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Park JB, Han SJ, Lee SB, Kim DH, Cheon JH, Hwang SW, Ye BD, Yang SK, Park SJ, Park SH. Optimal Treatment Approaches to Intestinal Behçet's Disease Complicated by Myelodysplastic Syndrome: The KASID and KSBD Multicenter Study. Yonsei Med J 2024; 65:265-275. [PMID: 38653565 PMCID: PMC11045345 DOI: 10.3349/ymj.2023.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/01/2023] [Accepted: 01/02/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Studies on intestinal Behçet's disease (BD) complicated by myelodysplastic syndrome (MDS) are rare, and no established therapeutic guidelines exist. This study aimed to evaluate the clinical presentation and outcomes of patients with intestinal BD complicated by MDS (intestinal BD-MDS) and suggest a treatment strategy. MATERIALS AND METHODS Data from patients with intestinal BD-MDS from four referral centers in Korea who were diagnosed between December 2000 and December 2022 were retrospectively analyzed. Clinical features and prognosis of intestinal BD-MDS compared with age-, sex-matched intestinal BD without MDS were investigated. RESULTS Thirty-five patients with intestinal BD-MDS were included, and 24 (70.6%) had trisomy 8. Among the 35 patients, 23 (65.7%) were female, and the median age at diagnosis for intestinal BD was 46.0 years (range, 37.0-56.0 years). Medical treatments only benefited eight of the 32 patients, and half of the patients underwent surgery due to complications. Compared to 70 matched patients with intestinal BD alone, patients with intestinal BD-MDS underwent surgery more frequently (51.4% vs. 24.3%; p=0.010), showed a poorer response to medical and/or surgical treatment (75.0% vs. 11.4%; p<0.001), and had a higher mortality (28.6% vs. 0%; p<0.001). Seven out of 35 patients with intestinal BD-MDS underwent hematopoietic stem cell transplantation (HSCT), and four out of the seven patients had a poor response to medical treatment prior to HSCT, resulting in complete remission of both diseases. CONCLUSION Patients with intestinal BD-MDS frequently have refractory diseases with high mortalities. HSCT can be an effective treatment modality for medically refractory patients with intestinal BD-MDS.
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Affiliation(s)
- Jung-Bin Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Jung Han
- Department of Internal Medicine and Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seung Bum Lee
- Department of Gastroenterology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine and Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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2
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Jachiet V, Hadjadj J, Zhao LP, Chasset F, Fain O, Fenaux P, Mekinian A. [Dysimmune manifestations associated with myelodysplastic neoplasms and chronic myelomonocytic leukaemias]. Bull Cancer 2023; 110:1147-1155. [PMID: 37414632 DOI: 10.1016/j.bulcan.2023.02.023] [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: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 07/08/2023]
Abstract
Systemic inflammatory or autoimmune diseases (SIAD) are observed in up to a quarter of patients with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML), with a broad clinical spectrum including asymptomatic biological abnormalities, isolated inflammatory clinical manifestations (recurrent fever, arthralgia, neutrophilic dermatoses…) or identified systemic diseases (giant cell arteritis, recurrent polychondritis…). Recent advances in molecular biology have shed new light on the pathophysiological mechanisms that link inflammatory manifestations and myeloid hemopathies, particularly in VEXAS syndrome following the identification of somatic mutations in the UBA1 gene, or in neutrophilic dermatoses with the concept of myelodysplasia cutis. Although the presence of SIAD does not seem to affect overall survival or the risk of transformation into acute myeloid leukemia, their treatment remains a challenge given the frequent high level of corticosteroid dependence as well as the poor efficacy and tolerance (cytopenias, infections) of conventional immunosuppressive agents. Recent prospective data supports the interest of a therapeutic strategy using demethylating agents and notably azacitidine to target the pathological clone.
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Affiliation(s)
- Vincent Jachiet
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Jérôme Hadjadj
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Lin-Pierre Zhao
- Université de Paris Cité, AP-HP, hôpital Saint-Louis, service d'hématologie, 75010 Paris, France
| | - François Chasset
- Sorbonne université, faculté de médecine, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Tenon, service de dermatologie, Paris, France
| | - Olivier Fain
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - Pierre Fenaux
- Université de Paris Cité, AP-HP, hôpital Saint-Louis, service d'hématologie, 75010 Paris, France
| | - Arsène Mekinian
- Sorbonne université, Assistance publique-Hôpitaux de Paris, centre hospitalo-universitaire Saint-Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France.
