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Giordano G, Cutuli MA, Lucchesi A, Magnifico I, Venditti N, Vergalito F, Gasperi M, Di Marco R. Iron Support in Erythropoietin Treatment in Myelodysplastic Syndrome Patients Affected by Low-Risk Refractory Anaemia: Real-Life Evidence from an Italian Setting. Acta Haematol 2019; 143:155-162. [PMID: 31533096 DOI: 10.1159/000501329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/01/2019] [Indexed: 11/19/2022]
Abstract
Refractory anaemia (RA) among myelodysplastic syndrome (MDS) is associated with a partial functional iron deficit and may require transfusions. In low-risk lymphoma and solid tumour patients, iron support improves erythropoietin (EPO) cost-effectiveness in treating anaemia. The aim of this study is to see if oral sucrosomial iron support improves the cost-effectiveness of EPO treatment in MDS patients affected by low-risk RA. We treated patients with EPO only or with EPO plus oral sucrosomial iron or intravenous (i.v.) iron. The need for transfusions was lowest in the group taking oral iron (p = 0.016) or not receiving supplementation at all (p = 0.022). We compared costs of EPO with i.v. ferric gluconate or oral sucrosomial iron supplementation or no iron supplementation. The oral iron group had fewer side effects, fewer patient medical visits in the out-patient setting, and fewer transfusions; this led to higher savings on direct hospital costs and indirect patient costs (lost days at work) and translated into a 50% abatement of overall expenditures. EPO treatment-related expenditures in MDS-RA patients were lowest with oral sucrosomial iron supplementation (Sideral®), with a longer interval between EPO administration in maintenance treatment, quicker hemoglobin recovery, lower ferritin increase and fewer blood transfusions.
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Affiliation(s)
- Giulio Giordano
- Division of Internal Medicine, Hematology Service, Regional Hospital "A. Cardarelli,", Campobasso, Italy,
| | - Marco Alfio Cutuli
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Alessandro Lucchesi
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Irene Magnifico
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Noemi Venditti
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Franca Vergalito
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Maurizio Gasperi
- Division of Internal Medicine, Hematology Service, Regional Hospital "A. Cardarelli,", Campobasso, Italy
- Division of Internal Medicine, Regional Hospital "A. Cardarelli,", Campobasso, Italy
| | - Roberto Di Marco
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
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2
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Tatic A, Vasilică M, Coliţă A, Vasilache D, Dobrea C, Jardan C, Găman AM, Crişan AM, Coliţă D, Coriu D. Refractory anemia with ringed sideroblasts and thrombocytosis without JAK2 V617F mutation: report of three cases. Rom J Morphol Embryol 2013; 54:1177-1182. [PMID: 24399021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In the WHO classification, there is a provisional entity called Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable (MDS/MPN, U). Refractory anemia with ringed sideroblasts associated with marked thrombocytosis (RARS-T) was included in this category. Recently published studies report a small percentage of patients with RARS-T. Sixty percent of these have JAK2 V617F mutation, which can suggest the coexistence of two pathological conditions (MDS and MPN). In this paper, we analyzed three patients diagnosed with RARS-T in the Department of Hematology, "Fundeni" Clinical Institute, Bucharest, Romania, during the period 2005-2011. The patients were investigated with cytogenetic exam and molecular biology. In these three cases were identified morphological features of multilineage dysplasia (two-lineage dysplasia in two cases and three-lineage dysplasia in one case). In two cases, thrombocytosis was under 1000×10(3)/μL and clinical evolution was similar to the myelodysplastic syndrome (transfusion dependent anemia with response to administration of erythropoietin). In the third case, the platelets were over 1000×10(3)/μL and with response to the treatment with Hydrea, which improved anemia. JAK2 V617F mutation was not identified in any case. RARS-T remains a provisional entity and requires a complex investigation of patients for the correct diagnosis of these patients. Therapeutic options should be personalized to each case in part because there is not yet a standardized treatment of these patients.
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Affiliation(s)
- Aurelia Tatic
- Center of Hematology and Bone Marrow Transplantation, "Fundeni" Clinical Institute, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
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3
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Zhang M, You Y, Li X, He Y, Zheng J, Li W, Zou P, Liu X, Liu F. Response to lenalidomide of a patient with t(2;3)(p23;q29) and JAK2 non-mutated refractory anemia with ring sideroblasts and thrombocytosis. Leuk Lymphoma 2012; 54:1544-6. [PMID: 23252419 DOI: 10.3109/10428194.2012.744456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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4
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García-Hernández FJ, González-León R, Castillo-Palma MJ, Ocaña-Medina C, Sánchez-Román J. Tocilizumab for treating refractory haemolytic anaemia in a patient with systemic lupus erythematosus. Rheumatology (Oxford) 2012; 51:1918-9. [PMID: 22513150 DOI: 10.1093/rheumatology/kes072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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5
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Abstract
According to the World Health Organization (WHO) classification of tumors of hematopoietic and lymphoid tissues, myelodysplastic/myeloproliferative neoplasms are clonal myeloid neoplasms that have some clinical, laboratory, or morphologic findings that support a diagnosis of myelodysplastic syndrome, and other findings that are more consistent with myeloproliferative neoplasms. These disorders include chronic myelomonocytic leukemia, atypical chronic myeloid leukemia (BCR-ABL1 negative), juvenile myelomonocytic leukemia, and myelodysplastic/myeloproliferative neoplasms, unclassifiable. The best characterized of these latter unclassifiable conditions is the provisional entity defined as refractory anemia with ring sideroblasts associated with marked thrombocytosis. This article focuses on myelodysplastic/myeloproliferative neoplasms of adulthood, with particular emphasis on chronic myelomonocytic leukemia and refractory anemia with ring sideroblasts associated with marked thrombocytosis. Recent studies have partly clarified the molecular basis of these disorders, laying the groundwork for the development of molecular diagnostic and prognostic tools. It is hoped that these advances will soon translate into improved therapeutic approaches.
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Affiliation(s)
- Mario Cazzola
- Department of Hematology Oncology, University of Pavia Medical School and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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6
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Abstract
A diagnosis of eosinophilic leukemia was suspected in a patient who presented with eosinophilia and a mild macrocytic anemia and was found to have trisomy 8. Further tests and the subsequent clinical course permitted an accurate diagnosis.
