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Murt A, Bayram B, Yılmaz U, Seyahi N, Eşkazan AE. Chronic Myeloid Leukemia in Renal Transplantation Patients in the Era of Tyrosine Kinase Inhibitors: A Case Report and Review of the Literature. Nephron Clin Pract 2024:1-6. [PMID: 38574488 DOI: 10.1159/000538532] [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: 09/06/2023] [Accepted: 03/16/2024] [Indexed: 04/06/2024] Open
Abstract
Lifelong immunosuppression, cytotoxic effects of some immunosuppressive drugs, and opportunistic oncogenic viruses increase malignancy risks in solid organ recipients. The risk of myeloid neoplasms including chronic myeloid leukemia (CML) is also increased in this patient population. Tyrosine kinase inhibitors (TKIs), the key element of CML therapy, should be used cautiously in transplantation patients as they may interact with calcineurin inhibitors. With this report, a 63-year-old female kidney transplant recipient who developed CML 9 years after kidney transplantation is presented. CML in this patient was treated with a slightly reduced dose of imatinib (300 mg) due to concerns of adverse events including its interaction with tacrolimus. Deep molecular response (DMR) was achieved at 12 months under imatinib treatment. The patient is still in DMR after 30 months of follow-up, and she did not experience any adverse events or acute rejection episodes. CML and the use of TKIs in kidney transplant patients have been discussed with an extensive literature review. In this patient population, TKIs are generally well tolerated with achievement of treatment responses and good prognosis. Graft functions are also well maintained as long as drug interactions are monitored.
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Affiliation(s)
- Ahmet Murt
- Division of Nephrology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Batuhan Bayram
- Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Umut Yılmaz
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Nurhan Seyahi
- Division of Nephrology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Zamani F, Karimi H, Mansoorian M, Basi A, Hosseini SA, Zahed Z, Seyedghasemipour N, Sahraie R. Early occurrence of acute myelomonocytic leukemia (M4/M5) after liver transplantation: a case report. J Med Case Rep 2023; 17:398. [PMID: 37667403 PMCID: PMC10478306 DOI: 10.1186/s13256-023-04126-2] [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] [Received: 06/22/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Acute myeloid leukemia is a rare event in post-liver-transplantation recipients. In the present report, we described a case of extramedullary acute myeloid leukemia, M4/M5 subtype, following orthotopic liver transplant. CASE PRESENTATION The patient was a 50-year-old Iranian woman who underwent orthotopic liver transplant due to hepatitis B-related cirrhosis (Child C, MELD (model for end-stage liver disease score) = 22). Orthotopic liver transplant was performed using the piggy back technique in January 2022. Induction immunosuppressive therapy was 1 gm methylprednisolone for 3 days followed by a triple maintenance immunosuppressive regimen including mycophenolate mofetil, prednisolone, and tacrolimus. About 5 months after orthotopic liver transplant in June 2022, the patient presented with leukocytosis, with white blood cell count of 99.4 × 103/µl, and physical examination revealed only cervical lymphadenopathy. Biopsy of cervical lymph nodes showed a myeloid tumor. She was immediately hospitalized. Eight hours after hospitalization, the patient gradually developed lethargy and decreased O2 saturation to approximately 89%. Flow cytometry demonstrated the markers of a myelomonocytic acute myeloid leukemia (M4/M5). Cytoreduction was immediately started by intensive leukopheresis followed by induction therapy. Because of a septic complication during the induction therapy, further chemotherapy was discontinued and broad-spectrum antibiotics and antifungal treatments started. Unfortunately, our patient died of severe septic shock 42 days after hospitalization. CONCLUSION Acute myeloid leukemia is a rare phenomenon after liver transplantation, and it can follow a rapidly fatal clinical course.
