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Zorzetto F, Scalas A, Longu F, Isoni MA, Angelucci E, Fozza C. Hemophagocytic Lymphohistiocytosis Secondary to Refractory Acute Myeloid Leukemia Resolved after Second-Line Treatment with Azacitidine plus Venetoclax. Mediterr J Hematol Infect Dis 2024; 16:e2024011. [PMID: 38223479 PMCID: PMC10786137 DOI: 10.4084/mjhid.2024.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH), also defined as hemophagocytic syndrome (HPS), represents a potentially life-threatening hyperinflammatory syndrome, characterized by impaired function of cytotoxic T lymphocytes, natural killer cells and macrophages. The main clinical features of HLH are prolonged fever, hepatosplenomegaly, cytopenia, hypertriglyceridemia, hyperferritinemia and hemophagocytosis in bone marrow, liver, spleen or lymph nodes. Secondary HLH typically occurs in conjunction with severe infections, malignancies or autoimmune disorders and intensive chemotherapy, potentially complicating treatment of acute myeloid leukemia (AML) in around 10% of cases. Herein we report for the first time a case of HLH secondary to refractory/relapsed AML resolved after a second line treatment with azacitidine plus venetoclax, thus offering a new potential therapeutic perspective in the context of a life-threatening clinical scenario.
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Affiliation(s)
- Francesco Zorzetto
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Alessandra Scalas
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Francesco Longu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Maria Antonia Isoni
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Emanuele Angelucci
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
| | - Claudio Fozza
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy; Ematologia e Terapie cellulari, IRCCS Ospedale Policlinico San Martino, Genova
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Marques-Maggio E, Maccio U, Marx A, Galli S, Schwab N, Frank A, Hamelin B, Varga Z, Nombela-Arrieta C, Mertz KD, Theocharides AP, Koelzer VH. Bone marrow haematopoiesis in patients with COVID-19. Histopathology 2023; 83:582-590. [PMID: 37317636 DOI: 10.1111/his.14969] [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: 01/13/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
AIMS Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection broadly affects organ homeostasis, including the haematopoietic system. Autopsy studies are a crucial tool for investigation of organ-specific pathologies. Here we perform an in-depth analysis of the impact of severe coronavirus disease 2019 (COVID-19) on bone marrow haematopoiesis in correlation with clinical and laboratory parameters. METHODS AND RESULTS Twenty-eight autopsy cases and five controls from two academic centres were included in the study. We performed a comprehensive analysis of bone marrow pathology and microenvironment features with clinical and laboratory parameters and assessed SARS-CoV-2 infection of the bone marrow by quantitative polymerase chain reaction (qPCR) analysis. In COVID-19 patients, bone marrow specimens showed a left-shifted myelopoiesis (19 of 28, 64%), increased myeloid-erythroid ratio (eight of 28, 28%), increased megakaryopoiesis (six of 28, 21%) and lymphocytosis (four of 28, 14%). Strikingly, a high proportion of COVID-19 specimens showed erythrophagocytosis (15 of 28, 54%) and the presence of siderophages (11 of 15, 73%) compared to control cases (none of five, 0%). Clinically, erythrophagocytosis correlated with lower haemoglobin levels and was more frequently observed in patients from the second wave. Analysis of the immune environment showed a strong increase in CD68+ macrophages (16 of 28, 57%) and a borderline lymphocytosis (five of 28, 18%). The stromal microenvironment showed oedema (two of 28, 7%) and severe capillary congestion (one of 28, 4%) in isolated cases. No stromal fibrosis or microvascular thrombosis was found. While all cases had confirmed positive testing of SARS-CoV-2 in the respiratory system, SARS-CoV-2 was not detected in the bone marrow by high-sensitivity PCR, suggesting that SARS-CoV-2 does not commonly replicate in the haematopoietic microenvironment. CONCLUSIONS SARS-CoV-2 infection indirectly impacts the haematological compartment and the bone marrow immune environment. Erythrophagocytosis is frequent and associated with lower haemoglobin levels in patients with severe COVID-19.
