1
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Cheffai A, Kechida M. Autoimmune diseases and myelodysplastic syndromes. Reumatologia 2024; 62:52-57. [PMID: 38558894 PMCID: PMC10979376 DOI: 10.5114/reum/184157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
Autoimmune diseases (ADs) and myelodysplastic syndrome (MDS) may be associated in approximately 10-20% of cases. Although this association has been well recognized, it is not always easily diagnosed. The exact physiopathological mechanism involved has yet to be determined but seems to be multifactorial. The therapeutic decision is not well codified and often represents a challenge. But overall, glucocorticosteroids have generally proven to be effective at the expense of a high incidence of dependence and relapse. This review aims to summarize and analyze all aspects of this association to provide an overview for practitioners and clinicians. A scientific search in databases (PubMed, Scopus, Web of Science, Google Scholar) was conducted using a combination of key words such as autoimmune diseases, myelodysplastic syndromes, and association. Articles from 1992 to 2022 were considered and relevant data were collected and summarized to provide a coherent detailed overview of the coexistence of ADs and MDS.
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Affiliation(s)
- Arij Cheffai
- Department of Internal Medicine and Endocrinology, Fattouma Bourguiba University Hospital, University of Monastir, Tunisia
| | - Melek Kechida
- Department of Internal Medicine and Endocrinology, Fattouma Bourguiba University Hospital, University of Monastir, Tunisia
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2
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Shi C, Gong S, Niu T, Li T, Wu A, Zheng X, Yang S, Ouyang G, Mu Q. The Prognostic Value of Pretherapy Peripheral Blood Inflammatory Indices in Myelodysplastic Syndromes. Front Oncol 2022; 12:877981. [PMID: 35558519 PMCID: PMC9086900 DOI: 10.3389/fonc.2022.877981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Inflammation appears to have a critical role in carcinogenesis tumor growth according to emerging research. The platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and plasma C-reactive protein (CRP) are considered to reflect the systemic inflammatory response and clinical prognosis. The prognostic value of inflammatory indices in myelodysplastic syndrome (MDS) patients remains unclear. Methods A total of 213 MDS patients were enrolled for the study. Univariate and multivariate analyses were performed to determine the prognostic significance of various indicators, including PLR, NLR, and CRP. Results MDS patients with higher PLR, NLR, and CRP levels had significantly shorter overall survival (OS). Based on univariate analysis, age (≥60 years), gender (men), lower hemoglobin level (<10 g/dl), higher bone marrow blast percentage (>5%), poorer karyotype, and higher Revised International Prognostic Scoring System (IPSS-R) score were significantly associated with shorter OS. Patients with higher CRP levels had shorter leukemia-free survival (LFS, P = 0.041). However, higher PLR and NLR had no significant influence on LFS (P > 0.05). Multivariate Cox proportional hazards regression analysis indicated that high PLR and CRP were also independent adverse prognostic factors for OS in MDS. Conclusions Elevated PLR and CRP predict poor prognosis independent of the IPSS-R and provide a novel evaluation factor for MDS patients.
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Affiliation(s)
- Cong Shi
- Stem Cell Transplantation Laboratory, Ningbo First Hospital, Ningbo, China
| | - Shengping Gong
- Cancer Radiotherapy and Chemotherapy Center, Ningbo First Hospital, Ningbo, China
| | - Tingting Niu
- Stem Cell Transplantation Laboratory, Ningbo First Hospital, Ningbo, China
| | - Tongyu Li
- Department of Hematology, Ningbo First Hospital, Ningbo, China
| | - An Wu
- Department of Hematology, Ningbo First Hospital, Ningbo, China
| | - Xiaojiao Zheng
- Department of Obstetrics and Gynaecology, Ningbo First Hospital, Ningbo, China
| | - Shujun Yang
- Department of Hematology, Ningbo First Hospital, Ningbo, China
| | - Guifang Ouyang
- Department of Hematology, Ningbo First Hospital, Ningbo, China
| | - Qitian Mu
- Stem Cell Transplantation Laboratory, Ningbo First Hospital, Ningbo, China
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3
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Loschi M, Roux C, Sudaka I, Ferrero-Vacher C, Marceau-Renaut A, Duployez N, Passeron T, Cluzeau T. Allogeneic stem cell transplantation as a curative therapeutic approach for VEXAS syndrome: a case report. Bone Marrow Transplant 2022; 57:315-318. [PMID: 34999727 DOI: 10.1038/s41409-021-01544-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022]
Abstract
TO THE EDITOR VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a newly described entity linked to somatic mutation of UBA1, encompassing inflammatory disorders and hematological malignancies. Patients experiments symptoms related to inflammatory manifestations on the skin, joints, lungs. Most patients are refractory to usual anti-inflammatory or immunosuppressive treatments. Half of them will develop hematological diseases, mostly myelodysplastic syndromes. VEXAS patients with hematological malignancies have a poor outcome and no curative option has been described so far. Because in the first reported cohort of VEXAS patients the UBA1 mutation was only found in hematopoietic stem cells but not in fibroblasts, we hypothesized that bone marrow transplantation would provide a cure for the disease. Here we report the case of a VEXAS patient who successfully received an allogeneic hematopoietic stem cell transplantation as a curative option.
