1
|
Sidda A, Manu G, Alsharedi M, Dotson J, Nahar N. DNA Methyl Transferase 3A (DNMT3A) Mutation Presenting as Isolated Pure Red Cell Aplasia. J Investig Med High Impact Case Rep 2022; 10:23247096221097523. [PMID: 35593442 PMCID: PMC9125062 DOI: 10.1177/23247096221097523] [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: 11/15/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare disorder mainly affecting the erythroid precursor cells. It presents with severe isolated reticulocytopenia with relatively normal counts in the myeloid and megakaryocytic lineages. It has been attributed to numerous congenital and acquired causes. DNA Methyl Transferase 3 Alpha (DNMT3A) mutation has been typically associated with myeloid and lymphoid malignancies. There is a scarcity of data regarding the association of DNMT3A mutation with PRCA. We report a case of a 73-year-old man who initially presented with anemia and reticulocytopenia. After a thorough evaluation and eventual bone marrow biopsy, he was diagnosed with PRCA. Further genetic testing identified a DNMT3A mutation. We are reporting this rare case to highlight the fact that DNMT3A mutation can also present as isolated PRCA in and of itself without the co-occurrence of leukemia, lymphoma, or myelodysplastic syndrome (MDS).
Collapse
Affiliation(s)
- Adarsh Sidda
- Department of Hematology & Oncology, Marshall University, Huntington, WV, USA
| | - Gurusidda Manu
- Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | | | - Jennifer Dotson
- Department of Hematology & Oncology, Marshall University, Huntington, WV, USA
| | - Niru Nahar
- Department of Pathology, Marshall University, Huntington, WV, USA
| |
Collapse
|
2
|
Wang H, Niu H, Zhang T, Xing L, Shao Z, Fu R. Low- and intermediate-risk myelodysplastic syndrome with pure red cell aplasia. ACTA ACUST UNITED AC 2021; 26:444-446. [PMID: 34153199 DOI: 10.1080/16078454.2021.1929694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Our aim is to investigate the clinical characteristics of low- and intermediate-risk myelodysplastic syndrome (MDS) with pure red cell aplasia (PRCA). METHODS We retrospectively reviewed the patients of low- and intermediate-risk MDS patients who had been diagnosed with PRCA in our hospital between January 2010 and December 2019. RESULTS There were 6 low- and intermediate-risk MDS patients with PRCA in our study, 1 male and 5 females, with a median age of 63.5 (50-75) years. It accounted for 7.7% (6/78) of all diagnosed PRCA cases and 1.67% (6/359) of diagnosed MDS cases during the same period. All patients were treated with multiple drugs, including recombinant human erythropoietin, cyclosporine, glucocorticoids, androgen, sirolimus, intravenous immunoglobulin and decitabine. Two patients achieved complete remission, two patients achieved partial remission and became blood transfusion independent. Two patients had no response and one patient died. CONCLUSION Low- and intermediate-risk MDS with PRCA was difficult to treat, but the prognosis was good.
Collapse
Affiliation(s)
- Huaquan Wang
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, People's Republic of China
| | - Haiyue Niu
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, People's Republic of China
| | - Tian Zhang
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, People's Republic of China
| | - Limin Xing
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, People's Republic of China
| | - Zonghong Shao
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, People's Republic of China
| | - Rong Fu
- Department of Hematology, General Hospital, Tianjin Medical University, Tianjin, People's Republic of China
| |
Collapse
|
3
|
Abstract
Idiopathic pure red cell aplasia (PRCA) and secondary PRCA associated with thymoma and large granular lymphocyte leukemia are generally considered to be immune-mediated. The PRCA2004/2006 study showed that poor responses to immunosuppression and anemia relapse were associated with death. PRCA may represent the prodrome to MDS. Thus, clonal hematopoiesis may be responsible for treatment failure. We investigated gene mutations in myeloid neoplasm-associated genes in acquired PRCA. We identified 21 mutations affecting amino acid sequences in 11 of the 38 adult PRCA patients (28.9%) using stringent filtering of the error-prone sequences and SNPs. Four PRCA patients showed 7 driver mutations in TET2, DNMT3A and KDM6A, and 2 PRCA patients carried multiple mutations in TET2. Five PRCA patients had mutations with high VAFs exceeding 0.3. These results suggest that clonal hematopoiesis by stem/progenitor cells might be related to the pathophysiology of chronic PRCA in certain adult patients.
Collapse
|
4
|
Gonsalves JF, Bazargan A, Ku M. Acquired Pure Red Cell Aplasia Associated with Chronic Myelomonocytic Leukemia: Too Many of One, Not Enough of the Other. Case Rep Oncol 2020; 13:1270-1274. [PMID: 33250742 PMCID: PMC7670337 DOI: 10.1159/000508934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022] Open
Abstract
There is a growing body of literature outlining the association between certain hematological malignancies, such as chronic myelomonocytic leukemia (CMML), and systemic autoimmune diseases. Diagnosis and management can be difficult, particularly when autoimmune phenomena overlap with features of the underlying illness. This is especially the case in patients who develop immune-mediated cytopenias in the context of underlying bone marrow disease. CMML associated with immune thrombocytopenia and hemolytic anemia has been reported a number of times in the literature; however, there are only scattered case reports describing CMML associated with acquired pure red cell aplasia. Here, we describe the diagnostic and management approach to a patient who developed both diseases.
