1
|
Ghazizadeh M, Moini M, Ghazizadeh M. Autoimmune hemolytic anemia due to mediastinal teratoma: A case report and review article. Clin Case Rep 2023; 11:e7908. [PMID: 37720713 PMCID: PMC10500046 DOI: 10.1002/ccr3.7908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 09/19/2023] Open
Abstract
Key Clinical Massage Autoimmune hemolytic anemia (AIHA) is a rare disease that is divided into primary and secondary types. In patients with AIHA we should consider mediastinal tumors as a serious cause. If such teratoma was found surgical removal of it is in order. Abstract Autoimmune hemolytic anemia (AIHA) is a rare disease that is divided into primary and secondary types. The secondary type usually appears as a complication to some diseases such as chronic inflammatory diseases, systemic lupus erythematosus (SLE), and malignancies. A 26 years-old female with a chief complaint of weakness, fatigue, and exertional dyspnea is diagnosed with AIHA. Initially, medical steroid treatment appeared to be successful and the anemia improved, however, by weaning steroid dosage the disease relapsed. Eventually, surgical resection of the mediastinal teratoma lead to the hemolysis being treated successfully. In patients with AIHA we should consider mediastinal tumors as a serious cause. If such teratoma was found surgical removal of it is in order.
Collapse
Affiliation(s)
- Maryam Ghazizadeh
- Department of Hematology—Oncology, Shahid Modarres HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Moini
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Matin Ghazizadeh
- Department of Otolaryngology, Head and Neck Surgery, Taleghani HospitalShahid Beheshti University of Medical SciencesTehranIran
| |
Collapse
|
2
|
An Unusual Presentation of Sacrococcygeal Germ Cell Tumor With Autoimmune Hemolytic Anemia as a Paraneoplastic Syndrome. J Pediatr Hematol Oncol 2022; 44:e911-e913. [PMID: 34486553 DOI: 10.1097/mph.0000000000002302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
The tumors that induce autoimmune hemolytic anemia (AIHA) are usually hematological neoplasms such as malignant lymphoma and chronic lymphocytic leukemia. AIHA associated with germ cell tumors is very rare with literature limited to case reports with most of them reported with ovarian dermoid, which abated with the removal of the tumor. We report an unusual presentation of AIHA with malignant sacrococcygeal germ cell tumor in a 3-year-old child, which rapidly disappeared after the excision of a sacrococcygeal teratoma.
Collapse
|
3
|
Yui JC, Brodsky RA. Updates in the Management of Warm Autoimmune Hemolytic Anemia. Hematol Oncol Clin North Am 2022; 36:325-339. [DOI: 10.1016/j.hoc.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
4
|
Giannotta JA, Fattizzo B, Cavallaro F, Barcellini W. Infectious Complications in Autoimmune Hemolytic Anemia. J Clin Med 2021; 10:E164. [PMID: 33466516 PMCID: PMC7796467 DOI: 10.3390/jcm10010164] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/16/2022] Open
Abstract
Autoimmune hemolytic anemia (AIHA) may be frequently challenged by infectious complications, mainly as a result of immunosuppressive treatments administered. Furthermore, infectious agents are known triggers of AIHA onset and relapse. Although being risk factors for mortality, infections are an underestimated issue in AIHA. This review will collect the available evidence on the frequency and type of infectious complications in AIHA, detailing the risk related to each treatment (i.e., steroids, rituximab, splenectomy, classic immunosuppressive agents, and new target drugs). Moreover, we will briefly discuss the infectious complications in AIHA secondary to other diseases that harbor an intrinsic infectious risk (e.g., primary immunodeficiencies, systemic autoimmune diseases, lymphoproliferative disorders, solid organ and hematopoietic stem cell transplants). Finally, viral and bacterial reactivations during immune suppressive therapies will be discussed, along with suggested screening and prophylactic strategies.
Collapse
Affiliation(s)
- Juri Alessandro Giannotta
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
| | - Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
- Department of Oncology and Oncohematology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy
| | - Francesca Cavallaro
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
- Department of Oncology and Oncohematology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy
| | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
| |
Collapse
|
5
|
de Jong J, Mitselos A, Jurczak W, Cordoba R, Panizo C, Wrobel T, Dlugosz-Danecka M, Jiao J, Sukbuntherng J, Ouellet D, Hellemans P. Ibrutinib does not have clinically relevant interactions with oral contraceptives or substrates of CYP3A and CYP2B6. Pharmacol Res Perspect 2020; 8:e00649. [PMID: 32945596 PMCID: PMC7506988 DOI: 10.1002/prp2.649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/11/2022] Open
Abstract
Ibrutinib may inhibit intestinal CYP3A4 and induce CYP2B6 and/or CYP3A. Secondary to potential induction, ibrutinib may reduce the exposure and effectiveness of oral contraceptives (OCs). This phase I study evaluated the effect of ibrutinib on the pharmacokinetics of the CYP2B6 substrate bupropion, CYP3A substrate midazolam, and OCs ethinylestradiol (EE) and levonorgestrel (LN). Female patients (N = 22) with B‐cell malignancies received single doses of EE/LN (30/150 μg) and bupropion/midazolam (75/2 mg) during a pretreatment phase on days 1 and 3, respectively (before starting ibrutinib on day 8), and again after ibrutinib 560 mg/day for ≥ 2 weeks. Intestinal CYP3A inhibition was assessed on day 8 (single‐dose ibrutinib plus single‐dose midazolam). Systemic induction was assessed at steady‐state on days 22 (EE/LN plus ibrutinib) and 24 (bupropion/midazolam plus ibrutinib). The geometric mean ratios (GMRs; test/reference) for maximum plasma concentration (Cmax) and area under the plasma concentration‐time curve (AUC) were derived using linear mixed‐effects models (90% confidence interval within 80%‐125% indicated no interaction). On day 8, the GMR for midazolam exposure with ibrutinib coadministration was ≤ 20% lower than the reference, indicating lack of intestinal CYP3A4 inhibition. At ibrutinib steady‐state, the Cmax and AUC of EE were 33% higher than the reference, which was not considered clinically relevant. No substantial changes were noted for LN, midazolam, or bupropion. No unexpected safety findings were observed. A single dose of ibrutinib did not inhibit intestinal CYP3A4, and repeated administration did not induce CYP3A4/2B6, as assessed using EE, LN, midazolam, and bupropion.