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Affiliation(s)
- Farhad Zamani
- Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hanie Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsenreza Mansoorian
- Department of Surgery, Transplant Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Basi
- Department of Hematology Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - S Ahmad Hosseini
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Zahed
- Department of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Roghayeh Sahraie
- Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Owens TJ, Patel SA, Greiner TC, Cannatella JJ, Grant WJ, Langnas AN, Vo HD. High-grade myelodysplastic syndrome in a pediatric multi-organ transplant recipient: A case report and literature review. Pediatr Transplant 2022; 26:e14287. [PMID: 35403329 DOI: 10.1111/petr.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/27/2021] [Accepted: 03/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric myelodysplastic syndrome is a rare but life-threatening condition requiring prompt recognition and management. METHODS We herein present the only reported case of a pediatric multi-organ transplant recipient developing myelodysplastic syndrome. RESULTS The patient was a 14-year-old girl on chronic calcineurin inhibitor therapy who presented with peri-rectal pain approximately 13 years after liver, small bowel, and pancreas transplant. The initial workup revealed pancytopenia and parvovirus B19 viremia. Her definitive diagnosis was complicated by a lack of adequate bone marrow biopsy specimens and expert consultation that resulted in treatment for hemophagocytic lymphohistiocytosis. She was later diagnosed with high-grade myelodysplastic syndrome. Although curative treatment with chemotherapy and hematopoietic stem cell transplantation was strongly considered, it was not performed due to the child's rapid clinical progression, ventilator status, and active infections. The patient died approximately 6 months following symptom onset. CONCLUSIONS This case emphasizes the importance of early recognition of myelodysplastic syndrome in multi-organ transplant recipients on chronic immunosuppression. Pancytopenia is a common presentation in the post-transplant period that requires thorough investigation. Multiple confounding considerations such as infection, immunosuppression, and systemic inflammation can delay the diagnosis of underlying hematological malignancies. Transplant care providers should be aware of myelodysplastic syndrome and advocate for a comprehensive evaluation, given early recognition and intervention can significantly improve outcomes.
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Affiliation(s)
- Trudie J Owens
- Department of Surgery, Transplantation Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sachit A Patel
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Timothy C Greiner
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jeffrey J Cannatella
- Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Wendy J Grant
- Department of Surgery, Transplantation Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Alan N Langnas
- Department of Surgery, Transplantation Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Hanh D Vo
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Dold L, Lutz P, Heine A, Weismüller TJ, Strassburg CP, Spengler U. Ruxolitinib for treatment of polycythemia vera and myelofibrosis in patients after liver transplantation. Clin Case Rep 2021; 9:e04782. [PMID: 34504700 PMCID: PMC8418679 DOI: 10.1002/ccr3.4782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/31/2021] [Accepted: 08/15/2021] [Indexed: 11/21/2022] Open
Abstract
Although ruxolitinib contributes to immunomodulation and can lead to severe infections, it seems a feasible treatment strategy for patients with polycythemia vera and myelofibrosis after liver transplantation.
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Affiliation(s)
- Leona Dold
- Department of Internal Medicine IRheinische Friedrich‐Wilhelms University BonnBonnGermany
- German Centre of Infection Research (DZIF)Partner site Cologne‐BonnBonnGermany
| | - Philipp Lutz
- Department of Internal Medicine IRheinische Friedrich‐Wilhelms University BonnBonnGermany
- German Centre of Infection Research (DZIF)Partner site Cologne‐BonnBonnGermany
| | - Annkristin Heine
- Department of Internal Medicine IIIRheinische Friedrich‐Wilhelms University BonnBonnGermany
| | - Tobias J. Weismüller
- Department of Internal Medicine IRheinische Friedrich‐Wilhelms University BonnBonnGermany
| | | | - Ulrich Spengler
- Department of Internal Medicine IRheinische Friedrich‐Wilhelms University BonnBonnGermany
- German Centre of Infection Research (DZIF)Partner site Cologne‐BonnBonnGermany
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5
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Luedke C, Zhao Y, McCracken J, Maule J, Yang LH, Jug R, Galeotti J, Siddiqi I, Gong J, Lu CM, Wang E. Myeloid neoplasms in the setting of chronic lymphocytic leukaemia/chronic lymphocytic leukaemia-like disease: a clinicopathological study of 66 cases comparing cases with prior history of treatment to those without. J Clin Pathol 2021; 75:292-301. [PMID: 33542108 DOI: 10.1136/jclinpath-2020-207334] [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: 12/10/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 11/04/2022]