Collapse
Affiliation(s)
- Jose Filipe Gonsalves
- Department of Clinical Hematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Ali Bazargan
- Department of Clinical Hematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Matthew Ku
- Department of Clinical Hematology, St Vincent's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Pure Red Cell Aplasia with Del(20q) Sensitive for Immunosuppressive Treatment. Case Rep Hematol 2020; 2020:1262038. [PMID: 32082654 PMCID: PMC6995481 DOI: 10.1155/2020/1262038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/13/2019] [Accepted: 12/28/2019] [Indexed: 11/17/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare syndrome that only affects the erythroid lineage. It is defined by a normocytic, normochromic anemia with a marked reticulocytopenia and severe reduction or absence of erythroid precursors in the bone marrow. Treatment of primary, idiopathic PRCA is immunosuppressive therapy. Although it is rare, isolated cytogenetic abnormalities can be seen in PRCA, and abnormal karyotype is associated with poor response to immunosuppressive therapy and poor prognosis. We describe a 77-year-old male with primary, idiopathic PRCA and a deletion of chromosome 20q, del(20q), in the bone marrow cells. He was successfully treated with immunosuppressive therapy and became transfusion-independent. The same cytogenetic abnormality has also been described in a few other reports; taken together, these observations suggest that del(20q) may represent a recurrent cytogenetic abnormality in PRCA. Our case report clearly illustrates that even patients with primary PRCA and an abnormal karyotype can respond to immunosuppression and become transfusion-independent.
Collapse
|
6
|
Balasubramanian SK, Sadaps M, Thota S, Aly M, Przychodzen BP, Hirsch CM, Visconte V, Radivoyevitch T, Maciejewski JP. Rational management approach to pure red cell aplasia. Haematologica 2017; 103:221-230. [PMID: 29217782 PMCID: PMC5792266 DOI: 10.3324/haematol.2017.175810] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/06/2017] [Indexed: 11/09/2022] Open
Abstract
Pure red cell aplasia is an orphan disease, and as such lacks rationally established standard therapies. Most cases are idiopathic; a subset is antibody-mediated. There is overlap between idiopathic cases and those with T-cell large granular lymphocytic leukemia, hypogammaglobulinemia, and low-grade lymphomas. In each of the aforementioned, the pathogenetic mechanisms may involve autoreactive cytotoxic responses. We selected 62 uniformly diagnosed pure red cell aplasia patients and analyzed their pathophysiologic features and responsiveness to rationally applied first-line and salvage therapies in order to propose diagnostic and therapeutic algorithms that may be helpful in guiding the management of prospective patients, 52% of whom were idiopathic, while the others involved large granular lymphocytic leukemia, thymoma, and B-cell dyscrasia. T-cell-mediated responses ranged between a continuum from polyclonal to monoclonal (as seen in large granular lymphocytic leukemia). During a median observation period of 40 months, patients received a median of two different therapies to achieve remission. Frequently used therapy included calcineurin-inhibitors with a steroid taper yielding a first-line overall response rate of 76% (53/70). Oral cyclophosphamide showed activity, albeit lower than that produced by cyclosporine. Intravenous immunoglobulins were effective both in parvovirus patients and in hypogammaglobulinemia cases. In salvage settings, alemtuzumab is active, particularly in large granular lymphocytic leukemia-associated cases. Other potentially useful salvage options include rituximab, anti-thymocyte globulin and bortezomib. The workup of acquired pure red cell aplasia should include investigations of common pathological associations. Most effective therapies are directed against T-cell-mediated immunity, and therapeutic choices need to account for associated conditions that may help in choosing alternative salvage agents, such as intravenous immunoglobulin, alemtuzumab and bortezomib.
Collapse
Affiliation(s)
- Suresh Kumar Balasubramanian
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Meena Sadaps
- Department of Internal Medicine, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Swapna Thota
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Mai Aly
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Bartlomiej P Przychodzen
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Cassandra M Hirsch
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Valeria Visconte
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Tomas Radivoyevitch
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, OH, USA
| |
Collapse
|
7
|
Cerchione C, Catalano L, Cerciello G, Avilia S, Picardi M, Risitano AM, Pisano I, Alfinito F, Pane F. Role of lenalidomide in the management of myelodysplastic syndromes with del(5q) associated with pure red cell aplasia (PRCA). Ann Hematol 2014; 94:531-4. [DOI: 10.1007/s00277-014-2192-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
|
8
|
Belizna C, Subra J, Henrion D, Ghali A, Renier G, Royer M, Corre YL, Martin L, Voswinkel J, Ifrah N. Prognosis of vasculitis associated myelodysplasia. Autoimmun Rev 2013; 12:943-6. [DOI: 10.1016/j.autrev.2013.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/23/2013] [Indexed: 12/17/2022]
|
9
|
Antiretroviral activity of 5-azacytidine during treatment of a HTLV-1 positive myelodysplastic syndrome with autoimmune manifestations. Virol J 2012; 9:1. [PMID: 22214262 PMCID: PMC3305386 DOI: 10.1186/1743-422x-9-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 01/03/2012] [Indexed: 12/20/2022] Open
Abstract
Myelodysplastic syndromes (MDS) are often accompanied by autoimmune phenomena. The underlying mechanisms for these associations remain uncertain, although T cell activation seems to be important. Human T-lymphotropic virus (HTLV-1) has been detected in patients with myelodysplastic syndromes, mostly in regions of the world which are endemic for the virus, and where association of HTLV-1 with rheumatological manifestation is not rare. We present here the case of a 58 year old man who presented with cytopenias, leukocytoclastic vasculitis of the skin and glomerulopathy, and was diagnosed as MDS (refractory anemia with excess blasts - RAEB 1). The patient also tested positive for HTLV-1 by PCR. After 8 monthly cycles of 5-azacytidine he achieved a complete hematologic remission. Following treatment, a second PCR for HTLV-1 was carried out and found to be negative. This is the first report in the literature of a HTLV-1-positive MDS with severe autoimmune manifestations, which was treated with the hypomethylating factor 5-azacitidine, achieving cytogenetic remission with concomitant resolution of the autoimmune manifestations, as well as HTLV-1-PCR negativity. HTLV-1-PCR negativity may be due to either immune mediated clearance of the virus, or a potential antiretroviral effect of 5-azacytidine. 5-azacytidine is known for its antiretroviral effects, although there is no proof of its activity against HTLV-1 infection in vivo.