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Affiliation(s)
- Michael Loschi
- Hematology Department, Nice University Medical Center, Cote d'Azur University, Nice, France. .,Cote d'Azur University, INSERM U1065, C3M, Nice, France.
| | - Christian Roux
- Rheumatology Department, Nice University Medical Center, Nice, France.,University Côte d'Azur, LAMHESS, INSERM, iBV, U1091, Nice, France
| | - Isabelle Sudaka
- Laboratoire d'hématologie, CHU de Nice, Hospital Pasteur, Nice, France
| | | | - Alice Marceau-Renaut
- University of Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020-UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France
| | - Nicolas Duployez
- University of Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020-UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France
| | - Thierry Passeron
- Cote d'Azur University, INSERM U1065, C3M, Nice, France.,Department of Dermatology, CHU Nice, University Côte d'Azur, Nice, France
| | - Thomas Cluzeau
- Hematology Department, Nice University Medical Center, Cote d'Azur University, Nice, France.,Cote d'Azur University, INSERM U1065, C3M, Nice, France
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4
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Delplanque M, Aouba A, Hirsch P, Fenaux P, Graveleau J, Malard F, Roos-Weil D, Belfeki N, Drevon L, Oganesyan A, Groh M, Mahévas M, Razanamahery J, Maigne G, Décamp M, Miranda S, Quemeneur T, Rossignol J, Sailler L, Sébert M, Terriou L, Sevoyan A, Hakobyan Y, Georgin-Lavialle S, Mekinian A. USAID Associated with Myeloid Neoplasm and VEXAS Syndrome: Two Differential Diagnoses of Suspected Adult Onset Still's Disease in Elderly Patients. J Clin Med 2021; 10:jcm10235586. [PMID: 34884286 PMCID: PMC8658409 DOI: 10.3390/jcm10235586] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Patients with solid cancers and hematopoietic malignancy can experience systemic symptoms compatible with adult-onset Still’s disease (AOSD). The newly described VEXAS, associated with somatic UBA1 mutations, exhibits an overlap of clinical and/or biological pictures with auto inflammatory signs and myelodysplastic syndrome (MDS). Objectives: To describe a cohort of patients with signs of undifferentiated systemic autoinflammatory disorder (USAID) concordant with AOSD and MDS/chronic myelomonocytic leukemia (CMML) and the prevalence of VEXAS proposed management and outcome. Methods: A French multicenter retrospective study from the MINHEMON study group also used for other published works with the support of multidisciplinary and complementary networks of physicians and a control group of 104 MDS/CMML. Results: Twenty-six patients were included with a median age at first signs of USAID of 70.5 years with male predominance (4:1). Five patients met the criteria for confirmed AOSD. The most frequent subtypes were MDS with a blast excess (31%) and MDS with multilineage dysplasia (18%). Seven patients presented with acute myeloid leukemia and twelve died during a median follow-up of 2.5 years. Six out of 18 tested patients displayed a somatic UBA1 mutation concordant with VEXAS, including one woman. High-dose corticosteroids led to a response in 13/16 cases and targeted biological therapy alone or in association in 10/12 patients (anakinra, tocilizumab, and infliximab). Azacytidine resulted in complete or partial response in systemic symptoms for 10/12 (83%) patients including 3 VEXAS. Conclusions: Systemic form of VEXAS syndrome can mimic AOSD. The suspicion of USAID or AOSD in older males with atypia should prompt an evaluation of underlying MDS and assessment of somatic UBA1 mutation.
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Affiliation(s)
- Marion Delplanque
- Service de Médecine Interne, Centre de Référence des Maladies Autoinflammatoires et des Amyloses (CEREMAIA), AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France; (M.D.); (S.G.-L.)
| | - Achille Aouba
- Service de Médecine Interne, CHU de Caen, Hôpital de la Côte de Nacre, 14033 Caen, France; (A.A.); (G.M.)
| | - Pierre Hirsch
- Service d’Hématologie Biologique, INSERM, Centre de Recherche Saint-Antoine, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, 75012 Paris, France; (P.H.); (F.M.); (L.D.)
| | - Pierre Fenaux
- Service d’Hématologie Seniors, AP-HP, Hôpital Saint-Louis, 75010 Paris, France; (P.F.); (M.S.)