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3
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Liu Z, Yang C, Bai X, Shen K, Qiao L, Wang Q, Yang H, Qian J. Clinical features and prognosis of patients with gastrointestinal Behcet's disease-like syndrome and myelodysplastic syndrome with and without trisomy 8. Semin Arthritis Rheum 2022; 55:152039. [DOI: 10.1016/j.semarthrit.2022.152039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
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4
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Horino T, Miyata T, Inoue M, Ono K, Ono A, Tagayasu Y, Nomoto D, Mizumoto T, Kubota T, Miyanari N, Baba H. Shanghai fever, a fatal enteric illness, in an adult patient with neutropenia caused by treatment-related myelodysplastic syndrome: a case report. Surg Case Rep 2022; 8:69. [PMID: 35435524 PMCID: PMC9016090 DOI: 10.1186/s40792-022-01426-5] [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] [Received: 12/22/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Shanghai fever is a rare community-acquired enteric illness with sepsis caused by Pseudomonas aeruginosa. Cases of Shanghai fever in pediatric patients have been reported; however, to the best of our knowledge, there are no reports of adult cases. Case presentation A 65-year-old man visited the emergency department with sudden onset of abdominal pain. He was diagnosed as treatment-related myelodysplastic syndrome after treatment of follicular lymphoma. Moderate tenderness in the middle right abdominal quadrants was noted. Computed tomography showed abdominal free air with a small amount of effusion to the surrounding edematous small intestine, and we performed emergency exploration. During operation, we found multiple bowel perforations with patchy necrotic lesions. The patient was admitted to an intensive care unit postoperatively. Blood culture showed Pseudomonas aeruginosa. His condition improved; however, on the 8th postoperative day, the abdominal drain tube showed turbid drainage. We performed re-operation and found anastomotic leakage with two new bowel perforations. After the re-operation, the patient showed signs of septic shock and his general condition got worse, and the patient died due to multiple organ failure on the 12th postoperative day. Conclusion Shanghai fever may occur in an adult patient with neutropenia.
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5
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Onaka T, Nakano K, Uemoto Y, Miyakawa N, Otsuka Y, Ogura-Kato A, Iwai F, Tanaka Y, Yonezawa A. Allogeneic Stem Cell Transplantation for Trisomy 8-Positive Myelodysplastic Syndrome or Myelodysplastic/Myeloproliferative Disease with Refractory Behçet's Disease, Case Report and the Review of Literature. Mod Rheumatol Case Rep 2022; 6:273-277. [PMID: 35365826 DOI: 10.1093/mrcr/rxac032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/12/2022] [Accepted: 03/25/2022] [Indexed: 11/12/2022]
Abstract
We had two cases of trisomy 8-positive myelodysplastic syndrome (MDS) with incomplete Behçet's disease (BD) in which the remissions of both diseases were maintained by allogeneic stem cell transplantation (allo-SCT). Among MDS with BD patients, sometimes it is difficult to control the symptoms of BD with standard therapies, such as corticosteroids and TNF inhibitors. Although there should be careful consideration regarding indications for transplantation, our two cases, in which refractory BD was completely controlled by allo-SCT, suggest that allo-SCT can be one of the treatment options for higher risk MDS with BD patients.
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Affiliation(s)
- Takashi Onaka
- Department of Hematology, Kokura Memorial Hospital, Japan
| | - Kazuhisa Nakano
- Department of Hematology, Kokura Memorial Hospital, Japan.,Department of Rheumatology, Kawasaki Medical School, Japan.,The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Yuri Uemoto
- Department of Hematology, Kokura Memorial Hospital, Japan.,The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Naoto Miyakawa
- Department of Hematology, Kokura Memorial Hospital, Japan
| | | | | | - Fumie Iwai
- Department of Hematology, Kokura Memorial Hospital, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
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6
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Abstract
Systemic auto-inflammatory or autoimmune diseases (SIADs) develop in up to a quarter of patients with myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML). With or without the occurrence of SIADs, the distribution of MDS subtypes and the international or CMML-specific prognostic scoring systems have been similar between MDS/CMML patients. Moreover, various SIADs have been described in association with MDS, ranging from limited clinical manifestations to systemic diseases affecting multiple organs. Defined clinical entities including systemic vasculitis, connective tissue diseases, inflammatory arthritis and neutrophilic diseases are frequently reported; however, unclassified or isolated organ impairment can also be seen. Although the presence of SIADs does not impact the overall survival nor disease progression to acute myeloid leukemia, they can help with avoiding steroid dependence and make associated adverse events of immunosuppressive drugs challenging. While therapies using steroids and immunosuppressive treatment remain the backbone of first-line treatment, increasing evidence suggests that MDS specific therapy (hypomethylating agents) and sparing steroids may be effective in treating such complications based on their immunomodulatory effect. The aim of this review was to analyze the epidemiological, pathophysiological, clinical and therapeutic factors of systemic inflammatory and immune disorders associated with MDS.