Collapse
Affiliation(s)
- Jan de Jong
- Clinical Pharmacology, Janssen Research & Development LLC, San Diego, CA, USA
| | - Anna Mitselos
- Clinical Research Oncology, Janssen Research & Development LLC, Beerse, Belgium
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Institute of Oncology, Krakow, Poland
| | - Raul Cordoba
- Lymphoma Unit, Department of Hematology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain.,Health Research Institute IIS-FJD, Madrid, Spain.,START Madrid, Phase 1 Clinical Trials Unit, Madrid, Spain
| | - Carlos Panizo
- Department of Hematology, Clínica Universidad de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Tomasz Wrobel
- Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | | | - James Jiao
- Clinical Pharmacology, Janssen Research & Development LLC, Raritan, NJ, USA
| | | | - Daniele Ouellet
- Clinical Pharmacology, Janssen Research & Development LLC, Spring House, PA, USA
| | - Peter Hellemans
- Clinical Research Oncology, Janssen Research & Development LLC, Beerse, Belgium
| |
Collapse
|
6
|
Lazarian G, Quinquenel A, Bellal M, Siavellis J, Jacquy C, Re D, Merabet F, Mekinian A, Braun T, Damaj G, Delmer A, Cymbalista F. Autoimmune haemolytic anaemia associated with COVID-19 infection. Br J Haematol 2020; 190:29-31. [PMID: 32374906 PMCID: PMC7267601 DOI: 10.1111/bjh.16794] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Gregory Lazarian
- Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris 13, Bobigny, France
| | - Anne Quinquenel
- CHU de Reims, Hôpital Robert-Debré, Université Reims Champagne-Ardenne, Reims, France
| | | | - Justine Siavellis
- Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris 13, Bobigny, France
| | | | - Daniel Re
- Hôpital Général d'Antibes, Antibes, France
| | - Fatiha Merabet
- Hôpital de Versailles, Université Versailles - Saint Quentin, Le Chesnay, France
| | - Arsene Mekinian
- Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Thorsten Braun
- Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris 13, Bobigny, France
| | - Gandhi Damaj
- Centre Hospitalier Régional Universitaire, Caen, France
| | - Alain Delmer
- CHU de Reims, Hôpital Robert-Debré, Université Reims Champagne-Ardenne, Reims, France
| | - Florence Cymbalista
- Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris 13, Bobigny, France
| |
Collapse
|
7
|
Zhou JC, Wu MQ, Peng ZM, Zhao WH, Bai ZJ. Clinical analysis of 20 patients with non-Hodgkin lymphoma and autoimmune hemolytic anemia: A retrospective study. Medicine (Baltimore) 2020; 99:e19015. [PMID: 32049797 PMCID: PMC7035012 DOI: 10.1097/md.0000000000019015] [Citation(s) in RCA: 4] [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: 11/26/2022] Open
Abstract
Non-Hodgkin lymphoma (NHL) can co-exist with autoimmune hemolytic anemia (AIHA), a phenomenon known as AIHA-associated NHL (AIHA/NHL). However, few studies have reported AIHA/NHL incidence or its clinical characteristics. We conducted a retrospective analysis of 20 AIHA/NHL patients treated at our hospital from 2009 to 2018. AIHA/NHL was presented by only 0.91% of the NHL and 9.8% of the AIHA patients. In addition, AIHA occurred most frequently with angioimmunoblastic T-cell lymphoma (AITL) (7.31%), followed by marginal zone B-cell lymphoma (MZBL) (6.25%), B-cell lymphoma-unclassified (BCL-U) (4.25%), chronic lymphocytic leukemia/small lymphocyte lymphoma (CLL/SLL) (2.50%), and mantle cell lymphoma (MCL) (2.30%). In addition to the CLL/SLL patients with impaired bone marrow, 66.7% of the AIHA/NHL patients had lymphoma bone marrow infiltration (LBMI), of which 4 patients presented LBMI in bone marrow smears (BMS) but not in bone marrow biopsy (BMB) and 6 were positive for BMB but not BMS. The 1-, 3- and 5-year survival rates of AIHA/NHL patients were 70%, 30% and 20%, respectively, and they responded poorly to chemotherapy. In conclusion, AIHA can co-exist with various NHLs and the defining clinical characteristic of AIHA/NHL is the high incidence of LBMI. However, both BMS and BMB should be performed to avoid missed diagnosis.
Collapse
|
8
|
Primary ovarian diffuse large B-cell lymphoma preceded by autoimmune hemolytic anemia. J Hematop 2019. [DOI: 10.1007/s12308-019-00377-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
9
|
A Case of Warm Autoimmune Hemolytic Anemia and a Pulmonary Embolus in a Patient Treated with Triple Therapy. Case Rep Hematol 2019; 2019:2564682. [PMID: 31534803 PMCID: PMC6732579 DOI: 10.1155/2019/2564682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/18/2019] [Accepted: 07/01/2019] [Indexed: 11/20/2022] Open
Abstract
Autoimmune hemolytic anemia (AIHA) can be caused by a variety of etiologies. AIHA is associated with the development of coagulopathy, leading to potentially fatal pulmonary emboli. Here, we present a case of a 66-year-old female with a past medical history of non-Hodgkin's lymphoma and gastritis treated with triple therapy that developed warm AIHA. The patient later succumbed to a suspected pulmonary embolus.
Collapse
|
10
|
Felemban AA, Rashidi ZA, Almatrafi MH, Alsahabi JA. Autoimmune hemolytic anemia and ovarian dermoid cysts in pregnancy. Saudi Med J 2019; 40:397-400. [PMID: 30957135 DOI: 10.15537/smj.2019.4.24107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ovarian teratoma is a rare cause of autoimmune hemolytic anemia (AIHA) by warm antibodies, resistant to corticosteroid therapy. This also implies that ovarian teratoma should be included in the differential diagnosis of AIHA, whether or not associated with pregnancy. We present a case of a primigravida who presented with ovarian dermoid cysts and AIHA at 24 weeks of gestation. The patient received corticosteroids, intravenous immunoglobulin, rituximab, and multiple blood transfusions, with no significant improvement. Hemoglobin levels returned to normal only after laparoscopic ovarian cystectomy. Autoimmune hemolytic anemia caused by dermoid cyst is a rare condition especially in pregnancy. However, in light of similar case reports and review of the existing literature, we conclude that surgical excision should be considered when AIHA and ovarian teratoma coexist.
Collapse
MESH Headings
- Adult
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/therapy
- Female
- Humans
- Ovarian Neoplasms/complications
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/therapy
- Ovariectomy/methods
- Ovary/surgery
- Postpartum Period
- Pregnancy
- Pregnancy Complications, Hematologic/diagnosis
- Pregnancy Complications, Hematologic/etiology
- Pregnancy Complications, Hematologic/therapy
- Pregnancy Complications, Neoplastic/diagnosis
- Pregnancy Complications, Neoplastic/surgery
- Pregnancy Outcome
- Teratoma/complications
- Teratoma/diagnosis
- Teratoma/therapy
- Treatment Outcome
- Young Adult
Collapse
Affiliation(s)
- Afaf A Felemban
- Reproductive and In Vitro Fertilization Unit, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. E-mail.
| | | | | | | |
Collapse
|
11
|
Naymagon L, Ward S, Naymagon S, Navada S. Severe Protein-Losing Enteropathy Due to an Indolent Splenic Lymphoma: Case Report and Review of the Literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e165-e168. [PMID: 30685184 DOI: 10.1016/j.clml.2018.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/20/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Leonard Naymagon
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Stephen Ward
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Naymagon
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shyamala Navada
- Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
12
|
Wongsaengsak S, Czader M, Suvannasankha A. Cold agglutinin-mediated autoimmune haemolytic anaemia associated with diffuse large B cell lymphoma. BMJ Case Rep 2018; 2018:bcr-2017-222064. [PMID: 29991541 DOI: 10.1136/bcr-2017-222064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cold agglutinin-mediated autoimmune haemolytic anaemia is associated with the development of autoantibodies that can agglutinate red blood cells at cold temperatures. While primary cold agglutinin disease is an idiopathic lymphoproliferative disorder, secondary cold agglutinin syndrome (CAS) complicates other diseases such as infections, autoimmune diseases and cancers, mostly low-grade lymphomas. Early recognition, treatment of CAS and treatment of its associated underlying diseases are crucial to a successful outcome. We report a case of CAS in a setting of diffuse large B cell lymphoma, in which the treatment course was complicated by worsened anaemia due to chemotherapy-induced myelosuppression. We reviewed previously reported cases and discussed diagnosis and treatment strategies, including novel complement inhibitors, as potential future therapy.
