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Khan O, Prakash S, Chung A, Wong SW, Kennedy VE. Monoclonal Gammopathy of Anemic Significance? Resolution of Pure Red Cell Aplasia With Daratumumab-Based Therapy. Am J Med 2024; 137:589-591. [PMID: 38401677 DOI: 10.1016/j.amjmed.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Omar Khan
- Department of Laboratory Medicine, University of California San Francisco Medical Center, San Francisco
| | - Sonam Prakash
- Department of Laboratory Medicine, University of California San Francisco Medical Center, San Francisco
| | - Alfred Chung
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco Medical Center, San Francisco
| | - Sandy W Wong
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco Medical Center, San Francisco
| | - Vanessa E Kennedy
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco Medical Center, San Francisco.
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2
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Strasser B, Heibl S, Thaler J, Haushofer A. T-cell large granular lymphocytic leukemia with low-grade bone marrow involvement complicated by acquired pure red cell aplasia. Blood Res 2023; 58:231-234. [PMID: 37964654 PMCID: PMC10758626 DOI: 10.5045/br.2023.2023141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Bernhard Strasser
- Institute of Laboratory Medicine, Hospital Wels-Grieskirchen, Wels, Austria
| | - Sonja Heibl
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Hospital Wels-Grieskirchen, Wels, Austria
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3
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Lobbes H. [Pure red cell aplasia: Diagnosis, classification and treatment]. Rev Med Interne 2023; 44:19-26. [PMID: 36336519 DOI: 10.1016/j.revmed.2022.10.385] [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: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Pure red cell aplasia (PRCA) is a rare anemia characterised by profound reticulocytopenia caused by a marked reduction in bone marrow erythroblasts, without abnormalities in other blood lineages. Blackfan-Diamond anemia is an inherited ribosomopathy responsible for a hereditary form of PRCA. Acquired PRCA are separated in primary and secondary forms, including Parvovirus B19 infection, thymoma, lymphoproliferative disorders, autoimmune diseases (lupus) and drug-induced PRCA. The pathophysiology of PRCA is not fully understood and involves both humoral and T lymphocyte autoreactive cells. In Parvovirus B19-related PRCA, treatment is based on polyvalent immunoglobulins. Thymectomy for thymoma is mandatory but results in prolonged remission in a limited number of cases. The therapeutic strategy is based on expert opinion: corticosteroids in monotherapy provide few sustained responses. The choice of an additional immunosuppressant drug is guided by the presence of an underlying disease. In most cases, cyclosporine A is the first choice providing the best response rate but requires a concentration monitoring (150 to 250 ng/mL). The second choice is cyclophosphamide in large granular lymphocyte leukaemia. Sirolimus (mTOR inhibitor) seems to be a promising option especially in refractory cases. Transfusion independence is the main objective. If the patient receives numerous red blood cell transfusions (> 20 packs), iron overload assessment is crucial to initiate an iron chelation. A retrospective and prospective national cohort (EPIC-F) has been set up and is now available to include each case of PRCA to improve the knowledge of this disease and to optimize the therapeutic strategy.
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Affiliation(s)
- Hervé Lobbes
- Service de médecine interne, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, Institut Pascal, 63000 Clermont-Ferrand, France.
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4
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Xu Q, Yu J, Lin X, Li Y, Zhang K. CB-LPD, MGUS, T-LGLL, and PRCA: A rare case report of 4 concomitant hematological disorders. Medicine (Baltimore) 2021; 100:e27874. [PMID: 34964755 PMCID: PMC8615434 DOI: 10.1097/md.0000000000027874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Monoclonal gammopathy of undetermined significance (MGUS) is a clinically asymptomatic clonal plasma cell or lymphoplasmacytic proliferative disorder. Recently, some case reports have described the association of pure red cell aplasia (PRCA) with MGUS, even with a relatively low monoclonal immunoglobulin burden. T large granular lymphocyte leukemia (T-LGLL) is a chronic lymphoproliferative disorder characterized by clonal expansion of T large granular lymphocytes, which is rare in China. There are some reports about T-LGL leukemia in patients with B-cell lymphoma; however, it is very rare that T-LGLL coexists with MGUS and clonal B-cell lymphoproliferative disorders (CB-LPD). PATIENT CONCERNS A 77-year-old man was hospitalized because of anemia. He was diagnosed with MGUS, CB-LPD, and PRCA. During the development of the disease, a group of abnormal T lymphocytes was detected by flow cytometry of peripheral blood. DIAGNOSIS Combining clinical manifestations with the result of T cell receptor gene rearrangement and immunophenotype, it was consistent with the diagnosis of T large granular lymphocyte leukemia. INTERVENTIONS The patient was treat with bortezomib and dexamethasone regimen, Rituximab and sirolimus. OUTCOMES The patient was transfusion independent after therapies. LESSONS We report a patient with 4 concomitant hematological disorders: T-LGLL, MGUS, CB-LPD, and PRCA, aiming to represent the clinical and flow cytometry characteristics of these concomitant diseases, analyze the mechanism between diseases, and provide a clinical reference.
