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Lafargue MC, Duong Van Huyen JP, Rennke HG, Essig M, Bobot M, Jourde-Chiche N, Sakhi H, KARRAS A, Boudhabhay I, Brunet P, Boulay H, Grobost V, Philipponnet C, Jeannel J, Chemouny J, Boffa JJ, Braham-Stambouli D, Selamet U, Riella LV, Fain O, Adès L, Fenaux P, Cohen C, Mekinian A. Kidney involvement in myelodysplastic syndromes. Clin Kidney J 2024; 17:sfae185. [PMID: 39099564 PMCID: PMC11292217 DOI: 10.1093/ckj/sfae185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction The objective of this study was to describe kidney involvement in patients with myelodysplastic syndromes (MDS), their treatments, and outcomes. Methods We conducted a multicenter retrospective study in seven centers, identifying MDS patients with acute kidney injury (AKI), chronic kidney disease (CKD), and urine abnormalities. Results Fifteen patients developed a kidney disease 3 months after MDS diagnosis. Median urine protein-to-creatinine ratio was 1.9 g/g, and median serum creatinine was 3.2 mg/dL. Ten patients had AKI at presentation, and 12 had extra-renal symptoms. The renal diagnoses included anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), ANCA negative vasculitis, C3 glomerulonephritis, immune complex-mediated glomerulonephritis, polyarteritis nodosa, and IgA vasculitis. All patients but one received a specific treatment for the MDS-associated kidney injury. The effect of MDS treatment on kidney injury could be assessed in six patients treated with azacitidine, and renal function evolution was heterogenous. After a median follow-up of 14 months, four patients had CKD stage 3, five had CKD stage 4, and three had end stage kidney disease. On the other hand, three evolved to an acute myeloid leukemia and three died. Compared to 84 MDS controls, patients who had kidney involvement were younger, had a higher number of dysplasia lineages, and were more eligible to receive hypomethylating agents, but no survival difference was seen between the two groups. Compared to 265 AAV without MDS, the ten with MDS-associated pauci-immune vasculitis were older, ANCA serology was more frequently negative, and more cutaneous lesions were seen. Conclusion The spectrum of kidney injuries associated with MDS is mostly represented by vasculitis with glomerular involvement, and especially AAV.
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Affiliation(s)
- Marie-Camille Lafargue
- Department of Nephrology, Tenon's Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Jean-Paul Duong Van Huyen
- Department of Pathology, Université Paris Cité, Necker's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marie Essig
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, Université Paris-Saclay, Paris, France
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, CHU de la Conception, Marseille, France
| | - Noémie Jourde-Chiche
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, CHU de la Conception, Marseille, France
| | - Hamza Sakhi
- Department of Nephrology, Necker's Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | - Idris Boudhabhay
- Department of Nephrology, Necker's Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Philippe Brunet
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, CHU de la Conception, Marseille, France
| | - Hugoline Boulay
- University of Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France
| | | | - Carole Philipponnet
- Nephrology, Dialysis and Transplantation Department, University Hospital, Clermont-Ferrand, France
| | - Juliette Jeannel
- Internal Medicine Department, Strasbourg University Hospital, Strasbourg, France
| | - Jonathan Chemouny
- Transplant Unit, Department of Nephrology, University Hospital, Rennes, France
| | - Jean-Jacques Boffa
- Department of Nephrology, Sorbonne University, Tenon's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Umut Selamet
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Leonardo V Riella
- Center for Transplantation Sciences, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivier Fain
- Sorbonne Université, Hôpital Saint-Antoine, Service de Médecine Interne et de l'Inflammation-(DHU i2B), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Adès
- Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Pierre Fenaux
- Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Camille Cohen
- Service de Néphrologie Hémodialyse, Hôpital Bichat - Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Arsène Mekinian
- Sorbonne Université, Hôpital Saint-Antoine, Service de Médecine Interne et de l'Inflammation-(DHU i2B), Assistance Publique-Hôpitaux de Paris, Paris, France
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2
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Tran Quang V, Wagner-Ballon O, Sloma I. Predicting which subsets of patients with myelodysplastic neoplasms are more likely to progress to overt chronic myelomonocytic leukemia. Leuk Lymphoma 2024:1-11. [PMID: 39004904 DOI: 10.1080/10428194.2024.2378816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024]
Abstract
The boundary between myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML) has been revised in the latest World Health Organization classification of myeloid malignancies. These changes were motivated by the description of a subgroup of MDS patients identified as oligomonocytic chronic myelomonocytic leukemia (OM-CMML) at risk of evolving into overt CMML. Various studies will be reviewed describing the clinical and biological features of MDS patients evolving to CMML. The efforts to discover biomarkers enabling the identification of these patients at the time of MDS diagnosis will be discussed. Finally, the molecular landscape of these patients will be presented with a specific focus on the biallelic inactivation of TET2 in light of its functional impact on hematopoietic stem cells, granule-monocytic differentiation, and its tight interplay with inflammation.
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Affiliation(s)
- Violaine Tran Quang
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Henri Mondor, Hematology and Immunology Department, Créteil, France
| | - Orianne Wagner-Ballon
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Henri Mondor, Hematology and Immunology Department, Créteil, France
| | - Ivan Sloma
- Univ Paris Est Créteil, INSERM, IMRB, Créteil, France
- AP-HP, Hôpital Henri Mondor, Hematology and Immunology Department, Créteil, France
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3
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Attieh RM, Begum F, Chitty D, Izzedine H, Jhaveri KD. Kidney and Urinary Tract Involvement in Chronic Myelomonocytic Leukemia. Kidney Med 2024; 6:100769. [PMID: 38313809 PMCID: PMC10837097 DOI: 10.1016/j.xkme.2023.100769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Chronic myelomonocytic leukemia (CMML) is a hematologic malignancy affecting the bone marrow and resulting in peripheral blood monocytosis. Kidney and urinary tract involvement is common and can present dramatically with life-threatening consequences. Kidney involvement can be the result of direct or indirect mechanisms, including prerenal azotemia, glomerular disease, tubulointerstitial involvement, and renovascular disorders. Urinary tract involvement, electrolyte and acid-base disorders, as well as nephrotoxicity from treatment of the disorder can also occur. Given this multifactorial pathogenesis involving several mechanisms concomitantly, nephrologists must exercise heightened awareness and maintain a low threshold for kidney biopsy. There is a pressing need for future research endeavors to elucidate and target the manifestations of CMML that involve the kidneys with the ultimate goal of augmenting overall prognosis and therapeutic outcomes.
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Affiliation(s)
- Rose Mary Attieh
- Division of Kidney Diseases and Hypertension, Department of Medicine, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
| | - Farhana Begum
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - David Chitty
- Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institute for Medical Research, Lake Success, New York
| | - Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Department of Medicine, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
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4
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Nathan DI, Dougherty M, Bhatta M, Mascarenhas J, Marcellino BK. Clonal hematopoiesis and inflammation: A review of mechanisms and clinical implications. Crit Rev Oncol Hematol 2023; 192:104187. [PMID: 37879493 DOI: 10.1016/j.critrevonc.2023.104187] [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: 06/03/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
Clonal hematopoiesis (CH) is defined by the presence of somatic mutations in hematopoietic stem and progenitor cells (HSPC). CH is associated primarily with advancing age and confers an elevated risk of progression to overt hematologic malignancy and cardiovascular disease. Increasingly, CH is associated with a wide range of diseases driven by, and sequelae of, inflammation. Accordingly, there is great interest in better understanding the pathophysiologic and clinical relationship between CH, aging, and disease. Both observational and experimental findings support the concept that CH is a potential common denominator in the inflammatory outcomes of aging. However, there is also evidence that local and systemic inflammatory states promote the growth and select for CH clones. In this review, we aim to provide an up-to-date summary of the nature of the relationship between inflammation and CH, which is central to unlocking potential therapeutic opportunities to prevent progression to myeloid malignancy.
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Affiliation(s)
- Daniel I Nathan
- Tisch Cancer Institute, Division of Hematology and Medical Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Max Dougherty
- Tisch Cancer Institute, Division of Hematology and Medical Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manasa Bhatta
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Mascarenhas
- Tisch Cancer Institute, Division of Hematology and Medical Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bridget K Marcellino
- Tisch Cancer Institute, Division of Hematology and Medical Oncology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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5
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Belizaire R, Wong WJ, Robinette ML, Ebert BL. Clonal haematopoiesis and dysregulation of the immune system. Nat Rev Immunol 2023; 23:595-610. [PMID: 36941354 PMCID: PMC11140722 DOI: 10.1038/s41577-023-00843-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/23/2023]
Abstract
Age-related diseases are frequently linked to pathological immune dysfunction, including excessive inflammation, autoreactivity and immunodeficiency. Recent analyses of human genetic data have revealed that somatic mutations and mosaic chromosomal alterations in blood cells - a condition known as clonal haematopoiesis (CH) - are associated with ageing and pathological immune dysfunction. Indeed, large-scale epidemiological studies and experimental mouse models have demonstrated that CH can promote cardiovascular disease, chronic obstructive pulmonary disease, chronic liver disease, osteoporosis and gout. The genes most frequently mutated in CH, the epigenetic regulators TET2 and DNMT3A, implicate increased chemokine expression and inflammasome hyperactivation in myeloid cells as a possible mechanistic connection between CH and age-related diseases. In addition, TET2 and DNMT3A mutations in lymphoid cells have been shown to drive methylation-dependent alterations in differentiation and function. Here we review the observational and mechanistic studies describing the connection between CH and pathological immune dysfunction, the effects of CH-associated genetic alterations on the function of myeloid and lymphoid cells, and the clinical and therapeutic implications of CH as a target for immunomodulation.
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Affiliation(s)
- Roger Belizaire
- Department of Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Waihay J Wong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle L Robinette
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Benjamin L Ebert
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Howard Hughes Medical Institute, Dana-Farber Cancer Institute, Boston, MA, USA.
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6
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Hochman MJ, DeZern AE. Myelodysplastic syndrome and autoimmune disorders: two sides of the same coin? Lancet Haematol 2022; 9:e523-e534. [PMID: 35772431 DOI: 10.1016/s2352-3026(22)00138-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 06/15/2023]
Abstract
Systemic inflammatory and autoimmune diseases and myelodysplastic syndromes have been linked in individual patients and in larger case series for at least 25 years. These associations frequently include thyroid disease, neutrophilic dermatoses, polyarthritis, connective tissue diseases, vasculitis, and autoimmune cytopenias. Studies have found that autoimmune disease (or its therapy) is a risk factor for the development of myelodysplastic syndromes, but such syndromes might also be an instigator of autoimmune disease. Epidemiological studies examining disease risk in myelodysplastic syndromes with and without comorbid autoimmune illness have reached mixed conclusions. The pathophysiology of myelodysplastic syndromes is tightly linked to excessive inflammatory activity in the bone marrow microenvironment, which could promote systemic inflammatory and autoimmune diseases directly or by stimulation of the adaptive immune response. Alternatively, autoimmune diseases could promote clonal evolution and disordered bone marrow growth, promoting the development of myeloid malignancy. Additionally, therapy-related myeloid neoplasms-including myelodysplastic syndromes-have been diagnosed after treatment of autoimmune diseases with immunosuppressant therapies. These associations raise the following question: are myelodysplastic syndromes and systemic inflammatory and autoimmune diseases two sides of the same coin-that is, do they share an underlying disease state that can manifest as a myeloid neoplasm, an autoinflammatory illness, or both? VEXAS syndrome, which was first reported in 2020, is caused by a mutation that affects myeloid-restricted cells and manifests with both myelodysplasia and autoinflammation, and could give insight into this biological possibility. We note that systemic inflammatory and autoimmune diseases are often steroid-dependent; however, studies have also evaluated the roles of other immunomodulating therapies. In this Viewpoint, we critically appraise and review the literature on the epidemiology, pathophysiology, and management of systemic inflammatory and autoimmune diseases that are associated with myelodysplastic syndromes and related diseases.