Collapse
|
10
|
Inui Y, Yamamoto K, Okamura A, Yakushijin K, Hayashi Y, Matsuoka H, Minami H. Isolated isochromosome 17q in myelodysplastic syndromes with pure red cell aplasia and basophilia. Intern Med 2012; 51:1579-84. [PMID: 22728494 DOI: 10.2169/internalmedicine.51.7298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Myelodysplastic syndromes (MDS) with pure red cell aplasia (PRCA) have been shown to be a rare form of MDS. A 35-year-old man presented with pancytopenia: hemoglobin 59 g/L, reticulocytes 2 × 10(9)/L, platelets 33 × 10(9)/L, and leukocytes 1.8 × 10(9)/L with 1% blasts. Bone marrow was hypercellular with 50.4% myeloid cells, 0.0% erythroblasts, 25.4% basophils, and 5.6% myeloblasts. Dysplastic changes including pseudo-Pelger-Huët anomaly of neutrophils and mononuclear micromegakaryocytes were found. Immunohistochemistry with glycophorin C confirmed erythroid aplasia. Cytogenetic analysis showed 46,XY,i(17)(q10)[18]/47,XY,+8[2]. Considering two reported cases, these findings indicate that isolated i(17q) may be implicated in the pathogenesis of MDS with PRCA as a recurrent cytogenetic aberration.
Collapse
Affiliation(s)
- Yumiko Inui
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Japan
| | | | | | | | | | | | | |
Collapse
|
11
|
de Hollanda A, Beucher A, Henrion D, Ghali A, Lavigne C, Lévesque H, Hamidou M, Subra JF, Ifrah N, Belizna C. Systemic and immune manifestations in myelodysplasia: A multicenter retrospective study. Arthritis Care Res (Hoboken) 2011; 63:1188-94. [DOI: 10.1002/acr.20504] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
12
|
Nitta H, Harada Y, Okikawa Y, Fujii M, Arihiro K, Kimura A, Harada H. Good's syndrome-associated pure red cell aplasia with myelodysplastic syndrome. Intern Med 2011; 50:2011-4. [PMID: 21921387 DOI: 10.2169/internalmedicine.50.5709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of Good's syndrome-associated pure red cell aplasia (PRCA) with myelodysplastic syndrome (MDS). In this case, effector memory T (T(EM)) cells were expanded in the bone marrow. It remains uncertain whether the development of MDS was caused by the basic marrow defects or radiation therapy. However, since CD8(+) perforin(+) T(EM) cells expanded in the bone marrow, as was previously described for 3 of our patients with thymoma-associated PRCA, it is highly possible that the pathogenic mechanism of PRCA that is accompanied by thymoma is related to the expanded CD8(+) perforin(+) T(EM) cells in this MDS-complicated case.
Collapse
Affiliation(s)
- Hideaki Nitta
- Department of Hematology and Oncology, Division of Clinical Research, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan.
| | | | | | | | | | | | | |
Collapse
|
13
|
Pilo F, Di Tucci AA, Dessalvi P, Caddori A, Angelucci E. The evolving clinical scenario of myelodysplastic syndrome: the need for a complete and up to date upfront diagnostic assessment. Eur J Intern Med 2010; 21:490-5. [PMID: 21111932 DOI: 10.1016/j.ejim.2010.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 08/22/2010] [Accepted: 09/08/2010] [Indexed: 11/24/2022]
Abstract
Until the beginning of the current millennium, few concrete therapeutic possibilities were available for myelodysplastic syndrome (MDS) patients. This situation has dramatically changed in the last decade when new knowledge, new drugs and new opportunities have become available for physicians and their MDS patients. A correct diagnostic and prognostic assessment of all MDS patients wherever they are first seen in a hematology or internal medicine department is mandatory to identify the best therapeutic option and the most appropriate resources allocation. This article will review modern diagnostic criteria and classification together with correlated new therapeutic opportunities.
Collapse
Affiliation(s)
- Federica Pilo
- Hematology Unit, Ospedale Oncologico di riferimento Regionale Armando Businco Cagliari, Italy
| | | | | | | | | |
Collapse
|
14
|
Martinaud C, Pons S, Ménard G, Gisserot O, de Jaureguiberry JP, Brisou P. [Myelodysplastic syndrome with erythroblastopenia]. Rev Med Interne 2010; 32:33-8. [PMID: 20801559 DOI: 10.1016/j.revmed.2010.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 06/04/2010] [Accepted: 07/16/2010] [Indexed: 10/19/2022]
Abstract
Myelodysplastic syndrome with erythroid hypoplasia or erythroblastopenia has not yet been clearly defined, and in most patients it is mistaken for acquired pure red cell aplasia. Including one additional patient reported in this article, a literature review revealed only 50 cases over the last 20 years. These patients were predominantly elderly males, all required regular packed red cell transfusions, and they had a poor prognosis, mainly because of acute transformation. The mechanisms of erythroid aplasia remain unclear. However, recent data suggest the association of an intrinsic stem cell defect with immunological implication.
