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Lee JW, Kim S, Jang PS, Chung NG, Cho B, Kim Y. Rapid resolution of bone marrow necrosis mimicking relapse of pediatric acute lymphoblastic leukemia. Blood Res 2020; 55:184-187. [PMID: 32883889 PMCID: PMC7536568 DOI: 10.5045/br.2020.2020175] [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: 07/17/2020] [Revised: 08/08/2020] [Accepted: 08/19/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jae Wook Lee
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Seongkoo Kim
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Pil-Sang Jang
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Nack-Gyun Chung
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Bin Cho
- Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, Seoul, Korea
| | - Yonggoo Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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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Xia J, Sun H, Yan Z, Zhu F, Zhao K, Xu K. Successful treatment of a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia complicated by bone marrow necrosis and acute renal insufficiency: A case report. Mol Clin Oncol 2018; 9:297-301. [PMID: 30112174 DOI: 10.3892/mco.2018.1661] [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: 04/18/2018] [Accepted: 06/19/2018] [Indexed: 11/06/2022] Open
Abstract
Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL) complicated by bone marrow necrosis (BMN) and acute renal insufficiency (ARI) is rare in clinical practice. The aim of the present study was to summarize the clinical characteristics and treatment methods of a case of Ph+ ALL complicated by BMN and ARI. A 23-year-old male patient presented with pyrexia and a 2-month history of bone pain, and was diagnosed with Ph+ ALL complicated with BMN and ARI on peripheral blood tests, blood biochemistry tests, BM smear and fluorescence in situ hybridization. The patient underwent repeated hemodialysis, imatinib combination and maintenance chemotherapy, followed by allogeneic hematopoietic stem-cell transplantation. Some of the clinical signs and symptoms were alleviated, whereas others disappeared, and renal function was restored to normal. BM aspiration confirmed absence of necrosis and null lymphoblasts. Therefore, timely accurate diagnosis and effective treatment are crucial for patients with Ph+ ALL exhibiting potentially fatal complications.
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Affiliation(s)
- Jieyun Xia
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Haiying Sun
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Zhiling Yan
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Feng Zhu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Kai Zhao
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
| | - Kailin Xu
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China.,Key Laboratory of Bone Marrow Stem Cell, Blood Diseases Institute, Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
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Soliman AH. Diagnostic and Prognostic Relevance of Bone Marrow Microenvironment Components in Non Hodgkin’s Lymphoma Cases Before and After Therapy. Asian Pac J Cancer Prev 2016; 17:5273-5280. [PMID: 28125873 PMCID: PMC5454670 DOI: 10.22034/apjcp.2016.17.12.5273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate stromal cells of the bone marrow microenvironment (BMM) in bone marrow trephine biopsy (BMTB) specimens, with a focus on fibronectin, tumor necrosis factor- alpha (TNF-α) and L-selectin in Non-Hodgkin’s lymphoma (NHL) patients, before and after therapy. Materials and Methods: A total of 80 de novo NHL patients, 64 with B-cell lymphomas 80%, (follicular cell lymphoma (FCL) in 32, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) in 12, and diffuse large cell lymphoma in 20) and 16 with T-cell lymphomas (20%) all diagnosed as T-Lymphoblastic lymphomas, were evaluated before and after therapy. For comparison, 25 age and sex matched BM donors, were included as a control group. BMTB material and BM aspirates were taken for morphological assessment of stromal cells, the plasma of these samples being examined for TNFα and L-selectin by ELISA, and fibronectin by radial immunodiffusion (RID). Results: BM stromal cells comprising reticular macrophages and fibroblasts were elevated in 53.3% of NHL cases at diagnosis, while BM fibronectin levels were decreased and BM TNFα and L-selectin were higher than in controls (p<0.05). In NHL cases, elevated values of BM TNFα and BM L-selectin were associated with signs of aggressive disease, including >1 extra nodal sites, detectable B symptoms, high grade, BM and CNS invasion, and a high International prognostic index (IPI) (p<0.05). Conclusion: BMM components, TNFα, L-selectin and fibronectin, in NHL can be useful in evaluating disease activity, extent and response to treatment and as prognostic markers according to the IPI.
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Affiliation(s)
- Amira H Soliman
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt.
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GATA1 mutation negative acute megakaryoblastic leukemia with acquired trisomy 21 presenting with extensive bone marrow necrosis in an adult: A case report and review of the literature. HUMAN PATHOLOGY: CASE REPORTS 2016. [DOI: 10.1016/j.ehpc.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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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Lackner H, Strenger V, Sovinz P, Beham-Schmid C, Pilhatsch A, Benesch M, Schwinger W, Ulreich R, Schmidt S, Urban C. Bone marrow necrosis in a girl with Hodgkin's disease. Support Care Cancer 2012; 20:2231-4. [PMID: 22773298 DOI: 10.1007/s00520-012-1502-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
Abstract
Bone marrow necrosis (BMN) is a rare finding in children with malignancy occurring most commonly in children with acute lymphoblastic leukemia. This article describes the first case of a girl who developed BMN during treatment for Hodgkin's disease. During the second cycle of chemotherapy, she experienced sudden profound bone pain in the lumbosacral region associated with elevated levels of lactate dehydrogenase (LDH), fibrin degradation products (D-Dimer), and alkaline phosphatase as well as pancytopenia and leukoerythroblastosis. MRI studies showed multiple confluent areas with low signal intensity and rim contrast enhancement in all vertebral bodies. Bone marrow biopsy revealed focal necrosis within hypocellular bone marrow. The patient responded quickly to symptomatic treatment with analgetics and heparin; however, elevations of LDH and D-Dimer persisted for 1.5 and 8 months, respectively. Clinicians should be aware of this rare condition to establish the diagnosis and to continue oncologic treatment as early as possible.
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Affiliation(s)
- Herwig Lackner
- Division of Pediatric Hematology/Oncology, Medical University of Graz, Graz, Austria
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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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Rivière E, Pillot J, Saghi T, Castaing Y, Pellegrin JL, Gruson D, Boyer A. [Extensive bone marrow necrosis with sepsis in primary thrombocytemia: a case report and literature review]. Rev Med Interne 2012; 33:279-83. [PMID: 22341976 DOI: 10.1016/j.revmed.2012.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 01/05/2012] [Accepted: 01/17/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Bone marrow necrosis is a very rare condition which is characterized by a necrosis of hematopoietic progenitors, adipocytes and reticulin network. CASE REPORT We report a 62-year-old woman admitted to an intensive care unit for an essential thrombocytemia associated with bone marrow necrosis complicated by septic shock and progressive multi-organ failure. To our knowledge, this is the second case reported in the literature. The clinical presentation of bone marrow necrosis includes non-specific symptoms such as fever, bone pain and sometimes a clinically significant medullar insufficiency syndrome. Biology can reveal cytopenias, elevated LDH and alkaline phosphatase serum levels. The diagnosis is confirmed by bone marrow trephine biopsy. Bone marrow necrosis is classified as extensive if more than 50% of the bone marrow biopsy show necrosis. Haematological malignancies (particularly leukaemia), and solid malignant tumours (particularly gastro-intestinal or lung cancers) represent up to 90% of aetiologies and must be actively researched. Also, sickle cell disease and catastrophic anti-phospholipid syndrome must also be investigated. Essential thrombocytemia remains an exceptional cause of bone marrow necrosis. CONCLUSION Overall the prognosis of bone marrow necrosis is poor unless appropriate and intensive treatment, especially for sickle cell disease in which complete medullar regeneration has been observed.
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Affiliation(s)
- E Rivière
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, avenue Magellan, 33600 Pessac, France.
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Mewhort-Buist TA, Liaw PC, Patel S, Atkinson HM, Berry LR, Chan AKC. Treatment of endothelium with the chemotherapy agent vincristine affects activated protein C generation to a greater degree in newborn plasma than in adult plasma. Thromb Res 2008; 122:418-26. [PMID: 18206217 DOI: 10.1016/j.thromres.2007.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 11/22/2007] [Accepted: 12/06/2007] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Activated protein C (APC) is well-established as a physiologically important anticoagulant. During development, plasma concentrations of protein C and alpha(2)macroglobulin, factors involved in APC generation, differ from adult levels. Chemotherapy drugs can perturb endothelial expression of PC-activating receptors. This study examines the effect of chemotherapy treatment of endothelium on APC generation in newborn and adult plasma. MATERIALS AND METHODS APC generations were initiated on endothelial cells treated with vincristine or media by recalcifying defibrinated plasma with buffer containing thromboplastin. APC generation was terminated by mixing timed subsamples into FFRCMK-EDTA or heparin, followed by EDTA. APC-PCI and APC-alpha(1)AT were assayed by ELISA. APC-alpha(2)M was measured chromogenically. Since heparin converts free APC to APC-PCI, the difference between APC-PCI detected in heparin subsamples and APC-PCI detected in FFRCMK-EDTA subsamples gave the free APC. Cellular expression of EPCR and TM were measured by flow cytometry and Western blot. RESULTS Vincristine-treated endothelium decreased free APC generation in newborn plasma to a greater degree than in adult plasma. APC-PCI levels in both adult and newborn plasma were unaffected by chemotherapy. Vincristine treatment reduced levels of APC-alpha(1) AT and APC-alpha(2) M to a greater degree in newborn plasma versus adult plasma. Expression of EPCR was reduced in cells treated with vincristine. Conversely, TM was reduced on the cell surface, but increased in whole cell lysates. CONCLUSIONS The differential response of newborn and adult plasma PC components to chemotherapy-mediated changes in cell surface components may be a factor in the increased risk of thrombosis in children receiving chemotherapy.
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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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Matsue K, Takeuchi M, Koseki M, Uryu H. Bone marrow necrosis associated with the use of imatinib mesylate in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia. Ann Hematol 2006; 85:542-4. [PMID: 16570152 DOI: 10.1007/s00277-005-0071-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 12/15/2005] [Indexed: 11/29/2022]
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13
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Azuma T, Sakai I, Matsumoto T, Ozawa A, Tanji N, Watanabe A, Uchida N, Narumi H, Yakushijin Y, Hato T, Yasukawa M, Fujita S. Leukemoid reaction in association with bone marrow necrosis due to metastatic prostate cancer. Intern Med 2005; 44:1093-6. [PMID: 16293925 DOI: 10.2169/internalmedicine.44.1093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 80-year-old man presented to the internist with fever, fatigue and leukocytosis up to 66.8 x 10(3)/microl. Although a chronic myelogenous leukemia was initially suspected, he was diagnosed as metastatic bone marrow tumor with bone marrow necrosis from primary prostate cancer on the basis of the clinical and pathological findings. The serum concentrations of IL-6 and TNF-alpha were mildly elevated to 65.0 pg/ml and, 54.0 pg/ml respectively. It is probable that these humoral factors were partially responsible for the leukemoid reaction although other factors induced by the bone marrow necrosis with bone marrow metastasis of prostate cancer are also likely involved.
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Affiliation(s)
- Taichi Azuma
- First Department of Internal Medicine, Ehime University School of Medicine
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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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