| | - Julie Graveleau
- Service de Médecine Interne, Centre Hospitalier Georges Charpak, 44600 Saint Nazaire, France;
| | - Florent Malard
- Service d’Hématologie Biologique, INSERM, Centre de Recherche Saint-Antoine, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, 75012 Paris, France; (P.H.); (F.M.); (L.D.)
| | - Damien Roos-Weil
- Service d’Hématologie, AP-HP, Hôpital Pitié Salpêtrière, 75013 Paris, France;
| | - Nabil Belfeki
- Service de Médecine Interne, Centre Hospitalier Marc Jacquet, 77000 Melun, France;
| | - Louis Drevon
- Service d’Hématologie Biologique, INSERM, Centre de Recherche Saint-Antoine, AP-HP, Hôpital Saint-Antoine, Sorbonne Université, 75012 Paris, France; (P.H.); (F.M.); (L.D.)
| | - Artem Oganesyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan 0051, Armenia; (A.O.); (A.S.); (Y.H.)
| | - Matthieu Groh
- Service de Médecine Interne, Hôpital Foch, 92150 Suresnes, France;
| | - Matthieu Mahévas
- Service de Médecine Interne, CHU Hôpital Henri Mondor, 94000 Créteil, France;
| | | | - Gwenola Maigne
- Service de Médecine Interne, CHU de Caen, Hôpital de la Côte de Nacre, 14033 Caen, France; (A.A.); (G.M.)
| | - Matthieu Décamp
- Laboratoire de Génétique CHU de Caen, Hôpital de la Côte de Nacre, 14000 Care, France;
| | - Sébastien Miranda
- Service de Médecine Interne, CHU Hôpital Charles Nicolle, 76000 Rouen, France;
| | - Thomas Quemeneur
- Service de Médecine Interne, CH de Valenciennes, 59300 Valenciennes, France;
| | - Julien Rossignol
- Service d’Hématologie Adultes, AP-HP, Hôpital Necker-Enfants Malades, 75015 Paris, France;
| | - Laurent Sailler
- Service de Médecine Interne, CHU Hôpital Purpan, 31059 Toulouse, France;
| | - Marie Sébert
- Service d’Hématologie Seniors, AP-HP, Hôpital Saint-Louis, 75010 Paris, France; (P.F.); (M.S.)
| | - Louis Terriou
- Service de Médecine Interne, CHR Lille, Sorbonne Université, 75005 Paris, France;
| | - Anna Sevoyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan 0051, Armenia; (A.O.); (A.S.); (Y.H.)
| | - Yervand Hakobyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan 0051, Armenia; (A.O.); (A.S.); (Y.H.)
| | - Sophie Georgin-Lavialle
- Service de Médecine Interne, Centre de Référence des Maladies Autoinflammatoires et des Amyloses (CEREMAIA), AP-HP, Hôpital Tenon, Sorbonne Université, 75020 Paris, France; (M.D.); (S.G.-L.)
| | - Arsène Mekinian
- Service de Médecine Interne, AP-HP, Hôpital Saint Antoine, Sorbonne Université, 75012 Paris, France
- Correspondence: ; Tel.: +33-1-49-28-23-92; Fax: +33-1-49-28-28-85
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Patel BA, Ferrada MA, Grayson PC, Beck DB. VEXAS syndrome: An inflammatory and hematologic disease. Semin Hematol 2021; 58:201-203. [PMID: 34802540 DOI: 10.1053/j.seminhematol.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Bhavisha A Patel
- Hematology Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, MD.
| | - Marcela A Ferrada
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, MD
| | - David B Beck
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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6
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Martin de Frémont G, Hirsch P, Gimenez de Mestral S, Moguelet P, Ditchi Y, Emile JF, Senet P, Georgin-Lavialle S, Hanslik T, Maurier F, Adedjouma A, Abisror N, Mahevas T, Malard F, Adès L, Fenaux P, Fain O, Chasset F, Mekinian A. Myeloid Clonal Infiltrate Identified With Next-Generation Sequencing in Skin Lesions Associated With Myelodysplastic Syndromes and Chronic Myelomonocytic Leukemia: A Case Series. Front Immunol 2021; 12:715053. [PMID: 34671345 PMCID: PMC8521190 DOI: 10.3389/fimmu.2021.715053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML) are associated with cutaneous manifestations. Next-generation sequencing (NGS) is a tool capable of identifying clonal myeloid cells in the skin infiltrate and thus better characterize the link between hematological diseases and skin lesions. Objective To assess whether skin lesions of MDS/CMML are clonally related to blood or bone marrow cells using NGS. Methods Comparisons of blood or bone marrow and skin samples NGS findings from patients presenting with MDS/CMML and skin lesions in three French hospitals. Results Among the 14 patients recruited, 12 patients (86%) had mutations in the skin lesions biopsied, 12 patients (86%) had a globally similar mutational profile between blood/bone marrow and skin, and 10 patients (71%) had mutations with a high variant allele frequency (>10%) found in the myeloid skin infiltrate. Mutations in TET2 and DNMT3A, both in four patients, were the most frequent. Two patients harbored a UBA1 mutation on hematopoietic samples. Limitations Limited number of patients and retrospective collection of the data. Blood and skin sampling were not performed at the exact same time point for two patients. Conclusion Skin lesions in the setting of MDS/CMML are characterized by a clonal myeloid infiltrate in most cases.