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Affiliation(s)
- Michael J Hochman
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy E DeZern
- Division of Hematologic Malignancies and Bone Marrow Transplantation, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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7
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Fozza C, Murtas A, Caocci G, La Nasa G. Autoimmune disorders associated with myelodysplastic syndromes: clinical, prognostic and therapeutic implications. Leuk Res 2022; 117:106856. [PMID: 35525186 DOI: 10.1016/j.leukres.2022.106856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/29/2022]
Abstract
Around one third of patients with myelodysplastic syndromes (MDS) suffer from concomitant autoimmune disorders (AD). However the actual burden of such an association appears to be quite heterogeneous in different studies probably due to variable criteria in selecting both MDS patients and subtypes of AD. Moreover, both the prognostic implications and the potential applications of specific therapeutic approaches in this patient subgroup are still at least partially under debate. The present review will try to shed some further light on the clinical association between MDS and AD in order to better delineate its prognostic significance and to suggest potential therapeutic algorithms available for these patients.
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Affiliation(s)
- Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
| | - Andrea Murtas
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy
| | - Giovanni Caocci
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
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8
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Xu GH, Lin J, Chen WQ. Concurrent ankylosing spondylitis and myelodysplastic syndrome: A case report. World J Clin Cases 2022; 10:1929-1936. [PMID: 35317144 PMCID: PMC8891766 DOI: 10.12998/wjcc.v10.i6.1929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/01/2021] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) is an autoimmune disease characterized by sacroiliitis and spondylitis, with a few hematological abnormalities. Myelodysplastic syndromes (MDS) are a heterogeneous group of hematopoietic stem cell disorders with frequent autoimmune phenomena. The relationship between AS and MDS remains unknown.
CASE SUMMARY We describe a rare case of concurrent AS and MDS. An 18-year-old man with low back pain and anemia was diagnosed with AS; however, the cause of anemia could not be determined by the first bone marrow examination. He recovered from anemia and the symptoms of AS resolved after treatment with etanercept, glucocorticoid, and blood transfusion, but he developed pancytopenia with an increased myeloblast count (from 2.5% to 9%). Chromosome analysis revealed del(7q) and trisomy 8. Refractory anemia with excess of blasts-1 (RAEB-1)/MDS was confirmed by repeating the bone marrow examination. He became blood transfusion-dependent and received decitabine-based chemotherapy but eventually died.
CONCLUSION We suspect that AS may be an early autoimmune phenomenon related to MDS. However, a condition of coexistence cannot be excluded.
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Affiliation(s)
- Guan-Hua Xu
- Division of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Jin Lin
- Division of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Wei-Qian Chen
- Division of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Lötscher F, Seitz L, Simeunovic H, Sarbu AC, Porret NA, Feldmeyer L, Borradori L, Bonadies N, Maurer B. Case Report: Genetic Double Strike: VEXAS and TET2-Positive Myelodysplastic Syndrome in a Patient With Long-Standing Refractory Autoinflammatory Disease. Front Immunol 2022; 12:800149. [PMID: 35126364 PMCID: PMC8811255 DOI: 10.3389/fimmu.2021.800149] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Somatic genetic mutations involving the innate and inflammasome signaling are key drivers of the pathogenesis of myelodysplastic syndromes (MDS). Herein, we present a patient, who suffered from a long-standing refractory adult-onset autoinflammatory syndrome (AIS), previously interpreted as various distinct rheumatic disorders. Developing pancytopenia and particularly macrocytic anemia prompted the screening for a hematological malignancy, which led to the diagnosis of a TET-2-positive MDS. The impressive and continuously changing range of organ involvement, with remarkable refractoriness to anti-inflammatory treatment, exceeded the common autoinflammatory phenotype of MDS patients. This prompted us to suspect a recently discovered disease, characterized by somatic mutations of the UBA1 gene: the VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, which was ultimately confirmed by genetic testing. Reevaluation of previous bone marrow biopsies showed the presence of characteristic vacuoles in myeloid- and erythroid progenitor cells. Our case illustrates that the triad of an unresponsive multisystemic autoinflammatory disease, hematological abnormalities and vacuoles in myeloid- and erythroid progenitors in the bone marrow biopsy should prompt screening for the VEXAS syndrome.
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Affiliation(s)
- Fabian Lötscher
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- *Correspondence: Fabian Lötscher, ; orcid.org/0000-0002-1626-9931
| | - Luca Seitz
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helena Simeunovic
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Adela-Cristina Sarbu
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Naomi A. Porret
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Bonadies
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern, University of Bern, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Britta Maurer
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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10
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Zeng H, Ma Y, He X, Cai S, Chen P, Chen Y, Luo H. Characteristics and Follow-Up of Organizing Pneumonia Associated with Haematological Malignancies. Int J Gen Med 2022; 15:301-310. [PMID: 35027840 PMCID: PMC8752074 DOI: 10.2147/ijgm.s337321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Organizing pneumonia (OP) is a secondary process in many diseases. Due to its low incidence and indistinct symptoms, there is limited information on OP associated with haematological malignancies. Therefore, the aim of this study was to discuss the characteristics and prognosis of OP associated with haematological malignancies. Methods We observed and analysed pathologically confirmed OP cases associated with haematological malignancies in a hospital record database and excluded cases of OP with known causes, including chemotherapy, radiotherapy, targeted therapy, transplantation and infection. Results There were five patients with OP underlying only haematological malignancies, including one case each of the following: myelodysplastic syndrome, acute myelogenous leukaemia, multiple myeloma, aplastic anaemia, and T cell lymphoma. Radiological findings did not show a distinct pattern, and two cases mimicked pulmonary aspergillosis with ground-glass opacity (GGO). The diagnosis of OP was confirmed by minimal invasive biopsy. Although all patients developed severe cases, steroids yielded favourable outcomes. Conclusion This study demonstrates that haematological malignancies may be a cause of OP and that minimal invasive biopsy may be an effective and safe method to confirm the diagnosis. Although OP associated with haematological malignancies may more frequently develop into severe cases, the OP lesions were steroid-responsive during follow-up.
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Affiliation(s)
- Huihui Zeng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yiming Ma
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Xue He
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Shan Cai
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Yan Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Unit of Respiratory Diseases, Central South University, Changsha, Hunan, People's Republic of China.,Hunan Centre for Evidence-Based Medicine Changsha, Hunan, People's Republic of China
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11
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Oganesyan A, Hakobyan Y, Terrier B, Georgin-Lavialle S, Mekinian A. Looking beyond VEXAS: Coexistence of undifferentiated systemic autoinflammatory disease and myelodysplastic syndrome. Semin Hematol 2021; 58:247-253. [PMID: 34802547 DOI: 10.1053/j.seminhematol.2021.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 01/24/2023]
Abstract
It has been established that individuals with myelodysplastic syndromes (MDS) have a higher frequency of systemic inflammatory disorders. On the other hand, patients with autoimmune diseases are at increased risk of MDS development. Both diseases can be associated with various genetic lesions and share diverse pathogenetic mechanisms. Recently identified VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, associated with somatic mutations in UBA1, encompasses a range of inflammatory conditions involving multiple organs along with hematological pathologies, including MDS, as well as characteristic bone marrow vacuolization of myeloid and erythroid precursors. This novel syndrome drove further attention to complex associations between MDS and adult-onset inflammatory conditions. The present narrative literature review discusses the clinical presentation, pathophysiology, management of concurrent MDS and systemic inflammatory diseases in parallel to the clinical picture of VEXAS syndrome.
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Affiliation(s)
- Artem Oganesyan
- Department of Adult Hematology, Yeolyan Hematology Center, Yerevan, Armenia; Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia
| | - Yervand Hakobyan
- Department of Adult Hematology, Yeolyan Hematology Center, Yerevan, Armenia; Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare and Systemic Autoimmune Diseases, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Georgin-Lavialle
- Internal Medicine Department, National Reference Center for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Sorbonne Université, INSERM U938, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arsene Mekinian
- Internal Medicine Department and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Saint-Antoine (CRSA), Sorbonne Universités, UMPC University Paris 06, INSERM U938, Paris, France.
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12
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Bizymi N, Pitsidianakis G, Ierodiakonou D, Stathakis G, Vasarmidi E, Hiraki S, Bolaki M, Karagiannis K, Fanaridis M, Liopyrakis K, Marinos L, Xilouri I, Antoniou KM, Tzanakis N. Case Report: Diagnosis of Myelodysplastic Syndrome in a 72-Year-Old Female With Interstitial Lung Disease. Front Med (Lausanne) 2021; 8:673573. [PMID: 34434942 PMCID: PMC8380831 DOI: 10.3389/fmed.2021.673573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Acute fibrinous and organizing pneumonia (AFOP) is an entity that can be secondary to various conditions leading to lung injury, such as infections, malignancies, and various autoimmune conditions or idiopathic interstitial lung disease, when no obvious underlying cause is identified. Myelodysplastic syndromes (MDS), on the other hand, are a spectrum of clonal myeloid disorders, with a higher risk of acute leukemia, characterized by ineffective bone marrow (BM) hematopoiesis and, thus, peripheral blood (PB) cytopenias. Immune deregulation is thought to take part in the pathophysiology of the disease, including abnormal T and/or B cell responses, innate immunity, and cytokine expression. In the literature, there are a few case reports of patients with MDS that have presented pulmonary infiltrates and were diagnosed as having AFOP or organizing pneumonia (OP). It is rare, though, to have isolated pulmonary infiltrates without Sweet's syndrome or even the pulmonary infiltrates to precede the diagnosis and treatment of MDS, which was our case. We present a 72-year-old female developing new lung infiltrates refractory to antibiotic treatment that responded well to corticosteroids and was histologically described as having OP. The treatment was gradually successfully switched to mycophenolate mofetil (MMF). The patient was later diagnosed with MDS. This interesting case report suggests firstly that a diagnosis of AFOP or OP should alert the clinician to search for an underlying cause including MDS and vice versa, the use of systemic steroids should not be postponed, and, finally, that MMF can successfully be used in these patients.