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Affiliation(s)
- Sarah Fletcher
- Department of Haematology, St Mary's Hospital, London, UK
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Wei J, Zhou XF, Zhao F, Zhou JF, Chen Y. Immunologic characteristics and prognosis of myelodysplastic syndrome new subtype: refractory anemia with excess blasts-II. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2009; 17:111-116. [PMID: 19236759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study was aimed to investigate the immunologic characteristics of refractory anemia with excess blasts-II (RAEB-II) which belongs to a new subtype of World Health Organization (WHO) classification of myelodysplastic syndrome (MDS) and to screen out the independent immunologic prognostic factors of MDS. 35 cases of adult patients with de novo MDS were investigated. The immunofluorescent analysis by multiparameter flow cytometry was performed at the double gating of CD45/SSC to determine the immunophenotype of MDS cells in all cases. All patients were followed up. 47 cases of acute myeloid leukemia (AML) M1, 51 cases of AML-M(2) and 38 cases of acute lymphocytic leukemia (ALL) were selected as control. Software SPSS 13.0 was applied to analyze all the related data. The results showed that the positive expression rate of HLA-DR in RAEB-II was 100%, which was high in sensitivity and specificity. CD13 (94.74%), CD33 (84.21%) and CD117 (78.95%) were also highly expressed in RAEB-II. CD13 in RAEB-II was significantly higher than that in refractory cytopenia with or without multilineage dysplasia (RA/RCMD) (p < 0.01) and REAB-I (p < 0.05); CD33, CD117 (p < 0.05) and stem cell antigen CD34 (p < 0.01) in RAEB-II were significantly higher than that in RCMD (p < 0.01), but no statistically significant difference was found as compared with RAEB-I (p > 0.05). Compared with AML-M(1) and AML-M(2), no significant difference of CD13 and CD117 in RAEB-II was found (p > 0.05). CD33 (p < 0.01) and CD34 (p < 0.05) were significantly lower than that in AML-M(1), but no significant difference was found as compared with AML-M(2) (p > 0.05); CD15 (p < 0.01) and CD11b (p < 0.05) was significantly lower than that in M(2), but no significant difference was found as compared with AML-M(1) (p > 0.05); MPO was significantly lower than that in AML-M(1) and M(2) (p < 0.05); HLA-DR was significantly higher than that on AML-M(2) (p < 0.05), but no significant difference was found as compared with AML-M(1) (p > 0.05). RAEB-II did not express CD2, CD3, CD5 and CD8 (positive rate 0%, p < 0.01) when compared with T-ALL; CD4 (p < 0.05) and CD7 (p < 0.01) were significantly lower than that in T-ALL. RAEB-II did not express CD19 and CD20 (positive rate 0%, p < 0.01) as compared with B-ALL; CD10, CD22 and cCD79a were significantly lower than that in B-ALL (p < 0.05). CD117 (p = 0.0197) and MPO (p = 0.0085) were the two prognostic immunological antigens as regards the overall survival (OS) of MDS; CD117 (p = 0.003) was the single parameter in Cox regression. It is concluded that RAEB-II expresses mainly myeloid antigen without or with little expression of lymphoid antigen. Unique individual immunophenotypic features can be detected in patients with RAEB-II. HLA-DR can be a specific parameter to distinguish the other subtypes of MDS. CD117 may be an independent prognostic immunological antigen as regards OS of MDS.
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Affiliation(s)
- Jia Wei
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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8
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Nozaki Y, Nagare Y, Kinoshita K, Urase F, Funauchi M. Successful treatment using tacrolimus plus corticosteroid in a patient with RA associated with MDS. Rheumatol Int 2007; 28:487-90. [PMID: 17764011 DOI: 10.1007/s00296-007-0445-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 07/30/2007] [Indexed: 01/06/2023]
Abstract
We report a case of rheumatoid arthritis (RA) complicated by myelodysplastic syndrome (MDS) successfully treated by tacrolimus. A 57-year-old woman had persistent pain and swelling in bilateral wrist and knee joints, in addition to severe anemia and leukopenia. She was diagnosed with MDS and RA based on the results of bone marrow aspiration and the criteria of RA. Combination therapy with tacrolimus (1.5 mg day(-1)) and prednisolone (10 mg day(-1)) improved her bicytopenia and polyarthralgia.
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Affiliation(s)
- Yuji Nozaki
- Department of Nephrology and Rheumatology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, Japan.
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Nakamura Y, Yujiri T, Ando T, Hisano S, Tanizawa Y. Nephrotic syndrome associated with thrombotic microangiopathy following allogeneic stem-cell transplantation for myelodysplastic syndrome. Br J Haematol 2007; 136:857-9; author reply 859-60. [PMID: 17341274 DOI: 10.1111/j.1365-2141.2007.06515.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Keijzer A, van der Valk P, Ossenkoppele GJ, van de Loosdrecht AA. Mucormycosis in a patient with low risk myelodysplasia treated with anti-TNF-alpha. Haematologica 2006; 91:ECR51. [PMID: 17194657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Accelerated programmed cell death or apoptosis appears to play an important role in the pathogenesis of myelodysplasia. As overexpression of TNF-alpha has been described to induce cell death in myelodysplasia, treatment with anti-TNF-alpha is currently being explored. Caution is needed because of an increased risk of opportunistic infection during anti-TNF-alpha treatment. We here describe a patient who was treated with anti-TNF-alpha for low risk myelodysplasia and died of invasive mucormycosis.
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Affiliation(s)
- A Keijzer
- VU-University Medical centre Amsterdam, department of haematology, de Boelelaan 1117, BR 240,1081 HV, Amsterdam, The Netherlands.
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D'Angelo G. Refractory anemia with ringed sideroblasts and chronic myelomonocytic leukemia: myelodysplastic/myeloproliferative disease. ACTA ACUST UNITED AC 2005; 11:171-3. [PMID: 16174602 DOI: 10.1532/lh96.05018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Here is reported the case of an elderly woman that, after surgical intervention, showed an important anemia, leucocytosis and thrombocytopenia. The leucocytosis was accompanied with clean increase of the monocytes. The morphological appearances, both peripheral blood and bone marrow, showed an evident overlapping of myelodysplastic and myeloproliferative picture, characterized from the presence of refractory anemia with ringed sideroblasts (RARS) and chronic myelomonocytic leukemia (CMML). The case has been reported because it is not frequent, besides, the CMML, until from the beginning of French-American-British (FAB) classification application, has raised problems of classification. Currently, the World Health Organization (WHO) has given an arrangement to the hematological picture with myelodysplastic and myeloproliferative morphological appearances, including this pathology in a new category: myelodysplastic/myeloproliferative diseases (MDS/MPD).
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Affiliation(s)
- Guido D'Angelo
- Azienda Ospedaliera S. Antonio Abate - Gallarate, Laboratorio di Chimica-Clinica, Ematologia e Microbiologia, Varese, Italy.
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Abstract
Myelodysplastic syndromes (MDS) are a set of oligoclonal disorders of hematopoietic stem cells characterized by ineffective hematopoiesis that manifest clinically as anemia, neutropenia, and/or thrombocytopenia of variable severity. The result often is transfusion-dependent anemia, an increased risk of infection or hemorrhage, and a potential to progress to acute myelogenous leukemia (AML). Although progression to acute leukemia can lead to death in patients with MDS, many deaths are consequences of cytopenias and marrow failure in the absence of transformation. Approximately 2/3 of patients succumb to the disease within 3-4 years after presentation, and individuals with high-risk MDS generally survive about 1 year. Given that the disease is more prevalent in the elderly who often have comorbid conditions, the current treatment of MDS consists mainly of supportive care. Curative treatments are restricted to younger, healthy individuals with histocompatible (HLA)-matched donors for allogenic transplant or those able to undergo intensive chemotherapeutic regimens. However, understanding of the pathophysiology of MDS and identification of potential cellular and molecular targets in recent years has led to novel therapeutic approaches. Encouraging results using these heterogeneous therapeutic approaches alone or in combination in Phase I and II trials, have, in turn, called into question previous classification systems and have confirmed the need for an all-encompassing molecular, diagnostic and prognostic staging system.