Collapse
Affiliation(s)
- Sariya Wongsaengsak
- Division of Hematology and Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Magdalena Czader
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Attaya Suvannasankha
- Division of Hematology and Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Division of Hematology and Oncology, Department of Medicine, Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
| |
Collapse
|
13
|
Jachiet V, Mekinian A, Carrat F, Grignano E, Retbi A, Boffa JJ, Ronco P, Rondeau E, Sellam J, Berenbaum F, Chazouillères O, Capron J, Alamowitch S, Chasset F, Frances C, Coppo P, Fain O. Autoimmune manifestations associated with lymphoma: characteristics and outcome in a multicenter retrospective cohort study. Leuk Lymphoma 2017; 59:1399-1405. [DOI: 10.1080/10428194.2017.1379075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Vincent Jachiet
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | - Arsène Mekinian
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | - Fabrice Carrat
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France
| | - Eric Grignano
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | - Aurelia Retbi
- Département d’Information médicale, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Jean-Jacques Boffa
- Service de Néphrologie et Dialyses, Hôpital Tenon, APHP, Université Paris 06, Paris France
| | - Pierre Ronco
- Service de Néphrologie et Dialyses, Hôpital Tenon, APHP, Université Paris 06, Paris France
| | - Eric Rondeau
- Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, APHP, Université Paris 06, Paris, France
| | - Jérémie Sellam
- Service de Rhumatologie-(DHU i2B), Hôpital Saint Antoine, APHP, Université Paris 06, Inserm UMRS_938, Paris, France
| | - Francis Berenbaum
- Service de Rhumatologie-(DHU i2B), Hôpital Saint Antoine, APHP, Université Paris 06, Inserm UMRS_938, Paris, France
| | - Olivier Chazouillères
- Service d’Hépatologie, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Jean Capron
- Service de Neurologie, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Sonia Alamowitch
- Service de Neurologie, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Francois Chasset
- Service de Dermatologie, Hôpital Tenon, APHP, Université Paris 06, Paris, France
| | - Camille Frances
- Service de Dermatologie, Hôpital Tenon, APHP, Université Paris 06, Paris, France
| | - Paul Coppo
- Service d'Hématologie, Centre de référence des Microangiopathies Thrombotiques, Hôpital Saint Antoine, APHP, Université Paris 06, Paris, France
| | - Olivier Fain
- Service de Médecine Interne-(DHU i2B), Hôpital Saint-Antoine, APHP, Université Paris 06, Paris, France
| | | |
Collapse
|
14
|
Fatima S, Siddiqui WA, Alshehri A. Hodgkin’s lymphoma presenting as autoimmune hemolytic anemia. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2017. [DOI: 10.4103/ejim.ejim_15_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Ntanishyan KI, Sabirov KR, Shcherbakova OV, Vybornykh DE, Shupletsova IA, Tsvetaeva NV. [Autoimmune hemolytic anemia associated with mesenteric teratoma]. TERAPEVT ARKH 2017; 89:78-81. [PMID: 28252632 DOI: 10.17116/terarkh201789178-81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The paper describes a case of autoimmune hemolytic anemia (AIHA) in a 27-year-old woman whose examination revealed mesenteric teratoma. AIHA was characterized by a hypertensive crisis and a temporary response to corticosteroid therapy that was complicated by the development of somatogenic psychosis and discontinued. A relapse of hemolysis developed 6 months later. The patient underwent laparoscopic splenectomy and removal of mesenteric root teratoma. Immediately after surgery, a hematological response was obtained as relief of hemolysis and restoration of a normal hemoglobin level. There is a sustained remission of AIHA for the next 16 months.
Collapse
Affiliation(s)
- K I Ntanishyan
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - K R Sabirov
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - O V Shcherbakova
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - D E Vybornykh
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - I A Shupletsova
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - N V Tsvetaeva
- Hematology Research Center, Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
16
|
Smirnova SJ, Sidorova JV, Tsvetaeva NV, Nikulina OF, Biderman BV, Nikulina EE, Kulikov SM, Sudarikov AB. Expansion of CD8+ cells in autoimmune hemolytic anemia. Autoimmunity 2016; 49:147-54. [DOI: 10.3109/08916934.2016.1138219] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
17
|
Mizuno Y, Shimura Y, Horiike S, Takimoto T, Maegawa S, Tanba K, Matsumura-Kimoto Y, Sumida Y, Tatekawa S, Tsukamoto T, Chinen Y, Mizutani S, Nagoshi H, Yamamoto-Sugitani M, Matsumoto Y, Kobayashi T, Kuroda J, Taniwaki M. Burkitt Lymphoma Preceded by Autoimmune Hemolytic Anemia due to Anti-D Antibody. Intern Med 2016; 55:2253-8. [PMID: 27523004 DOI: 10.2169/internalmedicine.55.6564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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 report a rare case of Burkitt lymphoma (BL) preceded by autoimmune hemolytic anemia (AIHA) caused by autoantibodies against D antigen. After a partial response to AIHA with prednisolone (PSL) treatment for 7 months, the patient developed BL with a t(8;22)(q24;q11.2) chromosomal translocation. Intensive immunochemotherapy, including rituximab, led to a complete response (CR) of BL; however, anti-D antibody remained detectable in the plasma and antibody-dissociated solution from erythrocytes, thus continuous therapy with PSL was necessary even after achievement of the CR. BL with AIHA is extremely rare, with only one previously reported case in the literature.
Collapse
Affiliation(s)
- Yoshimi Mizuno
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Alexandrescu S, Orengo JP, Toossi S, Perry A, Treseler P, Hess C, Margeta M. CNS intravascular large cell lymphoma in a patient with autoimmune hemolytic anemia. Neuropathology 2014; 35:170-4. [DOI: 10.1111/neup.12175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/17/2014] [Indexed: 01/06/2023]
Affiliation(s)
- Sanda Alexandrescu
- Department of Pathology; University of California San Francisco; San Francisco California USA
| | - James P. Orengo
- Department of Neurology; University of California San Francisco; San Francisco California USA
| | - Shahed Toossi
- Department of Neurology; University of California San Francisco; San Francisco California USA
| | - Arie Perry
- Department of Pathology; University of California San Francisco; San Francisco California USA
- Department of Neurological Surgery; University of California San Francisco; San Francisco California USA
| | - Patrick Treseler
- Department of Pathology; University of California San Francisco; San Francisco California USA
| | - Christopher Hess
- Department of Radiology & Biomedical Imaging; University of California San Francisco; San Francisco California USA
| | - Marta Margeta
- Department of Pathology; University of California San Francisco; San Francisco California USA
| |
Collapse
|
19
|
Pasquet F, Pavic M, Ninet J, Hot A. [Auto-immune diseases and cancers. Second part: auto-immune diseases complicating cancers and their treatment]. Rev Med Interne 2014; 35:656-63. [PMID: 25106665 DOI: 10.1016/j.revmed.2014.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 01/27/2014] [Accepted: 04/14/2014] [Indexed: 12/18/2022]
Abstract
Autoimmune diseases may reveal or occur during the course of a neoplasia or its treatment. Autoimmune cytopenia, especially haemolytic anaemia, is common in lymphoproliferative disorders such as chronic lymphoid leukemia. The link between cancer and myositis is well established. Dermatomyositis is associated with an increased relative risk of cancer of 3.4 to 4.4. A combination of detection of antibodies against p155 and TEP-computed tomography may be the best approach to ascertain the presence of occult malignancy in patients with dermatomyositis. A cutaneous or a systemic vascularitis may reveal a cancer, most often a haematological malignancy such as hairy cell leukemia. Paraneoplastic polyarthritis have been described in particular with adenocardinoma of the lungs. Underlying neoplasia should be considered in male smokers patients with new onset polyarthritis and poor health status. The prevalence of autoimmune conditions in myelodysplastic syndromes is 10 to 30%. Vasculitis and relapsing polychondritis are the most commonly reported manifestations. Immune manifestations can also be related to treatment. The most common treatment complications are autoimmune haemolytic anaemia with fludarabine and thyroiditis related to interferon and cervical radiotherapy.
Collapse
Affiliation(s)
- F Pasquet
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108, boulevardd Pinel, 69003 Lyon, France.
| | - M Pavic
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108, boulevardd Pinel, 69003 Lyon, France
| | - J Ninet
- Service de médecine interne, hôpital Édouard-Hérriot, 5, place d'Arsonval, 69003 Lyon cedex 03, France
| | - A Hot
- Service de médecine interne, hôpital Édouard-Hérriot, 5, place d'Arsonval, 69003 Lyon cedex 03, France
| |
Collapse
|
20
|
|
21
|
Kato A, Takiuchi Y, Aoki K, Ono Y, Arima H, Nagano S, Tabata S, Yanagita S, Matsushita A, Maruoka H, Wada M, Imai Y, Ishikawa T, Takahashi T. Enteropathy-associated T-cell lymphoma type II complicated by autoimmune hemolytic anemia. ACTA ACUST UNITED AC 2012; 51:119-23. [PMID: 22104311 DOI: 10.3960/jslrt.51.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
A 74-year-old man was admitted to hospital because of persistent fever, diarrhea, and abdominal pain. CT scanning showed extensive wall thickening of the colon. He was transferred to our hospital because he further developed ascites and paraaortic lymph node swelling. On presentation, he was extremely emaciated with superficial lymph node swelling, ascitic signs, and leg edema. Histological image of a biopsied mesenteric lymph node demonstrated diffuse infiltration of large abnormal T cells. Surface antigen analysis of abnormal cells in the ascites revealed positivity for CD3, CD8, CD56, and weak positivity for CD103. Polymerase chain reaction analysis showed monoclonal rearrangement of the T cell receptor (TCR) gene. The subtype of TCR was αβ. A diagnosis of enteropathy-associated T cell lymphoma (EATL) type II was made. The lymphoma involved the bone marrow. The patient also had severe hemolytic anemia with a positive Coomb's test result. An additional diagnosis for autoimmune hemolytic anemia (AIHA) was made, which was resistant to methylprednisolone therapy. We first treated him with only vincristine in addition to the steroid to avoid acute tumor lysis syndrome ; however, he died of septic shock that occurred soon after vincristine administration. To the best of our knowledge, this may be the first reported case of EATL complicated by AIHA.
Collapse
Affiliation(s)
- Aiko Kato
- Departments of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Autoimmune hemolytic anemia and immune thrombocytopenia as unusual presentations of childhood Hodgkin lymphoma: a case report and review of the literature. J Pediatr Hematol Oncol 2012; 34:280-2. [PMID: 22258348 DOI: 10.1097/mph.0b013e318236c4e4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We discuss an unusual clinical presentation of childhood Hodgkin lymphoma; a 16-year-old girl was referred for Coombs-positive severe anemia, thrombocytopenia, and asymptomatic anterior mediastinal mass. Bone marrow examination showed no evidence of neoplastic disease. Biopsy of the mass was possible only after administration of both intravenous immunoglobulins and steroids resulting in a prompt rise of the platelet count and partial hemoglobin level stabilization. The identification of this clinical picture as a possible complication of an underlying Hodgkin lymphoma presents difficulties in diagnosis and management of the primary condition.
Collapse
|
23
|
Dimou M, Angelopoulou MK, Pangalis GA, Georgiou G, Kalpadakis C, Pappi V, Tsopra O, Koutsoukos K, Zografos E, Boutsikas G, Moschogianni M, Vardounioti I, Petevi K, Karali V, Kanellopoulos A, Ntalageorgos T, Yiakoumis X, Bartzis V, Bitsani A, Pessach E, Efthimiou A, Korkolopoulou P, Rassidakis G, Kyrtsonis MC, Patsouris E, Meletis J, Panayiotidis P, Vassilakopoulos TP. Autoimmune hemolytic anemia and autoimmune thrombocytopenia at diagnosis and during follow-up of Hodgkin lymphoma. Leuk Lymphoma 2012; 53:1481-7. [DOI: 10.3109/10428194.2012.660628] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
24
|
Eskazan AE, Akmurad H, Ongoren S, Ozer O, Ferhanoglu B. Primary gastrointestinal diffuse large B cell lymphoma presenting with cold agglutinin disease. Case Rep Gastroenterol 2011; 5:262-6. [PMID: 21887126 PMCID: PMC3153337 DOI: 10.1159/000328445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cold agglutinin disease (CAD) is an autoimmune hemolytic anemia (AIHA) generally caused by IgM autoantibodies which exhibit maximal reactivity at 4°C. CAD can be idiopathic or secondary to some diseases and/or conditions. Only a minority of cases of secondary AIHA in non-Hodgkin's lymphoma (NHL) are associated with cold antibodies. Diffuse large B cell lymphoma (DLBCL) is the most common subtype of NHLs with a proportion of nearly 30% of all adult cases. 40% of patients with DLBCL have an extranodal disease or at least disease initially confined to extranodal sites. The most common extranodal site is the gastrointestinal tract. We present a patient with primary gastrointestinal DLBCL who presented with CAD and was treated with a CHOP-Rituximab regimen.
Collapse
Affiliation(s)
- Ahmet Emre Eskazan
- Department of Internal Medicine, Division of Hematology, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
25
|
Yamamoto G, Hosoi M, Miyagawa T, Ohmatsu H, Ichikawa M, Sugaya M, Kurokawa M. Evans syndrome with cytomegalovirus infection followed by emerging peripheral T-cell lymphoma. Ann Hematol 2011; 91:123-4. [DOI: 10.1007/s00277-011-1214-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 03/09/2011] [Indexed: 11/30/2022]
|
26
|
Use of Rituximab in Autoimmune Hemolytic Anemia Associated with Non-Hodgkin Lymphomas. Adv Hematol 2011; 2011:960137. [PMID: 21547266 PMCID: PMC3087411 DOI: 10.1155/2011/960137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 02/18/2011] [Indexed: 11/17/2022] Open
Abstract
The association between non-Hodgkin lymphomas and autoimmune disorders is a well-known event. Also autoimmune hemolytic anemia (AHA), although much more frequent in patients with chronic lymphocytic leukemia (CLL), has been described in this group of patients. In recent years, among the more traditional therapeutic options, rituximab, an anti-CD20 monoclonal antibody, has shown interesting results in the treatment of primary AHA. Although this drug has been frequently used for AHA in patients with CLL, much less data are available on its use in NHL patients. However, considering that the main pathogenetic mechanism of AHA in course of lymphoproliferative disorders seems to be an antibody production directly or indirectly mediated by the neoplastic clone, this monoclonal antibody represents an ideal therapeutic approach. In this paper we will briefly describe some biological and clinical features of NHL-patients with AHA. We will then analyze some studies focusing on rituximab in primary AHA, finally reviewing the available literature on the use of this drug in NHL related AHA.