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Affiliation(s)
- Nikoleta Bizymi
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece.,Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | | | - Despo Ierodiakonou
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece.,Department of Primary care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Georgios Stathakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Stavroti Hiraki
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Bolaki
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | | | - Michail Fanaridis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos Liopyrakis
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Leonidas Marinos
- Department of Hemopathology, Evangelismos General Hospital, Athens, Greece
| | - Irini Xilouri
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
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13
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Obiorah IE, Patel BA, Groarke EM, Wang W, Trick M, Ombrello AK, Ferrada MA, Wu Z, Gutierrez-Rodrigues F, Lotter J, Wilson L, Hoffmann P, Cardona DO, Patel N, Dulau-Florea A, Kastner DL, Grayson PC, Beck DB, Young NS, Calvo KR. Benign and malignant hematologic manifestations in patients with VEXAS syndrome due to somatic mutations in UBA1. Blood Adv 2021; 5:3203-3215. [PMID: 34427584 PMCID: PMC8405186 DOI: 10.1182/bloodadvances.2021004976] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022] Open
Abstract
Somatic mutations in UBA1 involving hematopoietic stem and myeloid cells have been reported in patients with the newly defined VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome. Here, we report clinical hematologic manifestations and unique bone marrow (BM) features in 16 patients with VEXAS. All patients were male and had a history of severe autoinflammatory and rheumatologic manifestations and a somatic UBA1 mutation (p.Met41). Ten patients had hematologic disorders: myelodysplastic syndrome (MDS; 6 of 16), multiple myeloma (2 of 16), monoclonal gammopathy of undetermined significance (2 of 16), and monoclonal B-cell lymphocytosis (2 of 16), and a few of those patients had 2 co-existing clonal processes. Although macrocytic anemia (100%) and lymphopenia (80%) were prevalent in all patients with VEXAS, thrombocytopenia and neutropenia were more common in patients with progression to MDS. All BMs in VEXAS patients had prominent cytoplasmic vacuoles in myeloid and erythroid precursors. In addition, most BMs were hypercellular with myeloid hyperplasia, erythroid hypoplasia, and varying degrees of dysplasia. All patients diagnosed with MDS were lower risk (low blast count, very good to intermediate cytogenetics) according to standard prognostic scoring with no known progression to leukemia. In addition, 10 of 16 patients had thrombotic events, including venous thromboembolism and arterial stroke. Although VEXAS presents symptomatically as a rheumatologic disease, morbidity and mortality are associated with progression to hematologic disease. Given the increased risk of developing MDS and multiple myeloma, surveillance for disease progression is important.
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Affiliation(s)
- Ifeyinwa Emmanuela Obiorah
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute
- Hematology Section, Department of Laboratory Medicine, Clinical Center
| | | | - Emma M Groarke
- Hematology Branch, National Heart, Lung, and Blood Institute
| | - Weixin Wang
- Hematology Section, Department of Laboratory Medicine, Clinical Center
| | - Megan Trick
- Hematology Section, Department of Laboratory Medicine, Clinical Center
| | - Amanda K Ombrello
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Marcela A Ferrada
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Zhijie Wu
- Hematology Branch, National Heart, Lung, and Blood Institute
| | | | - Jennifer Lotter
- Hematology Branch, National Heart, Lung, and Blood Institute
| | - Lorena Wilson
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Patrycja Hoffmann
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Daniela Ospina Cardona
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Nisha Patel
- Hematology Section, Department of Laboratory Medicine, Clinical Center
| | | | - Daniel L Kastner
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - David B Beck
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, and
| | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute
| | - Katherine R Calvo
- Hematology Section, Department of Laboratory Medicine, Clinical Center
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14
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Zheng X, Shao YQ, Li XX, Huang JB, Ge ML, Wang M, Jin P, Nie N, Zhang J, Zheng YZ. [Clinical characteristics and prognosis of 82 cases of cytopenia patients with positive Coombs' test]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:521-523. [PMID: 34384162 PMCID: PMC8295625 DOI: 10.3760/cma.j.issn.0253-2727.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 11/05/2022]
Affiliation(s)
- X Zheng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y Q Shao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - X X Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - J B Huang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - M L Ge
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - M Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - P Jin
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - N Nie
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - J Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | - Y Z Zheng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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15
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Briantais A, Séguier J, De Sainte Marie B, Mekinian A, Belizna C, Gondran G, Maurier F, Trouiller S, Willems L, Beyne-Rauzy O, Harlé JR, Vey N, Ebbo M, Schleinitz N. Inflammatory myopathies associated with myelodysplastic syndromes: A French multicenter case control study and literature review. Semin Arthritis Rheum 2021; 51:845-852. [PMID: 34175790 DOI: 10.1016/j.semarthrit.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/06/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Patients with inflammatory myopathies (IM) are known to have an increased risk of developing malignancies. Autoimmune and inflammatory diseases occur in up to 25% of patients with myelodysplastic syndrome (MDS). This study aimed to describe the rare association between IM and MDS. METHODS We report here the main characteristics, treatment, and outcome of 21 patients (11 national cases and 10 additional cases from a literature review) with IM associated to MDS. RESULTS Median age of patients at IM diagnosis was 66 years (range 26 - 78). Diagnosis of the two conditions were concomitant in most patients (n=14/21) whereas MDS diagnosis preceded IM diagnosis in 5 patients. Different types of IM were observed but dermatomyositis was the most frequent (59%). Compared to IM without MDS (IM/MDS-), patients with MDS (IM/MDS+) were older (median 66 vs 55, p=0.3), more frequently male (sex ratio M/F 1.125 vs 0.41, p=0.14) and positive for anti-TIF1γ (24% vs 4%, p=0.0039). Antisynthetase syndrome was never observed among IM/MDS+ patients (0% vs 28%, p=0.01). MDS WHO type was not univocal, but the prognostic score was of low risk in almost all cases. IM was usually steroid sensitive (82% of patients) but often steroid dependent (56% of patients). Overall survival of IM patients with MDS was worse compared to patients with IM without MDS (p=0.0002). CONCLUSION IM associated with MDS are mainly represented by dermatomyositis and/or anti-TIF1γ autoantibodies. Antisynthetase syndrome has not been described in association with MDS. Despite low-risk MDS, overall survival of IM patients with MDS is worse than IM patients without MDS.
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Affiliation(s)
- Antoine Briantais
- Aix Marseille Univ, Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Marseille, France.
| | - Julie Séguier
- Aix Marseille Univ, Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Marseille, France
| | - Benjamin De Sainte Marie
- Aix Marseille Univ, Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Marseille, France
| | - Arsène Mekinian
- Sorbonne Université, Department of Internal Medicine, Assistance Publique - Hôpitaux de Paris, CHU Saint-Antoine, Paris, France
| | | | | | - François Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Sébastien Trouiller
- Departement of Internal Medicine, Centre Hospitalier d'Aurillac, Aurillac, France
| | - Lise Willems
- Department of hematology, Assistance Publique - Hôpitaux de Paris, CHU Cochin, Paris, France
| | - Odile Beyne-Rauzy
- Department of Internal Medicine, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Jean-Robert Harlé
- Aix Marseille Univ, Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Marseille, France
| | - Norbert Vey
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Mikael Ebbo
- Aix Marseille Univ, Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Marseille, France
| | - Nicolas Schleinitz
- Aix Marseille Univ, Department of Internal Medicine, Assistance Publique - Hôpitaux de Marseille, CHU La Timone, Marseille, France
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16
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Arinobu Y, Kashiwado Y, Miyawaki K, Ayano M, Kimoto Y, Mitoma H, Akahoshi M, Miyamoto T, Horiuchi T, Akashi K, Niiro H. Autoimmune manifestations associated with myelodysplastic syndrome predict a poor prognosis. Medicine (Baltimore) 2021; 100:e25406. [PMID: 33787649 PMCID: PMC8021323 DOI: 10.1097/md.0000000000025406] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/28/2021] [Accepted: 03/12/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT We evaluated the clinical characteristics of autoimmune manifestations (AIMs) associated with myelodysplastic syndrome (MDS) to elucidate whether AIMs impacted MDS outcomes in Japan.This retrospective study including 61 patients who received a new diagnosis of MDS between January 2008 and December 2015 was conducted by the review of electronic medical records for the presence of AIMs within a 1-year period prior to or following the diagnosis of MDS.AIMs were identified in 12 of the 61 (20.0%) patients with MDS. The neutrophil counts and C-reactive protein levels in peripheral blood were significantly elevated in patients with AIMs, and the survival was shorter in those with AIMs compared to those without AIMs. Multivariate analysis demonstrated that the presence of AIMs and higher-risk disease according to the International Prognositic Scoring System (IPSS) were independent risk factors for increased mortality (hazard ratio, 4.76 and 4.79, respectively).This retrospective study revealed that the prognosis was poor in patients with MDS-associated AIMs. The treatment of MDS using the current algorithms is based on prognostic scoring systems such as IPSS. Treatment strategies for patients with MDS-associated AIMs should be reconsidered, even in those with low-risk MDS according to the IPSS.
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Affiliation(s)
- Yojiro Arinobu
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Yusuke Kashiwado
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Kohta Miyawaki
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Masahiro Ayano
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Yasutaka Kimoto
- Department of Internal Medicine and Clinical Immunology, Kyushu University Beppu Hospital, Beppu
| | - Hiroki Mitoma
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Mitsuteru Akahoshi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Takahiko Horiuchi
- Department of Internal Medicine and Clinical Immunology, Kyushu University Beppu Hospital, Beppu
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
| | - Hiroaki Niiro
- Department of Medical Education, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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17
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Schwotzer N, Provot F, Ville S, Daniel L, Le Fur A, Kissling S, Jourde-Chiche N, Karras A, Moreau A, Augusto JF, Gnemmi V, Perrochia H, Bataille S, Le Quintrec M, Goujon JM, Rotman S, Fakhouri F. Spectrum of Kidney Involvement in Patients with Myelodysplastic Syndromes. Kidney Int Rep 2021; 6:746-754. [PMID: 33732989 PMCID: PMC7938072 DOI: 10.1016/j.ekir.2020.12.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 02/03/2023] Open
Abstract
Introduction Myelodysplastic syndromes (MDS) are characterized by a high prevalence of associated autoimmune manifestations. Kidney involvement has been rarely reported in MDS patients. We report on the spectrum of kidney pathological findings in MDS patients. Methods We retrospectively identified MDS patients who had undergone a kidney biopsy between 2001 and 2019 in nine Swiss and French nephrology centres. Results Nineteen patients (median age 74 years [63-83]) were included. At the time of kidney biopsy, eleven (58%) patients had extra-renal auto-immune manifestations and sixteen (84%) presented with acute kidney injury. Median serum creatinine at diagnosis was 2.8 mg/dL [0.6-8.3] and median urinary protein to creatinine ratio was 1.2 g/g [0.2-11]. Acute tubulo-interstitial nephritis (TIN) was present in seven (37%) patients. Immunofluorescence study in one patient with acute TIN disclosed intense IgG deposits along the tubular basement membrane and Bowman’s capsule. Other kidney pathological features included ANCA-negative pauci-immune necrotizing and crescentic glomerulonephritis (n = 3), membranous nephropathy (n = 2), IgA nephropathy (n = 1), IgA vasculitis (n = 1), immunoglobulin-associated membrano-proliferative glomerulonephritis type I (n=1), crescentic C3 glomerulopathy (n = 1), fibrillary glomerulonephritis (n = 1) and minimal change disease (n = 1). Eleven (58%) patients received immunosuppressive treatments, among whom one developed a severe infectious complication. After a median follow-up of 7 month [1-96], nine (47%) patients had chronic kidney disease stage 3 (n = 6) or 4 (n = 3) and five (26%) progressed to end-stage kidney disease. Three patients died. Conclusions MDS are associated to several autoimmune kidney manifestations, predominantly acute TIN. MDS are to be listed among the potential causes of autoimmune TIN.