Collapse
Affiliation(s)
- C Martinaud
- Fédération des laboratoires, HIA Sainte-Anne, 2 boulevard Sainte-Anne, Toulon cedex 9, France.
| | | | | | | | | | | |
Collapse
|
15
|
Kar R, Rao S, Saxena R. Myelodysplastic syndromes: classification and prognostic scoring systems and their applicability in Indian scenario-experience from a tertiary care center. ACTA ACUST UNITED AC 2009; 14:145-9. [PMID: 19490759 DOI: 10.1179/102453309x402232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The myelodysplastic syndromes (MDS) are a group of clonal disorders characterized by ineffective haematopoiesis, cytopenias, morphologic dysplasia and leukemic transformation. Difficulties exist in classifying and prognosticating MDS. This study was done to evaluate FAB and WHO classifications and the role of infection especially tuberculosis contributing to secondary myelodysplasia. The clinico-hematological profile of all cases (n=78) of MDS diagnosed over the last one and a half years was analyzed. This included 73 cases of primary MDS and five cases of infection associated myelodysplasia. There were 50 male and 28 female patients. Mean age at presentation was 46.1 years (range: 9 to 82 years). Out of 73 cases, two progressed to AML during the study period. Seventy cases could be classified based on FAB and 62 based on WHO criteria. Five cases of FAB-RAEBt were AML by FAB. One case not classifiable as per FAB could be categorized by WHO and four cases not classifiable as WHO could be categorized by FAB classification. All fulfilled the minimal diagnostic criteria for MDS. The commonest subtype of MDS was RA by FAB (55.7%) and RCMD (21%) and MDS-U (21%) by WHO. Four patients with tuberculosis and one with HIV showed significant myelodysplasia along with reactive changes. The consensus proposal of minimal diagnostic criteria for MDS was most helpful in cases difficult to diagnose and classify. Coexisting infection especially tuberculosis causing secondary myelodysplasia needs to be kept in mind especially in the Indian subcontinent.
Collapse
Affiliation(s)
- Rakhee Kar
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | | | | |
Collapse
|
16
|
Sawada K, Hirokawa M, Fujishima N. Diagnosis and management of acquired pure red cell aplasia. Hematol Oncol Clin North Am 2009; 23:249-59. [PMID: 19327582 DOI: 10.1016/j.hoc.2009.01.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pure red cell aplasia is a syndrome characterized by a severe normocytic anemia, reticulocytopenia, and absence of erythroblasts from an otherwise normal bone marrow. Although the causes and natural course of this syndrome are variable and although the anemia in some patients can be managed by treatment of an underlying inflammatory or neoplastic disease, the pathogenesis of a large number of cases is autoimmune, including those associated with thymoma, and are best managed with immunosuppressive therapy.
Collapse
Affiliation(s)
- Kenichi Sawada
- Division of Hematology, Department of Medicine, Akita University School of Medicine, Hondo 1-1-1, Akita 018-8543, Japan.
| | | | | |
Collapse
|
17
|
Nishio N, Yagasaki H, Takahashi Y, Muramatsu H, Hama A, Xu Y, Villalobos IB, Kojima S. Congenital erythroid and myeloid hypoplasia terminating myelodysplastic syndrome. J Pediatr Hematol Oncol 2008; 30:692-5. [PMID: 18776763 DOI: 10.1097/mph.0b013e31816e23a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe a 4-month-old infant girl with congenital erythroid and myeloid hypoplasia who developed myelodysplastic syndrome. Bone marrow examination showed severe erythroid and myeloid hypoplasia without dysplastic morphology. Flow cytometry detected autoantibodies to myeloid cells, indicating a diagnosis of Diamond-Blackfan anemia with autoimmune neutropenia. The patient was administered prednisolone and rituximab, which brought the neutrophil count and hemoglobin level to within the normal range. However, bicytopenia recurred at the age of 22 months. She was diagnosed with myelodysplastic syndrome because of trilineage dysplasia and the clonal abnormality of 46,XX,dup(1)(q21;q32) in bone marrow. She was transplanted with cord blood from an unrelated human leukocyte antigen-matched donor and has since remained in complete remission for 20 months.
Collapse
Affiliation(s)
- Nobuhiro Nishio
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
An elderly man presented with a macrocytic anemia with severe reticulocytopenia. The observation of trilineage dysplasia in addition to red cell aplasia led to a diagnosis.
Collapse
Affiliation(s)
- James Uprichard
- Department of Haematology, Faculty of Medicine, St Mary's Hospital Campus of Imperial College, St Mary's Hospital, London, UK
| | | |
Collapse
|
19
|
Wang SA, Yue G, Hutchinson L, Landry ML, Hasserjian RP, Hao S, Galili N, Raza A, Woda BA. Myelodysplastic syndrome with pure red cell aplasia shows characteristic clinicopathological features and clonal T-cell expansion. Br J Haematol 2007; 138:271-5. [PMID: 17542981 DOI: 10.1111/j.1365-2141.2007.06648.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Dinçol G, Oztürk S, Palanduz S, Tutkan G, Yildirim N, Ayer M, Güvenç S. A case of myelodysplastic syndrome with erythroid hypoplasia associated with a familial translocation t(3;14)(p21.1;q24.1). Am J Hematol 2006; 81:883-7. [PMID: 16888788 DOI: 10.1002/ajh.20684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myelodysplastic syndrome (MDS) with erythroid hypoplasia, a rare form of MDS, has not yet been clearly defined. We report here a 20-year-old woman with severe transfusion-dependent anemia and reticulocytopenia. White blood cells and platelet counts were normal. Bone marrow examination showed a low percentage of erythroid precursors (6%) and a marked dyserythropoiesis and dysmegakaryopoiesis. A diagnosis of MDS (refractory anemia according to the FAB classification) with erythroid hypoplasia was made. Cytogenetic analysis of the bone marrow and peripheral blood revealed a 46,XX,t(3;14)(p21.1;q24.1) translocation, which was confirmed by fluorescence in situ hybridization analysis. This translocation was detected in the apparently healthy younger brother, father, and aunt (father's sister) of the patient. Clonality of T cells in the patient was not confirmed by the polymerase chain reaction and heteroduplex temperature-gradient gel electrophoresis. IgM serology for B19 parvovirus was negative. Other conditions known to be associated with erythroid hypoplasia, such as thymoma, were not present. The patient failed to respond to immunosuppressive therapy (antithymocyte globulin and cyclosporin A). Administration of recombinant human erythropoietin improved her anemia. To our knowledge, this balanced translocation, namely t(3;14)(p21.1;q24.1), which is present both in the patient with MDS with erythroid hypoplasia and in the healthy members of the family, has not been defined previously.
Collapse
Affiliation(s)
- Günçağ Dinçol
- Division of Hematology, Department of Internal Medicine, Istanbul Medical School, Istanbul University, 34390 Capa Istanbul, Turkey.
| | | | | | | | | | | | | |
Collapse
|
21
|
|
22
|
Abstract
The incidence of myelodysplastic syndrome (MDS) with erythroid hypoplasia/aplasia is probably underestimated because in most patients it is mistaken for acquired pure red blood cell aplasia. This report describes three children who fulfilled the criteria for MDS with erythroid hypoplasia/aplasia. All these patients had transfusion dependent anaemia, reticulocytopenia, erythroid hypoplasia/aplasia, severe dysgranulopoiesis, and dysmegakaryopoiesis.
Collapse
Affiliation(s)
- R Goyal
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | | | | |
Collapse
|
23
|
Ogata M, Ohtsuka E, Imamura T, Ikewaki J, Ogata Y, Kohno K, Nakayama T, Ono K, Saburi Y, Kikuchi H, Nasu M. Response to cyclosporine therapy in patients with myelodysplastic syndrome: a clinical study of 12 cases and literature review. Int J Hematol 2004; 80:35-42. [PMID: 15293566 DOI: 10.1532/ijh97.04051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cyclosporine (CyA) was administered to 12 patients with myelodysplastic syndrome (MDS), and a response (major erythroid response, according to International Working Group criteria) was observed in 7 patients (58.3%). The median duration of response was 18 months (range, 3-22 months). Two patients are still responding and continuing to take CyA. Three patients stopped because of malignancy complications. To identify variables associated with responsiveness to CyA therapy, we analyzed the treatments of 72 MDS patients, comprising the 12 new patients and 60 patients previously described in the literature. Responses were observed in 44 of the 72 patients (61.1%). Univariate analyses revealed that higher daily dose of CyA (P for trend test, .007) and shorter disease duration (median, 5 months versus 17.5 months, P = .04) were factors significantly associated with response. No significant associations were observed between response and bone marrow features such as erythroid hypoplasia or hypoplastic marrow. Multivariate analysis also demonstrated that high CyA dose (>5 mg/kg per day) was significantly associated with response (P = .02). The present study showed that CyA therapy is useful for MDS patients with any marrow cellularity. Shorter disease duration is a pretreatment variable correlated with response, and a higher CyA dose results in a higher response rate.
Collapse
Affiliation(s)
- Masao Ogata
- Second Department of Internal Medicine, Faculty of Medicine, Oita University Hasama-machi, Oita, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Kim HD, Kim KW, Park SY, Ko HJ, An YY, Shin SY, Jang JY. Myelodysplastic syndrome with erythroid aplasia following pure red cell aplasia. Korean J Intern Med 2004; 19:193-5. [PMID: 15481612 PMCID: PMC4531565 DOI: 10.3904/kjim.2004.19.3.193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Myelodysplastic syndrome (MDS) with erythroid aplasia is a very rare disorder that has not been clearly defined. We experienced a case of pure red cell aplasia (PRCA), which evolved to MDS with erythroid aplasia. A 59-year-old male with transfusion-dependent PRCA was referred to our hospital for an evaluation of newly developed thrombocytopenia. Two years ago, PRCA was diagnosed by the laboratory findings and a bone marrow examination, which showed no evidence of any myelodysplastic features and thymoma. Upon admission, the bone marrow findings showed marked hypercellularity. with numerous dysplastic features in the three lineages including erythroid hypoplasia. These findings were compatible with a diagnosis of MDS with red cell aplasia. It is very interesting that the PRCA evolved to MDS with red cell aplasia, which strongly suggests an autoimmune mechanism for the development of MDS.
Collapse
Affiliation(s)
| | - Kee Won Kim
- Correspondence to: Kee Won Kim, M.D., Department of Internal Medicine, Daejeon St. Mary’s Hospital, 520-2, Daehung2-dong, Chung-gu, Daejeon, 301-723, Korea, Tel: 82-42-220-9114, Fax: 82-42-255-8663, E-mail:
| | | | | | | | - So Young Shin
- Departments of Internal Medicine, Clinical Pathology Daejeon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Young Jang
- Departments of Internal Medicine, Radiation Oncology Daejeon St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| |
Collapse
|
25
|
Heo SW, Cho KH, Ryu JII, Chung SH, Kim CG, Kim SG, Choe JY. A case of relapsing polychondritis associated with myelodysplastic syndrome with erythroid hypoplasia/aplasia. Korean J Intern Med 2003; 18:251-4. [PMID: 14717237 PMCID: PMC4531637 DOI: 10.3904/kjim.2003.18.4.251] [Citation(s) in RCA: 10] [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: 01/24/2023] Open
Abstract
Relapsing polychondritis (RP) is a rare multisystem disorder. Myelodysplastic syndrome (MDS) with erythroid hypoplasia/aplasia is a rare form of myelodysplasia. Several cases of RP associated with MDS have recently been described. However, RP associated with MDS with erythroid hypoplasia/aplasia has never been reported. There was only one case report of polymyalgia rheumatica associated with MDS with erythroid hypoplasia/aplasia. In this study, we report a 79-year-old patient with RP, who developed MDS subtype refractory anemia (RA) with erythroid hypoplasia/aplasia, a very characteristic subtype of MDS.