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7
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Shifa I, Hazlewood GS, Durand C, Barr SG, Mydlarski PR, Beck PL, Burton JM, Khan FM, Jamani K, Osman M, Storek J. Efficacy of Allogeneic Hematopoietic Cell Transplantation for Autoimmune Diseases. Transplant Cell Ther 2021; 27:489.e1-489.e9. [PMID: 33775907 DOI: 10.1016/j.jtct.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/06/2021] [Accepted: 03/21/2021] [Indexed: 12/29/2022]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) may be efficacious for autoimmune diseases (AIDs), but its efficacy for individual AIDs is unknown. Factors influencing the likelihood of relapse for each AID are also unknown. This study aimed to determine the likelihood of relapse for each common AID and to generate hypotheses about factors influencing the likelihood of relapse. We reviewed charts of adult patients with nonhematologic AIDs who had undergone HCT in Alberta (n = 21) and patients described in the literature (n = 67). We used stringent inclusion criteria to minimize the inclusion of patients whose AID may have been cured before transplantation. We also used stringent definitions of AID relapse and remission. AID relapsed in 2 of 9 patients (22%) with lupus, in 4 of 12 (33%) with rheumatoid arthritis (RA), in 0 of 4 (0%) with systemic sclerosis (SSc), in 3 of 16 (19%) with psoriasis, in 1 of 12 (8%) with Behçet's disease (BD), in 1 of 15 (7%) with Crohn's disease (CD), in 0 of 5 (0%) with ulcerative colitis (UC), in 4 of 8 (50%) with multiple sclerosis (MS), and in 3 of 3 (100%) with type 1 diabetes mellitus (T1DM). Among highly informative patients (followed for >1 year after discontinuation of immunosuppressive therapy if no relapse, or donor AID status known if relapse), relapse occurred in 0 of 3 patients with lupus, in 2 of 7 with RA, in 0 of 2 with SSc, in 3 of 6 with psoriasis, in 0 of 3 with BD, in 0 of 10 with CD, in 0 of 3 with UC, in 2 of 3 with MS, and in 2 of 2 with T1DM. There appeared to be no associations between AID relapse and low intensity of pretransplantation chemoradiotherapy, multiple lines of AID therapy (surrogate for AID refractoriness) except perhaps for lupus, absence of serotherapy for graft-versus-host disease (GVHD) prophylaxis, lack of GVHD except perhaps for lupus, or incomplete donor chimerism. Even though remission commonly occurs after HCT in lupus, RA, SSc, psoriasis, BD, CD, and UC, HCT is efficacious for only a subset of patients. The efficacy appears to be unrelated to pretransplantation therapy, GVHD, or chimerism. Large studies are needed to determine the characteristics of patients likely to benefit from HCT for each AID.
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Affiliation(s)
- Iman Shifa
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Glen S Hazlewood
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Caylib Durand
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan G Barr
- Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - P Régine Mydlarski
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul L Beck
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jodie M Burton
- Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Faisal M Khan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kareem Jamani
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mohamed Osman
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jan Storek
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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8
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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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9
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Oka S, Ono K, Nohgawa M. The acquisition of trisomy 8 associated with Behçet's-like disease in myelodysplastic syndrome. Leuk Res Rep 2020; 13:100196. [PMID: 32211288 PMCID: PMC7082593 DOI: 10.1016/j.lrr.2020.100196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/26/2020] [Accepted: 03/07/2020] [Indexed: 01/22/2023] Open
Abstract
A relationship has been reported between myelodysplastic syndrome (MDS) and autoimmune disease. Behçet's disease is a multisystem inflammatory disorder with mucocutaneous, articular, gastrointestinal, neurological, and vascular manifestations. The co-occurrence of MDS with trisomy 8 and Behçet's-like disease was recently demonstrated. We herein describe a case that shows the relationship between the acquisition of trisomy 8 and occurrence of Behçet's-like disease. Immune dysregulation and altered T-cell hemostasis play an important role in the pathogenesis of Behçet's-like disease and MDS with trisomy 8.
