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Kumar V, Montgomery ND, van Deventer HW, Whang YE. Waldenström macroglobulinemia with secondary pure red cell aplasia in a patient with metastatic castrate resistant prostate cancer receiving an immune checkpoint inhibitor: a case report. J Med Case Rep 2023; 17:220. [PMID: 37245043 DOI: 10.1186/s13256-023-03948-4] [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: 01/17/2022] [Accepted: 04/24/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Hypoproliferative anemia is a frequently encountered adverse event in cancer patients receiving immune checkpoint inhibitors (ICI). Secondary pure red cell aplasia (PRCA) is a rare but recognized immune related adverse event. With the burgeoning use of ICIs, the association of secondary PRCA with an underlying lymphoproliferative disorder is often overlooked. CASE PRESENTATION We report a case of a 67-year-old non-Hispanic Caucasian male with metastatic castrate resistant prostate cancer, who developed severe transfusion dependent anemia with reticulocytopenia while receiving treatment with olaparib and pembrolizumab. His bone marrow findings demonstrated erythroid hypoplasia, in addition to a CD5-negative, CD10-negative monotypic B-cell population and a somatic MYD88L265P mutation. With a presence of an IgM-paraprotein, he was diagnosed with Waldenström macroglobulinemia (WM) with secondary PRCA and treated with 6 cycles of bendamustine and rituximab. He achieved a complete response with this regimen and was transfusion independent. CONCLUSION In this case, underlying WM was uncovered through systematic investigation of anemia caused by ICI therapy. This report highlights the possibility of a lymphoproliferative disorder in patients with concerns for PRCA with prior ICI exposure. If identified, treating the underlying lymphoproliferative disorder is highly efficacious in the management of the secondary PRCA.
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Affiliation(s)
- Vaibhav Kumar
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Chapel Hill, NC, 27599-7305, USA
| | - Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hendrik W van Deventer
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Young E Whang
- Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Chapel Hill, NC, 27599-7305, USA.
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Gérard A, Romani S, Van-Obberghen E, Fresse A, Muzzone M, Parassol N, Boscagli A, Rocher F, Borchiellini D, Drici MD. Case Report: Successful Treatment of Steroid-Refractory Immune Checkpoint Inhibitor-Related Pure Red Cell Aplasia With Cyclosporin. Front Oncol 2020; 10:1760. [PMID: 32984061 PMCID: PMC7484737 DOI: 10.3389/fonc.2020.01760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022] Open
Abstract
Anemia associated with Immune checkpoint inhibitor (ICI) is usually hemolytic and regenerative. Cases of non-regenerative pure red cell aplasia are rare, and typically improve upon drug discontinuation and after corticotherapy. We herein report a case of nivolumab-related erythroblastopenia refractory to steroids in a melanoma patient that improved only after treatment with cyclosporin. Nivolumab had been well tolerated for 2 months after being introduced as an adjuvant treatment. Hemoglobin level then progressively decreased from 12.7 g/dl as baseline value to a nadir of 4.3 g/dL despite transfusion with a total of 29 packed red blood cells in 3 months. Extensive workup including repeated bone marrow examinations led to the diagnosis of pure red cell aplasia. Anemia persisted despite nivolumab discontinuation and over a month of corticotherapy, but improved dramatically 3 days after cyclosporin initiation and did not recur upon cyclosporin tapering. The patient remains cancer-free 9 months after nivolumab withdrawal. This case highlights the under-recognized risk of erythroblastopenia in patients treated with ICI and proves cyclosporin is a valid alternative for the treatment of steroid-refractory cases.
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Affiliation(s)
- Alexandre Gérard
- Pharmacovigilance, Department of Clinical Pharmacology, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Serena Romani
- Pharmacovigilance, Department of Clinical Pharmacology, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Elise Van-Obberghen
- Pharmacovigilance, Department of Clinical Pharmacology, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Audrey Fresse
- Pharmacovigilance, Department of Clinical Pharmacology, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Marine Muzzone
- Pharmacovigilance, Department of Clinical Pharmacology, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Nadège Parassol
- Pharmacovigilance, Department of Clinical Pharmacology, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Annick Boscagli
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d’Azur, Nice, France
| | - Fanny Rocher
- Pharmacovigilance, Department of Clinical Pharmacology, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Delphine Borchiellini
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d’Azur, Nice, France
| | - Milou-Daniel Drici
- Pharmacovigilance, Department of Clinical Pharmacology, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
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Kawahigashi T, Kitagawa I, Tanaka E. Angioimmunoblastic T-cell lymphoma accompanied by pure red cell aplasia: A case report. World J Clin Oncol 2020; 11:405-411. [PMID: 32874954 PMCID: PMC7450812 DOI: 10.5306/wjco.v11.i6.405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Angioimmunoblastic T-cell lymphoma (AITL) is a peripheral T-cell lymphoma, which is a rare subtype of lymphoma. Patients with AITL often have skin lesions, which are observed in 50% of all cases; the chief complaint of this patient was palpable purpura. AITL often complicates autoimmune or hematological disorders; however, among these, pure red cell aplasia (PRCA) is a very rare complication of AITL. We herein report a case of AITL with PRCA.