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MESH Headings
- Anemia, Refractory/complications
- Anemia, Refractory/pathology
- Anemia, Refractory/therapy
- Blood Transfusion
- Clinical Trials, Phase I as Topic
- Clinical Trials, Phase II as Topic
- Combined Modality Therapy
- Hematopoiesis
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Neoplasm Staging/classification
- Neoplasm Staging/methods
- Neutropenia/etiology
- Neutropenia/pathology
- Neutropenia/therapy
- Risk Factors
- Stem Cell Transplantation
- Thrombocytopenia/etiology
- Thrombocytopenia/pathology
- Thrombocytopenia/therapy
- Transplantation, Homologous
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Affiliation(s)
- Daniel V T Catenacci
- Division of Hematology and Oncology, Department of Medicine, UCLA School of Medicine, Los Angeles, CA 90095-3075, USA
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González FA, Arrizabalaga B, Villegas A, Alonso D, Castro M, Remacha A, del Arco A, Martín Núñez G. Estudio del tratamiento con desferroxamina en perfusión subcutánea para la sobrecarga de hierro en pacientes con síndrome mielodisplásico. Med Clin (Barc) 2005; 124:645-7. [PMID: 15882510 DOI: 10.1157/13074739] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The progressive accumulation of iron in the organism contribute to one of the most important problems of morbidity and mortality in patients with myelodysplastic syndrome (MDS). We present an observational protocol, multicentre, open and non-aleatheorised, in patients diagnosed with MDS on transfusional regime with iron overload. The study was meant to prove the effectiveness of the parenteral treatment with desferrioxamine using continuous devices of subcutaneous profusion and evaluate the evolution of iron overload as well as transfusional requirements. PATIENTS AND METHOD There were 28 patients (12 men and 16 women), 12 AR, 15 AS and 1 unknown. Average monitoring lasted 13.5 months and there was a gradual loss of patients. 11 of them had gone during the first year. RESULTS After 12 months the average of ferritin decreased by 258.51 ng/dl (DE 1208.04; p = 9.4) and after 24 months, it decreased by 979.6 ng/dl (DE 810.31; p = 0.1). After 12 months the average of requirements increased by 60.57 gHb/month (DE 183.7; p = 0.029) and after 24 months, it increased by 167.3 g/Hb/month (DE 406.5; p = 0.36). CONCLUSIONS Desferroxiamine treatment is effective at least to prevent an iron overload in these patients, and therefore should be incorporated in the clinical practice.
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Kumar V, Dash S. Myelodysplastic syndrome with erythroid hypoplasia: a rare and distinct clincopathological entity--a report of two cases. INDIAN J PATHOL MICR 2005; 48:36-7. [PMID: 16758786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Erythroid hypoplasia in myelodysplastic syndrome (MDS) happens to be a rare association and is being recognized as a distinct clinico pathological entity. We report here two such cases diagnosed as Refractory anaemia (RA) and Refractory anaemia with excess blast (RAEB) who had marked suppression of the erythroid cell lines. Both patients presented with severe transfusion dependent anaemia. Recognition of these cases is important as alternative modalities of treatment such as immunosuppressives may be considered for these patients.
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Affiliation(s)
- Vijay Kumar
- Department of Haematology, PGIMER Chandigarh
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Ljung T, Bäck R, Hellström-Lindberg E. Hypochromic red blood cells in low-risk myelodysplastic syndromes: effects of treatment with hemopoietic growth factors. Haematologica 2004; 89:1446-53. [PMID: 15590394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The anemia of low-risk myelodysplastic syndromes (MDS), refractory anemia (RA) and RA with ringed sideroblasts (RARS), may respond to treatment with hematopoietic growth factors (GF)); erythropoietin (Epo) +/- granulocyte colony-stimulating factor (G-CSF). The present study was designed to assess whether functional iron deficiency may develop in MDS patients receiving these treatments. DESIGN AND METHODS Erythrocyte scattergrams from 34 patients with RA and RARS (untreated, transfused, or GF-treated with partial or complete erythroid response) were analyzed with Bayer-Advia equipment. RESULTS In untreated RARS, the proportion of hypochromic erythrocytes (Hypo-e, median 6.2%, range 1.1-8%) and hypochromic reticulocytes (Hypo-r, median 45%, range 22-48%), as well as mean corpuscular volume (MCV, median 101 fL) were significantly elevated compared to corresponding values in controls. These values increased further after GF-treatment (median 11%, 57%, and 105 fL, respectively), in spite of improved hemoglobin values and adequate body iron stores. The values observed in untreated RA patients largely fell within the normal range, and there was no significant influence of GF treatment. Notably, the hemoglobin content of reticulocytes (MCHr) did not differ between MDS and controls, and was not influenced by GF treatment. INTERPRETATION AND CONCLUSIONS The red cell population in RARS shows morphological abnormalities in terms of varying but overall increased size, and reduced hemoglobin concentration. The proportion of abnormal cells increases after successful pro-erythroid GF treatment, indicating that GF promote erythroblast survival, and maturation into erythrocytes. Hence, the finding of hypochromic red cells should not routinely be interpreted as a marker for Epo-induced functional iron deficiency in MDS.
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Affiliation(s)
- Therese Ljung
- Department of Medicine, Division of Hematology, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden
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Sakamoto O, Imaizumi M, Suzuki A, Sato A, Tanaka T, Ogawa E, Kumaki S, Iinuma K. Refractory autoimmune hemolytic anemia in a patient with chromosome 22q11.2 deletion syndrome. Pediatr Int 2004; 46:612-4. [PMID: 15491395 DOI: 10.1111/j.1442-200x.2004.01940.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
MESH Headings
- Abnormalities, Multiple
- Anemia, Hemolytic, Congenital/complications
- Anemia, Hemolytic, Congenital/genetics
- Anemia, Refractory/complications
- Autoimmune Diseases/complications
- Chromosome Deletion
- Chromosomes, Human, Pair 22/genetics
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Very Low Birth Weight
- Male
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Affiliation(s)
- Osamu Sakamoto
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
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17
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Dalamaga M, Karmaniolas K, Chavelas C, Liatis S, Ioannidis P, Matekovits H, Migdalis I. Coexistence of primary refractory anemia with ringed sideroblasts and T cell-lymphoblastic non-Hodgkin lymphoma. Acta Haematol 2004; 111:171-2. [PMID: 15034241 DOI: 10.1159/000076528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2003] [Accepted: 10/27/2003] [Indexed: 11/19/2022]
Affiliation(s)
- Maria Dalamaga
- Department of Internal Medicine, Hematology Section, NIMTS General Hospital, Athens, Greece.
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18
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Kubota N, Miyazawa K, Shoji N, Sumi M, Nakajima A, Kimura Y, Oshiro H, Ebihara Y, Ohyashiki K. A massive intraventricular thrombosis by disseminated mucormycosis in a patient with myelodysplastic syndrome during deferoxamine therapy. Haematologica 2003; 88:EIM13. [PMID: 14607766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Affiliation(s)
- Naoshi Kubota
- First Department of Internal Medicine, Second Department of Pathology, Tokyo Medical University
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Kabutomori O, Kanakura Y, Iwatani Y. Marked decreases of total and immature reticulocytes in myelodysplastic syndrome among patients with pancytopenia. Acta Haematol 2003; 109:212-3. [PMID: 12853698 DOI: 10.1159/000070975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2002] [Accepted: 01/27/2003] [Indexed: 11/19/2022]
Affiliation(s)
- Osamu Kabutomori
- Central Laboratory for Clinical Investigation, Osaka University Hospital, Suita, Japan.