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Affiliation(s)
- Satoko Oka
- Division of Hematology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Kazuo Ono
- Division of Pathology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Masaharu Nohgawa
- Division of Hematology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
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10
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How to treat myelodysplastic syndrome with clinical features resembling Behçet syndrome: a case-based systematic review. Ann Hematol 2020; 99:1193-1203. [DOI: 10.1007/s00277-020-03951-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/03/2020] [Indexed: 01/30/2023]
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11
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Tanaka N, Sakuraba H, Hiraga H, Mayama K, Kikuchi H, Kishida D, Akemoto Y, Hasui K, Ota S, Watanabe R, Murai Y, Maeda T, Kamata K, Tatsuta T, Sawaya M, Chinda D, Mikami T, Yamagata K, Ishiguro Y, Tanaka M, Fukuda S. Long-term maintenance of the mucosal healing induced by azacitidine therapy in a patient with intestinal Behçet's-like disease accompanied with myelodysplastic syndrome involving trisomy 8. Immunol Med 2019; 42:135-141. [PMID: 31707933 DOI: 10.1080/25785826.2019.1687251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Myelodysplastic syndromes (MDSs) are a group of myeloid neoplasms characterized by blood cell deformation and dysfunction, and MDS with trisomy 8 is closely linked with intestinal Behçet's-like diseases. Intestinal Behçet's-like disease is refractory to conventional therapies, including prednisolone, immunomodulators, and anti-tumor necrosis factor α agents. Here, we describe a 56-year-old woman with intestinal Behçet's-like disease ascribed to MDS with trisomy 8 who had multiple intractable intestinal ulcers. She presented with periodic fever and abdominal pain. The genetic analysis showed a heterozygous E148Q mutation in the Mediterranean fever gene. The patient did not tolerate treatment with colchicine because of diarrhea; therefore, azacitidine therapy was initiated. One cycle of azacitidine therapy improved the multiple intestinal ulcers, and the periodic fever and abdominal pain gradually disappeared. After eight cycles of azacitidine therapy, ileocolonoscopy, histological assessment and capsule endoscopy revealed mucosal healing. Azacitidine therapy was continued, and mucosal healing was maintained for more than 2 years. This case suggests that azacitidine therapy which has immunoregulatory effects and epigenetic modulations, might control intestinal Behçet's-like disease associated with MDS involving trisomy 8.
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Affiliation(s)
- Nahoko Tanaka
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotake Sakuraba
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroto Hiraga
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Community Healthcare Development in Odate and North Akita, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ko Mayama
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hidezumi Kikuchi
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yui Akemoto
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Pathology and Bioscience, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Keisuke Hasui
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shinji Ota
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Rina Watanabe
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhisa Murai
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takato Maeda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kosuke Kamata
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tetsuya Tatsuta
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Manabu Sawaya
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Chinda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Community Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tatsuya Mikami
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan
| | - Kazufumi Yamagata
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoh Ishiguro
- Division of Clinical Research, Hirosaki National Hospital, National Hospital Organization, Hirosaki, Japan
| | - Masanori Tanaka
- Department of Pathology and Laboratory Medicine, Hirosaki Municipal Hospital, Hirosaki, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan.,Division of Clinical Research, Hirosaki National Hospital, National Hospital Organization, Hirosaki, Japan
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12
