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Carvès S, Birsen R, Avouac J. Persistent remission of severe rheumatoid arthritis associated with myelodysplastic syndrome upon treatment with lenalidomide. Joint Bone Spine 2024; 91:105693. [PMID: 38246576 DOI: 10.1016/j.jbspin.2024.105693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/17/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Sandrine Carvès
- Rheumatology Department, Hôpital Cochin, AP-HP, Paris, France
| | - Rudy Birsen
- Hematology Department, Hôpital Cochin, AP-HP, Paris, France
| | - Jérôme Avouac
- Rheumatology Department, Hôpital Cochin, AP-HP, Paris, France.
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2
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Oh YJ, Shin DY, Hwang SM, Kim SM, Im K, Park HS, Kim JA, Song YW, Márquez A, Martín J, Lee DS, Park JK. Mutation of ten-eleven translocation-2 is associated with increased risk of autoimmune disease in patients with myelodysplastic syndrome. Korean J Intern Med 2020; 35:457-464. [PMID: 31640337 PMCID: PMC7061008 DOI: 10.3904/kjim.2018.247] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Myelodysplastic syndrome (MDS) is caused by genetic and epigenetic alteration of hematopoietic precursors and immune dysregulation. Approximately 20% of patients with MDS develop an autoimmune disease (AID). Here, we investigated whether particular genetic mutations are associated with AID in patients with MDS. METHODS Eighty-eight genetic mutations associated with myeloid malignancy were sequenced in 73 MDS patients. The association between these mutations and AID was then analyzed. RESULTS The median age of the 73 MDS patients was 70 years (interquartile range, 56 to 75), and 49 (67.1%) were male. AID was observed in 16 of 73 patients (21.9%). Mutations were detected in 57 (78.1%) patients. The percentage (68.8% vs. 80.7%, p = 0.32) and the mean number of mutations (1.8 ± 1.6 vs. 2.2 ± 1.8, p = 0.34) in MDS patients with or without AID were similar. However, the ten-eleven translocation- 2 (TET2) mutation rate was significantly higher in patients with AID than in those without (31.3% vs. 5.3%, respectively; p = 0.001). All TET2 mutations were variants of strong clinical significance. CONCLUSION Mutation of TET2 in patients with MDS may be associated with increased risk of developing AID.
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Affiliation(s)
- Yoon-Jeong Oh
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Dong-Yeop Shin
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sang Mee Hwang
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Min Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyongok Im
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Sue Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Ah Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ana Márquez
- Instituto de Parasitología y Biomedicina “López-Neyra”, CSIC, Granada, Spain
| | - Javier Martín
- Instituto de Parasitología y Biomedicina “López-Neyra”, CSIC, Granada, Spain
| | - Dong-Soon Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
- Dong-Soon Lee, M.D. Department of Laboratory Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-3986, Fax: +82-2-747-0359, E-mail:
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Jin Kyun Park, M.D. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea Tel: +82-2-2072-4765, Fax: +82-2-762-9662, E-mail:
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Evangelatos G, Vlachadami I, Kechagia M, Iliopoulos A. Rituximab and lenalidomide combination treatment for rheumatoid arthritis complicated with myelodysplastic syndrome: A case report. Mediterr J Rheumatol 2017; 28:217-220. [PMID: 32185287 PMCID: PMC7045997 DOI: 10.31138/mjr.28.4.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/29/2017] [Accepted: 11/10/2017] [Indexed: 02/02/2023] Open
Abstract
Rheumatoid arthritis patients might experience several hematologic complications. The development of myelodysplastic syndrome is not clearly associated with RA, even though it has been described in some patients with pre-existing disease. There are only few data available in the literature concerning the therapeutic approach of such patients. Herein, we report a case of RA complicated with progressive MDS, successfully treated with rituximab and lenalidomide combination therapy.