Collapse
Affiliation(s)
| | | | | | | | | | - Sang-Gyung Kim
- Departments of Internal Medicine and Clinical Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jung-Yoon Choe
- Correspondence to : Jung-Yoon Choe, M.D., Department of Internal Medicine, Daegu Catholic University Hospital, 3056-6 Daemyung 4-dong, Nam-gu, Daegu, 705-718, Korea Tel : 82-53-650-4027, Fax : 82-53-629-8248, E-mail :
| |
Collapse
|
26
|
Amin HM, Jilani I, Estey EH, Keating MJ, Dey AL, Manshouri T, Kantarjian HM, Estrov Z, Cortes JE, Thomas DA, Giles FJ, Albitar M. Increased apoptosis in bone marrow B lymphocytes but not T lymphocytes in myelodysplastic syndrome. Blood 2003; 102:1866-8. [PMID: 12730116 DOI: 10.1182/blood-2003-01-0221] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The hallmark of myelodysplastic syndrome (MDS) is enhanced apoptosis in myeloid, erythroid, and megakaryocytic cells in the bone marrow leading to ineffective hematopoiesis. Recent studies suggested that immunological and microenvironmental factors play a role in the pathophysiology of this disease. We report a significant increase in apoptosis in bone marrow B lymphocytes in MDS as compared to that found in acute myeloid leukemia and healthy controls. Furthermore, we demonstrate that patients with refractory anemia with excess blasts in transformation (RAEB-T) had apoptosis levels in lymphocytes similar to those seen in other subtypes of MDS. Our findings suggest that the alterations in B lymphocytes in the form of increased apoptosis can be seen in MDS and support the concept that immune modulation plays a role in the pathophysiology of MDS.
Collapse
Affiliation(s)
- Hesham M Amin
- Department of Hematopathology, Box 72, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
The myelodysplastic syndromes (MDS) comprise a heterogeneous group of clonal hematopoietic stem cell disorders, while, immunological abnormalities are frequently observed in patients with MDS. Several reports revealed that about 10% of MDS patients have clinical autoimmune disorders like skin vasculitis, rheumatic disease, or autoimmune hemolytic anemia. Furthermore, serological immunological abnormalities like hyper- or hypogammaglobulinemia, positivities of antinuclear antibody, positivities of direct Coombs test, or inverted CD4/8 ratios were found in 18-65% of patients with MDS. Recently immunosuppressive therapies including prednisolone, antithymocyte globulin, and cyclosporin A (CsA) are used to treat cytopenia in some patients with MDS. We examined the efficacy of CsA in 50 patients with MDS. Hematologic improvement was observed in 30 (60%) patients especially for erythroid lineage. There were significantly more responders with good karyotype or DRB1*1501 than with intermediate/poor karyotypes or with other HLA types. MDS with erythroid hypoplasia is a rare form of MDS, and has not yet been clearly defined. We reported four patients with MDS with erythroid hypoplasia who had morphological evidence of myelodysplasia and low percentage of erythroid precursors. Rearrangements of the TCR-beta and -gamma genes were seen in these patients using Southern blot and PCR analysis. Also they had skewed TCR usages using TCR repertoire analysis. Their anemia drastically improved with CsA therapy. We have to establish the clinical usefulness of immunosuppressive therapy in MDS patients and simple tools for revealing T-cell mediated myelosuppression in the individual patients for decision-making.
Collapse
Affiliation(s)
- Takashi Shimamoto
- First Department of Internal Medicine, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku Tokyo 160-0023, Japan.
| | | |
Collapse
|
28
|
Takata S, Kojima K, Fujii N, Kaneda K, Yoshida C, Hashimoto D, Asakura S, Shinagawa K, Tanimoto M. Successful treatment with cyclosporin A of myelodysplastic syndrome with erythroid hypoplasia associated with t(6;8)(q15;q22). CANCER GENETICS AND CYTOGENETICS 2003; 140:167-9. [PMID: 12645657 DOI: 10.1016/s0165-4608(02)00655-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a t(6;8)(q15;q22) in a patient with myelodysplastic syndrome (MDS) with erythroid hypoplasia. The patient was successfully treated with an immunosuppressive treatment with cyclosporin A, while the translocation was repeatedly detected as the sole anomaly with the percentages of positive cells ranging from 5% to 70%. To our knowledge, the t(6:8) has never been described in MDS.