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Asano T, Sato S, Furuya MY, Takahashi H, Shichishima-Nakamura A, Ohkawara H, Fujiwara T, Gunji N, Hashimoto C, Momma T, Saito M, Nakano H, Watanabe G, Temmoku J, Fujita Y, Matsuoka N, Kobayashi H, Watanabe H, Mouri M, Mashiyama F, Sakuma H, Ohira H, Mori M, Ikezoe T, Migita K. Intestinal Behçet disease associated with myelodysplastic syndrome accompanying trisomy 8 successfully treated with abdominal surgery followed by hematopoietic stem cell transplantation: A case report. Medicine (Baltimore) 2019; 98:e17979. [PMID: 31725663 PMCID: PMC6867715 DOI: 10.1097/md.0000000000017979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Intestinal Behçet disease (BD) with myelodysplastic syndrome (MDS) is a rare condition that is resistant to various immunosuppressive therapies. Several cases in which hematopoietic stem cell transplantation (HSCT) was effective for intestinal BD with MDS accompanying trisomy 8 have been reported. PATIENT CONCERNS We report an 18-year-old female with a 7-year history of BD. Colonoscopy demonstrated a huge ulcer in the cecum. Chromosomal examination revealed a karyotype of trisomy 8 in 87% of cells. Bone marrow examination revealed dysplastic cells in multilineages. DIAGNOSES A diagnosis of intestinal BD associated with MDS accompanying trisomy 8 was made. INTERVENTIONS The patient underwent ileocecal resection due to microperforations of ileocecal ulcers; she then underwent allogeneic peripheral blood stem cell transplantation (PBSCT) with her mother as a donor. OUTCOMES After the PBSCT, the patient's symptoms due to BD (fever, oral aphthae, abdominal pain, and genital ulcers) completely disappeared, with no severe adverse events. LESSONS The present case demonstrates that HSCT including PBSCT might be an effective new therapeutic option for refractory intestinal BD with MDS when immunosuppressive therapy has achieved insufficient efficacy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tomoyuki Momma
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima
| | - Motonobu Saito
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima
| | - Hiroshi Nakano
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima
| | | | | | | | | | | | | | - Mariko Mouri
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
| | - Fumi Mashiyama
- Department of Pediatrics, Hoshi General Hospital, Koriyama, Japan
| | - Hiroko Sakuma
- Department of Pediatrics, Hoshi General Hospital, Koriyama, Japan
| | | | - Masaaki Mori
- Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo
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13
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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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14
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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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15
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Kono M, Komeda Y, Sakurai T, Okamoto A, Minaga K, Kamata K, Hagiwara S, Inoue H, Enoki E, Matsumura I, Watanabe T, Kudo M. Induction of Complete Remission by Azacitidine in a Patient with Myelodysplastic Syndrome-Associated Inflammatory Bowel Disease. J Crohns Colitis 2018; 12:499-502. [PMID: 29253109 DOI: 10.1093/ecco-jcc/jjx170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/13/2017] [Indexed: 01/09/2023]
Abstract
Myelodysplastic syndrome [MDS] is a clonal disorder of bone marrow [BM] cells, caused by acquired chromosomal abnormalities and gene mutations. Pro-inflammatory antigen-presenting cells [APCs] originating from BM cells bearing chromosomal abnormalities and gene mutations can cause immune-mediated disorders including inflammatory bowel disease [IBD]. Here, we report the first case with MDS-associated IBD that was successfully treated with the DNA methyltransferase inhibitor, azacitidine [AZA]. A 75-year-old man with a 5-year history of MDS was admitted for examination of diarrhoea and high fever. Blood examination revealed pancytopenia and a marked elevation of C-reactive protein. Colonoscopy revealed multiple round ulcers from the terminal ileum to the sigmoid colon. Pathological examination of the endoscopic biopsy specimens showed destruction of crypt architecture and infiltration of CD3+ T cells and CD68+ macrophages. Surprisingly, administration of AZA, which has been approved for the treatment of high-risk MDS, improved the symptoms, and the multiple round ulcers disappeared. AZA treatment markedly decreased the expressions of tumour necrosis factor-α, interleukin-12 (IL-12)/23p40 and IL-17 in colonic biopsy samples, as assessed by quantitative reverse transcription polymerase chain reaction. In contrast, AZA treatment did not change the expression of forkhead box P3, a master regulator of regulatory T cells. These data suggest that AZA treatment led to complete remission in MDS-associated IBD through suppression of pro-inflammatory cytokine responses.