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Affiliation(s)
- Grégoire Martin de Frémont
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - Pierre Hirsch
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Biologique, Université Paris 06, Paris, France
| | - Santiago Gimenez de Mestral
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service d'Anatomopathologie, Université Paris 06, Paris, France
| | - Philippe Moguelet
- Service d'Anatomopathologie, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris (APHP) and Université de Versailles Saint Quentin en Yvelines, Boulogne Billancourt, France
| | - Yoan Ditchi
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service d'Anatomopathologie, Université Paris 06, Paris, France
| | - Jean-François Emile
- Sorbonne Université, AP-HP, Hôpital Tenon, Service d'Anatomopathologie, Université Paris 06, Paris, France
| | - Patricia Senet
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de Dermatologie, Université Paris 06, Paris, France
| | - Sophie Georgin-Lavialle
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de Médecine Interne, Université Paris 06, Paris, France
| | - Thomas Hanslik
- Service de Médecine Interne, Hôpital Ambroise Paré, Assistance Publique Hôpitaux de Paris (APHP) and Université de Versailles Saint Quentin en Yvelines, Boulogne Billancourt, France
| | - François Maurier
- Service de Médecine Interne et Immunologie Clinique, Groupe Hospitalier UNEOS, Metz, France
| | - Amir Adedjouma
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - Noémie Abisror
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - Thibault Mahevas
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - Florent Malard
- Sorbonne Université, AP-HP, Hôpital Saint-Antoine, Service d'Hématologie Clinique, Université Paris 06, Paris, France
| | - Lionel Adès
- Service d'Hématologie-Sénior, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, Paris, France
| | - Pierre Fenaux
- Service d'Hématologie-Sénior, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, Paris, France
| | - Olivier Fain
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
| | - François Chasset
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de Dermatologie, Université Paris 06, Paris, France
| | - Arsène Mekinian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Médecine Interne et Inflammation-[Département Médico-Universitaire (DMU)-i3], Université Paris 06, Paris, France
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[Polymyalgia rheumatic and chronic myelomonocytic leukemia]. Rev Med Interne 2020; 42:434-437. [PMID: 33129580 DOI: 10.1016/j.revmed.2020.08.008] [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: 12/16/2019] [Revised: 07/13/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Myelodysplasia (MDS) can occur as systemic manifestations such as connective tissue diseases or vasculitis. Rheumatological manifestations are also described in such context. Herein, we report the observation of a patient with chronic myelomonocytic leukemia (CMML) who developed systemic manifestations: polymyalgia rheumatica and pericarditis. CASE REPORT A 78-year-old patient was referred for the exploration of two months history of inflammatory shoulder pain associated with biological inflammatory syndrome. He presented with asthenia, anorexia and loss of 5kg in one month. He had a three years follow-up for a CMML without any specific treatment. All of the explorations carried out showed a typical polymyalgia rheumatica. A pericardial effusion requiring emergency drainage was synchronously diagnosed. All the symptoms occurred during a worsening of his hematological disease. The rheumatological manifestation was favorable after a short corticosteroid therapy and pericarditis did not recur after 2 years of follow-up. CONCLUSION It should be necessary to screen patients for MDS in a context of systemic manifestation, especially in elderly patients with an abnormal blood count (cytopenia, macrocytosis and monocytosis).
