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Prakash S, Alhariri S, Hassan M, Patel PK, Corral J. Improvement in Primary Autoimmune Myelofibrosis Following a Short Course of Steroids and Intravenous Immunoglobulins. Cureus 2022; 14:e29735. [PMID: 36340546 PMCID: PMC9621728 DOI: 10.7759/cureus.29735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/24/2022] Open
Abstract
Bone marrow fibrosis (BMF) is a histopathological finding appreciated in a multitude of conditions such as myeloproliferative diseases and malignant neoplasms, along with autoimmune disorders. Autoimmune myelofibrosis (AIMF) is a particularly uncommon etiology of benign BMF. AIMF may be primary with serologic evidence of autoantibodies or secondary to an underlying autoimmune disease. The authors aim to emphasize the importance of distinguishing between primary versus secondary causes owing to significant prognostic and therapeutic discrepancies and in hopes of expediting the diagnostic journey. Research has recommended a treatment strategy of high-dose steroids followed by a steroid taper. However, our patient responded positively to a short course of high-dose steroids and intravenous immunoglobulins (IVIG) as evidenced by an improvement in cytopenias and bone marrow fibrosis grading. This outcome warrants further research on the necessity of steroid tapers in AIMF.
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Cansu DÜ, Korkmaz C. AUTOIMMUNE MYELOFIBROSIS ASSOCIATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS: EXCEPTIONALLY RARE OR UNDERRECOGNIZED? CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2021. [DOI: 10.47316/cajmhe.2021.2.2.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which may involve several organs or organ systems. SLE may also have hematological as well as joint, kidney, and central nervous system involvements. Hematological abnormalities such as anemia, leukopenia, thrombocytopenia, and autoimmune hemolytic anemia are the best-known and most common hematological findings detected in SLE patients which are included in the classification criteria for SLE. Autoimmune myelofibrosis (AIMF) refers to bone marrow (BM) fibrosis (myelofibrosis) that develops in an autoimmune setting. Myelofibrosis is not among the SLE classification criteria and it is also not well-known. Current reports in the literature on SLE-associated AIMF are mostly restricted to case reports or reviews of such case reports. The occurrence of BM fibrosis in SLE patients has been explored merely in few studies which concluded that myelofibrosis is a rare symptom of SLE. Herein, we propose the hypothesis that SLE-associated AIMF is not rare and, on the contrary, it can indeed be more frequent than what is known or expected.
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Wibowo T, Kawada S, Ishida Y, Yoshimine Y, Ishikawa N, Kawamoto K, Kato Y, Higa S, Ogata A, Maeda K. Autoimmune myelofibrosis associated with systemic lupus erythematosus: a case report. Mod Rheumatol Case Rep 2020; 4:28-33. [PMID: 33086960 DOI: 10.1080/24725625.2019.1650697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A 66-year-old woman presented with severe anaemia, thrombocytopenia and lymphopenia. The bone marrow biopsy demonstrated hypocellular marrow with myelofibrosis (MF); there was no evidence of malignancy, but infiltration of peripheral T and B cells were noticed. Magnetic resonance imaging (MRI) revealed that bone marrow of the spine exhibited low signal intensity (SI) with spotty high SI in T1- and T2-weighted images. Because there was evidence of autoimmune abnormality, she had fulfilled the classification criteria for systemic lupus erythematosus (SLE). She was diagnosed with autoimmune myelofibrosis (AIMF) associated with SLE and was treated with corticosteroid. Cytopenia improved after 1 month of corticosteroid therapy. A repeated bone marrow biopsy demonstrated that cellularity had increased and that the amount of reticulin fibre had reduced after treatment. Compared with primary MF, AIMF has generally a favourable prognosis and is often associated with autoimmune diseases, especially SLE. Bone marrow biopsy, but not aspiration, was useful for diagnosing bone marrow fibrosis. Although the association between SLE and MF has been rarely reported, we should pay attention to MF as a possible cause of pancytopenia.