CASE SUMMARY A 77-year-old Japanese man presented to our hospital with complaints of loss of appetite for 2 mo and a 10-d history of palpable purpura. On physical examination, the patient was afebrile but had bilateral multiple palpable purpuric lesions over the lower extremities, lower abdomen, and part of the upper extremities. Moreover, lymphadenopathy of the bilateral inguinal, cervical, and supraclavicular nodes was noted. Laboratory and imaging studies and skin biopsy were conducted but were inconclusive. Based on inguinal lymph node excisional biopsy, we diagnosed the patient with AITL. Subsequently, the patient developed progressive normocytic normochromic anemia that necessitated almost daily blood transfusion. The clinical presentations and results of bone marrow assessment were consistent with those of PRCA, which is associated with AITL. Chemotherapy was initiated but was not effective. The patient refused further chemotherapy and opted to continue receiving best supportive care.
CONCLUSION PRCA is an extremely rare complication of AITL. As the pathophysiology remains unclear, further research is warranted.
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Affiliation(s)
- Teiko Kawahigashi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Izumi Kitagawa
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Eri Tanaka
- Department of Hematology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
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4
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Hochman MJ, Martin DB. Coincidence of autoimmune hemolytic anemia and pure red cell aplasia in a patient with CLL. Ann Hematol 2020; 100:579-580. [PMID: 32548659 DOI: 10.1007/s00277-020-04091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Michael J Hochman
- Department of Medicine, University of Washington Medical Center, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Daniel B Martin
- Department of Medicine, University of Washington Medical Center, 825 Eastlake Ave E, Seattle, WA, 98109, USA. .,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA.
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Immunosuppression therapy is effective for both acquired tumor-associated and primary pure red cell aplasia: a match pair case-control study. Ann Hematol 2020; 99:1485-1491. [PMID: 32488602 DOI: 10.1007/s00277-020-04105-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
No agreement had been reached on the treatment of patients with pure red cell aplasia (PRCA) secondary to indolent malignancies. Data was collected from patients with acquired PRCA from May, 2014 to May, 2018 in Peking Union Medical College Hospital. Tumor-associated PRCA and primary PRCA patients were matched at a ratio of 1:2 with compatible baseline characteristics. All patients had been treated with CsA or sirolimus for at least 6 months with the efficacy and adverse events recorded. Twelve tumor-associated PRCA patients (3 thymoma, 8 lymphoproliferative disorders, and 1 smoldering multiple myeloma) with stable underling disease and 24 acquired primary PRCA patients were selected. 83.3% tumor-associated PRCA patients and 100% primary PRCA patients (P = 0.436) responded to immunosuppression therapy (IST) at a median of 2.5 and 3.5 months (P = 0.137), respectively. No different was found in side effects. The ORR at the end of a median of 21.5-month follow-up was 75% and 70.8% (P = 0.795), respectively. No tumor progression was reported except one secondary patient had lymphoma relapse after 2 years of IST and was given chemotherapy again. These results suggested IST had similar effect, safety on patients with tumor-associated, and primary PRCA patients when the tumors were stable.
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6
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[How I diagnose and treat pure red cell aplasia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:5-9. [PMID: 32023747 PMCID: PMC7357908 DOI: 10.3760/cma.j.issn.0253-2727.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Pure red cell aplasia (PRCA) is a syndrome defined by a normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of erythroid precursors from the bone marrow. Diamond-Blackfan anemia is a congenital form of PRCA. Acquired PRCA may be either a primary disorder or secondary to some other disorder or agent. Primary acquired PRCA is an autoimmune disorder that is frequently antibody-mediated. Myelodysplastic syndromes may also present with the morphologic appearance of PRCA. Secondary acquired PRCA may be associated with collagen vascular/autoimmune disorders such as systemic lupus erythematosus; lymphoproliferative disorders such as chronic lymphocytic leukemia or large granular lymphocyte leukemia; infections, particularly B19 parvovirus; thymoma and other solid tumors; or a variety of other disorders, drugs, or toxic agents. The therapeutic approach to PRCA typically involves immunosuppression, but specific pathogenic subtypes are associated with specific therapeutic approaches. Cyclosporine A, with or without concurrent corticosteroids, appears to be the single most effective immunosuppressive agent.