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Goerner M, Gooley T, Flowers MED, Sullivan KM, Kiem HP, Sanders JE, Martin PJ, Storb R. Morbidity and mortality of chronic GVHD after hematopoietic stem cell transplantation from HLA-identical siblings for patients with aplastic or refractory anemias. Biol Blood Marrow Transplant 2003; 8:47-56. [PMID: 11858190 DOI: 10.1053/bbmt.2002.v8.pm11858190] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We analyzed effects of successive changes in prevention and treatment of chronic GVHD in 405 patients with aplastic anemia and refractory anemia given HLA-matched hematopoietic stem cell transplantation (HSCT) from 1970-1997. For analysis, patients were divided into group I, transplantations from 1970-1976; group II, 1977-1983; group III, 1984-1990; and group IV, 1991-1997. The overall incidence of chronic GVHD was 28%. Incidences of chronic GVHD for groups I through IV were 20%, 46%, 41%, and 22%, respectively, reflecting added buffy coat infusions in groups II and III. Five-year survival rates of patients with chronic GVHD for groups I through IV were 58%, 74%, 82%, and 76%, respectively (NS). Among group I patients, 50% were alive off immunosuppression, none were alive on immunosuppression, and 50% died. These figures were 76%, 0%, and 24% in group II; 80%, 10%, and 10% in group III; and 64%, 21%, and 14% in group IV patients. More serious infections and skin contractures were seen in group I than in groups II, III, and IV (P = .0001, .02, .01 and P =.0003, .001, .05, respectively). Lung complications, aseptic necroses, depression, and Karnofsky scores were comparable among groups. Gastrointestinal complications seemed less frequent among groups II through IV. Diabetes mellitus was more frequent in group IV than in groups I through III (P = .008). Secondary malignancies occurred in 33%, 6%, 3%, and 0% of patients in the 4 groups, respectively. In conclusion, over 28 years, chronic GVHD has remained challenging, with only slight improvements in quality of life. Decisive improvements in therapy and survival will have to await both a better understanding of the immunological events underlying chronic GVHD and better infection prevention and control.
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MESH Headings
- Adolescent
- Adult
- Anemia, Aplastic/complications
- Anemia, Aplastic/mortality
- Anemia, Aplastic/therapy
- Anemia, Refractory/complications
- Anemia, Refractory/mortality
- Anemia, Refractory/therapy
- Child
- Child, Preschool
- Chronic Disease
- Female
- Follow-Up Studies
- Graft vs Host Disease/complications
- Graft vs Host Disease/mortality
- Graft vs Host Disease/therapy
- Histocompatibility Testing
- Humans
- Immunosuppressive Agents/therapeutic use
- Incidence
- Male
- Middle Aged
- Siblings
- Stem Cell Transplantation/adverse effects
- Stem Cell Transplantation/mortality
- Stem Cell Transplantation/statistics & numerical data
- Survival Analysis
- Transplantation, Isogeneic/adverse effects
- Transplantation, Isogeneic/mortality
- Transplantation, Isogeneic/statistics & numerical data
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Affiliation(s)
- Martin Goerner
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle 98109-1024, USA
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21
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Qiao JH, Sun WJ, Yu CL, Wang DH, Guo M, Zhang S, Liu F, Ai HS. [Diagnosis and treatment of invasive pulmonary aspergillosis in malignant hematological diseases-3 cases reported]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2003; 11:202-4. [PMID: 12744749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Invasive pulmonary aspergillosis is difficult to diagnose and a critical ill with high mortality. In this paper, the diagnosis and treatment of invasive pulmonary aspergillosis complicated in 3 cases of hematological malignancy (2 acute leukemias and 1 MDS-RA) were retrospectively analysed. All patients had histories of hypoimmunity and were received prophylactic antifungal treatment. Pulmonary aspergillosis infection still occurred and confirmedly diagnosed by sputum examination. After 7 to 14 days of combination treatment of liposomal amphotericin B, itraconazole and flucytosine, 2 cases were cured and another showed effective. In conclusion, early diagnosis and treatment of invasive pulmonary aspergillosis are very critical and the therapeutic effectiveness of combined scheme with liposomal amphotericin B, itraconazole and flucytosine is very effective for pulmonary aspergillosis.
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Affiliation(s)
- Jian-Hui Qiao
- Department of Hematology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing 100039, China.
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22
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Steensma DP, Dispenzieri A, Moore SB, Schroeder G, Tefferi A. Antithymocyte globulin has limited efficacy and substantial toxicity in unselected anemic patients with myelodysplastic syndrome. Blood 2003; 101:2156-8. [PMID: 12411290 DOI: 10.1182/blood-2002-09-2867] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Antithymocyte globulin (ATG) has recently been popularized as an effective treatment in myelodysplastic syndrome (MDS). We treated 8 anemic MDS patients (refractory anemia [RA] and refractory anemia with excess blasts [RAEB-1]) with ATG (40 mg/kg/d for 4 days) and prednisone in a phase 2 trial. The study was stopped early according to a preset termination rule because of lack of efficacy. There were no salutary responses. Toxicities included serum sickness (in all patients), transient neutropenia and thrombocytopenia, diarrhea, vomiting, and syncope with a generalized seizure. At least 3 patients had the HLA-DR15 (DR2) allele. We conclude that the risk-benefit ratio of ATG in an unselected population of MDS patients may be unfavorable, and more work is needed to define the subset of patients who will respond to ATG before its widespread use can be recommended.
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Affiliation(s)
- David P Steensma
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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23
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Bogdanović R, Kuzmanović M, Marković-Lipkovski J, Ognjanović M, Mićić D, Stanković I, Stajić N, Nikolić V, Bunjevacki G. [Corticoid-sensitive nephrotic syndrome in children with myelodysplastic syndromes]. SRP ARK CELOK LEK 2002; 130:323-8. [PMID: 12577674 DOI: 10.2298/sarh0210323b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Several reports have documented various forms of glomerular diseases in adults with myelodysplastic syndromes (MDS), but similar reports in children are lacking. We describe two children with MDS-associated with steroid-responsive nephrotic syndrome (NS). Patient 1, who had MDS with myelofibrosis, presented also hepatosplenomegaly, pancytopenia, chronic hepatitis, moderate proteinuria, hypocomplementamia and elevated ANA titer. During initial prednisone treatment proteinuria markedly diminished and partial but transient haematological improvement occurred. Relapse subsequently occurred that was manifested by overt NS and pancytopenia. High doses of prednisolone led to remission of the renal disease but haematological remission did not occur. Persisting pancytopenia and repeated infections terminated in sepsis, two years after the onset of MDS. Patient 2, who had refractory anaemia with clonal monosomy 19, manifested bowel disease, hepatosplenomegaly, anaemia and non-organic specific autoantibodies. Prednisone led to both clinical and haematological remission. Haematologic disease relapsed 12 months later, when nephrotic-range proteinuria, haematuria and mild azotaemia were also found. Corticosteroid treatment led to long-lasting renal and haematologic remission, maintained by a small dosage of prednisone. In both patients, renal biopsy findings were consistent with those seen in idiopathic NS. A Medline search disclosed 16 cases of glomerulopathy in the course of MDS in adult patients. Clinical features included NS, usually accompanied by renal insufficiency with either acute, chronic, or rapidly progressive glomerulonephritis. On biopsy, membranous nephropathy, crescentic or mesangial proliferative glomerulonephritis and AL amyloidosis, were found. We conclude: (1) that glomerular disease may be present and should be searched for in patients with MDS; (2) that MDS can be added to the list of rare conditions associated with corticosteroid-responsive NS in children.