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Martin de Frémont G, Gobert D, Hor T, Fabiani B, Gimenez de Mestral S, Delhommeau F, Fain O, Mekinian A. Chronic myelomonocytic leukaemia associated with large- and medium-sized arteries vasculitis of the small bowel. Rheumatology (Oxford) 2019; 58:1882-1883. [PMID: 31098624 DOI: 10.1093/rheumatology/kez187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Grégoire Martin de Frémont
- Department of Internal Medicine and Inflammatory Disorders (DHU i2B), Hôpital Saint-Antoine AP-HP Sorbonne Université, Paris, France
| | - Delphine Gobert
- Department of Internal Medicine and Inflammatory Disorders (DHU i2B), Hôpital Saint-Antoine AP-HP Sorbonne Université, Paris, France
| | - Thevy Hor
- Department of Digestive Surgery, Hôpital Saint-Antoine AP-HP Sorbonne Université, Paris, France
| | - Bettina Fabiani
- Department of Pathology, Hôpital Saint-Antoine AP-HP Sorbonne Université, Paris, France
| | | | - François Delhommeau
- Department of Haematology, Hôpital Saint-Antoine AP-HP Sorbonne Université, Paris, France
| | - Olivier Fain
- Department of Internal Medicine and Inflammatory Disorders (DHU i2B), Hôpital Saint-Antoine AP-HP Sorbonne Université, Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine and Inflammatory Disorders (DHU i2B), Hôpital Saint-Antoine AP-HP Sorbonne Université, Paris, France
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9
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Delplanque M, Chasset F, Hirsch P, Malard F, Ditchi Y, Fain O, Mekinian A. Cutaneous lupus with Kikuchi disease-like inflammatory pattern associated with myelodysplastic syndrome. Rheumatology (Oxford) 2019; 58:554-556. [PMID: 30590766 DOI: 10.1093/rheumatology/key413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Marion Delplanque
- Department of Internal Medicine, APHP, Saint Antoine Hospital, Sorbonne Université, France
| | - François Chasset
- Department of Dermatology, APHP, Tenon Hospital, Sorbonne Université, France
| | - Pierre Hirsch
- Department of Haematology, APHP, Saint Antoine Hospital, Sorbonne Université, France
| | - Florent Malard
- Department of Clinical Haematology, APHP, Saint Antoine Hospital, Sorbonne Université, France
| | - Yoan Ditchi
- Department of Anatopopathology, APHP, Tenon Hospital, Sorbonne Université, France
| | - Olivier Fain
- Department of Internal Medicine, APHP, Saint Antoine Hospital, Sorbonne Université, France
| | - Arsene Mekinian
- Department of Internal Medicine, APHP, Saint Antoine Hospital, Sorbonne Université, France
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10
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Autoimmune manifestations associated with myelodysplastic syndromes. Ann Hematol 2018; 97:2015-2023. [PMID: 30091023 DOI: 10.1007/s00277-018-3472-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/06/2018] [Indexed: 12/19/2022]
Abstract
Autoimmune disorders (ADs) are encountered in 10 to 20% of patients with myelodysplastic syndromes (MDS). Available data suggest that ADs concern more often younger patients with higher risk IPSS. MDS subtypes associated with ADs are mainly MDS with single lineage dysplasia (MDS-SLD) and MDS with excess blasts (MDS-EB). Various types of ADs have been described in association with MDS, ranging from limited clinical manifestations to systemic diseases affecting multiple organs. Defined clinical entities as vasculitis, connective tissue diseases, inflammatory arthritis, and neutrophilic diseases are frequently reported; however, unclassified or isolated organ impairment can be seen. In general, ADs do not seem to confer worse survival, although certain ADs may be associated with adverse outcomes (i.e., vasculitis) or progression of MDS (Sweet syndrome). While steroids and immunosuppressive treatment (IST) remain the backbone of first-line treatment, increasing evidence suggests that MDS-specific therapy as hypomethylating agents, based on their immunomodulatory effect, may be effective in treating these complications and for sparing steroids.
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11
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Gérard AL, Cohen-Bittan J, Fenaux P, Leroux G, Verny M, Fain O, Boddaert J, Zerah L. Myelodysplastic Syndrome and Giant Cell Arteritis: A Nonfortuitous Association that Geriatricians Should Know About. J Am Geriatr Soc 2017; 65:2335-2337. [PMID: 28804869 DOI: 10.1111/jgs.15040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anne-Laure Gérard
- Department of Geriatrics, Unit of Peri-Operative Geriatric Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Judith Cohen-Bittan
- Department of Geriatrics, Unit of Peri-Operative Geriatric Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Fenaux
- Department of Senior Hematology, Hôpital Saint Louis, Paris 7 University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gaëlle Leroux
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Verny
- Department of Geriatrics, Unit of Peri-Operative Geriatric Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,University Pierre and Marie Curie Paris 06, University Hospital Department Fight Aging and Stress, UMR 8256, Paris, France
| | - Olivier Fain
- Department of Internal Medicine, Hôpital Saint Antoine, University Pierre and Marie Curie Paris 06, DHU i2B, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jacques Boddaert
- Department of Geriatrics, Unit of Peri-Operative Geriatric Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,University Pierre and Marie Curie Paris 06, University Hospital Department Fight Aging and Stress, UMR 8256, Paris, France
| | - Lorene Zerah
- Department of Geriatrics, Unit of Peri-Operative Geriatric Care, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,University Pierre and Marie Curie Paris 06, University Hospital Department Fight Aging and Stress, UMR 8256, Paris, France
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Galland J, Kawski H, Guichard JF, Maurier F. [Large vessel vasculitis with myelodysplastic syndrome: A rare association]. Rev Med Interne 2017; 38:474-477. [PMID: 28094068 DOI: 10.1016/j.revmed.2016.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 10/27/2016] [Accepted: 12/17/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The vasculitis can be the consequence of malignancy: most often hematologic rather than solid tumors. The association between large vessels vasculitis and myelodysplastic syndrome is rare. CASE REPORT A 55-year-old man experienced asthenia, fever, polyarthritis and inflammatory syndrome. Haematological investigations found a type 2 refractory anemia with excess blasts (RAEB-2) with discovery of severe anemia (Hb: 7,8g/dl) and thrombopenia (platelets: 40,000/mm3). Radiological examinations found thoracic aortitis and carotid vasculitis. Treatment in the form of steroids and azacitidine was instituted. The lack of control of both RAEB-2 and vasculitis was responsible for the death of the patient. CONCLUSION Myelodysplastic syndrome and large vessels vasculitis is a rare but serious association disease. The lack of efficiency of corticosteroids seems to be common. Prognosis depends on the haematological treatment effectiveness.
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Affiliation(s)
- J Galland
- Service de médecine interne, hôpital Belle-Isle, hôpitaux privés de Metz, 2, rue Belle-Isle, 57000 Metz, France.
| | - H Kawski
- Service de médecine interne, hôpital Belle-Isle, hôpitaux privés de Metz, 2, rue Belle-Isle, 57000 Metz, France
| | - J-F Guichard
- Service de médecine interne, hôpital Belle-Isle, hôpitaux privés de Metz, 2, rue Belle-Isle, 57000 Metz, France
| | - F Maurier
- Service de médecine interne, hôpital Belle-Isle, hôpitaux privés de Metz, 2, rue Belle-Isle, 57000 Metz, France
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13
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Zahid MF, Barraco D, Lasho TL, Finke C, Ketterling RP, Gangat N, Hanson CA, Tefferi A, Patnaik MM. Spectrum of autoimmune diseases and systemic inflammatory syndromes in patients with chronic myelomonocytic leukemia. Leuk Lymphoma 2016; 58:1488-1493. [DOI: 10.1080/10428194.2016.1243681] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Mohammad Faizan Zahid
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniela Barraco
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Terra L. Lasho
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christy Finke
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rhett P. Ketterling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Naseema Gangat
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Curtis A. Hanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ayalew Tefferi
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mrinal M. Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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14
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[Splanchnic venous thrombosis: A monocentric study of 31 cases]. ACTA ACUST UNITED AC 2016; 41:26-35. [PMID: 26725444 DOI: 10.1016/j.jmv.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 11/28/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Splanchnic vein thrombosis (SVT) denotes thrombosis of the hepatic venous system and of the extrahepatic portal system. They are often the manifestation of one or more underlying prothrombotic states and can sometimes present problems of therapeutic care. METHODS We report a monocentric study of 31 cases of SVT observed in an internal medicine department between January 2006 and June 2012. Epidemiological, clinical, laboratory, therapeutic and outcome data were analyzed. RESULTS There was a slight female predominance (sex-ratio: 1.2). Median patient age at diagnosis was 37 years. Most cases of SVT were chronic (61.2%). Abdominal pain was the predominant symptom in acute cases while the predominant signs in chronic forms were signs of portal hypertension. Extrasplanchnic thrombosis was noted in seven patients (22.5%). Behçet's disease was the most common etiology (32%). The treatment was based on anticoagulants and corticosteroids and immunosuppressants when an inflammatory etiology was found. The average follow-up was 17 months. There were five deaths (16%). CONCLUSION SVT often reflects the existence of a disease and/or an underlying prothrombotic state that should be identified to adapt the treatment and to avoid fatal complications.