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Affiliation(s)
- Nora Schwotzer
- Transplantation Center, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - François Provot
- Department of Nephrology and Renal Transplantation, CHRU de Lille, Lille, France
| | - Simon Ville
- Department of Nephrology and Immunology, CHU de Nantes, Nantes, France
| | | | - Awena Le Fur
- Department of Nephrology, CH La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Sébastien Kissling
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Noémie Jourde-Chiche
- Department of Nephrology, Aix-Marseille Univ, C2VN, INSERM, INRAE, AP-HM CHU de la Conception, Marseille, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne Moreau
- Pathology Department, CHU de Nantes, Nantes, France
| | | | | | | | | | | | | | - Samuel Rotman
- Service of Clinical Pathology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland
| | - Fadi Fakhouri
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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18
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Awada H, Thapa B, Visconte V. The Genomics of Myelodysplastic Syndromes: Origins of Disease Evolution, Biological Pathways, and Prognostic Implications. Cells 2020; 9:E2512. [PMID: 33233642 PMCID: PMC7699752 DOI: 10.3390/cells9112512] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
The molecular pathogenesis of myelodysplastic syndrome (MDS) is complex due to the high rate of genomic heterogeneity. Significant advances have been made in the last decade which elucidated the landscape of molecular alterations (cytogenetic abnormalities, gene mutations) in MDS. Seminal experimental studies have clarified the role of diverse gene mutations in the context of disease phenotypes, but the lack of faithful murine models and/or cell lines spontaneously carrying certain gene mutations have hampered the knowledge on how and why specific pathways are associated with MDS pathogenesis. Here, we summarize the genomics of MDS and provide an overview on the deregulation of pathways and the latest molecular targeted therapeutics.
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Affiliation(s)
- Hassan Awada
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44106, USA;
| | - Bicky Thapa
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Valeria Visconte
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44106, USA;
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19
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Wesner N, Fenaux P, Jachiet V, Ades L, Fain O, Mekinian A. [Behçet's-like syndrome and other dysimmunitary manifestations related to myelodysplastic syndromes with trisomy 8]. Rev Med Interne 2020; 42:170-176. [PMID: 33139078 DOI: 10.1016/j.revmed.2020.08.016] [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: 03/12/2020] [Revised: 08/20/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
Myelodysplastic syndromes (MDS) are clonal hematopoietic malignancies which are also characterised by immune dysregulation. The impaired immune response is mainly due to T lymphocytes (CD8 and T regulatory cells) with increased cell apoptosis. MDS could be associated in some cases with various clinical dysimmune features; however, only MDS with trisomy 8 is correlated with particular clinical phenotype. The latter is mainly Behçet's-like disease which includes orogenital aphtosis, skin features and severe ulcerative digestive disease of ileocaecal distribution. Other clinical manifestations, such as arthritis or neutrophilic dermatosis, have been also described in MDS patients with trisomy 8. The dysimmune manifestations, and among them the Behçet's-like disease, do not impact the overall survival or the risk of progression to acute myeloid leukemia. Immunosuppressive and immunomodulatory therapies, and among them TNF-α inhibitors, are usually ineffective to control the dysimmune manifestations. Targeting the underlying clonal disease with specific therapies, such as azacitidine, seems to be the best strategy to control these disorders, even in MDS patients with low-risk disease.
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Affiliation(s)
- N Wesner
- Department of internal medicine, inflammation-immunopathology-biotherapy department (DMU I3), Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, Sorbonne université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne universités, Inserm U938, centre de recherche Saint-Antoine (CRSA), Paris, France
| | - P Fenaux
- Department of hematology, Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, 75010 Paris, France
| | - V Jachiet
- Department of internal medicine, inflammation-immunopathology-biotherapy department (DMU I3), Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, Sorbonne université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne universités, Inserm U938, centre de recherche Saint-Antoine (CRSA), Paris, France
| | - L Ades
- Department of hematology, Assistance publique-Hôpitaux de Paris, hôpital Saint-Louis, 75010 Paris, France
| | - O Fain
- Department of internal medicine, inflammation-immunopathology-biotherapy department (DMU I3), Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, Sorbonne université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne universités, Inserm U938, centre de recherche Saint-Antoine (CRSA), Paris, France
| | - A Mekinian
- Department of internal medicine, inflammation-immunopathology-biotherapy department (DMU I3), Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, Sorbonne université, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Sorbonne universités, Inserm U938, centre de recherche Saint-Antoine (CRSA), Paris, France.
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20
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Chang MY, Lin SF, Wu SC, Yang WC. Myelodysplastic syndrome: the other cause of anemia in end-stage renal disease patients undergoing dialysis. Sci Rep 2020; 10:15557. [PMID: 32968161 PMCID: PMC7511931 DOI: 10.1038/s41598-020-72568-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/02/2020] [Indexed: 12/29/2022] Open
Abstract
In end-stage renal disease (ESRD) patients receiving dialysis, anemia is common and related to a higher mortality rate. Erythropoietin (EPO) resistance and iron refractory anemia require red blood cell transfusions. Myelodysplastic syndrome (MDS) is a disease with hematopoietic dysplasia. There are limited reports regarding ESRD patients with MDS. We aim to assess whether, for ESRD patients, undergoing dialysis is a predictive factor of MDS by analyzing data from the Taiwan National Health Insurance Research Database. We enrolled 74,712 patients with chronic renal failure (ESRD) who underwent dialysis and matched 74,712 control patients. In our study, we noticed that compared with the non-ESRD controls, in ESRD patients, undergoing dialysis (subdistribution hazard ratio [sHR] = 1.60, 1.16–2.19) and age (sHR = 1.03, 1.02–1.04) had positive predictive value for MDS occurrence. Moreover, more units of red blood cell transfusion (higher than 4 units per month) was also associated with a higher incidence of MDS. The MDS cumulative incidence increased with the duration of dialysis in ESRD patients. These effects may be related to exposure to certain cytokines, including interleukin-1, tumor necrosis factor-α, and tumor growth factor-β. In conclusion, we report the novel finding that ESRD patients undergoing dialysis have an increased risk of MDS.
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Affiliation(s)
- Min-Yu Chang
- Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Sheng-Fung Lin
- Division of Hematology and Medical Oncology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Shih-Chi Wu
- Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan
| | - Wen-Chi Yang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan. .,Faculty of School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Jagadish PS, Uhelski ACR, Redfield J, Thomson N, Ogbeide O. The Pulmonary Complications of Paraneoplastic Autoimmune Vasculitis in a Patient With Myelodysplastic Syndrome. Cureus 2020; 12:e9282. [PMID: 32821625 PMCID: PMC7431304 DOI: 10.7759/cureus.9282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Paraneoplastic autoimmune phenomena may occur in up to 30% of patients with myelodysplastic syndrome (MDS). We present the case of a patient with MDS who developed diffuse alveolar hemorrhage due to paraneoplastic autoimmune vasculitis. The patient was a 55-year-old male who had been referred for outpatient hematology/oncology evaluation by his primary care physician for incidentally discovered thrombocytopenia. When he presented to the clinic, he reported new-onset chills, weakness, and night sweats. He endorsed a 20-pound weight loss over two months as well as two weeks of fatigue, exertional dyspnea, and epistaxis. He was noted to be ill-appearing and had bilateral pitting edema to the knees. Vital signs revealed a temperature of 102.3 °F, oxygen saturation of 84% on room air, and tachycardia to the 90s. Labs showed hemoglobin of 5.7 g/dL, hematocrit of 17.2 g/dL, and platelet count of 27 kµL. He was admitted to the hospital for blood and platelet transfusions, empiric antibiotics, and further diagnostic studies. The peripheral blood smear showed 4% blasts and frequent dyspoietic granulocytes. Bone marrow biopsy (BMB) was performed to differentiate between acute leukemia and myelodysplasia. BMB revealed myelodysplasia with excess blasts and erythroid predominance.During hospitalization, the patient developed acute hypoxemic respiratory failure due to bronchoscopy-confirmed diffuse alveolar hemorrhage from thrombocytopenia. His platelet count was 12 kµL. High-dose corticosteroids (2 mg/kg prednisone) were initiated for suspected paraneoplastic autoimmune vasculitis, pending BMB results. The patient steadily improved, was extubated, and had reduced oxygen and transfusion requirements.High-dose steroids were stopped, and the patient was started on decitabine chemotherapy with the ultimate goal of bone marrow transplantation. On day five of decitabine, the patient developed acute hypoxic respiratory failure requiring intubation as well as hypotension requiring vasopressors. Given that recurrent diffuse alveolar hemorrhage was again suspected, high-dose steroids were resumed upon transfer to the ICU. He continued to decompensate and ultimately experienced ventricular tachycardia requiring three separate episodes of cardiopulmonary resuscitation. Per the family’s wishes, he was palliatively extubated, and he expired an hour later. Diffuse alveolar hemorrhage is a rare but potentially deadly pulmonary complication of MDS, stemming from a paraneoplastic autoimmune vasculitis. Patients who initially present with atypical autoimmune phenomena should raise suspicion for an underlying MDS, the presence of which can guide the promptness, extent, and duration of immunosuppressive therapy. Failure to expeditiously treat these patients with corticosteroids can lead to serious complications and death.
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22
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Roupie AL, Guedon A, Terrier B, Lahuna C, Jachiet V, Regent A, de Boysson H, Carrat F, Seguier J, Terriou L, Versini M, Queyrel V, Groh M, Benhamou Y, Maurier F, Ledoult E, Clech LL, D'Aveni M, Rossignol J, Galland J, Willems L, Chiche NJ, Peterlin P, Roux-Sauvat M, Parcelier A, Wemeau M, Lambert M, Belizna C, Puechal X, Swiader L, Cohen-Valensi R, Noc V, Dao E, Thepot S, de Frémont GM, Tanguy-Schmidt A, Koka AM, Bussone G, Philipponnet C, Konate A, Cavaille G, Guilpain P, Allain JS, Broner J, Solary E, Ruivard M, de Renzis B, Corm S, Baati N, Schleinitz N, Ponsoye M, Stamatoullas-Bastard A, Ades L, Dellal A, Tchirkov A, Aouba A, Fenaux P, Fain O, Mekinian A. Vasculitis associated with myelodysplastic syndrome and chronic myelomonocytic leukemia: French multicenter case-control study. Semin Arthritis Rheum 2020; 50:879-884. [PMID: 32896704 DOI: 10.1016/j.semarthrit.2020.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/13/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Our objective was to evaluate characteristics, treatment and outcome of vasculitis associated with myelodysplastic syndrome (MDS) and chronic myelomonicytic leukemia (CMML) PATIENTS AND METHODS: Retrospective descriptive analysis of MDS/CMML-related vasculitis and comparison with MDS/CMML patients without dysimmune features. RESULTS Seventy patients with vasculitis and MDS/CMML were included, with median age of 71.5 [21-90] years and male/female ratio of 2.3. Vasculitis was diagnosed prior to MDS/CMML in 31 patients (44%), and after in 20 patients. In comparison with MDS/CMML without autoimmune/inflammatory features, vasculitis with MDS/MPN showed no difference in MDS/CMML subtypes distribution nor International Prognostic Scoring System and CMML-specific prognostic (IPSS/CPSS) scores. Vasculitis subtypes included Giant cell arteritis in 24 patients (34%), Behçet's-like syndrome in 11 patients (20%) and polyarteritis nodosa in 6 patients (9%). Glucocorticoids (GCs) were used as first-line therapy for MDS/CMML vasculitis in 64/70 patients (91%) and 41 (59%) received combined immunosuppressive therapies during the follow-up. After a median follow-up of 33.2 months [1-162], 31 patients (44%) achieved sustained remission. At least one relapse occurred in 43 patients (61%). Relapse rates were higher in patients treated with conventional Disease Modifying Anti-Rheumatic Drug (DMARDs) (odds ratio 4.86 [95% CI 1.38 - 17.10]), but did not differ for biologics (odds ratio 0.59 [95% CI 0.11-3.20]) and azacytidine (odds ratio 1.44 [95% CI 0.21-9.76]) than under glucocorticoids. Overall survival in MDS/CMML vasculitis was not significantly different from MDS/CMML patients without autoimmune/inflammatory features (p = 0.5), but acute leukemia progression rates were decreased (log rank <0.05). CONCLUSION This study shows no correlation of vasculitis diagnoses with subtypes and severity of MDS/CMML, and no significant impact of vasculitis on overall survival. Whereas conventional DMARDs seem to be less effective, biologics or azacytidine therapy could be considered for even low-risk MDS/CMML vasculitis.
