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Gong Y, Li Y, Chen X, Yang H, Zhang Y, He G, Fan L. Refractory pure red cell aplasia associated with T-cell large granular lymphocyte leukemia treated by ruxolitinib. Ann Hematol 2024; 103:3239-3242. [PMID: 38935319 DOI: 10.1007/s00277-024-05856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
Acquired pure red cell aplasia (PRCA) is a rare syndrome characterized by normocytic normochromic anemia with severe reticulocytopenia and absence of erythroid precursors in the bone marrow. For refractory PRCA patients, the low response rate and high toxicity of alternative therapies pose a great challenge. T-cell large granular lymphocyte (T-LGL) leukemia is one of the most common conditions in secondary PRCA and also the most difficult form to manage with an inferior treatment response to other secondary PRCA forms. T-LGL leukemia exhibits sustained activation of the intracellular JAK-STAT signaling pathway. We herein report a case of PRCA associated with T-LGL leukemia that had been refractory to multiple lines of therapies and was successfully treated by ruxolitinib. The patient achieved complete remission and tolerated ruxolitinib well without occurrence of neutropenia or thrombocytopenia. This preliminary finding favors ruxolitinib as a potential salvage therapy for refractory PRCA associated with T-LGL leukemia.
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Affiliation(s)
- Yuemin Gong
- Department of Hematology, Jiangsu Province Hospital, Key Laboratory of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, The First Affiliated Hospital, Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, China
| | - Yue Li
- Department of Hematology, Jiangsu Province Hospital, Key Laboratory of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, The First Affiliated Hospital, Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, China
| | - Xiaoyu Chen
- Department of Hematology, Jiangsu Province Hospital, Key Laboratory of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, The First Affiliated Hospital, Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, China
| | - Hui Yang
- Department of Hematology, Jiangsu Province Hospital, Key Laboratory of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, The First Affiliated Hospital, Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, China
| | - Yawen Zhang
- Department of Hematology, Jiangsu Province Hospital, Key Laboratory of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, The First Affiliated Hospital, Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, China
| | - Guangsheng He
- Department of Hematology, Jiangsu Province Hospital, Key Laboratory of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, The First Affiliated Hospital, Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, China.
| | - Lei Fan
- Department of Hematology, Jiangsu Province Hospital, Key Laboratory of Hematology, Collaborative Innovation Center for Cancer Personalized Medicine, The First Affiliated Hospital, Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210000, China
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Strasser B, Heibl S, Hörmann G, Haushofer A. Diamond-Blackfan anemia with very late and fatal onset aplasia in a 55-year-old patient with RPL11 mutation. Ann Hematol 2024; 103:1011-1012. [PMID: 37993587 DOI: 10.1007/s00277-023-05553-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Bernhard Strasser
- Institute of Clinical Chemistry and Laboratory Medicine, Hospital Wels-Grieskirchen, Grieskirchnerstraße 42, Wels, 4600, Austria.
| | - Sonja Heibl
- Institute of Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
| | | | - Alexander Haushofer
- Institute of Clinical Chemistry and Laboratory Medicine, Hospital Wels-Grieskirchen, Grieskirchnerstraße 42, Wels, 4600, Austria
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Lobbes H, Lega JC, Le Guenno G, Ruivard M, Mainbourg S. Treatment strategy for acquired pure red cell aplasia: a systematic review and meta-analysis. Blood Adv 2023; 7:6451-6465. [PMID: 37624775 PMCID: PMC10632686 DOI: 10.1182/bloodadvances.2023010587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/22/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
The treatment of autoimmune acquired pure red cell aplasia (aPRCA) is challenging. Guidelines are based on expert recommendations in the absence of controlled trials. We assessed the efficacy of the main treatment strategy through a systematic review and meta-analysis using MEDLINE, EMBASE, and the Cochrane Library up to September 2022. The overall response rate (ORR) was pooled using random-effects models. In total, 24 observational studies (19 retrospective, median follow-up of 48 months) encompassing 753 patients (49% male) were included. Primary aPRCA represented 57% of the cases. The risk of bias was moderate to high using the ROBINS-I tool. Substantial heterogeneity (I2 > 50%) was retrieved. Corticosteroids as monotherapy as first-line treatment (186 patients, 13 studies) provided an ORR of 47% (95% confidence interval [CI], 34-60). Cyclosporine A was the most frequently used immunosuppressant agent (384 patients, 18 studies), providing an ORR of 74% (95% CI, 66-82) with a similar ORR in first- (73%) and second-line (76%) treatment and when cyclosporin was used as monotherapy (83%) or with corticosteroids (77%). A total of 112 patients (10 studies) received cyclophosphamide, with an ORR of 49% (95% CI, 35-64), which was higher when cyclophosphamide was combined with corticosteroids (48%) and used in second-line treatment (58%) than in monotherapy (31%), and in first-line treatment (44%). Sirolimus use was reported only after cyclosporine A failure and provided an ORR of 87% (95% CI, 68-100; 64 patients, 3 studies). Substantial uncertainty remains regarding the best treatment strategy in the absence of high-quality evidence. This study was registered on the PROPERO database as #CRD42022360452.
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Affiliation(s)
- Hervé Lobbes
- Service de Médecine Interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre de Compétence des cytopénies autoimmunes de l’adulte, Clermont-Ferrand, France
- Institut Pascal, Centre Hospitalier Universitaire de Clermont-Ferrand, Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont-Ferrand, France
| | - Jean-Christophe Lega
- Lyon Immunopathology Federation, Hospices Civils de Lyon, Lyon, France
- Service de Rhumatologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, Unité Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie évolutive, Centre National de la Recherche Scientifique, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Guillaume Le Guenno
- Service de Médecine Interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre de Compétence des cytopénies autoimmunes de l’adulte, Clermont-Ferrand, France
| | - Marc Ruivard
- Service de Médecine Interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre de Compétence des cytopénies autoimmunes de l’adulte, Clermont-Ferrand, France
- Institut Pascal, Centre Hospitalier Universitaire de Clermont-Ferrand, Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont-Ferrand, France
| | - Sabine Mainbourg
- Lyon Immunopathology Federation, Hospices Civils de Lyon, Lyon, France
- Equipe Evaluation et Modélisation des Effets Thérapeutiques, Unité Mixte de Recherche 5558, Laboratoire de Biométrie et Biologie évolutive, Centre National de la Recherche Scientifique, Université Claude Bernard Lyon 1, Villeurbanne, France
- Département de Médecine Interne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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