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Affiliation(s)
| | - Ioanna Vlachadami
- Department of Pathophysiology, General Hospital of Athens "Laiko", Athens, Greece
| | - Maria Kechagia
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Share Fund Hospital (NIMTS), Athens, Greece
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4
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Fozza C. The burden of autoimmunity in myelodysplastic syndromes. Hematol Oncol 2017; 36:15-23. [PMID: 28449370 DOI: 10.1002/hon.2423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 12/19/2022]
Abstract
The clinical history of patients with myelodysplastic syndromes (MDS) is characterised by bone marrow insufficiency as well as by the possible evolution into acute leukaemia. However a number of reports highlight the frequent occurrence of autoimmune manifestations involving different sites and organs. The present review will first describe the clinical pictures most often observed in MDS patients. The actual burden of autoimmunity will be then addressed by focusing on the few available registry studies. Finally, the potential collateral impact of specific treatments for MDS on the evolution of autoimmune disorders will be considered.
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Affiliation(s)
- Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
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Mekinian A, Braun T, Decaux O, Falgarone G, Toussirot E, Raffray L, Omouri M, Gombert B, De Wazieres B, Buchdaul AL, Ziza JM, Launay D, Denis G, Madaule S, Rose C, Grignano E, Fenaux P, Fain O. Inflammatory arthritis in patients with myelodysplastic syndromes: a multicenter retrospective study and literature review of 68 cases. Medicine (Baltimore) 2014; 93:1-10. [PMID: 24378738 PMCID: PMC4616329 DOI: 10.1097/md.0000000000000011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We describe the characteristics and outcome of inflammatory arthritis in patients with myelodysplastic syndrome (MDS) in a French multicenter retrospective study. Twenty-two patients with MDS (median age, 77.5 yr [interquartile range, 69-81]; 10 women) were included. Inflammatory arthritis presented as polyarthritis in 17 cases (77%) and with symmetric involvement in 15 cases (68%). At diagnosis, the median disease activity score 28 based on C-reactive protein (DAS28-CRP) was 4.5 [2-6.5]. Two patients had anti-citrullinated protein antibodies (ACPAs), and 1 had radiologic erosions. The median time between the diagnoses of arthritis and MDS was 10 months [6-42], with a median articular symptom duration of 3 months [2-8]. The diagnosis of both diseases was concomitant in 6 cases (27%); arthritis preceded MDS in 12 cases (55%), and occurred after MDS in 4 (18%). While the number of swollen and tender joints significantly decreased during follow-up, as did the median DAS28-CRP (from 4.3 [3.8-4.6] at baseline to 2.9 [1.75-3.3]; p < 0.05), CRP remained elevated (CRP >20 mg/L) in 8 patients (42%). Nevertheless, radiographic progression and new ACPA positivity were not observed during a median follow-up of 29 months [9-76]. While most of the patients were treated with steroids (n = 16) for arthritis, additional treatment was administered in only 4 patients (hydroxychloroquine, n = 2; sulfasalazine [Salazopyrin] and etanercept, n = 1, respectively). Eleven patients died during follow-up from acute myeloid leukemia (n = 5); infections (n = 3); or cerebral bleeding, cardiorespiratory failure, or undetermined cause (n = 1, respectively). Inflammatory arthritis associated with MDS can have various presentations and is often seronegative and nonerosive. Steroids alone are the most common treatment in MDS-associated arthritis, but that treatment is insufficient to control arthritis. Steroid-sparing strategies need to be identified.