Collapse
Affiliation(s)
- Shiro Takata
- Department of Medicine II, Okayama University Medical School, Okayama 700-8558, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Shimamoto T, Ohyashiki K. Myelodysplastic syndrome with erythroid hypoplasia is a new clinical entity responsive to cyclosporin A therapy. Leuk Lymphoma 2002; 43:1895-6. [PMID: 12685853 DOI: 10.1080/1042819021000006349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
30
|
Yamauchi T, Shirasaki H, Kuwata A, Yamashita T, Imamura S, Tsutani H, Ueda T. Pure red cell aplasia developing into myeloproliferation with myelodysplasia and subsequent leukemia after cyclosporin A therapy. Int J Hematol 2002; 75:514-8. [PMID: 12095153 DOI: 10.1007/bf02982116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We describe a very rare case of a patient who presented with red cell aplasia that later developed into myeloproliferation with myelodysplasia and eventually leukemia. A 63-year-old man presented with anemia and reticulocytopenia in May 1997. A bone marrow examination revealed erythroid aplasia with normal production of myeloid cells and megakaryocytes with a normal karyotype. After the diagnosis of pure red cell aplasia was made, the patient was treated with prednisolone and then with cyclosporin A (CyA). Two weeks after the initiation of CyA treatment, the peripheral reticulocyte count began to increase with a regrowth of erythroid cells in the bone marrow. Meanwhile, the peripheral white blood cell and platelet counts also increased to more than 10,000/microL and 1,000,000/microL, respectively. Examination of a bone marrow aspirate in December 1997 revealed myelodysplastic changes with trisomy 8. Despite the discontinuation of CyA and the administration of 1-beta-D-arabinofuranosylcytosine stearyl monophosphate, leukemia developed in August 1998. In September 1998, the patient died of sepsis during a neutropenic period that followed remission-induction therapy. In the mechanism of pathogenesis, CyA may induce upon pure red cell aplasia a secondary myeloproliferative disorder with myelodysplasia and leukemia. An alternative possibility is that CyA reduces autoimmune-mediated suppression of the underlying stem cell disorder and that the result of this reduction is the manifestation of myeloproliferation and leukemia.
Collapse
MESH Headings
- Cell Division/drug effects
- Chromosomes, Human, Pair 8
- Cyclosporine/administration & dosage
- Cyclosporine/adverse effects
- Fatal Outcome
- Humans
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/adverse effects
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Myelodysplastic Syndromes/chemically induced
- Myelodysplastic Syndromes/pathology
- Myeloproliferative Disorders/chemically induced
- Myeloproliferative Disorders/pathology
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/pathology
- Trisomy
Collapse
Affiliation(s)
- Takahiro Yamauchi
- First Department of Internal Medicine, Fukui Medical University, Matsuoka, Japan.
| | | | | | | | | | | | | |
Collapse
|
31
|
Roldán Schilling V, García Herola A, Serrano Fernández C, Teresa Parreño Ld LD. [Pure red cell aplasia and myelodysplastic changes]. Rev Clin Esp 2002; 202:182-3. [PMID: 11996755 DOI: 10.1016/s0014-2565(02)71022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
32
|
Shimamoto T, Iguchi T, Ando K, Katagiri T, Tauchi T, Ito Y, Yaguchi M, Miyazawa K, Kimura Y, Masuda M, Mizoguchi H, Ohyashiki K. Successful treatment with cyclosporin A for myelodysplastic syndrome with erythroid hypoplasia associated with T-cell receptor gene rearrangements. Br J Haematol 2001; 114:358-61. [PMID: 11529855 DOI: 10.1046/j.1365-2141.2001.02925.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Myelodysplastic syndrome (MDS) with erythroid hypoplasia, a rare form of MDS, has not yet been clearly defined. We report four patients with MDS with erythroid hypoplasia who received immunosuppressive therapy. All were elderly, had severe transfusion-dependent anaemia, morphological evidence of myelodysplasia and a low percentage (3.2-13.6%) of erythroid precursors. Administration of cyclosporin A (CsA) improved their anaemia; all transfusion-dependent patients achieved transfusion-independence. An inverted CD4/8 ratio was seen in three patients who also demonstrated T-cell receptor (TCR)-beta and -gamma gene rearrangements by Southern blotting and clonality by polymerase chain reaction. Treatment with CsA can be an attractive alternative treatment for patients with MDS with erythroid hypoplasia, which may be associated with a clonal abnormality in T cells.
Collapse
Affiliation(s)
- T Shimamoto
- First Department of Internal Medicine, Tokyo Medical University, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Park S, Merlat A, Guesnu M, Picard F, Viguié F, Vassilieff D, Dreyfus F. Pure red cell aplasia associated with myelodysplastic syndromes. Leukemia 2000; 14:1709-10. [PMID: 10995022 DOI: 10.1038/sj.leu.2401833] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
34
|
García-Suárez J, Pascual T, Muñoz MA, Herrero B, Pardo A. Myelodysplastic syndrome with erythroid hypoplasia/aplasia: a case report and review of the literature. Am J Hematol 1998; 58:319-25. [PMID: 9692397 DOI: 10.1002/(sici)1096-8652(199808)58:4<319::aid-ajh12>3.0.co;2-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Myelodysplastic syndrome (MDS) with erythroid hypoplasia/aplasia has not yet been clearly defined, and in most patients it is mistaken for acquired pure red cell aplasia (PRCA). We report a patient with severe transfusion-dependent anemia (Hb 6.9 g/dl) and reticulocytopenia. WBC and platelet counts were normal. Bone marrow examination showed a marked trilineage dysplasia and a low percentage of erythroid precursors (3%). A diagnosis of MDS (refractory anemia according to FAB classification) with erythroid hypoplasia/aplasia was made. Repeated cytogenetic analysis of bone marrow showed normal karyotypes. Moreover, serial IgM serology and DNA analysis of the patient's sera for B19 parvovirus were negative. Other conditions known to be associated with erythroid aplasia were also absent. The patient failed hematinics and prednisone therapy. He next received r-HuEPO (200 U/kg three times weekly). This form of therapy achieved a rapid and complete erythroid response. He has remained in complete erythroid response after a 7-month period on maintenance therapy of 100 U/kg three times weekly. A review of the literature revealed only 15 well-documented cases of MDS with erythroid hypoplasia/aplasia. All had morphological evidence of myelodysplasia. These patients were predominantly elderly males, all required regular packed red cell transfusions, and had an unfavorable prognosis, mainly because of a high rate of blastic transformation (frequently preceded by a myeloproliferative phase). The mechanism of erythroid hypoplasia in this subgroup of MDS remains uncertain. However, laboratory and clinical data suggest the existence of an intrinsic stem cell defect. None of the patients received hematopoietic growth factors. To our knowledge, our patient is the first case of MDS with erythroid hypoplasia where r-HuEPO was successfully attempted. The description of more cases is necessary to delineate the value of r-HuEPO therapy in this rare variant of MDS.