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Affiliation(s)
- Qinhong Xu
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Jieni Yu
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Xiaoyan Lin
- The Center of Clinical Laboratory, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Youli Li
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Kejie Zhang
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
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5
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Gurnari C, Pagliuca S, Awada H, Zawit M, Patel BJ, Visconte V, Valent J, Rogers HJ, Maciejewski JP. Monoclonal IgM gammopathy in adult acquired pure red cell aplasia: culprit or innocent bystander? Blood Cells Mol Dis 2021; 91:102595. [PMID: 34280665 DOI: 10.1016/j.bcmd.2021.102595] [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: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Carmelo Gurnari
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, USA; Department of Biomedicine and Prevention, PhD in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy.
| | - Simona Pagliuca
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, USA; Université de Paris, Paris, France
| | - Hassan Awada
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, USA
| | - Misam Zawit
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, USA
| | - Bhumika J Patel
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, USA; Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Valeria Visconte
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, USA
| | - Jason Valent
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, USA; Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jaroslaw P Maciejewski
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, USA; Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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6
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Good treatment-free survival of monoclonal gammopathy of undetermined significance associated pure red cell aplasia after bortezomib plus dexamethasone. Blood Cells Mol Dis 2021; 89:102573. [PMID: 33957358 DOI: 10.1016/j.bcmd.2021.102573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022]
Abstract
Pure red cell aplasia (PRCA) is a rare syndrome characterized by severe anemia and absence of erythroid precursors. PRCA associated to monoclonal gammopathy of undetermined significance (MGUS) is a scarce condition with less than five cases reported so far. There is no agreement on the treatment of MGUS associated PRCA and treatment- free survival (TFS) is an unmet clinical need. In this report, for the first time, we demonstrated two patients with MGUS associated PRCA obtained rapid remission and maintained TFS after accepting intensive short-term bortezomib plus dexamethasone. The first case was refractory to cyclosporine and prednisone, but achieved complete remission after ten doses of bortezomib. Moreover, he has kept TFS for 12 months. The other case initiated bortezomib plus dexamethasone as soon as making a definite diagnosis. She obtained complete remission after twelve doses of bortezomib and she has maintained a normal level of haemoglobin for 8 months.
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7
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Gurnari C, Maciejewski JP. How I manage acquired pure red cell aplasia in adults. Blood 2021; 137:2001-2009. [PMID: 33657207 PMCID: PMC8057257 DOI: 10.1182/blood.2021010898] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/18/2021] [Indexed: 12/19/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare hematological disorder with multiple etiologies. The multifaceted nature of this disease is emphasized by the variety of concomitant clinical features. Classic idiopathic presentation aside, prompt recognition of pathogenetic clues is important because of their diagnostic and therapeutic implications. As a consequence, treatment of PRCA is diverse and strictly dependent on the presented clinical scenario. Here, we propose a series of clinical vignettes that showcase instructive representative situations derived from our routine clinical practice. Using these illustrative clinical cases, we review the diagnostic workup needed for a precise diagnosis and the currently available therapeutic options, discussing their applications in regard to the various PRCA-associated conditions and individual patients' characteristics. Finally, we propose a treatment algorithm that may offer guidance for personalized therapeutic recommendations.
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Affiliation(s)
- Carmelo Gurnari
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; and
- Department of Biomedicine and Prevention, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, Rome, Italy
| | - Jaroslaw P Maciejewski
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH; and
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8
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Verma R. Molecular Pathways Engaged by Immunomodulatory Agents in Monoclonal Gammopathy-Associated Pure Red Cell Aplasia Rescue. Front Oncol 2020; 10:1490. [PMID: 33014791 PMCID: PMC7493653 DOI: 10.3389/fonc.2020.01490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Rakesh Verma
- Yale Cancer Center, Yale University, New Haven, CT, United States
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9
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Qiu Y, Jiang XY, Luo YP, Li J, Zhou DB, Cao XX. [A 55-year-old male with anemia and monoclonal gammopathy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:783-785. [PMID: 31648486 PMCID: PMC7342450 DOI: 10.3760/cma.j.issn.0253-2727.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Y Qiu
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - X Y Jiang
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - Y P Luo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - J Li
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - D B Zhou
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
| | - X X Cao
- Department of Hematology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China
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10
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Eziokwu AS, Silver B, Samaras C. Acquired red cell aplasia associated with monoclonal gammopathy of undetermined significance. Leuk Lymphoma 2019; 60:2337-2339. [DOI: 10.1080/10428194.2019.1574007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Bernard Silver
- Department of Hematology/Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Christy Samaras
- Department of Hematology/Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
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11
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Ito T, Nakaya A, Fujita S, Satake A, Nakanishi T, Azuma Y, Tsubokura Y, Konishi A, Hotta M, Yoshimura H, Ishii K, Nomura S. Secondary pure red cell aplasia in multiple myeloma treated with lenalidomide. Leuk Res Rep 2018; 10:4-6. [PMID: 29998058 PMCID: PMC6037886 DOI: 10.1016/j.lrr.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/05/2018] [Accepted: 06/29/2018] [Indexed: 12/05/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare disorder characterized by marked erythroid hypoplasia with maturation arrest in the bone marrow. Secondary acquired PRCA may be associated with hematologic disorders. A few case reports have described PRCA associated with multiple myeloma (MM). However, the clinical course and mechanism of PRCA associated with MM remain unknown. We herein report two cases of PRCA associated with MM in patients undergoing treatment with lenalidomide.