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Affiliation(s)
- Ewerton Marques-Maggio
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, University of Zurich, Zürich, Switzerland
- Medica Pathologie Zentrum Zürich, Zürich, Switzerland
| | - Umberto Maccio
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, University of Zurich, Zürich, Switzerland
| | - Alexandra Marx
- Stadtspital Zürich Waid, Klinik für Innere Medizin, Zürich, Switzerland
| | - Serena Galli
- Department of Medical Oncology and Hematology, University Hospital of Zurich, University of Zürich, Zürich, Switzerland
| | - Nathalie Schwab
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Angela Frank
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Baptiste Hamelin
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, University of Zurich, Zürich, Switzerland
| | - César Nombela-Arrieta
- Department of Medical Oncology and Hematology, University Hospital of Zurich, University of Zürich, Zürich, Switzerland
| | - Kirsten D Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Alexandre Pa Theocharides
- Department of Medical Oncology and Hematology, University Hospital of Zurich, University of Zürich, Zürich, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, University of Zurich, Zürich, Switzerland
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Zeylabi F, Nameh Goshay Fard N, Parsi A, Pezeshki SMS. Bone marrow alterations in COVID-19 infection: The root of hematological problems. Curr Res Transl Med 2023; 71:103407. [PMID: 37544028 DOI: 10.1016/j.retram.2023.103407] [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: 05/30/2023] [Revised: 07/04/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The 2019 coronavirus disease (COVID-19) is a respiratory infection caused by the SARS-CoV-2 virus with a significant impact on the hematopoietic system and homeostasis. The effect of the virus on blood cells indicates the involvement of the bone marrow (BM) as the place of production and maturation of these cells by the virus and it reminds the necessity of investigating the effect of the virus on the bone marrow. METHOD To investigate the effects of COVID-19 infection in BM, we reviewed literature from the Google Scholar search engine and PubMed database up to 2022 using the terms "COVID-19; SARS-CoV-2; Bone marrow; Thrombocytopenia; Hemophagocytosis; Pancytopenia and Thrombocytopenia. RESULTS Infection with the SARS-CoV-2 virus is accompanied by alterations such as single-line cytopenia, pancytopenia, hemophagocytosis, and BM necrosis. The presence of factors such as cytokine release syndrome, the direct effect of the virus on cells through different receptors, and the side effects of current treatments such as corticosteroids are some of the important mechanisms in the occurrence of these alterations. CONCLUSION To our knowledge, this review is the first study to comprehensively investigate BM alterations caused by SAR-CoV-2 virus infection. The available findings show that the significant impact of this viral infection on blood cells and the clinical consequences resulting from them are deeper than previously thought and it may be rooted in the changes that the virus causes in the BM of patients.
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Affiliation(s)
- Fatemeh Zeylabi
- Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Najmeh Nameh Goshay Fard
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abazar Parsi
- Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Jeyakanthan T, Ladel L, Khandpur B, Tan WY, Nasir SA. Coronavirus Does It Again: Post-COVID-19 Hemophagocytic Lymphohistiocytosis (HLH). Cureus 2023; 15:e35275. [PMID: 36968874 PMCID: PMC10036136 DOI: 10.7759/cureus.35275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a hematological disorder that results from an uncontrolled activation of the immune system, which can then lead to multisystem organ failure. Given the nonspecific nature of this illness, it can go undetected for too long, thereby causing permanent damage to organ systems. In adults, HLH has been associated with a number of infectious etiologies, particularly viral infections. Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global pandemic and has been associated with acute respiratory distress syndrome (ARDS). Among its other manifestations, COVID-19 has also been linked to HLH. In this report, we describe a case of a male patient who presented with multisystem organ failure and was found to have HLH. Since no clear etiology for his HLH could be elicited, it was determined to be a result of his recent COVID-19 infection.
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Lucas F, Sadigh S. Hematopathology of SARS-CoV-2 infection and COVID-19 disease. Surg Pathol Clin 2023; 16:197-211. [PMID: 37149356 PMCID: PMC9892324 DOI: 10.1016/j.path.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 and is associated with pronounced hematopathologic findings. Peripheral blood features are heterogeneous and very often include neutrophilia, lymphopenia, myeloid left shift, abnormally segmented neutrophils, atypical lymphocytes/plasmacytoid lymphocytes, and atypical monocytes. Bone marrow biopsies and aspirates are often notable for histiocytosis and hemophagocytosis, whereas secondary lymphoid organs may exhibit lymphocyte depletion, pronounced plasmacytoid infiltrates, and hemophagocytosis. These changes are reflective of profound innate and adaptive immune dysregulation, and ongoing research efforts continue to identify clinically applicable biomarkers of disease severity and outcome.
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Affiliation(s)
- Fabienne Lucas
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Sam Sadigh
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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