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Affiliation(s)
- Radovan Bogdanović
- Dr. Vukan Chupitsh Institute of Mother and Child Health Care of Serbia, Belgrade.
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24
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Wellman G, Veillon DM, Nordberg ML, Young RL, Cotelingam JD. Pathology case of the month. Elderly woman with fatigue. The 5q- Syndrome. J La State Med Soc 2002; 154:175-7. [PMID: 12236399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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25
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Hequet O, Salles G, Espinousse D, Dumontet C, Bouafia F, Thieblemont C, Revesz D, Coiffier B. Multifocal progressive leukoencephalopathy occurring after refractory anemia and multiple infectious disorders consecutive to severe lymphopenia. Ann Hematol 2002; 81:340-2. [PMID: 12107566 DOI: 10.1007/s00277-002-0458-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2002] [Accepted: 03/22/2002] [Indexed: 10/27/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is related to central nervous system infection with JC virus (JCV). This leukoencephalopathy occurs in immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS) or lymphoid malignancies. We describe here a patient with myelodysplastic syndrome who developed several life-threatening infections including listeriosis, tuberculosis, and PML. Listeriosis and recurrence of tuberculosis preceded the occurrence of PML. Neurologic features associated with major ataxia, speech disorders, and PML were documented by cranial magnetic resonance imaging showing typical features in the cerebellum and proven by polymerase chain reaction (PCR) detection of JCV DNA in the cerebrospinal fluid. No specific treatment was decided because of progression toward acute myeloid leukemia. In this case, PML occurred with no susceptibility and without immunosuppressive treatment. Our case adds further support to the association between the impairment of T-cell immune responses and myelodysplastic disorders.
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Affiliation(s)
- O Hequet
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite Cedex, France.
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26
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Simpson JK, Brockow K, Turner ML, Akin C, Metcalfe DD. Generalized erythematous macules and plaques associated with flushing, repeated syncope, and refractory anemia. J Am Acad Dermatol 2002; 46:588-90. [PMID: 11907513 DOI: 10.1067/mjd.2002.120446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Joanne K Simpson
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases/NIH, Bethesda, MD 20892-1908, USA
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27
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Seipelt G, Germing U, Koschmieder S, Böhme A, Aul C, Hoelzer D. Secondary acute myeloid leukaemia with monosomy 7 in identical adult twins. Br J Haematol 2002; 116:338-40. [PMID: 11841435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We report the development of secondary acute myeloid leukaemia (AML) with monosomy 7 in identical twins, both at the age of 52 years. In the first twin, induction therapy resulted in complete remission (CR). At relapse 9 months later monosomy 7 was found. The patient died of sepsis 11 months after diagnosis. The other twin presented with leucopenia and thrombocytopenia and refractory anaemia (RA) was diagnosed. During follow-up, fluorescence in situ hybridization analysis demonstrated a monosomy 7 in 11% of the cells. Twenty-eight months following diagnosis the patient progressed to RA with excess blasts in transformation and induction chemotherapy was initiated without achieving CR. Three months later an allogeneic stem cell transplantation from a niece was performed, resulting in CR of the secondary AML.
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MESH Headings
- Acute Disease
- Anemia, Refractory/complications
- Anemia, Refractory/genetics
- Anemia, Refractory, with Excess of Blasts/complications
- Anemia, Refractory, with Excess of Blasts/genetics
- Chromosomes, Human, Pair 7
- Diseases in Twins/genetics
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid/complications
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/surgery
- Male
- Middle Aged
- Monosomy
- Remission Induction
- Transplantation, Homologous
- Twins, Monozygotic
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Affiliation(s)
- Gernot Seipelt
- Universitätsklinik Frankfurt, Medizinische Klinik III, Hämatologie/Onkologie, Frankfurt/M, Germany.
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28
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Salvador-Osuna C, Fernandez-Mosteirin N, Mayayo P, Delgado P, Giralt M. Choroiditis as systemic manifestation of a Sweet's syndrome associated to myelodysplasia: a case report. Haematologica 2002; 87:ECR07. [PMID: 11801481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
- Carlos Salvador-Osuna
- Department of Hematology, Hospital Miguel Servet, Paseo de Isabel la Catolica no. 1, 50009 Zaragoza, Spain.
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29
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Affiliation(s)
- M Sivakumaran
- Department of Haematology, Peterborough District Hospital, Peterborough, UK.
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30
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Abstract
Invasive aspergillosis is an opportunistic infection that characteristically affects the immunocompromised host, resulting in a high degree of morbidity and mortality. Although the portal of entry is usually pulmonary, there are rare reports of invasive aspergillosis localized to the gastrointestinal tract. In addition, haematological spread may develop, with life threatening disseminated infection involving the vital organs and the gastrointestinal tract. Although disseminated infection is well recognized, the CT findings of gastrointestinal disease have not been reported to our knowledge. We describe the CT findings in a patient with invasive aspergillosis involving the gastrointestinal tract, which resulted in intestinal ischaemia complicated by small bowel obstruction.
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Affiliation(s)
- S S Shah
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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31
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Abstract
PURPOSE Our purpose was to describe cutaneous manifestations associated with myelodysplastic syndromes. METHODS Data from seven patients with cutaneous vasculitis (four cases), neutrophilic dermatosis (one case), relapsing polychondritis (one case), and possible erythema elevatum diutinum (one case) in association with myelodysplastic syndrome (refractory anaemia RA, RA with excess of blasts--RAEB-, RAEB in transformation RAEBt, chronic myelomonocytic leukaemia--CMML-), and analysis of the literature were reviewed. RESULTS The cutaneous manifestations of myelodysplastic syndrome may or may not be specific, and may reveal hemopathy transformation. The cutaneous vasculitis are the most frequent and polymorphic. The relation with neutrophilic dermatosis is more specific; they are a spectrum of diseases including pyoderma gangrenosum, Sweet's syndrome, erythema elevatum diutinum (nuclear segmentation anomalies of neutrophils both in the skin and in the blood are a biological marker of the association). Relapsing polychondritis is significantly associated with myelodysplastic syndromes. Their pathogenesis are controversial. CONCLUSION Early biopsy of cutaneous lesions in myelodysplastic syndromes is indicated. Analysis of blood cell count (and more bone marrow biopsy in relapsing polychondritis) is indispensable in these neutrophilic cutaneous or vasculitis diseases.