Collapse
|
27
|
Abstract
Autoimmune hemolytic anemia is a heterogeneous disease with respect to the type of the antibody involved and the absence or presence of an underlying condition. Treatment decisions should be based on careful diagnostic evaluation. Primary warm antibody autoimmune hemolytic anemias respond well to steroids, but most patients remain steroid-dependent, and many require second-line treatment. Currently, splenectomy can be regarded as the most effective and best-evaluated second-line therapy, but there are still only limited data on long-term efficacy and adverse effects. The monoclonal anti-CD20 antibody rituximab is another second-line therapy with documented short-term efficacy, but there is limited information on long-term efficacy and side effects. The efficacy of immunosuppressants is poorly evaluated. Primary cold antibody autoimmune hemolytic anemias respond well to rituximab but are resistant to steroids and splenectomy. The most common causes of secondary autoimmune hemolytic anemias are malignancies, immune diseases, or drugs. They may be treated in a way similar to primary autoimmune hemolytic anemias, by immunosuppressants or by treatment of the underlying disease.
Collapse
|
28
|
Puthenparambil J, Lechner K, Kornek G. Autoimmune hemolytic anemia as a paraneoplastic phenomenon in solid tumors: A critical analysis of 52 cases reported in the literature. Wien Klin Wochenschr 2010; 122:229-36. [DOI: 10.1007/s00508-010-1319-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
29
|
Kaku N, Seki M, Doi S, Hayashi T, Imanishi D, Imamura Y, Kurihara S, Miyazaki T, Izumikawa K, Kakeya H, Yamamoto Y, Yanagihara K, Tashiro T, Kohno S. A case of intravascular large B-cell lymphoma (IVLBCL) with no abnormal findings on chest computed tomography diagnosed by random transbronchial lung biopsy. Intern Med 2010; 49:2697-701. [PMID: 21173545 DOI: 10.2169/internalmedicine.49.3986] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old woman was admitted with refractory fever despite receiving broad-spectrum antibiotics. She had hypoxemia, severe anemia, elevated levels of serum lactic dehydrogenase and soluble interleukin-2 receptor, and a positive direct Coombs test, which suggested an underlying autoimmune hemolytic anemia (AIHA). Chest computed tomography (CT) showed no abnormal findings, but she had hypoxia, and her alveolar-arterial oxygen difference (A-aDO2) was increased. A random transbronchial lung biopsy (TBLB) was performed, and pathological analysis showed massive proliferation of tumor cells in the lumina of the small vessels. Intravascular large B-cell lymphoma (IVLBCL) was diagnosed, and her general status improved after chemotherapy.
Collapse
Affiliation(s)
- Norihito Kaku
- The Second Department of Internal Medicine, Nagasaki University Hospital, and Department of Hematology, Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Hauswirth AW, Skrabs C, Schützinger C, Gaiger A, Lechner K, Jäger U. Autoimmune hemolytic anemias, Evans' syndromes, and pure red cell aplasia in non-Hodgkin lymphomas. Leuk Lymphoma 2009; 48:1139-49. [PMID: 17577777 DOI: 10.1080/10428190701385173] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We analyzed 108 cases of non-CLL non-Hodgkin lymphoma (NHL) associated with autoimmune hemolytic anemia (AIHA) (+/- pure red cell aplasia (PRCA)) or Evans' syndrome. The analysis was based on cases reported in the literature, which were retrieved by means of Pubmed and Medline searches and of an original series of 121 patients with NHL as well as reference lists of papers in the field. The number of cases in various NHL subtypes was small (n = 6-25). Nevertheless, interesting and sometimes unexpected differences in sex prevalence, temporal relationship between onset of lymphoma and AIHA, stage of lymphoma, relative frequency of warm antibody-AIHA (WA-AIHA) and cold antibody (CA-AIHA), association with PRCA and response of AIHA to treatments were noted for various lymphoma entities. WA-AIHA was more frequent in B-cell lymphomas, while CA-AIHA and PRCA predominantly occurred in T-cell lymphomas. Anti-lymphoma treatment seemed to be more effective against AIHA than conventional therapy with steroids or immunoglobulin. Although generated by a literature survey, this compilation of data indicates a complex relation of lymphoma and AIHA and warrants more attention and specific studies.
Collapse
MESH Headings
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/therapy
- Humans
- Leukemia, Hairy Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Lymphoma, B-Cell/complications
- Lymphoma, Follicular/complications
- Lymphoma, Mantle-Cell/complications
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, T-Cell, Peripheral/complications
- Multiple Myeloma/complications
- Prognosis
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Red-Cell Aplasia, Pure/etiology
- Risk Factors
- Syndrome
Collapse
Affiliation(s)
- Alexander W Hauswirth
- Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
31
|
The B cell antigen receptor and overexpression of MYC can cooperate in the genesis of B cell lymphomas. PLoS Biol 2008; 6:e152. [PMID: 18578569 PMCID: PMC2435152 DOI: 10.1371/journal.pbio.0060152] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Accepted: 05/13/2008] [Indexed: 11/19/2022] Open
Abstract
A variety of circumstantial evidence from humans has implicated the B cell antigen receptor (BCR) in the genesis of B cell lymphomas. We generated mouse models designed to test this possibility directly, and we found that both the constitutive and antigen-stimulated state of a clonal BCR affected the rate and outcome of lymphomagenesis initiated by the proto-oncogene MYC. The tumors that arose in the presence of constitutive BCR differed from those initiated by MYC alone and resembled chronic B cell lymphocytic leukemia/lymphoma (B-CLL), whereas those that arose in response to antigen stimulation resembled large B-cell lymphomas, particularly Burkitt lymphoma (BL). We linked the genesis of the BL-like tumors to antigen stimulus in three ways. First, in reconstruction experiments, stimulation of B cells by an autoantigen in the presence of overexpressed MYC gave rise to BL-like tumors that were, in turn, dependent on both MYC and the antigen for survival and proliferation. Second, genetic disruption of the pathway that mediates signaling from the BCR promptly killed cells of the BL-like tumors as well as the tumors resembling B-CLL. And third, growth of the murine BL could be inhibited by any of three distinctive immunosuppressants, in accord with the dependence of the tumors on antigen-induced signaling. Together, our results provide direct evidence that antigenic stimulation can participate in lymphomagenesis, point to a potential role for the constitutive BCR as well, and sustain the view that the constitutive BCR gives rise to signals different from those elicited by antigen. The mouse models described here should be useful in exploring further the pathogenesis of lymphomas, and in preclinical testing of new therapeutics. It has long been suspected that the malignant proliferation of B lymphocytes known as lymphomas might represent a perversion of how the cells normally respond to antigen. In particular, the molecular receptor on the surface of the cells that signals the presence of antigen might be abnormally active in lymphomas. We have tested this hypothesis by engineering the genome of mice so that virtually all of the B cells are commandeered by a single version of the surface receptor, then stimulated that receptor with the molecule it is designed to recognize. Our results indicate that both the unstimulated and stimulated states of the receptor can cooperate with an oncogene known as MYC in the genesis of lymphomas. But the two states of the receptor give rise to different forms of lymphoma. In particular, the stimulated form cooperates with MYC to produce a disease that closely resembles Burkitt lymphoma. These results illuminate the mechanisms that are responsible for lymphomas and could inform the development of new strategies to treat the disease. A series of genetically engineered mice were used to substantiate a long-standing speculation that chronic immune-stimulus may be involved in the genesis of certain lymphomas, illuminating the pathogenesis of B cell lymphomas and suggesting new strategies to treat several forms of this malignancy, including Burkitt lymphoma.