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Affiliation(s)
- Masashi Kono
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ayana Okamoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Satoru Hagiwara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroaki Inoue
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Eisuke Enoki
- Department of Pathology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
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16
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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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17
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Nakamura Y, Matsuguma M, Tokunaga Y, Yamamoto K, Tanaka M, Tanaka Y, Yujiri T, Tanizawa Y. Successful Treatment of Behçet's Disease Associated with Acute Myeloid Leukemia with Myelodysplasia-related Changes Using Azacitidine and Tacrolimus before Allogeneic Hematopoietic Stem Cell Transplantation. Intern Med 2017; 56:1199-1202. [PMID: 28502936 PMCID: PMC5491816 DOI: 10.2169/internalmedicine.56.7808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The coexistence of acute myeloid leukemia (AML) with Behçet's disease (BD) is rare. The optimum treatment for AML-associated BD has not been established. We herein report a patient with BD who developed AML with myelodysplasia-related changes. Induction chemotherapy caused complete remission of the AML but worsened the BD. Thereafter, AML was treated with azacitidine. The BD was steroid-dependent. Tacrolimus was added, which improved the BD. The patient underwent allogeneic hematopoietic stem cell transplantation (HSCT) and remains in complete remission for both diseases. Allogeneic HSCT was found to be a potent therapeutic option for AML-associated BD. In addition, azacitidine and tacrolimus were shown to be a suitable bridging regimen before HSCT.
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Affiliation(s)
- Yukinori Nakamura
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
| | - Masafumi Matsuguma
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
| | - Yoshihiro Tokunaga
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
| | - Kaoru Yamamoto
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
| | - Mayumi Tanaka
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
| | - Yoshinori Tanaka
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
| | - Toshiaki Yujiri
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
| | - Yukio Tanizawa
- Third Department of Internal Medicine, Yamaguchi University School of Medicine, Japan
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18
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Multiple colonic ulcers associated with trisomy 8: serial changes in colonoscopic findings. Clin J Gastroenterol 2016; 9:298-301. [PMID: 27412026 DOI: 10.1007/s12328-016-0671-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/03/2016] [Indexed: 12/20/2022]
Abstract
We report a 54-year-old female patient with myelodysplastic syndrome (MDS) associated with trisomy 8, who had multiple colonic ulcers. The patient had been diagnosed as having MDS of refractory cytopenia with trisomy 8 10 years previously. She underwent colonoscopy for abdominal pain, which revealed severe circumferential stenosis with multiple ulcers in the ileocecal region and a discrete excavating ulcer in the transverse colon. The patient had been free from any dermatological, oral, genital or ocular symptoms suggestive of Behçet's disease (BD). A diagnosis of multiple colonic ulcers associated with MDS with trisomy 8 was thus suggested. Follow-up colonoscopies 5 and 6 years later revealed progression of the ileocecal stenosis to a circumferential ulcer, while the ulcer in the transverse colon had not changed. Because our patient lacked extraintestinal symptoms of BD, trisomy 8 was presumed to be responsible for her colonic ulcers.
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19
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Allogeneic stem cell transplantation in a patient with myelodysplastic syndrome and polyarteritis nodosa: a case report and systematic review. Ann Hematol 2016; 95:645-7. [PMID: 26787416 DOI: 10.1007/s00277-015-2587-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/19/2015] [Indexed: 11/27/2022]
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20
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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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21
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Lee WS, Kang MH, Hwang JH, Oh YJ, Yoo WH. Allogeneic hematopoietic stem cell transplantation for refractory Behcet's disease with myelodysplastic syndrome: a case report. Int J Rheum Dis 2015; 20:1860-1861. [PMID: 25990631 DOI: 10.1111/1756-185x.12669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Won-Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University, Jeonbuk, South Korea
| | - Mi-Hee Kang
- Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University, Jeonbuk, South Korea
| | - Joo-Hee Hwang
- Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University, Jeonbuk, South Korea
| | - Yoo-Jeong Oh
- Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University, Jeonbuk, South Korea
| | - Wan-Hee Yoo
- Division of Rheumatology, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University, Jeonbuk, South Korea
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22
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Nakanishi T, Horikoshi H, Kusanagi Y, Yamamura T, Takahashi R, Kimura F, Itoh K. Refractory Dermatomyositis Complicated with Myelodysplastic Syndrome. Intern Med 2015; 54:2507-11. [PMID: 26424313 DOI: 10.2169/internalmedicine.54.4762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein describe a case of refractory dermatomyositis (DM) complicated with myelodysplastic syndrome (MDS). Despite intensive immunosuppressive therapies, the activity of myositis, skin ulcers, and interstitial pneumonia did not improve. The patient ultimately died following the progression of interstitial pneumonia. There are few reports of DM accompanying MDS to date, and any association in the pathogenesis between the two is still unclear. However, underlying MDS may have the potential to influence the therapeutic response of DM.