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8
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Jain M, Shukla A, Kumar A, Kushwaha R, Tripathi AK. Anaemia in CD5 Negative Chronic Lymphoproliferative Disorder: Importance of Bone Marrow Examination. J Clin Diagn Res 2017; 11:XL01. [PMID: 28571248 DOI: 10.7860/jcdr/2017/21088.9605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Mili Jain
- Assistant Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ayush Shukla
- Senior Resident, Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rashmi Kushwaha
- Associate Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anil Kumar Tripathi
- Professor, Department of Clinical Hematology, King George's Medical University, Lucknow, Uttar Pradesh, India
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9
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Abstract
Pure red cell aplasia (PRCA) is a syndrome defined by a normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of erythroid precursors from the bone marrow. Diamond-Blackfan anemia is a congenital form of PRCA. Acquired PRCA may be either a primary disorder or secondary to some other disorder or agent. Primary acquired PRCA is an autoimmune disorder that is frequently antibody-mediated. Myelodysplastic syndromes may also present with the morphologic appearance of PRCA. Secondary acquired PRCA may be associated with collagen vascular/autoimmune disorders such as systemic lupus erythematosus; lymphoproliferative disorders such as chronic lymphocytic leukemia or large granular lymphocyte leukemia; infections, particularly B19 parvovirus; thymoma and other solid tumors; or a variety of other disorders, drugs, or toxic agents. The therapeutic approach to PRCA typically involves immunosuppression, but specific pathogenic subtypes are associated with specific therapeutic approaches. Cyclosporine A, with or without concurrent corticosteroids, appears to be the single most effective immunosuppressive agent.
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MESH Headings
- Adrenal Cortex Hormones/therapeutic use
- Anemia, Diamond-Blackfan/drug therapy
- Anemia, Diamond-Blackfan/immunology
- Anemia, Diamond-Blackfan/pathology
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/immunology
- Autoimmune Diseases/pathology
- Cyclosporine/therapeutic use
- Humans
- Immunosuppressive Agents/therapeutic use
- Leukemia, Large Granular Lymphocytic/drug therapy
- Leukemia, Large Granular Lymphocytic/immunology
- Leukemia, Large Granular Lymphocytic/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Myelodysplastic Syndromes/drug therapy
- Myelodysplastic Syndromes/etiology
- Myelodysplastic Syndromes/immunology
- Myelodysplastic Syndromes/pathology
- Parvoviridae Infections/drug therapy
- Parvoviridae Infections/immunology
- Parvoviridae Infections/pathology
- Parvovirus B19, Human/immunology
- Thymoma/drug therapy
- Thymoma/immunology
- Thymoma/pathology
- Vasculitis/drug therapy
- Vasculitis/immunology
- Vasculitis/pathology
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Affiliation(s)
- Robert T Means
- Office of the Dean, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN
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Van den Bergh M, Alvarez-Argote J, Panwala AH, Dasanu CA. Autoimmune disorders in patients with T-cell lymphoma: a comprehensive review. Curr Med Res Opin 2015. [PMID: 26211818 DOI: 10.1185/03007995.2015.1074066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Increased risk of B-cell lymphoma in patients with autoimmune diseases is well known. Medical literature also links various autoimmune conditions with T-cell lymphomas (TCLs), a rarer but very heterogeneous group of generally aggressive neoplasms. METHODS Herein, we provide a comprehensive analysis of the available peer-reviewed literature on epidemiology, clinico-laboratory features and management of autoimmune diseases in patients with TCL. Most relevant publications were identified through searching the PubMed/Medline database for articles published from inception to June 2014. FINDINGS Prevalence of various hematologic and non-hematologic autoimmune conditions in patients with TCL appears to be increased. Due to the rarity of TCL, scientific literature on autoimmune conditions in these patients consists mainly of case series and isolated reports. CONCLUSIONS Autoimmune disorders can develop prior to, during or after the onset of TCL. The diagnosis of TCL should prompt early recognition of certain autoimmune disorders if clinical suspicion exists. A dysfunctional immune response in these patients may be responsible for the occurrence of autoimmunity. Conversely, autoimmune conditions might create a favorable milieu for T-cell lymphoma pathogenesis. Therefore, their presence should increase the suspicion of TCL in an appropriate clinico-laboratory context. There is need for larger studies to assess further the TCL-autoimmunity relationship as prognosis and management of these patients can be considerably affected.