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Affiliation(s)
- Anne Laure Roupie
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Alexis Guedon
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Constance Lahuna
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Vincent Jachiet
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Alexis Regent
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Hubert de Boysson
- Department of Internal Medicine, CHU Caen, Avenue de la côte de nacre, 14033 Caen, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP Sorbonne Université, Hôpital Saint Antoine, 75012 Paris, France
| | - Julie Seguier
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, CHU Lille, Lille, France
| | | | | | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndromes (CEREO), Foch Hospital, Suresnes, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Rouen, Rouen, France
| | - Francois Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Emmanuel Ledoult
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France
| | | | - Maud D'Aveni
- Department of Hematology, CHU Nancy, Nancy, France
| | - Julien Rossignol
- Department of Hematology, Gustave Roussy Cancer Center, 94805, Villejuif, France
| | - Joris Galland
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Lise Willems
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Noemie Jourde Chiche
- Department of Nephrology, Centre de Néphrologie et de Transplantation Rénale, Assistance Publique-Hôpitaux de Marseille, Hôpital La Conception, Marseille, France
| | | | | | - Anne Parcelier
- Department of Hematology, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | | | - Marc Lambert
- Department of Internal Medicine, CHU Lille, Lille, France
| | - Cristina Belizna
- Department of Vascular Medicine, CHU d'Angers, UMR-CNRS 6015 INSERM 1083, Angers, France
| | - Xavier Puechal
- Department of Internal Medicine - National Reference Center for Rare and Systemic Autoimmune Diseases, Assistance Publique - Hôpitaux deAP-HP, Hôpital Cochin, Université de Paris, Paris, France
| | - Laure Swiader
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Rolande Cohen-Valensi
- Department of Internal Medicine, CH de Martigues Hôpital des Rayettes, Martigues, France
| | - Valérie Noc
- Department of Nephrology, CH Hyères, Hyères, France
| | - Emmanuel Dao
- Department of Nephrology, CH Hyères, Hyères, France
| | | | | | | | | | - Guillaume Bussone
- Department of Internal Medicine, Hôpital Antoine Béclère, Clamart, France
| | | | - Amadou Konate
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Guilhem Cavaille
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | - Philippe Guilpain
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Jean-Sébastien Allain
- Department of Internal Medicine and Clinical Immunology, CHU Lille, Lille, France; Pôle cardio vasculaire et métabolisme, CH Saint-Malo, Saint-Malo, France
| | - Jonathan Broner
- Department of Internal Medicine, CHU de Nîmes, Nîmes, France
| | - Eric Solary
- Department of Hematology, Gustave Roussy Cancer Center, 94805, Villejuif, France
| | - Marc Ruivard
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Benoit de Renzis
- Department of Hematology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sélim Corm
- Department of Hematology, Médipôle de Savoie, Charles Les Eaux, France
| | - Nadia Baati
- Department of Hematology, CH Strasbourg, Strasbourg, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Matthieu Ponsoye
- Department of Internal Medicine, CHU Ambroise Paré, Boulogne- Billancourt, France
| | | | - Lionel Ades
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Azeddine Dellal
- Department of Rheumatology, Montfermeil Hospital, 93370 Montfermeil, France
| | - Andrei Tchirkov
- Department of Medical Cytogenetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Montpellier, Montpellier, France
| | - Pierre Fenaux
- Department of Medical Cytogenetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Fain
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, Paris, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
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Autoimmune disease in CMML-the chicken or the egg? Best Pract Res Clin Haematol 2019; 33:101136. [PMID: 32460986 DOI: 10.1016/j.beha.2019.101136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Abstract
Chronic myelomonocytic leukemia (CMML) is a clonal disorder that is associated with a wide range of systemic inflammatory and autoimmune diseases (SIADs). Approximately 20% of patients with CMML will have an associated SIAD and recognizing this association is critical to the evaluation, prognostication and management of patients with CMML. In this paper, we review the evidence supporting a causative link between these two entities as well as the direction of this relationship. We argue that the data favors CMML as the antecedent and causative disease state with a few notable exceptions. Better understanding of this relationship aids clinicians in the education of their patients and in determining the optimal management approach at the bedside. It is important to recognize opportunities to harmonize the treatments of these disease processes, which may enhance the effectiveness of treatment while reducing the burden of adverse effects from redundant therapies.
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Fozza C, La Nasa G, Caocci G. The Yin and Yang of myelodysplastic syndromes and autoimmunity: The paradox of autoimmune disorders responding to therapies specific for MDS. Crit Rev Oncol Hematol 2019; 142:51-57. [PMID: 31376677 DOI: 10.1016/j.critrevonc.2019.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/25/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022] Open
Abstract
The biological milieu and clinical picture of myelodysplastic syndromes (MDS) is characterised by a variety of immune mechanisms and manifestations, including an increased frequency of autoimmune disorders. The present review will try to shed some light on the potential clinical and pathogenetic implications of these immune processes in MDS by focusing on the beneficial effects exerted by some MDS-modifying therapies on autoimmune manifestations.
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Affiliation(s)
- Claudio Fozza
- Hematology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 12, 07100 Sassari, Italy.
| | - Giorgio La Nasa
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
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Deshayes S, Liozon E, Chanson N, Sacré K, Moulinet T, Blanchard-Delaunay C, Espitia O, Groh M, Versini M, Le Gallou T, Kahn JE, Grobost V, Humbert S, Samson M, Mourot Cottet R, Mazodier K, Dartevel A, Campagne J, Dumont A, Bienvenu B, Lambert M, Daumas A, Saadoun D, Aouba A, de Boysson H. Concomitant association of giant cell arteritis and malignancy: a multicenter retrospective case-control study. Clin Rheumatol 2019; 38:1243-1249. [PMID: 30617596 DOI: 10.1007/s10067-018-04407-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Some studies suggest that there is an increased risk of malignancies in giant cell arteritis (GCA). We aimed to describe the clinical characteristics and outcomes of GCA patients with concomitant malignancy and compare them to a GCA control group. METHOD Patients with a diagnosis of GCA and malignancy and with a maximal delay of 12 months between both diagnoses were retrospectively included in this study and compared to a control group of age-matched (3:1) patients from a multicenter cohort of GCA patients. RESULTS Forty-nine observations were collected (median age 76 years). Malignancies comprised 33 (67%) solid neoplasms and 16 (33%) clonal hematologic disorders. No over-representation of a particular type of malignancy was observed. Diagnosis of GCA and malignancy was synchronous in 7 (14%) patients, while malignancy succeeded GCA in 29 (59%) patients. Malignancy was fortuitously diagnosed based on abnormalities observed in laboratory tests in 26 patients, based on imaging in 14 patients, and based on symptoms or clinical examination in the nine remaining patients. Two patients had a concomitant relapse of both conditions. When compared to the control group, patients with concomitant GCA and malignancy were more frequently male (p < 0.001), with an altered general state (p < 0.001), and polymyalgia rheumatica (p < 0.01). CONCLUSIONS This study does not indicate an over-representation of any particular type of malignancy in GCA patients. Initial follow-up dictated by vasculitis may have led to an early identification of malignancy. Nevertheless, GCA male patients with an altered general state and polymyalgia rheumatica might more frequently show concomitant malignancies.
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Affiliation(s)
- S Deshayes
- Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue de la Côte de Nacre, 14000, Caen, France
| | - E Liozon
- Department of Internal Medicine, CHU Limoges, Limoges, France
| | - N Chanson
- Department of Internal Medicine, Hôpital Bichat, Paris, France
| | - K Sacré
- Department of Internal Medicine, Hôpital Bichat, Paris, France
| | - T Moulinet
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - C Blanchard-Delaunay
- Department of Internal Medicine, Centre Hospitalier Georges Renon, Niort, France
| | - O Espitia
- Department of Internal Medicine, CHU Nantes, Nantes, France
| | - M Groh
- Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndromes (CEREO), Hôpital Foch, Suresnes, France
| | - M Versini
- Institut Arnault Tzanck, Saint Laurent du Var, France
| | - T Le Gallou
- Department of Internal Medicine, CHU Rennes, Rennes, France
| | - J-E Kahn
- Department of Internal Medicine, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - V Grobost
- Department of Internal Medicine, CHU Estaing, Clermont-Ferrand, France
| | - S Humbert
- Department of Internal Medicine, CHU de Besançon, Besançon, France
| | - M Samson
- Department of Internal Medicine and Clinical Immunology, CHU Dijon, Dijon, France
| | - R Mourot Cottet
- Department of Internal Medicine, Hôpital Civil, Strasbourg, France
| | - K Mazodier
- Department of Internal Medicine, Hôpital de la Conception, Marseille, France
| | - A Dartevel
- Department of Internal Medicine, CHU Grenoble, Grenoble, France
| | - J Campagne
- Department of Infectious and Systemic Diseases, Hôpital d'Instruction des Armées, Metz, France
| | - A Dumont
- Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue de la Côte de Nacre, 14000, Caen, France
| | - B Bienvenu
- Department of Internal Medicine, Hôpital Saint Joseph, Marseille, France
| | - M Lambert
- Department of Internal Medicine, CHU de Lille, Lille, France
| | - A Daumas
- Department of Geriatric and Internal Medicine, CHU de Marseille, Marseille, France
| | - D Saadoun
- Department of Internal Medicine, Hôpital Pitié Salpétrière, Paris, France
| | - A Aouba
- Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue de la Côte de Nacre, 14000, Caen, France
| | - H de Boysson
- Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, Avenue de la Côte de Nacre, 14000, Caen, France.
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Retuning the immune system in myelodysplastic syndromes: from immunomodulatory approaches to vaccination strategies and non myeloablative hemopoietic cell transplant. Crit Rev Oncol Hematol 2019; 133:112-119. [DOI: 10.1016/j.critrevonc.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/09/2018] [Accepted: 11/05/2018] [Indexed: 12/24/2022] Open
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Creamer AW, Protheroe R, Gunawardena H, Barratt SL. Pancytopaenia and breathlessness: Hickam’s Dictum prevails! Thorax 2018; 73:1187-1190. [DOI: 10.1136/thoraxjnl-2018-212088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/04/2022]
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Jacobse J, Sijpkens YWJ, van 't Wout JW, Peters EEM, Vlasveld LT. Vasculitis in Myelodysplastic Syndrome and Chronic Myelomonocytic Leukemia: A Report of Two Cases. J Hematol 2018; 7:158-162. [PMID: 32300432 PMCID: PMC7155851 DOI: 10.14740/jh461w] [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: 09/07/2018] [Accepted: 10/18/2018] [Indexed: 11/30/2022] Open
Abstract
There is a clear association between myelodysplastic syndrome (MDS)/chronic myelomonocytic leukemia (CMML) and autoimmune manifestations such as vasculitis. It is not clear if autoimmune manifestations in myelodysplastic syndrome are a cause or consequence. We describe two patients with polyarteritis nodosa and large vessel vasculitis, as presenting symptom of a myelodysplastic syndrome with excess blasts type 2 and chronic myelomonocytic leukemia respectively. Immunosuppressive treatment resulted in amelioration of the vasculitis with improvement of the myelodysplastic features in the first patient and rapid evolution to acute myeloid leukemia in the other patient. The association between MDS/CMML and autoimmune manifestations, such as vasculitis, emphasizes the role of autoimmunity in the clinical features and even pathogenesis of MDS/CMML.