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Affiliation(s)
- J J Morand
- Service de dermatologie, hôpital d'instruction des armées Laveran, BP 50, 13998 Marseille Armées, France
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32
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Kizaki M, Takayama N, Kawai Y, Okamoto S, Ikeda Y. Development of acute erythremia from myelodysplastic syndrome after treatment with 1,25-dihydroxyvitamin D(3). Am J Hematol 2001; 67:215-6. [PMID: 11391727 DOI: 10.1002/ajh.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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33
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Alexandrakis MG, Chatzivasili A, Stefanaki K, Eliopoulos GD. Co-existence of cutaneous true histiocytic lymphoma with refractory anaemia: report of a case. Haematologia (Budap) 2001; 30:61-7. [PMID: 10841328 DOI: 10.1163/15685590051129913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The case of a 70-year-old man with refractory anaemia who developed cutaneous true histiocytic lymphoma two years after diagnosis, is described. Whether this association is a simple coincidence or indicates some etiopathogenetic relationship between these two unrelated disorders is unknown and needs the analysis of more cases.
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MESH Headings
- Aged
- Anemia, Refractory/complications
- Anemia, Refractory/pathology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Fatal Outcome
- Humans
- Immunophenotyping
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/surgery
- Male
- Prednisone/administration & dosage
- Skin Neoplasms/complications
- Skin Neoplasms/drug therapy
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
- Vincristine/administration & dosage
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Affiliation(s)
- M G Alexandrakis
- Department of Haematology of the University of Crete School of Medicine, University Hospital of Heraklion, Greece
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34
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Abstract
BACKGROUND Immunodeficiency in pediatric patients with myelodysplastic syndrome (MDS) has not been described. We report the clinical course of three children with MDS, hypogammaglobulinemia, and reduced numbers of B-cells and B-cell precursors. OBSERVATIONS Three patients with recurrent infection who were younger than 1-year-old had MDS of the refractory anemia (RA) subtype diagnosed. All had reduced numbers of circulating B-cells and hypogammaglobulinemia. In two patients, cytogenetic studies revealed a monosomy 7 karyotype and bone marrow studies showed decreased numbers of CD34+ progenitor cells and CD 19+ B-cells. Both patients had prolonged courses (7 yrs 10 mos and 6 yrs 9 mos) characterized by recurrent infection and slowly progressive pancytopenia. Both received allogeneic bone marrow transplantation (BMT). The third patient had normal cytogenetic studies and a normal number of CD34+ progenitors but decreased CD19+ B-cells in the bone marrow. She had a stable course with refractory anemia over the course of 7 years. CONCLUSIONS Pediatric patients with MDS may have hypogammaglobulinemia and reduced numbers of B-cells. These findings do not preclude a relatively stable and prolonged clinical course. Children with newly diagnosed MDS should have an immunologic evaluation in addition to their hematologic assessment.
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Affiliation(s)
- K Srivannaboon
- Department of Hematology/Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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35
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Abstract
A case of leukemia cutis (LC) of monocytic lineage in a patient with myelodysplastic syndrome (MDS) is presented. Cutaneous infiltrates were recognized concurrent with diagnosis of refractory anemia (RA) with monocytosis. Skin infiltrates subsequently spontaneously regressed although MDS progressed with increasing monocytosis, anemia, and thrombocytopenia. Death occurred 6 months after diagnosis with evolution of acute monoblastic leukemia complicated by sepsis. This case supports previous observations of poor prognosis associated with leukemia cutis. LC associated with MDS is reviewed including the role of monocytes.
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Affiliation(s)
- L L Yavorkovsky
- Department of Medicine, The Brooklyn Hospital Center, New York 10201, USA.
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36
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Saunthararajah Y, Molldrem JL, Rivera M, Williams A, Stetler-Stevenson M, Sorbara L, Young NS, Barrett JA. Coincident myelodysplastic syndrome and T-cell large granular lymphocytic disease: clinical and pathophysiological features. Br J Haematol 2001; 112:195-200. [PMID: 11167802 DOI: 10.1046/j.1365-2141.2001.02561.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Myelodysplastic syndrome (MDS) and T-cell large granular lymphocytic disease (T-LGL) are bone marrow failure disorders. Successful use of immunosuppressive agents to treat cytopenia in MDS and LGL suggests a common pathophysiology for the two conditions. Of 100 patients with initial diagnoses of either MDS or T-LGL referred to the National Institutes of Health for immunosuppressive treatment of cytopenia, nine had characteristics of both T-LGL and MDS (T-LGL/MDS). Fifteen patients with T-LGL received cyclosporin (CSA) (10 responses). Eight out of nine patients with T-LGL/MDS received CSA (two responses) and one patient received ATG (one response). Of 76 patients with MDS, eight received CSA (one response) and 68 received ATG (21 responses). The response to immunosuppression was significantly lower in patients with T-LGL/MDS and MDS than in patients with T-LGL disease alone (28% vs. 66%, P = 0.01). The proportion of T-helper cells and T-suppressor cells with an activated phenotype (HLA-DR(+)) was increased in patients with T-LGL, T-LGL/MDS and MDS, but the increase in activated T-suppressor cells in patients with T-LGL/MDS was not statistically significant. Autoreactive T cells may suppress haematopoiesis and contribute to the cytopenia in T-LGL and some patients with MDS, leading to T-LGL/MDS. The lower response rate of MDS or T-LGL/MDS to immunosuppression, compared with T-LGL alone, may reflect the older age and intrinsic stem cell abnormalities in MDS and T-LGL/MDS patients.
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MESH Headings
- Adult
- Age Factors
- Aged
- Anemia, Refractory/complications
- Anemia, Refractory/genetics
- Anemia, Refractory/immunology
- Anemia, Refractory, with Excess of Blasts/complications
- Anemia, Refractory, with Excess of Blasts/genetics
- Anemia, Refractory, with Excess of Blasts/immunology
- Anemia, Sideroblastic/complications
- Anemia, Sideroblastic/genetics
- Anemia, Sideroblastic/immunology
- Female
- Gene Rearrangement, T-Lymphocyte
- Humans
- Immunophenotyping
- Karyotyping
- Leukemia, T-Cell/complications
- Leukemia, T-Cell/genetics
- Leukemia, T-Cell/immunology
- Lymphocyte Count
- Male
- Middle Aged
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/immunology
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Regulatory/immunology
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Affiliation(s)
- Y Saunthararajah
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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37
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Pastore RD, Chadburn A, Kripas C, Schattner EJ. Novel association of haemophagocytic syndrome with Kaposi's sarcoma-associated herpesvirus-related primary effusion lymphoma. Br J Haematol 2000; 111:1112-5. [PMID: 11167749 DOI: 10.1046/j.1365-2141.2000.02478.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Haemophagocytic syndrome (HPS) is a fulminant, often fatal, systemic illness that occurs in association with infection and malignancy. We provide the first report of HPS that heralded a primary effusion lymphoma (PEL), a rare neoplasm linked to Kaposi's sarcoma-associated herpesvirus. The patient was a 38-year-old man with acquired immunodeficiency syndrome who presented with fever, sweats, lymphadenopathy, splenomegaly and refractory anaemia. Examination of the spleen demonstrated haemophagocytosis; analysis of ascites revealed PEL. Treatment with chemotherapy and ganciclovir resulted in complete remission of both conditions. This case illustrates the diagnostic challenges posed by HPS and supports the trial of antiviral agents in combination with chemotherapy in patients with PEL.