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Affiliation(s)
| | | | - Amruta H Panwala
- a a University of Connecticut , Internal Medicine, Farmington, CT , USA
| | - Constantin A Dasanu
- b b Lucy Curci Cancer Center, Eisenhower Medical Center, Rancho Mirage , CA , USA
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Fujimi A, Kamihara Y, Kanisawa Y, Hashimoto A, Nakajima C, Hayasaka N, Uemura N, Okuda T, Minami S, Iyama S, Takada K, Sato T, Hara A, Iwata Y, Furuichi K, Wada T, Kato J. Anti-erythropoietin receptor antibody-associated pure red cell aplasia accompanied by Coombs-negative autoimmune hemolytic anemia in a patient with T cell/histiocyte-rich large B cell lymphoma. Int J Hematol 2014; 100:490-3. [PMID: 25096221 DOI: 10.1007/s12185-014-1652-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 01/19/2023]
Abstract
A 79-year-old female diagnosed with T cell/histiocyte-rich large B cell lymphoma in complete remission after six cycles of rituximab-combined chemotherapy developed severe anemia, reticulocytopenia, and bone marrow erythroid hypoplasia. She was diagnosed with pure red cell aplasia (PRCA) accompanied by Coombs-negative autoimmune hemolytic anemia evidenced by a lack of glycophorin-A-positive cells in the bone marrow, haptoglobin under the detection level, and a high titer of RBC-bound IgG. Anti-erythropoietin receptor (EPOR) antibody was detected in the serum, and oligoclonal α/β and γ/δ T cells were also detected in her peripheral blood by Southern blotting analysis. Parvovirus B19 DNA was not detected by PCR. Although the treatment with rituximab had limited efficacy (specifically, only for hemolysis), subsequent cyclosporine therapy led to prompt recovery of erythropoiesis with the disappearance of anti-EPOR antibody and oligoclonal T cells. This is the first case report of anti-EPOR antibody-associated PRCA in a patient with malignant lymphoma treated successfully with cyclosporine.
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/immunology
- Antibodies, Monoclonal/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Female
- Fluorodeoxyglucose F18
- Histiocytes/pathology
- Humans
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasm Staging
- Positron-Emission Tomography
- Receptors, Erythropoietin/antagonists & inhibitors
- Red-Cell Aplasia, Pure/chemically induced
- Red-Cell Aplasia, Pure/complications
- Red-Cell Aplasia, Pure/drug therapy
- T-Lymphocytes/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- Akihito Fujimi
- Department of Hematology and Oncology, Oji General Hospital, 3-4-8 Wakakusa-Cho, Tomakomai, 053-8506, Japan,
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12
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Pure red cell aplasia complicating the course of long-standing mantle cell lymphoma. Int J Hematol 2014; 99:777-81. [PMID: 24668076 DOI: 10.1007/s12185-014-1563-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/22/2014] [Accepted: 02/23/2014] [Indexed: 10/25/2022]
Abstract
Pure red cell aplasia (PRCA) is a rare cause of severe hypoplastic anemia characterized by profound depletion of erythroid precursors. Although PRCA may be associated with lymphoproliferative diseases, it has never been described in mantle cell lymphoma (MCL). We report what to our knowledge is the first case of a patient with indolent, non-nodal MCL complicated by PRCA. The patient presented with severe hypoproliferative anemia in the setting of a long-standing diagnosis of B-cell chronic lymphocytic leukemia. Bone marrow studies revealed the complete absence of erythroid progenitors. Cyclin D1 positivity on immunohistochemistry, confirmed by a positive FISH for t(11;14) (q13;q32), established the final diagnosis of MCL in conjunction with PRCA. Rituximab monotherapy led to rapid remission of splenomegaly and the leukemic picture, but the patient achieved transfusion independency only with subsequent administration of cyclosporine-A, and remained so during the subsequent 15 months despite the gradual disease recurrence.