Collapse
|
32
|
Rutherford GC, Dineen RA, O'Connor A. Imaging in the investigation of paraneoplastic syndromes. Clin Radiol 2007; 62:1021-35. [PMID: 17920860 DOI: 10.1016/j.crad.2007.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 06/04/2007] [Accepted: 06/08/2007] [Indexed: 01/13/2023]
Abstract
Paraneoplastic syndromes are a heterogeneous group of disease presentations caused by underlying tumours. As they are non-metastatic in nature an intensive diagnostic evaluation is warranted to identify potentially curable lesions. The selection of the appropriate method of imaging is important in these cases, especially when history and physical examination are unrevealing. In this review the important paraneoplastic syndromes and underlying malignancies are discussed along with relevant imaging strategies.
Collapse
Affiliation(s)
- G-C Rutherford
- Department of Diagnostic Imaging, Queen's Medical Centre, Nottingham UK.
| | | | | |
Collapse
|
33
|
Lachenal F, Berger F, Ghesquières H, Biron P, Hot A, Callet-Bauchu E, Chassagne C, Coiffier B, Durieu I, Rousset H, Salles G. Angioimmunoblastic T-cell lymphoma: clinical and laboratory features at diagnosis in 77 patients. Medicine (Baltimore) 2007; 86:282-292. [PMID: 17873758 DOI: 10.1097/md.0b013e3181573059] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We retrospectively analyzed 77 patients with pathologically diagnosed angioimmunoblastic T-cell lymphoma from a single city. There were 43 men and 34 women; the median age was 64.5 years (range, 30-91 yr). Average time between first symptoms of the disease and diagnosis was 3.6 months. At diagnosis, peripheral nodes were present in all but 1 patient, and were generalized in 90% of cases. Constitutional symptoms were reported in 77% of cases and spleen enlargement in 51%. A cutaneous eruption--morbilliform, urticarial, or more polymorphic--was present in 45% of patients; in one-third of them, the eruption occurred after drug administration. Other clinical manifestations included pleuritis (22%); arthralgia or arthritis (17%); ear, nose, and throat involvement (14%); central or peripheral neurologic manifestations (10%); and ascites (5%). Most patients presented with advanced disease at diagnosis (bone marrow involvement in 60% of cases). The main laboratory abnormalities were elevated lactate dehydrogenase levels (71%), inflammatory syndrome (67%), hypergammaglobulinemia (50%), anemia (51%), and lymphopenia (52%). Auto- or disimmune manifestations were reported in one-third of patients: autoimmune hemolytic anemia was present at diagnosis in 19% of patients and thrombocytopenic purpura in 7%. Documented vasculitis was described in 12% of cases. Clonality was analyzed in lymph nodes in 47 patients: T-cell and B-cell clones were found in 45 (96%) and 20 (45%) patients, respectively. Chromosomal abnormalities were identified in 62% of cases: trisomies 3, 5, 18, 19, additional X chromosome, and deletion of chromosome 7 were the most common abnormalities. The current study underlines the diversity of presenting manifestations of angioimmunoblastic T-cell lymphoma.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers/blood
- Cytological Techniques
- Diagnostic Errors
- Disease Progression
- Female
- Follow-Up Studies
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunoblastic Lymphadenopathy/complications
- Immunoblastic Lymphadenopathy/diagnosis
- Immunoblastic Lymphadenopathy/immunology
- Immunoblastic Lymphadenopathy/pathology
- Immunoblastic Lymphadenopathy/virology
- Kaplan-Meier Estimate
- Lymphoma, T-Cell, Peripheral/complications
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/virology
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- RNA, Viral/analysis
- Retrospective Studies
- Severity of Illness Index
Collapse
Affiliation(s)
- Florence Lachenal
- From Hospices Civils de Lyon, Department of Internal Medicine (FL, ID, HR), Department of Pathology (FB), Department of Cytogenetic and Molecular Biology (ECB), and Department of Hematology (BC, GS), Centre Hospitalier Lyon Sud, Pierre-Bénite; Department of Internal Medicine (AH), Hospital Edouard Herriot, Lyon; Department of Hematology (HG, PB) and Department of Pathology (CC), Centre Léon Bérard, Lyon; and Université Claude Bernard Lyon 1 (FL, FB, AH, ECB, BC, ID, HR, GS), Lyon, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hussain SS, Ebbs AM, Curtin NJ, Keidan AJ. Delayed haemolytic transfusion reaction due to anti-Jkb in a patient with non-Hodgkin's lymphoma-transient nature of anti-Jkb and the importance of early serological diagnosis. Transfus Med 2007; 17:197-9. [PMID: 17561862 DOI: 10.1111/j.1365-3148.2007.00745.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Delayed haemolytic transfusion reactions (DHTRs) are relatively common following blood transfusions. In the UK, DHTRs were responsible for 10.2% of all serious transfusion-related hazards between 1996 and 2003. In most cases, there is minor or no morbidity, and the reaction may go unnoticed. However, in some cases, a large fall in haemoglobin level and major morbidity may occur. Even in such serious cases, the true cause of the patient's clinical deterioration may be unrecognized if serological investigation is not carried out immediately because of the often transient nature of the antibodies involved. Failure to make the correct diagnosis will lead to inappropriate treatment and expose the patient to risk of further serious transfusion reactions. We describe a case of DHTR caused by anti-Jk(b) antibodies, which illustrates the difficulty in diagnosing this common but under-recognized reaction and shows the transient nature of the antibody involved, which became undetectable within 4 weeks.
Collapse
Affiliation(s)
- S S Hussain
- Department of Oncology, Charing Cross Hospital, London, UK
| | | | | | | |
Collapse
|
35
|
Win N, Tiwari D, Keevil VL, Needs M, Lakhani A. Mixed-type autoimmune haemolytic anaemia: unusual cases and a case associated with splenic T-cell angioimmunoblastic non-Hodgkin's lymphoma. Hematology 2007; 12:159-62. [PMID: 17454198 DOI: 10.1080/110245330601111466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The diagnosis of mixed-type autoimmune haemolytic anaemia (AIHA) is based on demonstrating the presence of "warm" IgG auto-antibody and "low titre" ( < 64 at 4 degrees C), "high thermal amplitude" (reacting at or >30 degrees C) "cold" IgM auto-antibody. Mixed-type AIHA is uncommon. Red cell agglutination on the peripheral blood film is a common finding in mixed-type AIHA and can lead, initially, to a mis-diagnosis of cold haemmagglutinin disease (CHAD). Mixed-type AIHA is rare and can be idiopathic or secondary, often associated with systemic lupus erythematosus (SLE) and lymphoma. In general, patients with mixed-type AIHA show a dramatic response to steroid therapy and frequently require few or no transfusions. We report two unusual cases of mixed-type AIHA. Case one was unusual as the patient developed AIHA while on steroid medication. Case two, we believe, is the first reported case of splenic T cell angioimmunoblastic non-Hodgkins lymphoma (NHL) associated with mixed-type AIHA. The patient failed to respond to steroids, intravenous immunoglobulin, chemotherapy and treatment with rituximab. The patient received 33 units of red cells over a 9-week period. She finally underwent splenectomy with resolution of haemolysis. DAT tested with monospecific reagents, and thorough serological investigations is required to reach the diagnosis of mixed-type AIHA. Awareness of this condition is important as management may be different from either treating warm AIHA or CHAD.
