these 23 cases with BMN were children, and 20 cases were in adults. Sixteen of these cases (80%) had underlying malignant disease, and four (20%) had nonmalignant disease. Among the malignant cases, three cases had acute myeloblastic leukemia (AML), four had relapsed Hodgkin's disease (R-HD), one had acute lymphoblastic leukemia (ALL), two had chronic myelocytic leukemia (CML), two had non-Hodgkin's lymphoma (NHL), three had disseminated intravascular coagulation (DIC) associated with metastatic solid tumor, and one had myelodysplastic syndrome/myeloproliferative syndrome (MDS/MPS). Among the nonmalignant cases, two had tuberculosis infection, one had anti-phospholipid syndrome (APS), and one had a history of drug ingestion. The most common symptoms were bone pain, fever, fatigue, and jaundice. The most common laboratory findings were variable and associated with underlying disease, but anemia, leukopenia, thrombocytopenia, and high LDH and alkaline phosphatase levels were detected in the majority of the cases, as was also seen in other series. BMN was graded according to the extent of necrosis in the BM biopsy, and necrosis was extensive in 12 cases, moderate in five cases, and mild in three cases. Increased reticulin was found in 16 cases; four cases had severe, eight had moderate, and four had mild fibrosis, and this was found to be an interesting accompanying finding in BMN. In conclusion malignancy is the most common cause of BMN but some nonmalignant conditions such as tuberculosis and APS may be the underlying cause of BMN.
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Affiliation(s)
- Semra Paydas
- Department of Oncology, Cukurova University Faculty of Medicine, Balcal, Adana, Turkey.
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Seki Y, Koike T, Yano M, Aoki S, Hiratsuka M, Fuse I, Aizawa Y. Bone marrow necrosis with dyspnea in a patient with malignant lymphoma and plasma levels of thrombomodulin, tumor necrosis factor-alpha, and D-dimer. Am J Hematol 2002; 70:250-3. [PMID: 12111773 DOI: 10.1002/ajh.10136] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-Hodgkin's lymphoma (peripheral T cell, unspecified, clinical stage IIIEA) was diagnosed in a 54-year-old male. He was treated weekly with chemotherapy consisting of pirarubicin hydrochloride, cyclophosphamide, methotrexate, vincristine sulfate, etoposide, and prednisolone. After 6 weeks of treatment in a state of partial remission, he exhibited sudden dyspnea, chest pain, fever, and drowsiness. The patient had received 100 microg/day of granulocyte colony stimulating factor (G-CSF) for 6 days before the onset. Laboratory data showed an elevated lactate dehydrogenase (LDH) level, leukoerythroblastosis in the peripheral blood, and no decrease in the serum haptoglobin level. There were no findings of acute myocardial infarction or pulmonary thromboembolism. Bone marrow specimen showed the characteristic features of necrosis without any signs of the involvement of lymphoma cells. No indications of infections were found. This patient was diagnosed as having bone marrow necrosis (BMN) during the recovery phase of bone marrow with G-CSF treatment after chemotherapy for malignant lymphoma. After conservative therapy, inhalation of oxygen and stopping the administration of G-CSF, all clinical symptoms subsided except that the elevation of LDH continued for 1 month. The plasma level of tumor necrosis factor-alpha (TNF-alpha) was high just after the onset of BMN. The thrombomodulin (TM) level was high just before the onset of BMN and continued to be high for 2 weeks. Cross-linked fibrin degradation products (D-dimer) were also high just after the onset of BMN and continued to be high for 3 weeks after the onset. Although dyspnea is a rare symptom of BMN, it is important to rule out in BMN during the recovery phase of bone marrow with G-CSF treatment after chemotherapy for malignant lymphoma. Activated neutrophils in the small vessels of the lung by G-CSF and microthrombi, suggested by the elevation of D-dimer, may participate in the onset of dyspnea, which is a rare symptom of the onset of BMN.
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Affiliation(s)
- Yoshinobu Seki
- First Department of Internal Medicine, Niigata University Medical Hospital, Niigata University, Niigata, Japan.
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Venkateswaran L, Duerst R, Haut P, Kletzel M, Chou P. Bone marrow necrosis associated with relapse of acute myelogenous leukemia following unrelated hematopoeitic stem cell transplantation using an immunoablative regimen. MEDICAL AND PEDIATRIC ONCOLOGY 2002; 38:148-9. [PMID: 11813193 DOI: 10.1002/mpo.1299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bashawri L, Satti MB. Bone marrow necrosis: report of five cases and review of the literature. Ann Saudi Med 2000; 20:78-82. [PMID: 17322755 DOI: 10.5144/0256-4947.2000.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- L Bashawri
- Department of Pathology, College of Medicine, King Faisal University, Dammam, Saudi Arabia
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