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Affiliation(s)
- Takashi Nakanishi
- Division of Hematology and Rheumatology, Department of Internal Medicine, National Defense Medical College, Japan
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23
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Toyonaga T, Nakase H, Matsuura M, Minami N, Yamada S, Honzawa Y, Hukata N, Yoshino T, Chiba T, Okazaki K. Refractoriness of intestinal Behçet's disease with myelodysplastic syndrome involving trisomy 8 to medical therapies - our case experience and review of the literature. Digestion 2014; 88:217-21. [PMID: 24247154 DOI: 10.1159/000355341] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/28/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Gastrointestinal lesions of Behçet's disease (BD) are often refractory to medical therapy and sometimes result in serious comorbidities such as gastrointestinal perforation and massive bleeding. There are several reports of patients with BD comorbid with myelodysplastic syndrome (MDS) involving trisomy 8 that frequently have intestinal lesions refractory to conventional medical therapy. Little is known about the efficacy of infliximab (IFX) for these intestinal lesions. METHODS We present 2 cases of intestinal BD with MDS involving trisomy 8 who did not respond to IFX, and review previous reports of BD with MDS involving trisomy 8 concerning their responsiveness to conventional medical therapy. RESULTS Among 31 previously reported cases that received medical treatment for BD, 19 (61.3%) showed temporary improvement of the BD symptoms, 9 (29.0%) deteriorated, and 3 (9.7%) showed no change. All of the 9 cases that showed deterioration had intestinal lesions. Our 2 cases failed to respond to IFX, resulting in a poor prognosis. CONCLUSIONS IFX might not be effective for improving intestinal BD comorbid with MDS involving trisomy 8. Trisomy 8 is associated with the BD prognosis and refractoriness to conventional medical therapy.
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Affiliation(s)
- Takahiko Toyonaga
- Department of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Japan
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24
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Soysal T, Salihoğlu A, Esatoğlu SN, Gültürk E, Eşkazan AE, Hatemi G, Hatemi I, Öngören Aydın Ş, Erzin YZ, Başlar Z, Tüzüner N, Ferhanoğlu B, Çelik AF. Bone marrow transplantation for Behçet's disease: a case report and systematic review of the literature. Rheumatology (Oxford) 2014; 53:1136-41. [PMID: 24505123 DOI: 10.1093/rheumatology/ket479] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Behçet's disease (BD) can be life threatening and may be refractory to corticosteroids and immunosuppressives. There has been some experience with haematopoietic stem cell transplantation (HSCT) in BD either for severe, refractory disease or for a haematological condition. The objectives of this study were to describe a BD patient undergoing HSCT and to evaluate the outcomes of BD patients who underwent HSCT. METHODS We report a BD patient with refractory gastrointestinal (GI) involvement who had HSCT for concomitant myelodysplastic syndrome (MDS). We also performed a systematic literature search regarding HSCT for either refractory disease or concomitant haematological conditions in BD patients. RESULTS A 30-year-old woman with refractory GI BD involvement with trisomy 8 MDS underwent a successful myeloablative allogeneic HSCT resulting in complete resolution of both BD and MDS. Additionally we identified 14 manuscripts providing data on 19 patients with BD who had HSCT. Among these 20 patients, including ours, refractory disease was the indication of transplantation in 9, while 11 patients were transplanted because of accompanying haematological conditions. Transplant indications for the nine patients (four male, five female) with refractory BD were neurological involvement in five, pulmonary artery aneurysm in two, GI disease in one and not reported in one patient. Three patients with neurological disease, both patients with pulmonary artery aneurysm and the patient with intestinal involvement achieved complete remission of their disease. Six patients transplanted for haematological conditions, including the presented case, also had GI involvement of BD. All of these patients achieved complete remission of GI findings after HSCT. CONCLUSION When considering HSCT, the potential adverse events and complications, which can be fatal, need to be kept in mind.