Collapse
Affiliation(s)
- J García-Suárez
- Department of Hematology, Príncipe de Asturias University Hospital, University of Alcalá de Henares, Madrid, Spain
| | | | | | | | | |
Collapse
|
35
|
Matsushima T, Murakami H, Kim K, Uchiumi H, Murata N, Tamura J, Sawamura M, Karasawa M, Naruse T, Tsuchiya J. Steroid-responsive pulmonary disorders associated with myelodysplastic syndromes with der(1q;7p) chromosomal abnormality. Am J Hematol 1995; 50:110-5. [PMID: 7572989 DOI: 10.1002/ajh.2830500207] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report three patients with pulmonary disorders associated with myelodysplastic syndromes (MDS). All three patients had symptoms of pyrexia and respiratory discomfort. One patient had pulmonary eosinophilia with bilateral pleural effusion, one had interstitial pneumonia, and one had bilateral pleural effusion caused by systemic vasculitis. Elevated C-reactive protein (CRP) levels, polyclonal hypergammaglobulinemia, and morphological abnormalities in peripheral blood were observed in all three patients. The bone marrow of these patients revealed trilineage dysplasia and eosinophilia. Cytogenetic analysis showed [46,XY,-7,+der(1q;7p)]. Antibiotic treatment was not effective. However, improvement was dramatic after corticosteroid treatment; CRP levels were reduced and the hypergammaglobulinemia was improved. These cases suggest that MDS with [-7,+der(1q;7p)] may be correlated with bone marrow eosinophilia and that an immunologic abnormality may be involved in the pulmonary disorders.
Collapse
Affiliation(s)
- T Matsushima
- Third Department of Internal Medicine, Gunma University School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Much of the applied terminology of myelodysplastic syndromes (MDS) in childhood is confusing and not mutually exclusive. It is therefore proposed that the FAB classification of MDS is used in children in order to improve diagnostic precision and to facilitate epidemiologic, clinical, and therapeutic comparisons. The true incidence of childhood MDS is unknown but the rate may approximate the incidence of acute myelogenous leukemia. A pooled analysis of eight larger series representing 110 children less than 15 years old at diagnosis with de novo MDS classified according to the FAB recommendations showed that the more aggressive subtypes dominated, which partly may reflect that the less advanced cases are underdiagnosed. The median age at presentation was 6.0 years. The male/female ratio was 1.6. Monosomy 7 was the most frequent cytogenetic abnormality. The median survival was 13 months and the probability of survival three years from diagnosis was 16%. Spontaneous remission may be observed very infrequently. Allogeneic bone marrow transplantation (BMT) represents the only potentially curative treatment. The survival rate three years after BMT is about 50%. Major differences between childhood and adult MDS exist with respect to the distribution of FAB subgroups, the rate of progression, and the cytogenetic findings. The literature on MDS in children is still sparse and there is an obvious need for more studies designed to determine the incidence, clinical and laboratory characteristics, the natural course, and the efficacy of contemporary treatment options.
Collapse
Affiliation(s)
- H Hasle
- Department of Pediatrics, Odense University Hospital, Denmark
| |
Collapse
|
37
|
Ho PJ, Gibson J, Vincent P, Joshua D. The myelodysplastic syndromes: diagnostic criteria and laboratory evaluation. Pathology 1993; 25:297-304. [PMID: 8265251 DOI: 10.3109/00313029309066593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- P J Ho
- Haematology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales
| | | | | | | |
Collapse
|
38
|
|
39
|
Kouides PA, Bennett JM. Morphology and Classification of Myelodysplastic Syndromes. Hematol Oncol Clin North Am 1992. [DOI: 10.1016/s0889-8588(18)30324-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Abstract
MDS is primarily a disease of the elderly. Cases who give a history of exposure to X-rays, cytotoxic drugs or leukaemogenic chemicals may be younger. Many cases of MDS present because of an incidental blood count. The most prominent clinical features are those of anaemia, neutropenia, thrombocytopenia. Because haemopoietic tissue is also dysfunctional the pathological effect is often greater than the figures would suggest, even leading to infection of bleeding with normal neutrophil or platelet counts. Occult abscesses are a particular feature. Despite documented abnormalities of the lymphoid system, neither infections characteristic of T-cell immunodeficiency nor autoimmunity is a problem. The proliferation of monocytes in CMML leads to organomegaly, leukaemia cutis, serous effusions and vasculitic lesions caused by the mishandling of circulating immune complexes. Cancer is no commoner than in age-matched controls, but coincident lymphoid tumours do occur. Many patients require long-term blood transfusion and will run into problems of iron overload unless precautions are taken.
Collapse
Affiliation(s)
- T Hamblin
- Royal Victoria Hospital, Bournemouth, U.K
| |
Collapse
|
41
|
|
42
|
Patton WN, Bunce CM, Brown G, Larkin S. Defective erythropoiesis in myelodysplastic syndromes. J Clin Pathol 1991; 44:965. [PMID: 1752994 PMCID: PMC496647 DOI: 10.1136/jcp.44.11.965-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|