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Affiliation(s)
- Justin Jacobse
- Department of Internal Medicine, HMC Bronovo, The Hague, Netherlands
| | - Yvo W J Sijpkens
- Department of Internal Medicine, HMC Bronovo, The Hague, Netherlands
| | - Jan W van 't Wout
- Department of Internal Medicine, HMC Bronovo, The Hague, Netherlands
| | - Elke E M Peters
- Department of Pathology, HMC Bronovo, The Hague, Netherlands
| | - L Tom Vlasveld
- Department of Internal Medicine, HMC Bronovo, The Hague, Netherlands
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Seguier J, Gelsi-Boyer V, Ebbo M, Hamidou Z, Charbonnier A, Bernit E, Durand JM, Harlé JR, Vey N, Schleinitz N. Autoimmune diseases in myelodysplastic syndrome favors patients survival: A case control study and literature review. Autoimmun Rev 2018; 18:36-42. [PMID: 30408583 DOI: 10.1016/j.autrev.2018.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 07/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND We conducted a monocentric retrospective study of patients with myelodysplastic syndromes (MDS) and autoimmune or inflammatory disorders (AIMs) and a literature review. We analyzed the association with subgroups of the WHO 2016 MDS classification and patient's survival in a case control study. Risk factors associated with survival were analyzed by uni- and multivariate analysis. RESULTS From all MDS patients 11% presented with AIMs. These were heterogeneous and the most frequent where polyarthritis (25%) and autoimmune cytopenias (17%). No difference for frequency and type of AIMs was observed for the WHO 2016 MDS subgroups (p = .3). In the case control study WHO classification, karyotype abnormalities, IPSS-R and IPSS were similar in both groups. The overall survival from MDS diagnosis was better in the group with AIMs [10.3 ± 0.6 (IC95% 6.2-12.9) versus 4.8 ± 1.1 years (IC95% 4.2-8.7), p = .04]. The better survival was restricted to MDS with low or intermediate-1 IPSS [11.1 ± 1.5 (IC95% 9.9-NR) versus 8.7 ± 1.3 years (IC95% 4.8-10.3), p = .006]. The better survival was only observed when AIMs diagnosis was timely associated or appeared after MDS diagnosis (p = .04). Factors associated with a better overall survival and survival without AML were steroid dependence [respectively HR = 0.042, p = .003, (IC95% 0.005-0.33) and HR = 0.07, p = .002, (IC95% 0.013-0.39)], a diagnosis of AIMs and MDS timely associated [respectively HR = 0.05, p = .009, (IC95% 0.006-0.478) and HR = 0.1, p = .008, (IC95% 0.018-0.54)] or a diagnosis of AIMs after MDS [respectively HR = 0.024, p = .009, (IC95% 0.001-0.39) and HR = 0.04, p = .008, (IC95% 0.003-0.43)]. CONCLUSION Autoimmune and inflammatory diseases associated to MDS are heterogeneous. AIMs diagnosed after or concomitantly to MDS seems associated with a better survival. Prospective studies are necessary to demonstrate that autoimmunity is associated to a better control of the MDS clone.
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Affiliation(s)
- Julie Seguier
- Aix-Marseille Univ, APHM, Medecine Interne Hôpital de la Timone, Marseille, France
| | | | - Mikael Ebbo
- Aix-Marseille Univ, APHM, Medecine Interne Hôpital de la Timone, Marseille, France
| | - Zeinab Hamidou
- Aix-Marseille Univ, APHM, EA 3279, Département de santé publique, Marseille, France
| | - Aude Charbonnier
- Institut Paoli-Calmettes, Département d'Hématologie, Marseille, France
| | - Emmanuelle Bernit
- Aix-Marseille Univ, APHM, Medecine Interne Hôpital de la Timone, Marseille, France
| | - Jean-Marc Durand
- Aix-Marseille Univ, APHM, Medecine Interne Hôpital de la Timone, Marseille, France
| | - Jean-Robert Harlé
- Aix-Marseille Univ, APHM, Medecine Interne Hôpital de la Timone, Marseille, France
| | - Norbert Vey
- Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Nicolas Schleinitz
- Aix-Marseille Univ, APHM, Medecine Interne Hôpital de la Timone, Marseille, France.
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Senjo H, Higuchi T, Morimoto M, Koyamada R, Yanaoka C, Okada S. Simultaneous Presentation of Giant Cell Arteritis and Myelodysplastic Syndrome in an Elderly Japanese Man. Intern Med 2018; 57:2889-2893. [PMID: 29780154 PMCID: PMC6207824 DOI: 10.2169/internalmedicine.9791-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
An 81-year-old Japanese man presented with constitutional symptoms and anemia and was diagnosed with giant cell arteritis (GCA) and myelodysplastic syndrome (MDS) simultaneously. His symptoms and anemia improved promptly with steroids; however, the MDS rapidly progressed to overt leukemia. While MDS patients are at an increased risk of autoimmune diseases, an association with GCA has rarely been reported. This case illustrates the importance of considering GCA as a cause of anemia in elderly patients if MDS is already diagnosed, even in countries where the prevalence of GCA is very low. The simultaneous development of GCA and MDS suggests a common pathogenetic link between these two diseases.
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Affiliation(s)
- Hajime Senjo
- Internal Medicine, St. Luke' s International Hospital, Japan
| | - Takakazu Higuchi
- Division of Hematology, St. Luke' s International Hospital, Japan
| | - Masaya Morimoto
- Division of Hematology, St. Luke' s International Hospital, Japan
| | - Ryosuke Koyamada
- Division of Hematology, St. Luke' s International Hospital, Japan
| | - Chisun Yanaoka
- Immuno-Rheumatology Center, St. Luke' s International Hospital, Japan
| | - Sadamu Okada
- Division of Hematology, St. Luke' s International Hospital, Japan
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31
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Hematological malignancies mimicking rheumatic syndromes: case series and review of the literature. Rheumatol Int 2018; 38:1743-1749. [DOI: 10.1007/s00296-018-4107-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022]
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32
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Serizawa K, Tanaka H, Morita Y, Taniguchi T, Ashida T, Matsumura I. Immunemodulatory Effects of 5-Azacitidin Through Expansion of Functional Regulatory T Cells on Paraneoplastic Inflammation Associated With Myelodysplastic Syndromes: A Case Report. Front Oncol 2018; 8:204. [PMID: 29922595 PMCID: PMC5996049 DOI: 10.3389/fonc.2018.00204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/21/2018] [Indexed: 01/18/2023] Open
Abstract
Myelodysplastic syndrome (MDS) is a heterogeneous group of clonal disorders of hematopoietic stem cells, characterized by dysplastic hematopoiesis and dysregulated immune system resulting in various clinical conditions. Paraneoplastic inflammatory syndromes, which are well known to be associated with MDS, show response to immune-modulated therapy and often disappear during the course of hematologic management. Azacitidine (5-Aza) was shown to prolong survival of high-risk MDS patients, however, the effects of 5-Aza on paraneoplastic inflammation in MDS have yet to be elucidated. 5-Aza was administered to a 60-year-old man with MDS accompanying Sweet’s syndrome at a dose of 75 mg/m2/daily subcutaneously for 7 days every 28 days. 5-Aza was not only effective in controlling systemic symptoms caused by paraneoplastic inflammation, but hematologic improvements were also observed after four cycles of the 5-Aza treatment. Immune profiling in peripheral blood before and after 5-Aza treatment revealed that the effector and naive regulatory T cells in lymphocytes drastically increased after the 5-Aza treatment, i.e., 5-Aza might induce a shift in lymphocytic populations toward immunosuppression in this patient. Our results raised the immune-mediated effect of 5-Aza on both dysplastic hematopoiesis and paraneoplastic inflammation in myelodyplastic syndromes.
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Affiliation(s)
- Kentaro Serizawa
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Hirokazu Tanaka
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Yasuyoshi Morita
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Takahide Taniguchi
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Takashi Ashida
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
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33
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Bernat AL, Priola SM, Elsawy A, Farrash F, Taslimi S, Gentili F. Chronic subdural collection overlying an intra-axial hemorrhagic lesion in chronic myelomonocytic leukemia: special report and review of the literature. Expert Rev Neurother 2018; 18:371-377. [PMID: 29658352 DOI: 10.1080/14737175.2018.1464391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Chronic myelomonocytic leukaemia (CMML) is a clonal hematopoietic stem cell disorder characterized by the presence of an absolute monocytosis in the peripheral blood (>1 x 109/L) and the presence of myelodysplastic and myeloproliferative features in the bone marrow. Involvement of the central nervous system (CNS) is uncommon in CMML.Areas covered: Herein described is a case report of a CMML patient who presents with symptomatic chronic subdural collection overlying a haemorrhagic brain lesion, along with diffuse dural infiltration, after two cycles of azacytidine. Surgical intervention was performed to alleviate the mass effect on the brain, and obtain a tissue sample for diagnosis. Histopathological report confirmed brain infiltration with myeloid leukemic cells.Expert commentary: Despite its rarity, cerebral dissemination should be considered even in patients with CMML. A multidisciplinary approach, lead by a hematologist, is mandatory in order to correct the underlying haematological disorder, with specific attention to the coagulation profile. Surgical intervention is necessary for symptomatic patients, and should be performed once an improvement of clinical conditions has been achieved. Despite appropriate surgical and medical therapy, the prognosis remains poor with high risk of perioperative complications, such as rebleeding, and progressive systemic involvement.
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Affiliation(s)
- Anne-Laure Bernat
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Stefano Maria Priola
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Ahmad Elsawy
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Faisal Farrash
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Shervin Taslimi
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Fred Gentili
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
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Autoimmune disorders are common in myelodysplastic syndrome patients and confer an adverse impact on outcomes. Ann Hematol 2018; 97:1349-1356. [PMID: 29572561 DOI: 10.1007/s00277-018-3302-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/11/2018] [Indexed: 12/19/2022]
Abstract
The coexistence of autoimmune disorders (AD) in patients with myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML) has been widely recognized, although with distinct results regarding their prevalence and impact on the outcomes of the underlying hematological process. This study was aimed to analyze the prevalence, clinical characteristics, and outcomes of MDS with AD in a series of 142 patients diagnosed with MDS and CMML. AD was ascertained by both the presence of clinical symptoms or compatible serological tests. In total, 48% patients were diagnosed as having AD, being hypothyroidism the most commonly reported clinical AD (8%) and antinuclear antibodies the most frequent serological parameter identified (23.2%). The presence of AD was associated with female gender, lower hemoglobin levels, and higher IPSS-R. Overall survival for patients with AD was inferior to those with no AD (69 vs. 88% at 30 months; HR 2.75, P = 0.008). Notably, clinical but not isolated immune serological parameters had an impact on the outcomes of patients with AD. Finally, in a multivariate analysis, the presence of AD (HR 2.26) along with disease risk categories (very low and low vs. intermediate, high, and very high IPSS-R; HR 4.62) retained their independent prognostic value (P < 0.001). In conclusion, AD are prevalent in MDS and CMML patients and have prognostic implications, especially in lower-risk MDS patients.
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35
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Wang S, Broder N, Marchetta P, Nowatzky J. Myelodysplastic syndrome presenting as a Behçet's-like disease with aortitis. BMJ Case Rep 2018; 2018:bcr-2017-220649. [PMID: 29545422 DOI: 10.1136/bcr-2017-220649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 46-year-old Hispanic man presented with fever, genital ulcers, left eye redness and chest pain. Physical examination was notable for a healed oral ulcer and scrotal ulcers, and bilateral superficial thrombophlebitis. He was found to have new-onset pancytopenia. CT of the chest showed pericardial and pleural effusions and rapidly progressing inflammation of the aortic arch and ascending vessels. Although the patient had Behcet's disease (BD)-like symptoms, pancytopenia could not be explained by the diagnosis, prompting a bone marrow biopsy which showed myelodysplastic syndrome. This report highlights the importance of excluding alternate disorders before making a diagnosis of Behcet's disease if atypical, BD-incompatible or incomplete constellations of symptoms and findings are present.
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Affiliation(s)
- Shudan Wang
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, USA
| | - Noam Broder
- Department of Medicine, NYU School of Medicine, New York, USA
| | - Paula Marchetta
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, USA
| | - Johannes Nowatzky
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, USA
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36
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37
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Rajabally YA, Attarian S. Chronic inflammatory demyelinating polyneuropathy and malignancy: A systematic review. Muscle Nerve 2017; 57:875-883. [PMID: 29194677 DOI: 10.1002/mus.26028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 12/19/2022]
Abstract
A systematic review of the literature was performed on the association of chronic inflammatory demyelinating polyneuropathy (CIDP) with malignancy. Hematological disorders are the most common association, particulalry non-Hodgkin lymphoma. CIDP frequently precedes the malignancy diagnosis, and there is a favorable CIDP response to treatment more than 70% of the time. Melanoma is the second most common association and may be accompanied by antiganglioside antibodies; CIDP shows a good response to immunotherapy. Other cancers are rare, with variable timings and presentations but good responses to immunomodulation and/or cancer therapy. Unusual neurological features such as ataxia, distal/upper limb predominance, or cranial/respiratory/autonomic involvement may suggest associated malignancy as may abdominal pain, diarrhea/constipation, poor appetite/weight loss, dermatological lesions, and lymphadenopathy. In the appropriate clinical and electrophysiological setting, CIDP associated with cancer should be considered. Immunomodulatory therapy, cancer treatment alone, or a combination may be effective. Muscle Nerve 57: 875-883, 2018.
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Affiliation(s)
- Yusuf A Rajabally
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom.,Regional Neuromuscular Service, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Shahram Attarian
- Reference Centre for Neuromuscular Diseases and ALS, Centre Hospitalier Universitaire La Timone, Marseille, France.,Aix-Marseille University, Inserm, GMGF, Marseille, France
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38
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Li AW, Yin ES, Stahl M, Kim TK, Panse G, Zeidan AM, Leventhal JS. The skin as a window to the blood: Cutaneous manifestations of myeloid malignancies. Blood Rev 2017; 31:370-388. [DOI: 10.1016/j.blre.2017.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/26/2017] [Accepted: 07/11/2017] [Indexed: 12/18/2022]
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39
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Gao Y, Gong M, Zhang C, Kong X, Ma Y. Successful eltrombopag treatment of severe refractory thrombocytopenia in chronic myelomonocytic leukemia: Two cases reports: A CARE-compliant article. Medicine (Baltimore) 2017; 96:e8337. [PMID: 29069007 PMCID: PMC5671840 DOI: 10.1097/md.0000000000008337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Thrombocytopenia in chronic myelomonocytic leukemia (CMML) is usually attributed to impaired marrow production resulting from cytotoxic drug use or CMML itself ("CMML-induced thrombocytopenia"). In very rare cases, immune thrombocytopenia (ITP) can be a complication of CMML ("CMML-associated ITP"). However, treatment of severe thrombocytopenia in patients with CMML is still a challenge. PATIENT CONCERNS Case 1 was a 61-year-old female patient admitted to our hospital because of skin petechiae and purpura for 6 days. She had increased monocyte cell count (1.82 × 10/L), markedly decreased platelet count (2 × 10/L), hypercellularity of the megakaryocyte lineage with many immature megakaryocytes, and ZRSR2(zinc finger CCCH-type, RNA binding motif and serine/arginine rich 2) mutation. She failed to the treatment of corticosteroids, intravenous immunoglobulin (IVIg), TPO (thrombopoietin), and cyclosporin A (CsA). Case 2 was a 72-year-old female patient with thrombocytosis and monocytosis for 4 years, and thrombocytopenia for 6 months. After 10 courses of decitabine therapy, she had a persistent severe thrombocytopenia and decreased number of megakaryocytes, TET2 (tet methylcytosine dioxygenase 2) and SRSF2 (serine and arginine rich splicing factor 2) mutations were detected. She was dependent on platelet transfusion. DIAGNOSES Case 1 was diagnosed as CMML-associated ITP, and case 2 as CMML with decitabine therapy-induced thrombocytopenia. INTERVENTIONS Both patients were treated with eltrombopag. OUTCOMES In both patients, the platelet counts returned to the normal within 1 week after eltrombopag therapy. The platelet count in case 1 patient remained stable at 141-200 × 10/L for 20 months with stopping therapy for 3 months. In case 2 patient, eltrombopag was stopped 1 month later. Her platelet count decreased to 41 × 10/L, but was stable at ∼30 × 10/L for 3 months with platelet transfusion independency for 12 months. Both patients had no adverse effects with eltrombopag. LESSONS CMML-associated ITP is very rare and easily misdiagnosed. To the best of our knowledge, case 1 is the first reported case of the successful treatment of CMML-associated ITP with eltrombopag. Both CMML-associated ITP and decitabine therapy-induced thrombocytopenia in these 2 patients were highly sensitive and safe to eltrombopag therapy.
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MESH Headings
- Aged
- Antimetabolites, Antineoplastic/adverse effects
- Azacitidine/adverse effects
- Azacitidine/analogs & derivatives
- Benzoates/administration & dosage
- DNA-Binding Proteins/genetics
- Decitabine
- Dioxygenases
- Drug Monitoring
- Female
- Hematologic Agents/administration & dosage
- Humans
- Hydrazines/administration & dosage
- Leukemia, Myelomonocytic, Chronic/blood
- Leukemia, Myelomonocytic, Chronic/complications
- Leukemia, Myelomonocytic, Chronic/diagnosis
- Leukemia, Myelomonocytic, Chronic/drug therapy
- Middle Aged
- Mutation
- Nuclear Proteins/genetics
- Platelet Count/methods
- Proto-Oncogene Proteins/genetics
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Purpura, Thrombocytopenic, Idiopathic/physiopathology
- Pyrazoles/administration & dosage
- Ribonucleoproteins/genetics
- Serine-Arginine Splicing Factors/genetics
- Thrombocytopenia/chemically induced
- Thrombocytopenia/diagnosis
- Thrombocytopenia/drug therapy
- Thrombocytopenia/physiopathology
- Thrombopoietin/agonists
- Treatment Outcome
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Affiliation(s)
| | | | | | - Xudong Kong
- Department of Pharmacology, China-Japan Friendship Hospital, Beijing, China
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40
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Mekinian A, Dervin G, Lapidus N, Kahn JE, Terriou L, Liozon E, Grignano E, Piette JC, Rauzy OB, Grobost V, Godmer P, Gillard J, Rossignol J, Launay D, Aouba A, Cardon T, Bouillet L, Broner J, Vinit J, Ades L, Carrat F, Salvado C, Toussirot E, Versini M, Costedoat-Chalumeau N, Fraison JB, Guilpain P, Fenaux P, Fain O. Biologics in myelodysplastic syndrome-related systemic inflammatory and autoimmune diseases: French multicenter retrospective study of 29 patients. Autoimmun Rev 2017; 16:903-910. [DOI: 10.1016/j.autrev.2017.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 12/23/2022]
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41
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Fozza C. The burden of autoimmunity in myelodysplastic syndromes. Hematol Oncol 2017; 36:15-23. [PMID: 28449370 DOI: 10.1002/hon.2423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 12/19/2022]
Abstract
The clinical history of patients with myelodysplastic syndromes (MDS) is characterised by bone marrow insufficiency as well as by the possible evolution into acute leukaemia. However a number of reports highlight the frequent occurrence of autoimmune manifestations involving different sites and organs. The present review will first describe the clinical pictures most often observed in MDS patients. The actual burden of autoimmunity will be then addressed by focusing on the few available registry studies. Finally, the potential collateral impact of specific treatments for MDS on the evolution of autoimmune disorders will be considered.
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Affiliation(s)
- Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
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42
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Yamakawa K, Yoshino T, Watanabe K, Kawano K, Kurita A, Matsuzaki N, Yuba Y, Yazumi S. Effectiveness of cyclosporine as a treatment for steroid-resistant Cronkhite-Canada syndrome; two case reports. BMC Gastroenterol 2016; 16:123. [PMID: 27716071 PMCID: PMC5053148 DOI: 10.1186/s12876-016-0541-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/26/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cronkhite-Canada syndrome (CCS) is a rare non-inherited disorder, characterized by gastrointestinal polyposis and ectodermal changes. The pathophysiology remains unclear. Treatment with corticosteroids is considered the mainstay treatment because of its high efficacy. However, some patients have steroid-resistant CCS. The therapeutic strategy for steroid-resistant CCS is not yet established. We report two cases with steroid-resistant CCS that were effectively treated with cyclosporine (CyA). We evaluated the therapeutic strategy for steroid-resistant CCS based on reviews of previous reports. CASE PRESENTATION Our patients with CCS were first treated with prednisolone. No clinical response was noted, and treatment with CyA was initiated. After beginning CyA treatment, both clinical symptoms and polyposis markedly improved. Up to the present, 55 cases of CCS treated with corticosteroids and their response were reported. Out of the 57 patients, including our 2 cases, 9 (16 %) did not respond clinically to corticosteroids. In 7 of the 9 steroid-resistant cases, the prognosis after corticosteroids treatment was described. In 5 of the 7 steroid-resistant cases, immunosuppressive treatments induced remission. In 4 of these 5 cases, moreover, the key drug of treatments was calcineurin inhibitor. CONCLUSIONS Treatment with calcineurin inhibitor, such as CyA, could be a potential option for steroid-resistant CCS.