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13
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Primary cutaneous T cell lymphoma with bone marrow infiltration and erythroblastopenia--a rare association. Hematol Oncol Stem Cell Ther 2014; 7:99-101. [PMID: 24625522 DOI: 10.1016/j.hemonc.2014.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 01/04/2014] [Accepted: 01/15/2014] [Indexed: 11/23/2022] Open
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14
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Chonabayashi K, Tamori S, Taniwaki M, Fujita H, Shimazu Y, Matsui Y, Hishizawa M, Usami K, Takaori-Kondo A. Refractory IGκ/IRF4-positive DLBCL with CDKN2A/2B deletion. Ann Hematol 2013; 93:893-4. [PMID: 23989669 DOI: 10.1007/s00277-013-1889-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 08/20/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Kazuhisa Chonabayashi
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan,
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15
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Tao J, Zheng FP, Tian H, Lin Y, Li JZ, Chen XL, Chen JN, Shao CK, Wu B. Angioimmunoblastic T-cell lymphoma-associated pure red cell aplasia with abdominal pain. World J Clin Oncol 2013; 4:75-81. [PMID: 23936760 PMCID: PMC3708066 DOI: 10.5306/wjco.v4.i3.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/03/2013] [Accepted: 06/04/2013] [Indexed: 02/06/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a unique type of peripheral T-cell lymphoma with a constellation of clinical symptoms and signs, including weight loss, fever, chills, anemia, skin rash, hepatosplenomegaly, lymphadenopathy, thrombocytopenia and polyclonal hypergammaglobulinemia. The histological features of AITL are also distinctive. Pure red cell aplasia is a bone marrow failure characterized by progressive normocytic anemia and reticulocytopenia without leucopenia or thrombocytopenia. However, AITL with abdominal pain and pure red cell aplasia has rarely been reported. Here, we report a rare case of AITL-associated pure red cell aplasia with abdominal pain. The diagnosis was verified by a biopsy of the enlarged abdominal lymph nodes with immunohistochemical staining.
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Ku M, Bazargan A, Nandurkar H, Tam C. Effective treatment of Waldenström macroglobulinemia associated pure red cell aplasia with standard antilymphomatous chemotherapy. Leuk Lymphoma 2013; 55:692-4. [PMID: 23841509 DOI: 10.3109/10428194.2013.802316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthew Ku
- Department of Haematology, St Vincent's Hospital , Melbourne , Australia
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17
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Hirokawa M, Fukuda T, Ohashi K, Hidaka M, Ichinohe T, Iwato K, Kanamori H, Murata M, Sakura T, Imamura M, Adachi S, Suzuki R, Morishima Y, Sakamaki H. Efficacy and Long-Term Outcome of Treatment for Pure Red Cell Aplasia after Allogeneic Stem Cell Transplantation from Major ABO-Incompatible Donors. Biol Blood Marrow Transplant 2013; 19:1026-32. [DOI: 10.1016/j.bbmt.2013.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 04/05/2013] [Indexed: 10/27/2022]
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18
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Waldenström's macroglobulinaemia complicated by pure red cell aplasia: a case report. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:630-3. [PMID: 23736934 DOI: 10.2450/2013.0235-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 02/28/2013] [Indexed: 12/27/2022]
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19
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Xu LH, Fang JP, Weng WJ, Huang K, Guo HX, Liu Y, Zhang JH. Pure red cell aplasia associated with cytomegalovirus and Epstein-Barr virus infection in seven cases of Chinese children. ACTA ACUST UNITED AC 2012; 18:56-9. [PMID: 23321155 DOI: 10.1179/1607845412y.0000000044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pure red cell aplasia (PRCA) associated with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infection is uncommon. Here, we describe the clinical features and management of seven cases of Chinese children with PRCA associated with viral infections. The patients presented with pallor on admission. Blood cell counts and marrow smears showed anemia, reticulocytopenia, and aplasia of erythroblasts. Serological investigation and DNA polymerase chain reactions for CMV were positive in four patients and those tests for EBV were positive in other three patients. All patients received blood transfusion, corticosteroids treatment, and ganciclovir injection. Two patients had a complete response and one had a partial response after the treatments. The other three patients had a complete response to second-line therapies, including high-dose methylprednisolone, cyclosporin A, and intravenous immunoglobulin. Only one patient had no response to the therapies. Our results indicated that it might be important to combine immunosuppressive drugs with an antiviral drug in the management of PRCA associated with CMV and EBV infection.