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Affiliation(s)
- Tansri Wibowo
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan.,Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shoji Kawada
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan.,Division of Rheumatology, Department of Internal Medicine, Daini Osaka Police Hospital, Osaka, Japan
| | - Yutaka Ishida
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan.,Division of Rheumatology, Department of Internal Medicine, Daini Osaka Police Hospital, Osaka, Japan
| | - Yuko Yoshimine
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan.,Division of Rheumatology, Department of Internal Medicine, Daini Osaka Police Hospital, Osaka, Japan
| | - Nachi Ishikawa
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan.,Division of Rheumatology, Department of Internal Medicine, Daini Osaka Police Hospital, Osaka, Japan
| | - Keisuke Kawamoto
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan.,Division of Rheumatology, Department of Internal Medicine, Daini Osaka Police Hospital, Osaka, Japan
| | - Yasuhiro Kato
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan.,Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shinji Higa
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan.,Division of Rheumatology, Department of Internal Medicine, Daini Osaka Police Hospital, Osaka, Japan
| | - Atsushi Ogata
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan.,Division of Rheumatology, Department of Internal Medicine, Daini Osaka Police Hospital, Osaka, Japan.,Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Keiji Maeda
- Division of Rheumatology, Department of Internal Medicine, NTT West Osaka Hospital, Osaka, Japan
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Kakiuchi S, Takagi I, Akiyama H, Matsuba H, Rikitake J, Kajimoto K, Hayashi Y, Iwata N. Autoimmune Myelofibrosis in Sjögren's Syndrome: Report of a Case. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e924983. [PMID: 32956337 PMCID: PMC7505477 DOI: 10.12659/ajcr.924983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 49-year-old Final Diagnosis: Autoimmune myelofibrosis Symptoms: Bleeding Medication:— Clinical Procedure: Bone marrow biopsy Specialty: Hematology
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Affiliation(s)
- Seiji Kakiuchi
- Department of Hematology, Yodogawa Christian Hospital, Osaka, Japan
| | - Ikumi Takagi
- Department of Hematology, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroaki Akiyama
- Department of Hematology, Yodogawa Christian Hospital, Osaka, Japan
| | - Hiroyuki Matsuba
- Department of Hematology, Yodogawa Christian Hospital, Osaka, Japan
| | - Junpei Rikitake
- Department of Hematology, Yodogawa Christian Hospital, Osaka, Japan
| | | | - Yoshitake Hayashi
- Division of Molecular Medicine and Medical Genetics, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Nobuko Iwata
- Department of Hematology, Yodogawa Christian Hospital, Osaka, Japan
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Garmezy B, Schaefer JK, Mercer J, Talpaz M. A provider's guide to primary myelofibrosis: pathophysiology, diagnosis, and management. Blood Rev 2020; 45:100691. [PMID: 32354563 DOI: 10.1016/j.blre.2020.100691] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 03/20/2020] [Accepted: 04/02/2020] [Indexed: 12/23/2022]
Abstract
Although understanding of the pathogenesis and molecular biology of primary myelofibrosis continues to improve, treatment options are limited, and several biological features remain unexplained. With an appropriate clinical history, exam, laboratory evaluation, and bone marrow biopsy, the diagnosis can often be established. Recent studies have better characterized prognostic factors and driver mutations in myelofibrosis, facilitated by use of next-generation sequencing. These advances have facilitated development of a management strategy that is based on both risk factors and clinical phenotype. For low-risk patients, treatment will depend on symptom severity. For patients with higher-risk disease, several treatments are available including JAK inhibitors, allogeneic hematopoietic stem cell transplant, and clinical trials using novel molecularly targeted therapies and rational drug combinations. In this review, we outline what is known about the disease pathogenesis, discuss an approach to reaching the diagnosis, review the prognosis of myelofibrosis, and detail current therapeutic strategies.
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Affiliation(s)
- Benjamin Garmezy
- Division of Cancer Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Jordan K Schaefer
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Jessica Mercer
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Moshe Talpaz
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
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Abstract
Systemic lupus erythematosus is a chronic autoimmune condition with variable organ system involvement; manifestations can range from mild to potentially life threatening. Early diagnosis is important, as progression of disease can be halted. Diagnosis is made by review of signs and symptoms, imaging, and serology.
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Affiliation(s)
- Ruba Kado
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Suite 7C27 North Ingalls Building, 300 North Ingalls SPC 5422, Ann Arbor, MI 48109-5422, USA.
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Üsküdar Cansu D, Üsküdar Teke H, Işiksoy S, Korkmaz C. Bone marrow as a target organ of systemic lupus erythematosus: analysis of cases with myelofibrosis. Int J Rheum Dis 2018; 21:1049-1059. [PMID: 29671953 DOI: 10.1111/1756-185x.13308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Cytopenia in the course of systemic lupus erythematosus (SLE) may be due to multiple factors. In this study, we aimed primarily to evaluate the detailed results of bone marrow (BM) biopsies of SLE patients, secondly to determine the myelofibrosis (MF) frequency and thirdly to compare BM morphologic findings as well as the clinical and laboratory parameters between groups (with MF and without MF) in cytopenic SLE patients. METHODS We retrospectively analyzed 224 SLE patients' files. Patients were divided into two groups according to whether they had MF or not. Concurrent SLE organ involvements, medical therapy and detailed BM findings were recorded. RESULTS Forty-five (20%) of 224 SLE patients were found to have undergone BM biopsy due to cytopenia. Four patients were excluded (two drug-induced cytopenia, one lymphoma, one insufficient BM biopsy samples). While MF was detected in 29 (70.7%) of the 41 patients, 12 patients did not have MF. Between the two groups, no differences were identified in terms Systemic Lupus Erythematosus Disease Activity Index, BM cellularity, or BM dysplastic changes (P = 0.788, P = 0.672 and P = 0.494, respectively). In the SLE-associated MF group, 27 patients responded to immunosuppressive therapy and corticosteroids, but two patients were unresponsive. The response time was longer for the SLE-associated MF group compared to the without MF group (3.3 ± 3.1 months vs. 1.7 ± 1.2 months, P = 0.091). Correlation analysis revealed that increased degree of BM fibrosis delayed the response time (r = 0.471, P = 0.002). CONCLUSIONS MF is common in SLE patients. SLE-associated MF as an additional factor for cytopenia in SLE patients may lead to delayed response to appropriate therapy, which may be dependent on the increased grade of BM fibrosis.
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Affiliation(s)
- Döndü Üsküdar Cansu
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Hava Üsküdar Teke
- Division of Hematology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Serap Işiksoy
- Department of Pathology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Cengiz Korkmaz
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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