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Satoh T, Kayano H, Watanabe A, Ohta A, Endoh T, Shimizu Y, Fukushima T, Tanaka R, Yasuda M. Lethal macrophage-related complications of juvenile myelomonocytic leukemia with a blastic crisis: an autopsy case report. Int J Hematol 2021; 114:517-523. [PMID: 34272652 DOI: 10.1007/s12185-021-03189-5] [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: 03/11/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
For hematopoietic stem cell transplantation to be successful, complications must be managed. Graft-versus-host disease is particularly important, but various other complications, treatment side effects, and relapse of primary disease may also occur. We report an autopsy case of juvenile myelomonocytic leukemia with a blastic crisis, in which activated and recovered autologous macrophage-related complications after cord blood transplantation caused the patient's death. Pathological analysis of autopsy specimens revealed diffuse infiltration of mature macrophages into the skin but scarce lymphocytes. These macrophages were found in the bone marrow interspersed with a small number of blasts that had previously occupied about 60% of the bone marrow before death. The direct cause of death was an opportunistic airway infection due to bone marrow and immune failures triggered by overactivation and proliferation of macrophages. Genetic analysis showed the activated macrophages were autologous. Together these findings indicate that the patient died from macrophage-mediated complications, but not from a blastic crisis or conventional graft-versus-host disease. When macrophage activation persists after hematopoietic stem cell transplantation, macrophage-mediated complications should be considered as a differential diagnosis. To manage this complication, pathology specimens should be examined to check for the presence of effector cells at an early stage.
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Affiliation(s)
- Tsugumi Satoh
- Department of Pathology, Saitama Medical University, International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama-ken, Japan.
| | - Hidekazu Kayano
- Department of Pathology, Saitama Medical University, International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama-ken, Japan.,Faculty of Health and Medical Care, School of Medical Technology, Saitama Medical University, Saitama, Japan
| | - Atsuko Watanabe
- Department of Pediatric Hematology and Oncology, Saitama Medical University, International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama-ken, Japan
| | - Atsuhiko Ohta
- Department of Pediatric Hematology and Oncology, Saitama Medical University, International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama-ken, Japan
| | - Takuya Endoh
- Department of Pediatric Hematology and Oncology, Saitama Medical University, International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama-ken, Japan
| | - Yuki Shimizu
- Department of Pediatric Hematology and Oncology, Saitama Medical University, International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama-ken, Japan
| | - Takashi Fukushima
- Department of Pediatric Hematology and Oncology, Saitama Medical University, International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama-ken, Japan
| | - Ryuhei Tanaka
- Department of Pediatric Hematology and Oncology, Saitama Medical University, International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama-ken, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University, International Medical Center, 1397-1, Yamane, Hidaka-shi, Saitama-ken, Japan
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Motonaga T, Furuta T, Okada S, Ohnishi Y, Suzuki Y, Yasudo H, Hasegawa S. Responses to Treatment According to the Cytokine Profiles of Pericardial Effusion in Two Children with Idiopathic Pericarditis. Int Heart J 2020; 61:1307-1310. [PMID: 33191347 DOI: 10.1536/ihj.20-282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute pericarditis is inflammation of the pericardium with or without pericardial effusion. In the pediatric population, most patients with acute pericarditis are diagnosed with idiopathic pericarditis. Herein, we present two children with idiopathic pericarditis who underwent immunological assessment of pericardial effusion for the first time. Both patients showed equally high levels of interleukin-6 in the pericardial effusion. However, they had different treatment responses, in accordance with the pericardial effusion and serum interleukin-10 concentrations. Our present cases suggest that interleukin-10 may be associated with the response to anti-inflammatory therapy in idiopathic acute pericarditis.
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Affiliation(s)
- Takahiro Motonaga
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Takashi Furuta
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Yuji Ohnishi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Yasuo Suzuki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Hiroki Yasudo
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
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Ito M, Fujino M. Macrophage‐mediated complications after stem cell transplantation. Pathol Int 2019; 69:679-687. [DOI: 10.1111/pin.12865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/17/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Masafumi Ito
- Department of PathologyJapanese Red Cross, Nagoya First Hospital Aichi Japan
| | - Masahiko Fujino
- Department of PathologyJapanese Red Cross, Nagoya First Hospital Aichi Japan
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