Collapse
MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/chemically induced
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/immunology
- Anti-Inflammatory Agents/adverse effects
- Anti-Inflammatory Agents/therapeutic use
- Antibodies, Anti-Idiotypic/blood
- Antibodies, Anti-Idiotypic/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Autoantibodies/blood
- Autoantibodies/immunology
- Combined Modality Therapy
- Complement C3d/immunology
- Coombs Test
- Cryoglobulins/analysis
- Cryoglobulins/immunology
- Cyclophosphamide/administration & dosage
- Diagnosis, Differential
- Erythrocyte Transfusion
- Fatal Outcome
- Female
- Humans
- Immunoglobulin G/blood
- Immunoglobulin G/immunology
- Immunoglobulin M/blood
- Immunoglobulin M/immunology
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppressive Agents/therapeutic use
- Immunotherapy
- Lymphoma, T-Cell/blood
- Lymphoma, T-Cell/complications
- Lymphoma, T-Cell/drug therapy
- Lymphoma, T-Cell/surgery
- Lymphoma, T-Cell/therapy
- Male
- Osteoarthritis/drug therapy
- Paraneoplastic Syndromes/etiology
- Paraneoplastic Syndromes/immunology
- Prednisolone/adverse effects
- Prednisolone/therapeutic use
- Prednisone/administration & dosage
- Rituximab
- Splenectomy
- Splenic Neoplasms/blood
- Splenic Neoplasms/complications
- Splenic Neoplasms/drug therapy
- Splenic Neoplasms/surgery
- Splenic Neoplasms/therapy
- Temperature
- Vincristine/administration & dosage
Collapse
Affiliation(s)
- Nay Win
- NBS - Tooting Centre, Cranmer Terrace, London, UK
| | | | | | | | | |
Collapse
|
36
|
Kim I, Lee JY, Kwon JH, Jung JY, Song HH, Park YL, Ro E, Choi KC. A case of autoimmune hemolytic anemia associated with an ovarian teratoma. J Korean Med Sci 2006; 21:365-7. [PMID: 16614532 PMCID: PMC2734022 DOI: 10.3346/jkms.2006.21.2.365] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Autoimmune hemolytic anemia associated with an ovarian teratoma is a very rare disease. However, treating teratoma is the only method to cure the hemolytic anemia, so it is necessary to include ovarian teratoma in the differential diagnosis of autoimmune hemolytic anemia. We report herein on a case of a young adult patient who had severe autoimmune hemolytic anemia that was induced by an ovarian teratoma. A 25-yr-old woman complained of general weakness and dizziness for 1 week. The hemoglobin level was 4.2 g/dL, and the direct and indirect antiglobulin tests were all positive. The abdominal computed tomography scan revealed a huge left ovarian mass, and this indicated a teratoma. She was refractory to corticosteroid therapy; however, after surgical resection of the ovarian mass, the hemoglobin level and the reticulocyte count were gradually normalized. The mass was well encapsulated and contained hair and teeth. She was diagnosed as having autoimmune hemolytic anemia associated with an ovarian teratoma. To the best of our knowledge, this is the first such a case to be reported in Korea.
Collapse
Affiliation(s)
- Ickkeun Kim
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jue Yong Lee
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Joo Young Jung
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Hun Ho Song
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Young lee Park
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Korea
| | - Eusun Ro
- Department of Obstetrics and Gynecology, College of Medicine, Hallym University, Chuncheon, Korea
| | - Kyung Chan Choi
- Department of Pathology, College of Medicine, Hallym University, Chuncheon, Korea
| |
Collapse
|
37
|
Bairey O, Blickstein D, Monselise Y, Lahav J, Stark P, Prokocimer M, Nativ HM, Kirgner I, Pazgal I, Shaklai M. Antiphospholipid antibodies may be a new prognostic parameter in aggressive non-Hodgkin's lymphoma. Eur J Haematol 2006; 76:384-91. [PMID: 16466368 DOI: 10.1111/j.1600-0609.2005.00620.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Patients with malignancies have an increased prevalence of antiphospholipid antibodies (APA). The aim of this study was to determine the prevalence of IgG, IgM, and IgA anticardiolipin antibodies (aCL) and anti-beta-2 glycoprotein I antibodies (anti-beta2-GPI) in patients with non-Hodgkin's lymphoma (NHL), and to investigate their clinical and prognostic significance. METHODS The study group included 86 patients with NHL. Enzyme-linked immunosorbent assay kits were used to measure the concentrations of aCL and anti-beta2-GPI, and coagulation tests, to measure lupus anticoagulant (LAC) activity. Blood was collected at diagnosis in all patients and at follow-up in 15. Median follow-up time was 1.9 yr. RESULTS Elevated APA levels were found in 35 patients (41%) at diagnosis: one patient aCL IgG, five patients aCL IgM, five aCL IgA, one anti-beta2-GPI IgG, 14 anti-beta2-GPI IgM, and 19 anti-beta2-GPI IgA; LAC activity was found in three of 67 patients (4.5%). There was no significant correlation between elevated APA levels and patient's age or sex, disease stage or grade, bone marrow involvement, B symptoms, serum lactate dehydrogenase levels, serum beta2 microglobulin levels, International Prognostic Index (IPI) score, performance status, type of treatment, or response to treatment. There was a correlation between elevated APA and absence of extranodal disease (P = 0.045). A strong negative correlation was found between elevated APA at diagnosis and survival time. Two-year survival was 90 +/- 5% for patients without APA at diagnosis compared with 63 +/- 11% for patients with an elevated APA levels (P = 0.0025). APA added to the predictive value of IPI for event-free and overall survival. CONCLUSIONS APA are elevated in 41% of NHL patients at diagnosis and are correlated with shortened survival. Their level may serve as an independent prognostic variable in aggressive NHL.