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Mekinian A, Grignano E, Braun T, Decaux O, Liozon E, Costedoat-Chalumeau N, Kahn JE, Hamidou M, Park S, Puéchal X, Toussirot E, Falgarone G, Launay D, Morel N, Trouiller S, Mathian A, Gombert B, Schoindre Y, Lioger B, De Wazieres B, Amoura Z, Buchdaul AL, Georgin-Lavialle S, Dion J, Madaule S, Raffray L, Cathebras P, Piette JC, Rose C, Ziza JM, Lortholary O, Montestruc F, Omouri M, Denis G, Rossignol J, Nimubona S, Adès L, Gardin C, Fenaux P, Fain O. Systemic inflammatory and autoimmune manifestations associated with myelodysplastic syndromes and chronic myelomonocytic leukaemia: a French multicentre retrospective study. Rheumatology (Oxford) 2015; 55:291-300. [DOI: 10.1093/rheumatology/kev294] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Indexed: 01/02/2023] Open
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16
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Pasquet F, Pavic M, Ninet J, Hot A. [Auto-immune diseases and cancers. Second part: auto-immune diseases complicating cancers and their treatment]. Rev Med Interne 2014; 35:656-63. [PMID: 25106665 DOI: 10.1016/j.revmed.2014.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 01/27/2014] [Accepted: 04/14/2014] [Indexed: 12/18/2022]
Abstract
Autoimmune diseases may reveal or occur during the course of a neoplasia or its treatment. Autoimmune cytopenia, especially haemolytic anaemia, is common in lymphoproliferative disorders such as chronic lymphoid leukemia. The link between cancer and myositis is well established. Dermatomyositis is associated with an increased relative risk of cancer of 3.4 to 4.4. A combination of detection of antibodies against p155 and TEP-computed tomography may be the best approach to ascertain the presence of occult malignancy in patients with dermatomyositis. A cutaneous or a systemic vascularitis may reveal a cancer, most often a haematological malignancy such as hairy cell leukemia. Paraneoplastic polyarthritis have been described in particular with adenocardinoma of the lungs. Underlying neoplasia should be considered in male smokers patients with new onset polyarthritis and poor health status. The prevalence of autoimmune conditions in myelodysplastic syndromes is 10 to 30%. Vasculitis and relapsing polychondritis are the most commonly reported manifestations. Immune manifestations can also be related to treatment. The most common treatment complications are autoimmune haemolytic anaemia with fludarabine and thyroiditis related to interferon and cervical radiotherapy.
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Affiliation(s)
- F Pasquet
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108, boulevardd Pinel, 69003 Lyon, France.
| | - M Pavic
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108, boulevardd Pinel, 69003 Lyon, France
| | - J Ninet
- Service de médecine interne, hôpital Édouard-Hérriot, 5, place d'Arsonval, 69003 Lyon cedex 03, France
| | - A Hot
- Service de médecine interne, hôpital Édouard-Hérriot, 5, place d'Arsonval, 69003 Lyon cedex 03, France
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17
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Fernández-Sojo J, Vives S, Oliveras Vilà T, Ribera JM. Derrame pericárdico exudativo y oligoartritis en un paciente recién diagnosticado de síndrome mielodisplásico. Med Clin (Barc) 2014; 143:43-4. [DOI: 10.1016/j.medcli.2013.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
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18
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Hadjadj J, Michel M, Chauveheid MP, Godeau B, Papo T, Sacre K. Immune thrombocytopenia in chronic myelomonocytic leukemia. Eur J Haematol 2014; 93:521-6. [DOI: 10.1111/ejh.12393] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Jérôme Hadjadj
- Université Paris Diderot; PRES Sorbonne Paris Cité; Paris France
- Assistance Publique Hôpitaux de Paris; Paris France
- Département de Médecine Interne; Hôpital Bichat; Paris France
| | - Marc Michel
- Assistance Publique Hôpitaux de Paris; Paris France
- Université Paris Est Créteil Val de Marne; Créteil France
- Département de Médecine Interne; Centre de référence des cytopénies auto- Immunes de l'Adulte; Hôpital Henri Mondor; Créteil France
| | - Marie-Paule Chauveheid
- Université Paris Diderot; PRES Sorbonne Paris Cité; Paris France
- Assistance Publique Hôpitaux de Paris; Paris France
- Département de Médecine Interne; Hôpital Bichat; Paris France
| | - Bertrand Godeau
- Assistance Publique Hôpitaux de Paris; Paris France
- Université Paris Est Créteil Val de Marne; Créteil France
- Département de Médecine Interne; Centre de référence des cytopénies auto- Immunes de l'Adulte; Hôpital Henri Mondor; Créteil France
| | - Thomas Papo
- Université Paris Diderot; PRES Sorbonne Paris Cité; Paris France
- Assistance Publique Hôpitaux de Paris; Paris France
- Département de Médecine Interne; Hôpital Bichat; Paris France
- INSERM U1149; Paris France
- Departement Hospitalo-Universitaire FIRE (Fibrosis Inflammation and Remodelling in Renal and Respiratory Diseases); Hôpital Bichat; Paris France
| | - Karim Sacre
- Université Paris Diderot; PRES Sorbonne Paris Cité; Paris France
- Assistance Publique Hôpitaux de Paris; Paris France
- Département de Médecine Interne; Hôpital Bichat; Paris France
- INSERM U1149; Paris France