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Affiliation(s)
- Arsène Mekinian
- From the Service de médecine interne (AM, EG, OF), Université Paris 13, AP-HP, Hôpital Jean Verdier, Bondy; Service d'hématologie clinique (TB, PF), Université Paris 13, AP-HP, Avicenne, Bobigny; Service de médecine interne (OD), Université Rennes 1, Hôpital Universitaire de Rennes, Rennes; Service de rhumatologie (GF), Université Sorbonne Paris Cité, Université Paris 13, Li2P, EA4222, Hôpital Avicenne, Bobigny; Centre Investigation Clinique Biothérapie CBT-506 & Service de rhumatologie (ET), CHU Besançon, Besançon; Service de médecine interne (LR), CHU de Bordeaux, Bordeaux; Service de rhumatologie (MO), CH Romilly/Seine; Service de médecine interne (BG), Hôpital de La Rochelle, La Rochelle; Service de médecine interne et gériatrique (BDW), CHU Nîmes, Nîmes; Service de médecine interne (A-LB), CH Douai, Douai; Service de rhumatologie (J-MZ), CH Croix Saint Simon, Paris; Service de médecine interne (DL), CHU Lille, Université Lille II, Lille; Service de médecine interne (GD), Hôpital de Rochefort, Rochefort; Service de médecine interne (SM), CHG Albi, Albi; and Service d'hématologie clinique (CR), Hôpital Saint-Vincent de Paul, UC Lille, Univ Nord de France, Lille; France
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Braun T, Fenaux P. Myelodysplastic Syndromes (MDS) and autoimmune disorders (AD): Cause or consequence? Best Pract Res Clin Haematol 2013; 26:327-36. [DOI: 10.1016/j.beha.2013.09.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Al Ustwani O, Ford LA, Sait SJN, Block AMW, Barcos M, Vigil CE, Griffiths EA, Thompson JE, Wang ES, Ambrus J, Wetzler M. Myelodysplastic syndromes and autoimmune diseases--case series and review of literature. Leuk Res 2013; 37:894-9. [PMID: 23692654 DOI: 10.1016/j.leukres.2013.04.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 03/02/2013] [Accepted: 04/03/2013] [Indexed: 12/18/2022]
Abstract
Our objective was to recognize the association of autoimmune diseases (AD) in patients with myelodysplastic syndromes (MDS) and understand how this association could affect prognosis and management of both diseases. We describe our cohort of 10 patients and 34 patients reported in the English literature in addition to ten cohort studies. Interestingly, four cases showed improvement in AD after 5-azacitidine treatment. The mechanism(s) of the association between AD and MDS are discussed. Treatment could be targeted against AD, MDS or both, though based on recent reports, treating MDS with hypomethylating agents alone could improve the associated AD.
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Affiliation(s)
- Omar Al Ustwani
- Leukemia Section, Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, USA
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Fain O, Braun T, Stirnemann J, Fenaux P. Manifestations systémiques et auto-immunes des syndromes myélodysplasiques. Rev Med Interne 2011; 32:552-9. [DOI: 10.1016/j.revmed.2010.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 07/26/2010] [Accepted: 08/11/2010] [Indexed: 12/18/2022]
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Die Rationale für Knochenmarkuntersuchungen bei Patienten mit entzündlich-rheumatischen Erkrankungen. Wien Klin Wochenschr 2009; 121:690-9. [DOI: 10.1007/s00508-009-1264-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 09/17/2009] [Indexed: 12/17/2022]
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10
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Successful treatment of MDS with lenalidomide, complicated by transient autoimmune hemolysis. Ann Hematol 2009; 89:327-9. [DOI: 10.1007/s00277-009-0802-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 07/27/2009] [Indexed: 10/20/2022]
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Anderson LA, Pfeiffer RM, Landgren O, Gadalla S, Berndt SI, Engels EA. Risks of myeloid malignancies in patients with autoimmune conditions. Br J Cancer 2009; 100:822-8. [PMID: 19259097 PMCID: PMC2653768 DOI: 10.1038/sj.bjc.6604935] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Autoimmune conditions are associated with an elevated risk of lymphoproliferative malignancies, but few studies have investigated the risk of myeloid malignancies. From the US Surveillance Epidemiology and End Results (SEER)-Medicare database, 13 486 myeloid malignancy patients (aged 67+ years) and 160 086 population-based controls were selected. Logistic regression models adjusted for gender, age, race, calendar year and number of physician claims were used to estimate odds ratios (ORs) for myeloid malignancies in relation to autoimmune conditions. Multiple comparisons were controlled for using the Bonferroni correction (P<0.0005). Autoimmune conditions, overall, were associated with an increased risk of acute myeloid leukaemia (AML) (OR 1.29) and myelodysplastic syndrome (MDS, OR 1.50). Specifically, AML was associated with rheumatoid arthritis (OR 1.28), systemic lupus erythematosus (OR 1.92), polymyalgia rheumatica (OR 1.73), autoimmune haemolytic anaemia (OR 3.74), systemic vasculitis (OR 6.23), ulcerative colitis (OR 1.72) and pernicious anaemia (OR 1.57). Myelodysplastic syndrome was associated with rheumatoid arthritis (OR1.52) and pernicious anaemia (OR 2.38). