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Ozsoylu S. About the treatment of kasabach-merritt syndrome. Turk J Haematol 2014; 30:94. [PMID: 24385766 PMCID: PMC3781646 DOI: 10.4274/tjh.02703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 11/14/2012] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sinasi Ozsoylu
- Retired Professor of Pediatrics, Hematology, and Hepatology ; Honorary Fellow of American Academy of Pediatrics ; Honorary Member of American Pediatric Society ; Fellow of Islamic World Academy of Sciences
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Ozsoylu S, Berenschot HW. Megadose Methylprednisolone (MDMP) Treatment in a Patient with Autoimmune Hemolytic Anemia (AIHA) Resistant to Conventional Corticosteroid Administration: A Case Report. TURKISH JOURNAL OF HAEMATOLOGY : OFFICIAL JOURNAL OF TURKISH SOCIETY OF HAEMATOLOGY 2014; 30:194-7. [PMID: 24385786 PMCID: PMC3878473 DOI: 10.4274/tjh.2012.0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 09/19/2012] [Indexed: 12/01/2022]
Abstract
A female in the Netherlands with severe autoimmune hemolytic anemia (AIHA) was treated with conventional corticosteroid (2 mg/kg/d in divided doses) and blood transfusions for 18 months without improvement. The presented patient responded to megadose methylprednisolone (MDMP) 30 mg/kg/d for 3 d, followed by 20 mg/kg for 4 d, and subsequently 10, 5, 2, and 1 mg/kg/d each for 1 week. Conflict of interest:None declared.
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Affiliation(s)
- Sinasi Ozsoylu
- Fatih University, School of Medicine, Department of Hematology, Ankara, Turkey ; Albert Schweitzer Hospital, Division of Hematology, Dordrecht, Netherlands
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Ozsoylu S. Megadose Methylprednisolone (MDMP) for Hemangiomatosis. TURKISH JOURNAL OF HAEMATOLOGY : OFFICIAL JOURNAL OF TURKISH SOCIETY OF HAEMATOLOGY 2012; 29:436. [PMID: 24385740 PMCID: PMC3781610 DOI: 10.5505/tjh.2012.55706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/12/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sinasi Ozsoylu
- Retired Prof of Pediatrics, Hematology, Hepatology, Ankara, Turkey ; Honorary Fellow of American Academy of Pediatrics ; Honorary Member of American Pediatric Society
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Kim T, Roh MR, Cho S, Chung KY. Kasabach-merritt syndrome arising from tufted angioma successfully treated with systemic corticosteroid. Ann Dermatol 2010; 22:426-30. [PMID: 21165213 DOI: 10.5021/ad.2010.22.4.426] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 11/30/2009] [Accepted: 12/03/2009] [Indexed: 11/08/2022] Open
Abstract
We report a case of Kasabach-Merritt syndrome arising from a tufted angioma successfully treated with systemic corticosteroid. A 2-month-old male infant presented with a palm-sized, erythematous induration on his left pubis. The lesion was diagnosed as tufted angioma histopathologically. After 1 month, the lesion suddenly expanded to the abdomen and scrotum. Initial laboratory tests were consistent with consumptive coagulopathy. He was diagnosed with Kasabach-Merritt syndrome and treated with intravenous dexamethasone at 0.32 mg/kg/day (equivalent to prednisolone 2.0 mg/kg/day). Two days after initiating the treatment, his platelet counts recovered and the lesion ceased to expand. Steroid therapy was converted to oral prednisolone and the dosage was subsequently tapered, and the lesion gradually involuted with no signs of recurrence for a year.
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Affiliation(s)
- Taegyun Kim
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Ryan C, Price V, John P, Mahant S, Baruchel S, Brandão L, Blanchette V, Pope E, Weinstein M. Kasabach-Merritt phenomenon: a single centre experience. Eur J Haematol 2009; 84:97-104. [PMID: 19889011 DOI: 10.1111/j.1600-0609.2009.01370.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Kasabach-Merritt phenomenon (KMP) can lead to life-threatening bleeding, and its optimum treatment has not been established. We review the experience of managing KMP in a single institution. METHODS A retrospective chart review on all children with KMP treated at the Hospital for Sick Children, Toronto, over an 18 yr period was carried out. RESULTS All 15 patients had profound thrombocytopenia and hypofibrinogenemia at presentation, half had bleeding symptoms, and three had cardiac failure. All patients received corticosteroids. Five responded to steroids alone, given for an average of 13 wk, increasing platelets to >20 x 10(9)/L at a mean of 6.2 d and fibrinogen >1 g/dL at 25.6 d. Ten patients received at least one other therapeutic modality in addition to steroids, including vincristine, interferon, anti-platelet agents and pentoxifylline. Five patients received vincristine, for a mean of 6 wk, with two patients responding. Eight patients received interferon, for a mean of 4 months, with two patients responding. Overall, the mean time to increasing platelets >20 x 10(9)/L was 56 d, to >150 x 10(9)/L was 88 d and fibrinogen >1 g/dL 49 d. Ten patients showed a partial response to embolisation, with a mean of 2.8 procedures performed. Thrombotic complications occurred in 7%. Twelve patients remain alive, with relapse in six patients, all treated successfully. One patient died, and two patients have been lost to follow-up. CONCLUSION KMP is a rare condition, with significant morbidity and mortality. The therapeutic approach should include a multidisciplinary team and consensus on guidelines.
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Affiliation(s)
- Clodagh Ryan
- Department of Haematology, Mercy University Hospital, Grenville Place, Cork, Ireland
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Abstract
Kasabach-Merritt phenomenon (KMP) is a rare thrombocytopenic consumption coagulopathy associated with an enlarging tufted angioma or kaposiform hemangioendothelioma. We report a case series of patients with KMP and discuss the treatment options and outcomes. Nine patients with a diagnosis of KMP were identified through retrospective chart review-6 had "definite KMP" and 3 had "less likely KMP." The hematologic features of KMP and those of chronic coagulopathy seen with other vascular malformations can be similar, which makes KMP difficult to distinguish.
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Drucker AM, Pope E, Mahant S, Weinstein M. Vincristine and Corticosteroids as First-Line Treatment of Kasabach-Merritt Syndrome in Kaposiform Hemangioendothelioma. J Cutan Med Surg 2009; 13:155-9. [DOI: 10.2310/7750.2008.08006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Historically, patients with the consumptive coagulopathy Kasabach-Merritt syndrome (KMS) have been treated with systemic corticosteroids as first-line therapy, but many patients do not respond. Recently, there have been increasing reports of the use of the chemotherapeutic drug vincristine in these patients. Objective: To report a case of a newborn with a kaposiform hemangioendothelioma (KHE) of the right leg associated with KMS treated successfully with vincristine and oral corticosteroids. Methods: The patient's chart and the literature on the subject were reviewed using Medline and PubMed. Results: Treatment with vincristine and corticosteroids lead to sustained shrinking of the tumor and correction of the thrombocytopenia and coagulopathy through 1 year of age. We believe this is the first report in the North American literature of corticosteroids and vincristine being used concomitantly as first-line therapy for KHE with KMS. Conclusion: Vincristine and corticosteroids should be considered first-line treatment for KMS.
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Affiliation(s)
- Aaron M. Drucker
- From the Department of Paediatrics and Paediatric Dermatology, The Hospital for Sick Children and the University of Toronto, Toronto, ON
| | - Elena Pope
- From the Department of Paediatrics and Paediatric Dermatology, The Hospital for Sick Children and the University of Toronto, Toronto, ON
| | - Sanjay Mahant
- From the Department of Paediatrics and Paediatric Dermatology, The Hospital for Sick Children and the University of Toronto, Toronto, ON
| | - Miriam Weinstein
- From the Department of Paediatrics and Paediatric Dermatology, The Hospital for Sick Children and the University of Toronto, Toronto, ON
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Yetgin S, Ozsoylu S. Comparison of megadose methylprednisolone versus conventional dose prednisolone in hematologic disorders. J Pediatr Hematol Oncol 2007; 29:253-9. [PMID: 17414568 DOI: 10.1097/mph.0b013e3180335be0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Glucocorticoids (GCs) are known for their clinically useful effects in immunologic and inflammatory disorders. Although there is a huge volume of knowledge concerning the cellular and molecular effects of GCs, statements regarding their effects in multiple diseases at variable doses are not clear-cut owing to pharmacogenetic differences. The main actions of GCs in hematologic disorders have been related to their differentiation-inducing and apoptosis-inducing effects, but modification of several steps of the hematopoietic and/or immune pathway has also been reported. In our clinic, mega-dose methylprednisolone (MDMP) has been successfully used for treatment of different hematologic diseases, such as leukemias, bone marrow failure in aplastic anemia, hypoplastic anemia, myelodysplastic syndrome, neutropenia, autoimmune diseases, and in some congenital hereditary diseases. Both clinical and experimental studies in our department revealed that MDMP was more effective than conventional dose steroids. It is interesting that MDMP can be curative in some congenital hereditary diseases such as Diamond-Blackfan syndrome. However, more research is required to clarify their roles in biology, physiology, and molecular genetics.
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Affiliation(s)
- Sevgi Yetgin
- Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
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Horikawa H, Tada T, Honda O. Anesthesia and perioperative management for Kasabach-Merritt syndrome--report of a case. J Anesth 2005; 6:492-5. [PMID: 15278525 DOI: 10.1007/s0054020060492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/1991] [Accepted: 02/03/1992] [Indexed: 11/27/2022]
Affiliation(s)
- H Horikawa
- Department of Anesthesia, Yamagata University School of Medicine, Yamagata, Japan
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Özsoylu Ş. Megadose methylprednisolone for Kasabach-Merritt syndrome. Eur J Pediatr 2003; 162:562. [PMID: 12748852 DOI: 10.1007/s00431-002-1142-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2002] [Accepted: 11/21/2002] [Indexed: 11/29/2022]
Affiliation(s)
- Şinasi Özsoylu
- Medical Faculty, Fatih University, Alparslan Türkeş cad. No.57, 06510 , Emek-Ankara, Turkey.
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Atalay M, Gordillo G, Roy S, Rovin B, Bagchi D, Bagchi M, Sen CK. Anti-angiogenic property of edible berry in a model of hemangioma. FEBS Lett 2003; 544:252-7. [PMID: 12782326 DOI: 10.1016/s0014-5793(03)00509-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hemangiomas represent a powerful model to study in vivo angiogenesis. Monocyte chemotactic protein 1 (MCP-1) is known to be responsible for recruiting macrophages to sites of infection or inflammation and facilitate angiogenesis. Recently we have demonstrated that edible berry extracts potently suppress inducible vascular endothelial growth factor expression and in vitro angiogenesis. Comparative analysis of several berry extracts led to the observation that wild blueberry and a berry mix were most effective. Our goal was to follow up on our findings with wild blueberry and the berry mix (OptiBerry). The present work rests on our current finding that these two berry powders significantly inhibit inducible MCP-1 expression in endothelioma cells. Therefore, we sought to examine the effects of wild blueberry and berry mix in an in vivo model of experimental angiogenesis. Reporter studies showed that the berry powders significantly inhibited basal MCP-1 transcription and inducible nuclear factor kappaB transcription. Endothelioma cells pre-treated with berry powders showed diminished ability to form hemangioma. Histological analysis demonstrated markedly decreased infiltration of macrophages in hemangioma of treated mice compared to placebo-treated controls. The current results provide the first in vivo evidence substantiating the anti-angiogenic property of edible berries.
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Affiliation(s)
- Mustafa Atalay
- Laboratory of Molecular Medicine, Department of Surgery, 512 Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Medical Center, 473 W. 12th Avenue, Columbus 43210, USA
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George M, Singhal V, Sharma V, Nopper AJ. Successful surgical excision of a complex vascular lesion in an infant with Kasabach-Merritt syndrome. Pediatr Dermatol 2002; 19:340-4. [PMID: 12220282 DOI: 10.1046/j.1525-1470.2002.t01-1-00097.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Kasabach-Merritt syndrome, the association of a vascular lesion and consumptive coagulopathy, can represent a diagnostic and therapeutic challenge to clinicians. We describe an infant with a large complex vascular lesion of the left forearm that was successfully surgically excised. We propose surgical excision as an appropriate therapeutic option for some cases of Kasabach-Merritt syndrome.
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Affiliation(s)
- Manju George
- Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, Missouri 64108, USA
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Blei F, Karp N, Rofsky N, Rosen R, Greco MA. Successful multimodal therapy for kaposiform hemangioendothelioma complicated by Kasabach-Merritt phenomenon: case report and review of the literature. Pediatr Hematol Oncol 1998; 15:295-305. [PMID: 9658430 DOI: 10.3109/08880019809014013] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We present the management challenge provided by a patient with kaposiform hemangioendothelioma associated with Kasabach-Merritt phenomenon. A female child presented at 14 months of age with an ecchymotic swelling of her right upper arm and axilla. Subsequently, she developed profound thrombocytopenia and hypofibrinogenemia (Kasabach-Merritt phenomenon). Biopsy of the lesion revealed kaposiform hemangioendothelioma, which has been reported as the predominant pathologic diagnosis associated with Kasabach-Merritt phenomenon. To achieve involution of the lesion and preserve function of the arm, the following interventions were involved: embolization, systemic interferon, cyclophosphamide, epsilon aminocaproic acid, and compression therapy. The clinical management of this patient was formidable until we arrived at the proper combination of therapies. Multimodal intervention may be required to manage fastidious hemangioendotheliomas of childhood, achieve clinical improvement, and prevent further morbidity.
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Affiliation(s)
- F Blei
- Department of Pediatrics, NYU Medical Center, New York 10016, USA.
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An unusual case of giant cavernous hemangioma presenting as a lytic lesion in manubrium sterni. EUROPEAN JOURNAL OF PLASTIC SURGERY 1997. [DOI: 10.1007/bf01159500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Esassolak M, Yalman D, Aras AB, Haydaroǧlu A, Özsaran Z, Çetingül N. Radiotherapy in kasabach-merritt syndrome. Radiography (Lond) 1997. [DOI: 10.1016/s1078-8174(97)90020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Esterly NB. Cutaneous hemangiomas, vascular stains and malformations, and associated syndromes. CURRENT PROBLEMS IN PEDIATRICS 1996; 26:3-39. [PMID: 8932511 DOI: 10.1016/s0045-9380(96)80023-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Bernini JC, Carrillo JM, Buchanan GR. High-dose intravenous methylprednisolone therapy for patients with Diamond-Blackfan anemia refractory to conventional doses of prednisone. J Pediatr 1995; 127:654-9. [PMID: 7562296 DOI: 10.1016/s0022-3476(95)70134-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To assess the efficacy and toxicity of very high doses of glucocorticoids in patients with congenital pure red cell aplasia (Diamond-Blackfan anemia) who did not respond to standard doses of prednisone. STUDY DESIGNS We prospectively treated eight patients with transfusion-dependent Diamond-Blackfan anemia with high intravenous doses of methylprednisolone. All patients had previously not responded to one or more oral courses of prednisone in standard doses and were dependent on erythrocyte transfusions. Every patient initially received methylprednisolone at a dose of 30 mg/kg per day, followed by slow tapering for 4 weeks, but none responded. All patients then received a second treatment course starting at 100 mg of methylprednisolone per kilogram per day, again followed by slow tapering of the dosage. RESULTS Three patients had a complete response that has been sustained for 21+, 31+, and 41+ months, respectively. One patient had a partial response. Toxic effects included a rise in serum alanine aminotransferase activity in all patients, transient diabetes mellitus in one child, and three episodes of bacteremia in two patients with intravenous access devices. CONCLUSIONS We conclude that very high doses of methylprednisolone may induce sustained remission in some patients with transfusion-dependent Diamond-Blackfan anemia refractory to standard-dose prednisone therapy.
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Affiliation(s)
- J C Bernini
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063, USA
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Ricketts RR, Hatley RM, Corden BJ, Sabio H, Howell CG. Interferon-alpha-2a for the treatment of complex hemangiomas of infancy and childhood. Ann Surg 1994; 219:605-12; discussion 612-4. [PMID: 8203969 PMCID: PMC1243204 DOI: 10.1097/00000658-199406000-00003] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The authors describe the use of interferon-alpha-2a (IFN-alpha-2a) in the treatment of complex hemangiomas and review the role of interferon (IFN) in this example of an angiogenic disease. SUMMARY BACKGROUND DATA Hemangiomas are the most frequent tumors of infants and children. They grow rapidly for 6 to 8 months and then resolve over a period of years. Approximately 5% produce life-, sight-, or limb-threatening complications, with mortality rates between 20% and 50%. Aggressive therapy with steroids, arterial ligation or embolization, or surgery has been used in these situations with variable results and high morbidity. Recently, IFN-alpha was found to be effective treatment in these complex hemangiomas. METHODS Four infants and one child were treated with IFN-alpha-2a at an initial subcutaneous dose of 1 million units/m2/day and a sustained dose of 3 million units/m2/day for 5 to 11 months. Appropriate laboratory values were monitored and adverse reactions and ultimate response to therapy were recorded. RESULTS Two patients experienced minor complications that were managed easily. Three patients had total or near-total regression of the hemangioma, one had partial (50%) regression, and one had stabilization but no regression after an average of 7.1 months of IFN therapy. CONCLUSION Interferon-alpha inhibits angiogenesis and endothelial cell migration and proliferation in vitro. The patients in this study add to the growing number who have benefited from IFN therapy. As such, IFN-alpha should be considered as a first-line agent in treating complex hemangiomas of infants and children.
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Affiliation(s)
- R R Ricketts
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Klein C, Hauser M, Hadorn HB. Interferon alpha-2a therapy of consumptive coagulopathy in Kasabach-Merritt syndrome. Eur J Pediatr 1992; 151:919. [PMID: 1473549 DOI: 10.1007/bf01954133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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