Collapse
Affiliation(s)
- Osnat Bairey
- Institute of Hematology, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Jardin F, Lévesque H, Tilly H. [Auto-immune manifestations in Non-Hodgkin's lymphoma]. Rev Med Interne 2004; 26:557-71. [PMID: 15996570 DOI: 10.1016/j.revmed.2004.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Accepted: 11/01/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE A wide spectrum of auto-immune manifestations is frequently reported in non-Hodgkin's lymphoma (NHL). The purpose of the review is to describe the immune manifestations observed in NHL, according to their histological subtype and to discuss the current physiopathological hypothesis with their therapeutic relevance. CURRENT KNOWLEDGE AND KEY POINTS Most of the organs can be targeted by an immune process due to the lymphoproliferative disease: they include skin diseases (paraneoplastic pemphigus, vasculitis, urticaria, acrosyndromes), peripheral and central nervous system involvement (polyneuropathy, multifocal neuropathy), haematological manifestations (immune cytopenia, acquired bleeding disorders), rheumatologic diseases (arthritis, systemic vasculitis, myositis) and renal lesion (cryoglobulinemia, glomerulopathies). A higher prevalence of autoantibodies, such as antinuclear antibodies, Antiphospholipid antibodies, or endomysium antibodies, is observed in NHL but usually without clinical manifestations. In B-cell NHL, clinical and biological immune manifestations are more frequently observed in indolent lymphoma than in aggressive NHL. In T-cell NHL, immune manifestations are frequent and polymorphous, preceding usually the diagnosis of lymphoma. The prognosis value of the immune manifestations in NHL is unclear. Immune manifestations can be also be related to the treatment procedure, including fludarabine, Interferon, autograft or Rituximab. The physiopathology of the immune manifestations may involve auto-antibodies production by natural CD5+ autoreactive B-cell from which is issue the proliferation, a lost of immune tolerance, an abnormality in the Fas/Fas Ligand pathway or a chronic antigenic stimulation. FUTURE PROSPECTS AND PROJECTS As observed in T-cell lymphoma cases, immunosuppressive treatment can control both immune manifestations and lymphoproliferation, suggesting that lymphoma and auto-immunity may be the two aspects of the same process. The monoclonal antibody anti-CD20 (rituximab), able to suppress the tumoral cells and change the B-cell repertoire is the most promising treatment to cure immune disorders related to NHL. So far, rituximab has been successfully used in mixed cryoglobulinemia and cold agglutinins secondary to NHL.
Collapse
Affiliation(s)
- F Jardin
- Département d'hématologie clinique et groupe d'étude des syndromes lymphoprolifératifs, Inserm U164, centre Henri-Becquerel, 76000 Rouen, France.
| | | | | |
Collapse
|
39
|
Abstract
Paraneoplastic syndromes are manifestations of malignancies that have produced effects that are distant from the primary tumor or metastases. Paraneoplastic syndromes are not caused by local effects of compression or infiltration into tissues, but are generally due to ectopic hormone production, autoimmune phenomena, or overproduction of cytokines. Paraneoplasia may be the presenting symptom of underlying malignancy and can affect almost any organ system, such as the neurologic syndromes associated with small-cell lung cancer or hypercalcemia associated with squamous cell carcinomas. Lymphoproliferative disorders are also associated with many paraneoplastic disorders; however, to date, most published information has been in the form of case reports and series of small numbers of patients. In this review, the most common paraneoplastic syndromes associated with non-Hodgkin's lymphoma and Hodgkin's disease will be discussed.
Collapse
Affiliation(s)
- Karl T Hagler
- Division of Hematology/Oncology, Department of Medicine, UF/Shands Cancer Center, University of Florida College of Medicine, Gainesville, 32610, USA
| | | |
Collapse
|
40
|
Jung CK, Park JS, Lee EJ, Kim SH, Kwon HC, Kim JS, Roh MS, Yoon SK, Kim KH, Han JY, Kim HJ. Autoimmune hemolytic anemia in a patient with primary ovarian non-Hodgkin's lymphoma. J Korean Med Sci 2004; 19:294-6. [PMID: 15082907 PMCID: PMC2822315 DOI: 10.3346/jkms.2004.19.2.294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The primary ovarian lymphoma is a rare disease with poor prognosis. The incidence of autoimmune hemolytic anemia in patients with non-Hodgkin's lymphoma is estimated at 3%. However, a substantial portion of the previously reported cases of ovarian lymphoma actually represented ovarian involvement by more diffuse lymphomatous process. If stringent criteria are used for case selection, true primary ovarian lymphoma usually carries a favorable prognosis. We present a primary malignant lymphoma of ovary accompanied by autoimmune hemolytic anemia in a 29-yr-old patient. After ablative surgery, the hemoglobin level and the reticulocyte count were normalized. One year following surgery and chemotherapy, the patient is alive and disease free.
Collapse
Affiliation(s)
- Chang Kil Jung
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Jong Seung Park
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Eun Ju Lee
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Sung Hyun Kim
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Hyuk Chan Kwon
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Jae Seok Kim
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Mee Sook Roh
- Department of Pathology, College of Medicine, Dong-A University, Busan, Korea
| | - Seoung Kook Yoon
- Department of Diagnostic Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Kyeong-Hee Kim
- Department of Laboratory Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Jin-Yeong Han
- Department of Laboratory Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| |
Collapse
|
41
|
Guyomard S, Salles G, Coudurier M, Rousset H, Coiffier B, Bienvenu J, Fabien N. Prevalence and pattern of antinuclear autoantibodies in 347 patients with non-Hodgkin's lymphoma. Br J Haematol 2003; 123:90-9. [PMID: 14510947 DOI: 10.1046/j.1365-2141.2003.04587.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The presence of antinuclear autoantibodies (ANA) was investigated in a large cohort of patients with non-Hodgkin's lymphoma (NHL) in order to assess their frequency, specificity and prognostic relevance. ANA were analysed in 347 patients with different histological subgroups of NHL and in 213 controls using an indirect immunofluorescence technique on HEp2 cells. As the appearance of autoantibodies may be found after treatment of NHL, samples were collected at the time of diagnosis of NHL before any therapy. Sixty-six (19%) NHL patients and 12 (5.6%) patients from the control group displayed ANA. The prevalence between the two groups was found to be significantly higher in NHL patients (P < 0.0001) with a marked increased prevalence in follicular and mantle cell lymphoma subgroups. Autoantibodies directed against mitotic proteins or mitotic-associated proteins were found in 6.9% of NHL patients versus 0.5% in the control group (P < 0.001), with a significantly increased incidence in follicular and mantle cell lymphoma subgroups (P < 0.0001). Some 28% of the patients with positive ANA displayed clinical symptoms that could correspond to classical autoimmune manifestations, this frequency appearing to be higher in the marginal zone/mucosa-associated lymphoid tissue lymphoma subgroup. These data demonstrate a significant incidence of ANA before any treatment in NHL occurrence, which seems to be higher in some histological subgroups with particular ANA, such as ANA directed against mitotic proteins or mitotic-associated proteins.
Collapse
Affiliation(s)
- Stephanie Guyomard
- Department of Autoimmunity Department of Clinical Hematology Department of Internal Medicine, Centre Hospitalier Lyon-Sud, HCL, Pierre-Bénite, France
| | | | | | | | | | | | | |
Collapse
|
42
|
Ehrenfeld M, Abu-Shakra M, Buskila D, Shoenfeld Y. The dual association between lymphoma and autoimmunity. Blood Cells Mol Dis 2001; 27:750-6. [PMID: 11778659 DOI: 10.1006/bcmd.2001.0442] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Autoimmune rheumatic diseases and lymphocytic malignancies are related and this association is bidirectional. Lymphomas occur more frequently in the course of autoimmune disease and autoimmune rheumatic manifestations occur in the course of lymphocytic malignancies. An increased incidence of malignant lymphocytic diseases is present in patients with rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, and autoimmune thyroid disease. Descriptions of lymphocytic malignancies among other autoimmune rheumatic disease have been published. In some patients, the malignant disease is diagnosed months or years before the appearance of the rheumatic disease.
Collapse
Affiliation(s)
- M Ehrenfeld
- Research Centre for Autoimmune Diseases, Sheba Medical Centre, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | | | | | | |
Collapse
|
43
|
|