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Affiliation(s)
- Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Aya Nakaya
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Shinya Fujita
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Takahisa Nakanishi
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Yoshiko Azuma
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Yukie Tsubokura
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Akiko Konishi
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Masaaki Hotta
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Hideaki Yoshimura
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Kazuyoshi Ishii
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka 573-1010, Japan
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12
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Balasubramanian SK, Sadaps M, Thota S, Aly M, Przychodzen BP, Hirsch CM, Visconte V, Radivoyevitch T, Maciejewski JP. Rational management approach to pure red cell aplasia. Haematologica 2017; 103:221-230. [PMID: 29217782 PMCID: PMC5792266 DOI: 10.3324/haematol.2017.175810] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/06/2017] [Indexed: 11/09/2022] Open
Abstract
Pure red cell aplasia is an orphan disease, and as such lacks rationally established standard therapies. Most cases are idiopathic; a subset is antibody-mediated. There is overlap between idiopathic cases and those with T-cell large granular lymphocytic leukemia, hypogammaglobulinemia, and low-grade lymphomas. In each of the aforementioned, the pathogenetic mechanisms may involve autoreactive cytotoxic responses. We selected 62 uniformly diagnosed pure red cell aplasia patients and analyzed their pathophysiologic features and responsiveness to rationally applied first-line and salvage therapies in order to propose diagnostic and therapeutic algorithms that may be helpful in guiding the management of prospective patients, 52% of whom were idiopathic, while the others involved large granular lymphocytic leukemia, thymoma, and B-cell dyscrasia. T-cell-mediated responses ranged between a continuum from polyclonal to monoclonal (as seen in large granular lymphocytic leukemia). During a median observation period of 40 months, patients received a median of two different therapies to achieve remission. Frequently used therapy included calcineurin-inhibitors with a steroid taper yielding a first-line overall response rate of 76% (53/70). Oral cyclophosphamide showed activity, albeit lower than that produced by cyclosporine. Intravenous immunoglobulins were effective both in parvovirus patients and in hypogammaglobulinemia cases. In salvage settings, alemtuzumab is active, particularly in large granular lymphocytic leukemia-associated cases. Other potentially useful salvage options include rituximab, anti-thymocyte globulin and bortezomib. The workup of acquired pure red cell aplasia should include investigations of common pathological associations. Most effective therapies are directed against T-cell-mediated immunity, and therapeutic choices need to account for associated conditions that may help in choosing alternative salvage agents, such as intravenous immunoglobulin, alemtuzumab and bortezomib.
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Affiliation(s)
- Suresh Kumar Balasubramanian
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Meena Sadaps
- Department of Internal Medicine, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Swapna Thota
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Mai Aly
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Bartlomiej P Przychodzen
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Cassandra M Hirsch
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Valeria Visconte
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Tomas Radivoyevitch
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
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13
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Ladha A, Fudym Y, Gentile TC. Clinical Resolution of Red Cell Aplasia Associated del 17p Multiple Myeloma, When Treated With Bortezomib and Dexamethasone. J Hematol 2017; 7:29-31. [PMID: 32300408 PMCID: PMC7155860 DOI: 10.14740/jh356w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/01/2017] [Indexed: 11/18/2022] Open
Abstract
Red cell aplasia has been rarely described in association with multiple myeloma. We present a case of a 79-year-old female, who was initially diagnosed with iron deficiency anemia, which did not improve with iron supplementation and required blood transfusions. Bone marrow biopsy showed red cell aplasia associated with kappa light chain multiple myeloma with 14.8% plasma cells. Further tests showed 0.35 g/dL M protein, and kappa/lambda ratio was 131.84. Cytogenetic showed deletion 13q, deletion 17p, loss of 1p and gain of chromosome 5. Multiple myeloma directed treatment with bortezomib and dexamethasone was initiated. Patient had clinical resolution of anemia and did not require further blood transfusions. This is an intriguing case of red cell aplasia associated with poor risk multiple myeloma (del 17p), which showed clinical improvement in anemia with bortezomib-based therapy. This case highlights the role of clonal plasma cells proliferation in the pathogenesis of red cell aplasia as myeloma directed treatment helped patient to become transfusion independent.
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Affiliation(s)
- Abdullah Ladha
- Department of Hematology and Oncology, State University of New York (SUNY) Upstate Medical University, 750 E Adam St, Syracuse, NY 13210, USA
| | - Yelena Fudym
- Department of Pathology, State University of New York (SUNY) Upstate Medical University, 750 E Adam St, Syracuse, NY 13210, USA
| | - Teresa C Gentile
- Department of Hematology and Oncology, State University of New York (SUNY) Upstate Medical University, 750 E Adam St, Syracuse, NY 13210, USA
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