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MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Acquired Immunodeficiency Syndrome/drug therapy
- Adult
- Anemia, Refractory/complications
- Anemia, Refractory/drug therapy
- Anemia, Refractory/virology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiviral Agents/therapeutic use
- Cyclophosphamide/therapeutic use
- Ganciclovir/therapeutic use
- Herpesvirus 8, Human
- Histiocytosis, Non-Langerhans-Cell/complications
- Histiocytosis, Non-Langerhans-Cell/drug therapy
- Humans
- Lung Neoplasms/complications
- Lung Neoplasms/drug therapy
- Lung Neoplasms/virology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Methylprednisolone/therapeutic use
- Sarcoma, Kaposi/complications
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/virology
- Vincristine/therapeutic use
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Affiliation(s)
- R D Pastore
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA
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38
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Shirota T, Yamamoto H, Hayashi S, Fujimoto H, Harada Y, Hayashi T. Myelodysplastic syndrome terminating in erythropoietic protoporphyria after 15 years of aplastic anemia. Int J Hematol 2000; 72:44-7. [PMID: 10979208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The authors report a case of aplastic anemia in which refractory anemia, a subtype of myelodysplastic syndrome (MDS), developed 15 years after the onset and was subsequently followed by erythropoietic protoporphyria (EPP). Defects of stem cells in MDS are thought to be responsible for the disturbance of the heme biosynthetic pathway, leading to the development of EPP.
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Affiliation(s)
- T Shirota
- Third Department of Internal Medicine, Tokyo Medical University, Japan
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39
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Arenas M, Tovar A, Martínez V, Calduch JV, del Mar Segarra M, Mata B. [Lymphatic tuberculosis with an atypical presentation in a patient with myelodysplastic syndrome: an unusual association]. Enferm Infecc Microbiol Clin 2000; 18:294-6. [PMID: 11075492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
MESH Headings
- Aged
- Aged, 80 and over
- Anemia, Refractory/complications
- Anemia, Refractory/diagnosis
- Anemia, Refractory/drug therapy
- Anemia, Refractory/pathology
- Anemia, Sideroblastic/complications
- Anemia, Sideroblastic/diagnosis
- Anemia, Sideroblastic/drug therapy
- Anemia, Sideroblastic/pathology
- Anti-Bacterial Agents
- Antitubercular Agents/therapeutic use
- Bone Marrow/pathology
- Drug Therapy, Combination/therapeutic use
- Ethambutol/therapeutic use
- Female
- Folic Acid/therapeutic use
- Humans
- Immunocompromised Host
- Isoniazid/therapeutic use
- Rifampin/therapeutic use
- Thyroxine/therapeutic use
- Tuberculosis, Lymph Node/complications
- Tuberculosis, Lymph Node/drug therapy
- Vitamin B Complex/therapeutic use
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40
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Abstract
We investigated the effect of Helicobacter pylori eradication on sideropenic refractory anaemia in adolescent girls with H. pylori-associated antral gastritis without evidence of haemorrhage or clinical symptoms other than sideropenic anaemia. We conducted an open therapeutic trial in 21 adolescent girls aged 15-17 y with sideropenic refractory anaemia, which was defined as iron-deficiency anaemia refractory to oral iron therapy for 3 mo. All subjects underwent gastroduodenal endoscopy. Thirteen patients with confirmed H. pylori infection were given a 2-wk course of triple therapy and 6 wk of oral ferrous sulfate. We compared the mean levels of haemoglobin and serum ferritin among the "initial sample" (the time when the sampling was done before treatment with oral iron), "before eradication" (the time prior to triple therapy for eradication after subjects had been given oral iron for 3 mo) and "after eradication" (the time when the follow-up endoscopy was performed) data in 11 subjects in whom H. pylori infection was eradicated. Haemoglobin levels (g/dl) were 8.6+/-1.9, 8.6+/-1.4 and 11.3+/-2.3, respectively. Serum ferritin levels (microg/l) were 4.6+/-2.4, 4.2+/-2.3 and 17.5+/-6.7, respectively. After eradication of H. pylori, mean levels of haemoglobin (p = 0.0002) and serum ferritin (p = 0.0002) showed a prominent increase between "before eradication" and "after eradication". In conclusion, adolescent girls with sideropenic refractory anaemia should be evaluated for H. pylori infection. If H. pylori infection is coexistent, its eradication along with iron supplementation could correct the anaemia.
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Affiliation(s)
- Y H Choe
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Inchon, South Korea.
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41
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Choe YH, Lee JE, Kim SK. Effect of helicobacter pylori eradication on sideropenic refractory anaemia in adolescent girls with Helicobacter pylori infection. Acta Paediatr 2000; 89:154-7. [PMID: 10709883 DOI: 10.1080/080352500750028753] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
We investigated the effect of Helicobacter pylori eradication on sideropenic refractory anaemia in adolescent girls with H. pylori-associated antral gastritis without evidence of haemorrhage or clinical symptoms other than sideropenic anaemia. We conducted an open therapeutic trial in 21 adolescent girls aged 15-17 y with sideropenic refractory anaemia, which was defined as iron-deficiency anaemia refractory to oral iron therapy for 3 mo. All subjects underwent gastroduodenal endoscopy. Thirteen patients with confirmed H. pylori infection were given a 2-wk course of triple therapy and 6 wk of oral ferrous sulfate. We compared the mean levels of haemoglobin and serum ferritin among the "initial sample" (the time when the sampling was done before treatment with oral iron), "before eradication" (the time prior to triple therapy for eradication after subjects had been given oral iron for 3 mo) and "after eradication" (the time when the follow-up endoscopy was performed) data in 11 subjects in whom H. pylori infection was eradicated. Haemoglobin levels (g/dl) were 8.6+/-1.9, 8.6+/-1.4 and 11.3+/-2.3, respectively. Serum ferritin levels (microg/l) were 4.6+/-2.4, 4.2+/-2.3 and 17.5+/-6.7, respectively. After eradication of H. pylori, mean levels of haemoglobin (p = 0.0002) and serum ferritin (p = 0.0002) showed a prominent increase between "before eradication" and "after eradication". In conclusion, adolescent girls with sideropenic refractory anaemia should be evaluated for H. pylori infection. If H. pylori infection is coexistent, its eradication along with iron supplementation could correct the anaemia.
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Affiliation(s)
- Y H Choe
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Inchon, South Korea.
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42
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Abstract
Relapsing polychondritis (RP) is a rare multisystem disorder. We describe two case reports of patients with RP, one of whom developed myelodysplasia subtype refractory anaemia (RA) and the other, refractory anaemia with ringed sideroblasts (RARS). We also review the literature of association between RP and haematological disorders.
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Affiliation(s)
- B Myers
- Queens Medical Centre, Nottingham, UK
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43
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Nawata R, Shinohara K, Takahashi T, Yamada T, Katsuki K. [Refractory anemia with trisomy-8 complicated by Behçet's disease with elevated levels of inflammatory cytokines]. Rinsho Ketsueki 1999; 40:1100-4. [PMID: 10565228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
A man with refractory anemia and trisomy 8 complained of repeated febrile episodes. He exhibited oral aphtha, exanthema, genital ulcer, and epididymitis. Laboratory data obtained during febrile episodes revealed leukocytosis with elevated CRP and ESR. Repeated examinations for infectious bacterial agents were negative. HLA analysis detected HLA-B51. Behçet's disease of incomplete type was diagnosed and successfully treated with prednisolone. It was speculated that the repeated febrile episodes may have been a manifestation of neutrophil hyper-function induced by increased blood levels of inflammatory cytokines, including IL-6, IL-8 and G-CSF, in association with rare complications of Behçet's disease.