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Affiliation(s)
- Teoman Soysal
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Sinem Nihal Esatoğlu
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Emine Gültürk
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Gülen Hatemi
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ibrahim Hatemi
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Şeniz Öngören Aydın
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yusuf Ziya Erzin
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Zafer Başlar
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nükhet Tüzüner
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Burhan Ferhanoğlu
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Aykut Ferhat Çelik
- Division of Hematology, Division of Rheumatology, Division of Gastroenterology, Department of Internal Medicine and Division of Hematopathology, Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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25
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Lin Y, Li G, Zheng W, Tian X, Zhang F. Behcet's disease associated with malignancy: a report of 41 Chinese cases. Int J Rheum Dis 2013; 17:459-65. [PMID: 24354961 DOI: 10.1111/1756-185x.12269] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify the clinical characteristics of Behcet's disease (BD) associated with malignancies. METHOD Among 651 BD patients sequentially hospitalized in Peking Union Medical College Hospital from 1995 to 2012, 41 patients developed malignancies. Clinical characteristics were compared between patients with and without malignancies, as well as between patients with hematological and solid malignancies. RESULTS The numbers of patients with various types of malignancies were listed as follows: (i) 29 cases developed hematologic malignancies which included myelodysplastic syndrome (MDS) as the most common diagnosis in 20 cases, leukemia in seven cases, anaplastic anemia in two cases and lymphoma in one case; (ii) 13 cases developed malignant solid neoplasms which included colorectal cancer in three cases, urothelial carcinoma of bladder in two cases, esophageal cancer, gastric cancer, pancreatic cancer, thyroid cancer, breast cancer, cervical cancer, renal cell carcinoma and metastatic adenocarcinoma of unknown primary in one case each. Female gender, older age and gastrointestinal tract involvement were more frequently observed among patients with malignancy than those without. Older age, longer disease duration were more commonly seen in BD patients with solid neoplasms than in those with hematologic malignancies. Exacerbation of BD manifestations during the emergence of malignancy was more frequently observed among patients with hematologic malignancies than among those with malignant solid neoplasms. CONCLUSION This study demonstrated that MDS and colorectal cancer were the most common hematologic malignancy and malignant solid neoplasm associated with BD, respectively. Gastrointestinal involvement is likely to be a risk factor for BD patients to develop malignancy. Further studies will be required to ascertain the pathogenic link between these two entities.
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Affiliation(s)
- Yi Lin
- Department of Oncology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, China
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26
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Tanaka H, Shimizu N, Tougasaki E, Kawajiri C, Hashimoto S, Takeda Y, Sakai S, Takeuchi M, Ohwada C, Sakaida E, Takagi T, Nakaseko C. Successful treatment by azacitidine therapy of intestinal Behçet's disease associated with myelodysplastic syndrome. Int J Hematol 2013; 97:520-4. [PMID: 23519573 DOI: 10.1007/s12185-013-1316-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 12/14/2022]
Abstract
Myelodysplastic syndrome (MDS) is a heterogeneous group of clonal hematopoietic stem cell diseases. It has been reported that several autoimmune diseases are associated with MDS. Recently, the co-occurrence of MDS with trisomy 8 and rare disorders of the immune system, such as Behçet's disease (BD), has been described. Prognosis in the older-onset group of MDS-associated BD is unfavorable. Here, we report a case of MDS-associated intestinal BD treated successfully by azacitidine therapy. A 59-year-old Japanese male suffering from recurrent high fever, melena, and oral and genital ulcerations was diagnosed with MDS with trisomy 8 and intestinal BD by endoscopic and bone marrow examinations. Immunosuppressive therapies, including infliximab, were ineffective. Due to his severe emphysema, the patient was considered ineligible for stem cell transplantation, and azacitidine therapy was initiated. With the exception of fever, the symptoms of intestinal BD improved, and severe malnutrition and anemia were ameliorated. Fluorescence in situ hybridization analyses of the bone marrow before the eighth cycle revealed that the trisomy 8 had not decreased. To our knowledge, this is the first report of azacitidine therapy for MDS-associated BD. We suggest that azacitidine may control intestinal BD by mechanisms other than those responsible for its effect in MDS.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Hematology, Oami Municipal Hospital, 884-1 Tomita, Oamishirasato, Chiba, Japan.
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27
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Affiliation(s)
- Hye Won Lee
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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28
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Chung JW, Cheon JH, Lee KJ, Kim JS, Jang SJ, Yang WI, Kim TI, Kim WH. Aplastic Anemia with Trisomy 8 and Trisomy 9 in Intestinal Behçet's Disease. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 55:256-60. [DOI: 10.4166/kjg.2010.55.4.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Joo Won Chung
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyong Joo Lee
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seon-Jung Jang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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