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Affiliation(s)
- Lu-Hong Xu
- Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Hirokawa M, Sawada K. [Bone marrow failure syndrome (idiopathic hematopoietic disorders): progress in diagnosis and treatment. Topics: III. Diagnosis and treatments 2, Pure red cell aplasia]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2012; 101:1937-44. [PMID: 22896997 DOI: 10.2169/naika.101.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Zhang M, Hu S, Ashwani N, Li J, Zhao W, He H. Pediatric T-cell acute lymphoblastic leukemia with transient pure red cell aplasia. Pediatr Blood Cancer 2012; 58:1002-3. [PMID: 22294462 DOI: 10.1002/pbc.23407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/29/2011] [Indexed: 11/11/2022]
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Vlachaki E, Diamantidis MD, Klonizakis P, Haralambidou-Vranitsa S, Ioannidou-Papagiannaki E, Klonizakis I. Pure red cell aplasia and lymphoproliferative disorders: an infrequent association. ScientificWorldJournal 2012; 2012:475313. [PMID: 22593689 PMCID: PMC3349208 DOI: 10.1100/2012/475313] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 10/26/2011] [Indexed: 11/17/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare bone marrow failure syndrome defined by a progressive normocytic anaemia and reticulocytopenia without leukocytopenia and thrombocytopenia. Secondary PRCA can be associated with various haematological disorders, such as chronic lymphocytic leukaemia (CLL) or non-Hodgkin lymphoma (NHL). The aim of the present review is to investigate the infrequent association between PRCA and lymphoproliferative disorders. PRCA might precede the appearance of lymphoma, may present simultaneously with the lymphoid neoplastic disease, or might appear following the lymphomatic disorder. Possible pathophysiological molecular mechanisms to explain the rare association between PRCA and lymphoproliferative disorders are reported. Most cases of PRCA are presumed to be autoimmune mediated by antibodies against either erythroblasts or erythropoietin, by T-cells secreting factors selectively inhibiting erythroid colonies in the bone marrow or by NK cells directly lysing erythroblasts. Finally, focus is given to the therapeutical approach, as several treatment regimens have failed for PRCA. Immunosuppressive therapy and/or chemotherapy are effective for improving anaemia in the majority of patients with lymphoma-associated PRCA. Further investigation is required to define the pathophysiology of PRCA at a molecular level and to provide convincing evidence why it might appear as a rare complication of lymphoproliferative disorders.
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Affiliation(s)
- Efthymia Vlachaki
- Department of Haematology, Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 546 42, Thessaloniki, Greece
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Yamamoto G, Maki H, Ichikawa M, Kurokawa M. Pure red cell aplasia with follicular lymphoma showing regression and progression parallel to lymphoma. Int J Hematol 2011; 94:576-7. [PMID: 22116626 DOI: 10.1007/s12185-011-0969-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 11/08/2011] [Accepted: 11/09/2011] [Indexed: 10/15/2022]
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Harris SJ, Seah JAA, Barnett F, White SC. Inflammatory breast cancer and secondary Pure Red Cell Aplasia. Acta Oncol 2011; 50:727-8. [PMID: 21574834 DOI: 10.3109/0284186x.2011.562917] [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: 11/13/2022]
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Sawada K. Guest editorial: the seven wonders of erythropoiesis. Int J Hematol 2011; 93:1-4. [PMID: 21222183 DOI: 10.1007/s12185-010-0762-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 12/27/2010] [Indexed: 11/25/2022]
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Martinaud C, Pons S, Ménard G, Gisserot O, de Jaureguiberry JP, Brisou P. [Myelodysplastic syndrome with erythroblastopenia]. Rev Med Interne 2010; 32:33-8. [PMID: 20801559 DOI: 10.1016/j.revmed.2010.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 06/04/2010] [Accepted: 07/16/2010] [Indexed: 10/19/2022]
Abstract
Myelodysplastic syndrome with erythroid hypoplasia or erythroblastopenia has not yet been clearly defined, and in most patients it is mistaken for acquired pure red cell aplasia. Including one additional patient reported in this article, a literature review revealed only 50 cases over the last 20 years. These patients were predominantly elderly males, all required regular packed red cell transfusions, and they had a poor prognosis, mainly because of acute transformation. The mechanisms of erythroid aplasia remain unclear. However, recent data suggest the association of an intrinsic stem cell defect with immunological implication.
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Affiliation(s)
- C Martinaud
- Fédération des laboratoires, HIA Sainte-Anne, 2 boulevard Sainte-Anne, Toulon cedex 9, France.
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