- Departement Hospitalo-Universitaire FIRE (Fibrosis Inflammation and Remodelling in Renal and Respiratory Diseases); Hôpital Bichat; Paris France
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Adénocarcinome du nasopharynx et polychondrite atrophiante : polychondrite paranéoplasique ? Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Mekinian A, Braun T, Decaux O, Falgarone G, Toussirot E, Raffray L, Omouri M, Gombert B, De Wazieres B, Buchdaul AL, Ziza JM, Launay D, Denis G, Madaule S, Rose C, Grignano E, Fenaux P, Fain O. Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter retrospective study and literature review of 68 cases. Medicine (Baltimore) 2014; 93:1-10. [PMID: 24378738 PMCID: PMC4616329 DOI: 10.1097/md.0000000000000011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We describe the characteristics and outcome of inflammatory arthritis in patients with myelodysplastic syndrome (MDS) in a French multicenter retrospective study. Twenty-two patients with MDS (median age, 77.5 yr [interquartile range, 69-81]; 10 women) were included. Inflammatory arthritis presented as polyarthritis in 17 cases (77%) and with symmetric involvement in 15 cases (68%). At diagnosis, the median disease activity score 28 based on C-reactive protein (DAS28-CRP) was 4.5 [2-6.5]. Two patients had anti-citrullinated protein antibodies (ACPAs), and 1 had radiologic erosions. The median time between the diagnoses of arthritis and MDS was 10 months [6-42], with a median articular symptom duration of 3 months [2-8]. The diagnosis of both diseases was concomitant in 6 cases (27%); arthritis preceded MDS in 12 cases (55%), and occurred after MDS in 4 (18%). While the number of swollen and tender joints significantly decreased during follow-up, as did the median DAS28-CRP (from 4.3 [3.8-4.6] at baseline to 2.9 [1.75-3.3]; p < 0.05), CRP remained elevated (CRP >20 mg/L) in 8 patients (42%). Nevertheless, radiographic progression and new ACPA positivity were not observed during a median follow-up of 29 months [9-76]. While most of the patients were treated with steroids (n = 16) for arthritis, additional treatment was administered in only 4 patients (hydroxychloroquine, n = 2; sulfasalazine [Salazopyrin] and etanercept, n = 1, respectively). Eleven patients died during follow-up from acute myeloid leukemia (n = 5); infections (n = 3); or cerebral bleeding, cardiorespiratory failure, or undetermined cause (n = 1, respectively). Inflammatory arthritis associated with MDS can have various presentations and is often seronegative and nonerosive. Steroids alone are the most common treatment in MDS-associated arthritis, but that treatment is insufficient to control arthritis. Steroid-sparing strategies need to be identified.
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Affiliation(s)
- Arsène Mekinian
- From the Service de médecine interne (AM, EG, OF), Université Paris 13, AP-HP, Hôpital Jean Verdier, Bondy; Service d'hématologie clinique (TB, PF), Université Paris 13, AP-HP, Avicenne, Bobigny; Service de médecine interne (OD), Université Rennes 1, Hôpital Universitaire de Rennes, Rennes; Service de rhumatologie (GF), Université Sorbonne Paris Cité, Université Paris 13, Li2P, EA4222, Hôpital Avicenne, Bobigny; Centre Investigation Clinique Biothérapie CBT-506 & Service de rhumatologie (ET), CHU Besançon, Besançon; Service de médecine interne (LR), CHU de Bordeaux, Bordeaux; Service de rhumatologie (MO), CH Romilly/Seine; Service de médecine interne (BG), Hôpital de La Rochelle, La Rochelle; Service de médecine interne et gériatrique (BDW), CHU Nîmes, Nîmes; Service de médecine interne (A-LB), CH Douai, Douai; Service de rhumatologie (J-MZ), CH Croix Saint Simon, Paris; Service de médecine interne (DL), CHU Lille, Université Lille II, Lille; Service de médecine interne (GD), Hôpital de Rochefort, Rochefort; Service de médecine interne (SM), CHG Albi, Albi; and Service d'hématologie clinique (CR), Hôpital Saint-Vincent de Paul, UC Lille, Univ Nord de France, Lille; France
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Moussaid Y, Bertaux M, Chargari C, Helissey C, Le Moulec S, Errihani H, Vedrine L. Fièvre et cancer : éléments de diagnostic pour une prise en charge adaptée. Rev Med Interne 2013. [PMID: 23199412 DOI: 10.1016/j.revmed.2012.10.368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y Moussaid
- Service d'oncologie et radiothérapie, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
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Cluzeau T, Fenaux P. Nouveaux outils et traitements pour les syndromes myélodysplasiques. Rev Med Interne 2013; 34:159-67. [DOI: 10.1016/j.revmed.2012.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 05/06/2012] [Accepted: 06/02/2012] [Indexed: 11/25/2022]
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25
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Un syndrome myélodysplasique révélé par un syndrome de Sweet. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Eddou H, Helissey C, Konopacki J, Souleau B, de Revel T, Malfuson JV. Syndrome d’Evans : attention aux diagnostics par excès. Rev Med Interne 2012; 33:155-8. [DOI: 10.1016/j.revmed.2011.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/06/2011] [Accepted: 12/18/2011] [Indexed: 01/23/2023]
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