Abstract
AIMS Myeloid neoplasms occur in the setting of chronic lymphocytic leukaemia (CLL)/CLL-like disease. The underlying pathogenesis has not been elucidated. METHODS Retrospectively analysed 66 cases of myeloid neoplasms in patients with CLL/CLL-like disease. RESULTS Of these, 33 patients (group 1) had received treatment for CLL/CLL-like disease, while the other 33 patients (group 2) had either concurrent diagnoses or untreated CLL/CLL-like disease before identifying myeloid neoplasms. The two categories had distinct features in clinical presentation, spectrum of myeloid neoplasm, morphology, cytogenetic profile and clinical outcome. Compared with group 2, group 1 demonstrated a younger age at the diagnosis of myeloid neoplasm (median, 65 vs 71 years), a higher fraction of myelodysplastic syndrome (64% vs 36%; OR: 3.1; p<0.05), a higher rate of adverse unbalanced cytogenetic abnormalities, including complex changes, -5/5q- and/or -7/7q- (83% vs 28%; OR: 13.1; p<0.001) and a shorter overall survival (median, 12 vs 44 months; p<0.05). CONCLUSIONS Myeloid neoplasm in the setting of CLL/CLL-like disease can be divided into two categories, one with prior treatment for CLL/CLL-like disease and the other without. CLL-type treatment may accelerate myeloid leukaemogenesis. The risk is estimated to be 13-fold higher in patients with treatment than those without. The causative agent could be attributed to fludarabine in combination with alkylators, based on the latency of myeloid leukaemogenesis and the cytogenetic profile.
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Affiliation(s)
- Catherine Luedke
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yue Zhao
- Pathology, Duke University Medical Center, Durham, North Carolina, USA .,Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jenna McCracken
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jake Maule
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lian-He Yang
- Pathology, Duke University Medical Center, Durham, North Carolina, USA.,Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China
| | - Rachel Jug
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan Galeotti
- Pathology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Imran Siddiqi
- Pathology, University of Southern California, Los Angeles, California, USA
| | - Jerald Gong
- Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chuanyi Mark Lu
- Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Endi Wang
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
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Chronic myeloid leukemia in solid organ transplant patients: a case series. Int J Hematol 2020; 113:214-218. [PMID: 33021721 DOI: 10.1007/s12185-020-03014-5] [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: 07/29/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
Solid organ transplant (SOT) has transformed the survival and quality of life of patients with end-organ dysfunction. Lifelong need for immunosuppressive medications prolongs life expectancy, but results in altered immune function and is associated with a higher risk of certain malignancies, including chronic myeloid leukemia (CML). In this article, we report on six patients, aged 41-79 years, diagnosed with CML, from 3 to 132 months post-various organ transplants and treated with different tyrosine kinase inhibitors (TKI), including first generation (i.e., imatinib) and second generation (i.e., dasatinib and nilotinib). Use of second-generation TKIs has not been previously reported in this population. In these six cases, treatment with different TKIs in SOT patients was feasible, well tolerated and achieved good efficacy, which was maintained in extended follow-up, as well.
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Fujiwara Y, Matsuoka KI, Iwamoto M, Sumii Y, Abe M, Mizuhara K, Urata T, Saeki K, Meguri Y, Asada N, Ennishi D, Nishimori H, Fujii K, Fujii N, Sugita J, Kobayashi H, Oto T, Maeda Y. Allogeneic hematopoietic stem cell transplantation in a prior lung transplant recipient. Int J Hematol 2020; 112:871-877. [PMID: 32803699 DOI: 10.1007/s12185-020-02967-x] [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: 04/23/2020] [Revised: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
Hematological diseases after solid organ transplant (SOT) are an emerging issue as the number of long-term SOT survivors increases. Expertise in managing patients requiring allogeneic hematopoietic stem cell transplantation (HSCT) after SOT from independent donors is needed; however, clinical reports of HSCT after SOT are limited, and the feasibility and risk are not well understood. In particular, HSCT in prior lung transplant recipients is thought to be complicated as the lung is immunologically distinct and is constantly exposed to the surrounding environment. Herein, we describe a case of successful HSCT in a patient with myelodysplastic syndromes who had previously received a lung transplant from a deceased donor for bronchiolitis obliterans syndrome. Reports about cases of HSCT after lung transplant are quite rare; thus, we discuss the mechanisms of immune tolerance through the clinical course of our case. This case suggests that HSCT after SOT can be considered a therapeutic option in cases where the transplanted organ is functionally retained and the hematological disease is in remission.