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Affiliation(s)
- R Nawata
- Department of Medicine, Yamaguchi Prefecture Central Hospital
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44
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Molina M, Ortega G, Vera V, Pérez Luján R. [Cardiac tamponade and myelodysplastic syndrome]. An Med Interna 1999; 16:323-4. [PMID: 10422309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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45
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Ferrara F, Copia C, Annunziata M, di Noto R, Russo C, Palmieri S, Spasiano A, del Vecchio L. Complete remission of refractory anemia following a single high dose of cyclophosphamide. Ann Hematol 1999; 78:87-8. [PMID: 10089024 DOI: 10.1007/s002770050478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We describe a case of stable complete remission in a patient with refractory anemia complicated by severe autoimmune hemolytic anemia, achieved with a single high dose (4 g/m2) of cyclophosphamide (cyclo). Concomitantly, an effective mobilization of CD34-positive cells was induced. Other immunosuppressive approaches including high-dose methylprednisolone, high-dose immunoglobulin, and cyclosporine had been ineffective. This finding suggests that, in selected cases, an immunologic mechanism may mediate cytopenia in myelodysplastic syndromes (MDS). In addition, it demonstrates that successful mobilization of peripheral blood stem cells can be induced with high-dose cyclo in MDS.
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MESH Headings
- Adult
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/pathology
- Anemia, Hemolytic, Autoimmune/therapy
- Anemia, Refractory/complications
- Anemia, Refractory/drug therapy
- Anemia, Refractory/pathology
- Anemia, Refractory/therapy
- Autoimmune Diseases/complications
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/pathology
- Autoimmune Diseases/therapy
- Blood Transfusion
- Bone Marrow/pathology
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/therapeutic use
- Cyclosporine/therapeutic use
- Hematopoietic Stem Cell Mobilization
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/therapeutic use
- Male
- Methylprednisolone/therapeutic use
- Remission Induction
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Affiliation(s)
- F Ferrara
- Division of Hematology, Cardarelli General Hospital, Naples, Italy.
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46
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Xu K, Hao Y. [Refractory anemia and preleukemia: an analysis of 92 cases]. Zhonghua Xue Ye Xue Za Zhi 1999; 20:65-8. [PMID: 11601200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To investigate the relationship between MDS-RA (refractory anemia subtype of myelodysplastic syndromes) and preleukemia (PL). METHODS Hematological parameters of 86 RA and 6 PL patients were retrospectively analyzed. RESULTS Thirty-four RA cases (39.53%) transformed into acute leukemia (AL), RA with excess blasts (RAEB), or RAEB in transformation (RAEB-t). As compared with 52 non-transformed RA cases, the transformed cases showed the following hematological features: 1. higher frequencies of immature granulocytes (P < 0.005), erythroblasts (P < 0.05) and megaloerythrocytes (P < 0.05), and higher granulocyte nuclear lobulation (P < 0.001) in peripheral blood; 2. higher percentages of early erythroid and granulocytic lineages (P < 0.05), and higher frequencies of erythroblasts with multiple nuclei (P < 0.05), pseudo Pelger-Huet abnormality (P < 0.05), and micromegakaryocytes (P < 0.005) in bone marrow. CONCLUSION There is a higher overlap between RA and PL; the above hematological features may be useful for predicting the transformation of RA patients. Based on those findings, a score system for predicting the transformation of RA was proposed.
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Affiliation(s)
- K Xu
- Institute of Hematology, CAMS and PUMC, Tianjin 300020
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47
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Takami A, Nakao S, Ontachi Y, Yamauchi H, Matsuda T. Successful therapy of myelodysplastic syndrome with menatetrenone, a vitamin K2 analog. Int J Hematol 1999; 69:24-6. [PMID: 10641439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Although vitamin K2 is an inducer of the in vitro differentiation of myeloid leukemic cell lines, its clinical efficacy in the treatment of myelodysplastic syndrome (MDS) is unclear. We administered a vitamin K2 analog, menatetrenone, at 45 mg daily to an 80-year-old woman with MDS (refractory anemia) heavily dependent on red-cell transfusions. The patient's pancytopenia gradually improved, and she became transfusion-independent after 14 months. Pancytopenia recurred when menatetrenone was discontinued but recovered again with readministration. Administration of menatetrenone at a dose effective in improving osteoporosis may also be useful in restoring hematopoiesis in MDS patients, possibly by way of inducing differentiation.
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Affiliation(s)
- A Takami
- Department of Medicine, Kurobe City Hospital, Toyama, Japan
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48
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Forrest DL, Horsman DE, Jensen CL, Berry BR, Dalal BI, Barnett MJ, Nantel SH. Myelodysplastic syndrome with hypereosinophilia and a nonrandom chromosomal abnormality dic(1;7): confirmation of eosinophil clonal involvement by fluorescence in situ hybridization. Cancer Genet Cytogenet 1998; 107:65-8. [PMID: 9809037 DOI: 10.1016/s0165-4608(98)00055-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of de novo myelodysplastic syndrome (MDS) with hypereosinophilia and dic(1;7) in which eosinophil clonal involvement was confirmed by fluorescence in situ hybridization. There have been two previous reports in the literature of eosinophilic MDS with dic(1;7) or t(1;7) in which eosinophil clonality was demonstrated. The specific breakpoints on chromosomes 1 and 7 differ in the three cases, making it difficult to implicate disruption of a single gene as causative; nevertheless, the nonrandom occurrence of t(1;7) or dic(1;7) with malignant eosinophilic proliferations suggests that this chromosomal rearrangement is involved in the etiology of the disease.
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Affiliation(s)
- D L Forrest
- Leukemia/Bone Marrow Transplantation Program of British Columbia, Vancouver General Hospital, Canada
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49
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Rubio Barbón S, Triviño López A, Zanabili Y. [Granuloma of bone marrow in myelodysplastic syndrome without excess of blasts]. An Med Interna 1998; 15:562. [PMID: 9844238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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50
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Kajisawa C, Matsui C, Morohashi M. A specific cutaneous lesion revealing myelodysplastic syndrome. Eur J Dermatol 1998; 8:517-8. [PMID: 9854168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We report on an 86-year-old man with an ulcerated nodule on his left lower leg. Peripheral blood examination and bone marrow findings were compatible with the refractory anemia with an excess of blasts in transformation (RAEB-T) which is typical of the myelodysplastic syndrome (MDS). Because histological examination showed an infiltration of atypical cells of myeloid origin, this lesion was diagnosed as a specific lesion of MDS. Sometimes, only a subjective symptom, such as a skin lesion, precedes the diagnosis of MDS.
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MESH Headings
- Aged
- Aged, 80 and over
- Anemia, Refractory/complications
- Anemia, Refractory/pathology
- Anemia, Refractory, with Excess of Blasts/complications
- Anemia, Refractory, with Excess of Blasts/drug therapy
- Anemia, Refractory, with Excess of Blasts/pathology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy, Needle
- Bone Marrow/pathology
- Diagnosis, Differential
- Fatal Outcome
- Humans
- Leg Ulcer/etiology
- Leg Ulcer/pathology
- Male
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Affiliation(s)
- C Kajisawa
- Department of Dermatology, Faculty of Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194 Japan.
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