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Affiliation(s)
- Kohei Yamakawa
- Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480 Japan
| | - Takuya Yoshino
- Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480 Japan
| | - Kotaro Watanabe
- Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480 Japan
| | - Koichiro Kawano
- Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480 Japan
| | - Akira Kurita
- Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480 Japan
| | - Naomi Matsuzaki
- Department of Pathology, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480 Japan
| | - Yoshiaki Yuba
- Department of Pathology, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480 Japan
| | - Shujiro Yazumi
- Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480 Japan
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43
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Lee SH, Kim JH, Park S, Won CY, Lee JH, Yi SY, Park HK, Chang SH, Jung H, Lee SS, Koo HK. Pulmonary Leukocytoclastic Vasculitis as an Initial Presentation of Myelodysplastic Syndrome. Tuberc Respir Dis (Seoul) 2016; 79:302-306. [PMID: 27790283 PMCID: PMC5077735 DOI: 10.4046/trd.2016.79.4.302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/07/2015] [Accepted: 08/10/2016] [Indexed: 11/24/2022] Open
Abstract
Systemic vasculitis involving the lung is a rare manifestation of myelodysplastic syndrome (MDS), and secondary vasculitis is considered to have poor prognosis. A 44-year-old man presented with fever and dyspnea of 1 month duration. A chest radiograph revealed bilateral multiple wedge shaped consolidations. In addition, the results of a percutaneous needle biopsy for non-resolving pneumonia were compatible with pulmonary vasculitis. Bone marrow biopsy was performed due to the persistence of unexplained anemia and the patient was diagnosed with MDS. We reported a case of secondary vasculitis presenting as non-resolving pneumonia, later diagnosed as paraneoplastic syndrome of undiagnosed MDS. The cytopenia and vasculitis improved after a short course of glucocorticoid treatment, and there was no recurrence despite the progression of underlying MDS.
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Affiliation(s)
- Seung Hyun Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jae Hyung Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sejin Park
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Chang Youn Won
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Joo-Hyun Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Seong Yoon Yi
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hye Kyeong Park
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sun Hee Chang
- Department of Pathology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hoon Jung
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung-Soon Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hyeon-Kyoung Koo
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Zeidan AM, Stahl M, Komrokji R. Emerging biological therapies for the treatment of myelodysplastic syndromes. Expert Opin Emerg Drugs 2016; 21:283-300. [DOI: 10.1080/14728214.2016.1220534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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45
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Wolach O, Stone R. Autoimmunity and Inflammation in Myelodysplastic Syndromes. Acta Haematol 2016; 136:108-17. [PMID: 27337745 DOI: 10.1159/000446062] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 01/28/2023]
Abstract
Autoimmune and inflammatory conditions (AICs) are encountered in up to 25% of patients with myelodysplastic syndromes (MDS). A wide range of AICs have been reported in association with MDS and can range from limited clinical manifestations to systemic diseases affecting multiple organs. Vasculitides, connective tissue diseases, and inflammatory arthritis are frequently reported in different studies; noninfectious fever and constitutional symptoms at presentation are common. Associations between AICs and specific MDS characteristics vary by study, but the available data suggest that AICs cluster more often in younger patients with higher-risk MDS. In general, AICs do not seem to confer worse survival, although certain AICs may be associated with adverse outcome (e.g. vasculitis) or progression of MDS (Sweet's syndrome). Nonetheless, these complications may have a significant impact on quality of life and affect the timing and type of MDS-directed therapy. The mainstay of management of these complications in the short term relies on immunosuppressive drugs. Increasing evidence suggests that hypomethylating agents may be effective in treating these complications and reduce steroid dependence. While the pathogenesis of AICs is incompletely understood, growing appreciation of cellular immune deregulation, cytokine hypersecretion, and the genetic heterogeneity underlying MDS may improve our understanding of common pathways linking MDS, inflammation, and autoimmunity.
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Affiliation(s)
- Ofir Wolach
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass., USA
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Williamson BT, Foltz L, Leitch HA. Autoimmune Syndromes Presenting as a Paraneoplastic Manifestation of Myelodysplastic Syndromes: Clinical Features, Course, Treatment and Outcome. Hematol Rep 2016; 8:6480. [PMID: 27499837 PMCID: PMC4961871 DOI: 10.4081/hr.2016.6480] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/30/2016] [Accepted: 05/02/2016] [Indexed: 12/28/2022] Open
Abstract
Autoimmune manifestations (AIM) are reported in up to 10-30% of myelodysplastic syndromes (MDS) patients; this association is not well defined. We present herein a retrospective chart review of single center MDS patients for AIM, a case discussion and a literature review. Of 252 MDS patients examined, 11 (4.4%) had AIM around MDS diagnosis. International Prognostic Scoring System scores were: low or intermediate (int)-1 (n=7); int-2 or high (n=4). AIM were: culture negative sepsis (n=7); inflammatory arthritis (n=3); vasculitis (n=4); sweats; pericarditis; polymyalgia rheumatica (n=2 each); mouth ulcers; pulmonary infiltrates; suspicion for Behcet's; polychondritis and undifferentiated (n=1 each). AIM treatment and outcome were: prednisone +/- steroid sparing agents, n=8, ongoing symptoms in 5; azacitidine (n=3), 2 resolved; and observation, n=1, ongoing symptoms. At a median follow up of 13 months, seven patients are alive. In summary, 4.4% of MDS patients presented with concomitant AIM. MDS should remain on the differential diagnosis of patients with inflammatory symptoms.
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Affiliation(s)
- Bradley T. Williamson
- Departments of Medicine, St. Paul’s Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Lynda Foltz
- Departments of Hematology, St. Paul’s Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Heather A. Leitch
- Departments of Hematology, St. Paul’s Hospital and the University of British Columbia, Vancouver, BC, Canada
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Lee SJ, Park JK, Lee EY, Joo SH, Jung KC, Lee EB, Song YW, Yoon SS. Certain Autoimmune Manifestations Are Associated With Distinctive Karyotypes and Outcomes in Patients With Myelodysplastic Syndrome: A Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e3091. [PMID: 27043672 PMCID: PMC4998533 DOI: 10.1097/md.0000000000003091] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Autoimmune manifestations (AIMs) are common in patients with myelodysplastic syndrome (MDS). This study aimed to investigate whether AIMs are associated with a specific cytogenetic abnormalities and worse survival in patients with MDS. A total of 67 MDS patients with AIMs and 134 age- and sex-matched MDS patients without AIMs, all of whom received medical care at Seoul National University Hospital from January 2000 through July 2014, were enrolled. The clinical features, chromosomal abnormalities, and outcomes were examined. The effect of AIMs on mortality was estimated after adjusting for age, sex, and the International Prognostic Scoring System. The mean age (±SD) at the time of MDS diagnosis was 54.5 ± 17.1 years, and 44.8% of patients were male. Neutrophilic dermatosis (ND; Sweet syndrome and pyoderma gangrenosum) was the most prevalent AIM (n = 24 36%]), followed by Behcet disease (10 [15%]), rheumatoid arthritis (9 [13%]), vasculitis (8 [12%]), myositis (3 [4%]), spondyloarthropathy (3 [4%]), and systemic lupus erythematous (2 [3%]). ND and vasculitis occurred at the time of MDS diagnosis, whereas other AIMs occurred years after MDS diagnosis. Deletion of 5q was associated with ND (P = 0.001), whereas trisomy 8 was associated with Behcet disease (P = 0.015). Strikingly, ND was associated with a 1.8-fold increase in mortality (95% CI 1.033-3.093; P = 0.038). Certain AIMs in MDS patients are associated with distinctive karyotypes and worse survival. A larger study is needed to confirm whether the presence of AIMs influences disease outcome in MDS.
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Affiliation(s)
- Sang Jin Lee
- From the Division of Rheumatology (SJL, JKP, EYL, EBL, YWS), Seoul National University Hospital; Department of Molecular Medicine and Biopharmaceutical Sciences (SJL, JKP, YWS), Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul; Division of Rheumatology (SHJ), Chung Buk University Hospital, Cheongju, Department of Pathology (KCJ); and Division of Hematology and Oncology (S-SY), Seoul National University Hospital, Seoul, Korea
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48
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Higher Risk Myelodysplastic Syndromes in Patients with Well-Controlled HIV Infection: Clinical Features, Treatment, and Outcome. Case Rep Hematol 2016; 2016:8502641. [PMID: 26904323 PMCID: PMC4745308 DOI: 10.1155/2016/8502641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/27/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction. In advanced HIV prior to combination antiretroviral therapy (ART), dysplastic marrow changes occurred and resolved with ART. Few reports of myelodysplastic syndromes (MDS) in well-controlled HIV exist and management is undefined. Methods. Patients with well-controlled HIV and higher risk MDS were identified; characteristics, treatment, and outcomes were reviewed. Results. Of 292 MDS patients since 1996, 1 (0.3%) was HIV-positive. A 56-year-old woman presented with cytopenias. CD4 was 1310 cells/mL and HIV viral load <40 copies/mL. Bone marrow biopsy showed RCMD and karyotype included del(5q) and del(7q); IPSS was intermediate-2 risk. She received azacitidine at 75% dose. Cycle 2, at full dose, was complicated by marrow aplasia and possible AML; she elected palliation. Three additional HIV patients with higher risk MDS, aged 56-64, were identified from the literature. All had deletions involving chromosomes 5 and 7. MDS treatment of 2 was not reported and one received palliation; all died of AML. Conclusion. Four higher risk MDS in well-controlled HIV were below the median age of diagnosis for HIV-negative patients; all had adverse karyotype. This is the first report of an HIV patient receiving MDS treatment with azacitidine. Cytopenias were profound and dosing in HIV patients should be considered with caution.
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Abstract
Myelodysplastic syndrome (MDS) encompasses a heterogeneous group of diseases originating in hematopoietic stem cells and is characterized by inefficient hematopoiesis and dysplastic changes in the bone marrow. In peripheral blood patients show anemia (mostly macrocytic), frequently accompanied by neutropenia and thrombocytopenia. Thus, clinically the patients suffer from fatigue (anemia), increased bleeding (thrombocytopenia) and infectious complications (neutropenia). Approximately one quarter of MDS patients develop acute myeloid leukemia (AML) in the course of the disease, which is characterized by a 20 % or more increase of blasts in the bone marrow. The estimated overall survival as well as the risk for AML transformation can be calculated with the international prognostic scoring system (IPSS) as well as the revised IPSS score (IPSS-R). Novel sequencing methods (e.g. next generation sequencing) allow the detection of recurrent gene mutations in MDS patients. Genes of the splicing machinery as well as genes involved in epigenetic regulation (e.g. ASXL1 and TET2) are most frequently mutated in MDS. Therapy is selected based on the patient risk profile (IPSS). Allogeneic stem cell transplantation is a curative approach for high risk patients (i.e. IPSS int-2 and higher) with a good performance status and a biological age below 70 years. Otherwise, high risk patients are treated with demethylating agents (e.g. decitabine and azacitidine). Low risk patients (IPSS low and int-1) mainly receive supportive therapy including iron chelation. An exceptional position is presented by MDS with an isolated 5q deletion as it can be treated with lenalidomide with good success. Enrolling patients in clinical trials is strongly recommended to improve the prospects of this disease.
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Affiliation(s)
- F Thol
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
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Endo M, Sekikawa A, Tsumura T, Maruo T, Osaki Y. A Case of Myelodysplastic Syndrome with Intestinal Behçet's Disease-Like Symptoms Treated by Prednisolone and Azacitidine. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:827-31. [PMID: 26590106 PMCID: PMC4662094 DOI: 10.12659/ajcr.895431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patient: Female, 68 Final Diagnosis: Myelodysplastic Syndrome with Intestinal Behçet’s Disease-Like Symptoms Symptoms: Abdominal pain • fever • oral ulcer Medication: — Clinical Procedure: CT • bone marrow examination • colonoscopy Specialty: Hematology
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Affiliation(s)
- Masatsugu Endo
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Akira Sekikawa
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takehiko Tsumura
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takanori Maruo
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yukio Osaki
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
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