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Affiliation(s)
- Yuki Fujiwara
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan.
| | - Miki Iwamoto
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Yuichi Sumii
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Masaya Abe
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Kentaro Mizuhara
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Tomohiro Urata
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Kyosuke Saeki
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Yusuke Meguri
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Daisuke Ennishi
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Keiko Fujii
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Nobuharu Fujii
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
| | - Junichi Sugita
- Department of Hematology, Hokkaido University Hospital, Hokkaido, Japan
| | - Hajime Kobayashi
- Department of Hematology, Obihiro Kosei Hospital, Hokkaido, Japan
| | - Takahiro Oto
- Department of Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan
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8
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Etienne I, Benghiat FS, Knoop C. Chronic myeloid leukemia may no longer be a contraindication to lung transplantation. J Heart Lung Transplant 2020; 39:987-988. [PMID: 32312659 DOI: 10.1016/j.healun.2020.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/28/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Isabelle Etienne
- Department of Pulmonology, Erasme University Hospital, Brussels, Belgium
| | | | - Christiane Knoop
- Department of Pulmonology, Erasme University Hospital, Brussels, Belgium.
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Yamane H, Ide K, Tanaka A, Hashimoto S, Nagoshi H, Tahara H, Ohira M, Seidakhmetov A, Marlen D, Tanaka Y, Ohdan H. Successful Treatment of Chronic Myeloid Leukemia With Dasatinib After Kidney Transplantation: A Case Report. Transplant Proc 2019; 52:600-603. [PMID: 31733802 DOI: 10.1016/j.transproceed.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Chronic myeloid leukemia (CML) is a rare malignancy in kidney transplant (KT) recipients. Although dasatinib is the first-line treatment for CML, it has inhibitory activity against CYP3A4; this might increase the blood concentration of tacrolimus (administered to KT patients for immune suppression). Furthermore, tacrolimus can also increase blood concentrations of dasatinib through P-glycoprotein inhibition. METHODS Here, we report a case of sustained molecular remission of CML with prolonged first-line dasatinib therapy in a KT recipient being treated with tacrolimus. A 61-year-old woman developed CML-chronic phase (CML-CP) 38 months post KT. Her maintenance immunosuppressive therapy consisted of tacrolimus, mycophenolate mofetil, and methylprednisolone. Considering the potential drug interaction with tacrolimus, dasatinib was administered at a low dose of 50 mg/day. Her immune status was evaluated regularly by assessing the mixed lymphocyte reaction (MLR) using an intracellular carboxyfluorescein diacetate succinimidyl ester (CFSE)-labeling technique; immunosuppressive therapy was adjusted accordingly. RESULTS The patient achieved complete hematologic remission (CHR) after 1 month of dasatinib treatment. Six months after dasatinib treatment, she achieved a major molecular response. During the observation period, neither antibody-mediated nor acute cellular rejection were encountered in the patient. She remained in CHR with a major molecular response 12 months after the diagnosis of CML-CP. CONCLUSION Data obtained from immune monitoring assays using CFSE-MLR helped us to successfully manage a KT recipient with CML-CP being treated with dasatinib. Drug-drug interactions are a key consideration while designing treatment regimens; such strategies would ensure that drug-drug interactions do not negatively affect the treatment outcomes.
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Affiliation(s)
- Hiroaki Yamane
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Asuka Tanaka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Hashimoto
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hisao Nagoshi
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine (RIRBM), Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akhmet Seidakhmetov
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Doskali Marlen
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuka Tanaka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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10
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Zhao Y, Maule J, Li Y, Neff J, McCall CM, Hao T, Yang W, Rehder C, Yang LH, Wang E. Sequential development of human herpes virus 8-positive diffuse large B-cell lymphoma and chronic myelomonocytic leukemia in a 59 year old female patient with hemoglobin SC disease. Pathol Res Pract 2019; 215:152704. [PMID: 31699472 DOI: 10.1016/j.prp.2019.152704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 12/01/2022]
Abstract
Hematolymphoid neoplasms, including lymphoma and myeloid neoplasms, can occur in patients with sickle cell disease (SCD) or equivalent hemoglobinopathy, but an underlying connection between the two conditions has yet to be fully determined. Herein, we report a unique case of sequential development of two separate hematolymphoid neoplasms, human herpes virus 8 (HHV8)-positive diffuse large B-cell lymphoma (DLBCL) and chronic myelomonocytic leukemia, in a 59 year-old African American female with hemoglobin SC disease. While etiology of immunodeficiency is unknown, the potential causes include hydroxyurea therapy, disease related immunomodulation, chronic inflammation, and relatively old age. The leukemia cells demonstrated profound trilineage dysplasia and harbored complex cytogenetic abnormalities with loss of chromosome 5q and 7q, which are often observed in therapy-related myeloid neoplasms. Besides the potential causes listed above, we propose that myeloid leukemia in this setting may result from genomic changes due to excessive hematopoietic replication triggered by a hemolysis-induced cytokine storm. While myeloid neoplasms in the setting of SCD seems to herald a dismal clinical outcome per the literature, the HHV8-positive DLBCL in our case was apparently indolent, opposing the current perception of its clinical outcome.
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Affiliation(s)
- Yue Zhao
- Department of Pathology, First affiliated Hospital and College of Basic Medical Science of China Medical University, Shenyang, 110122 PR China; Department of Pathology, Duke University School of Medicine, Durham, NC, USA, 27710
| | - Jake Maule
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA, 27710
| | - Yang Li
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA, 27710; Division of Hematology/Oncology, Department of Medicine, Shengjing Hospital affiliated to China Medical University, Shenyang, 110004, PR China
| | - Jadee Neff
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA, 27710
| | - Chad M McCall
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA, 27710
| | - Tie Hao
- Department of Clinical Laboratory, Anshan Central Hospital, Anshan, Liaoning, 114001 PR China
| | - Weihong Yang
- Department of Clinical Laboratory, Anshan Central Hospital, Anshan, Liaoning, 114001 PR China
| | - Catherine Rehder
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA, 27710
| | - Lian-He Yang
- Department of Pathology, First affiliated Hospital and College of Basic Medical Science of China Medical University, Shenyang, 110122 PR China; Department of Pathology, Duke University School of Medicine, Durham, NC, USA, 27710
| | - Endi Wang
- Department of Pathology, Duke University School of Medicine, Durham, NC, USA, 27710.
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11
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Yang LH, Su P, Luedke C, Lu CM, Louissaint A, McCall CM, Rapisardo S, Vallangeon B, Wang E. Chronic Myeloid Leukemia Following Treatment for Primary Neoplasms or Other Medical Conditions. Am J Clin Pathol 2018; 150:246-258. [PMID: 29992292 DOI: 10.1093/ajcp/aqy050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Therapy-related chronic myeloid leukemia (CML) has been reported, but its clinical presentation and pathologic features have not yet been well characterized. METHODS Twenty-one cases of CML following treatment for primary diseases were collected and retrospectively analyzed. RESULTS The clinical presentation, pathologic features, and cytogenetic profile were similar to de novo CML. In particular, those with an isolated Philadelphia chromosome constituted 88.9% of our cases, and additional aberrations characteristic of therapy-related acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) were not identified in this study. The patients responded to imatinib/derivatives and survived with limited follow-up. CONCLUSIONS Therapy-related CML has a clinical presentation, pathologic features, and cytogenetic profile akin to de novo CML. Absence of additional significant aberrations seems to suggest a pathogenesis different from therapy-related AML/MDS. Therapy-related CML exhibits a robust therapeutic response to imatinib/derivatives and favorable clinical outcomes similar to de novo CML.
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Affiliation(s)
- Lian-He Yang
- Department of Pathology, First Affiliated Hospital and College of Basic Sciences of China Medical University, Shenyang, China
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Pu Su
- Department of Pathology, Duke University Medical Center, Durham, NC
- Department of Medicine, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Catherine Luedke
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Chuanyi Mark Lu
- Department of Laboratory Medicine, University of California San Francisco
| | - Abner Louissaint
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Chad M McCall
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Sarah Rapisardo
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Bethany Vallangeon
- Department of Pathology, East Carolina University Medical Center, Greenville, NC
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
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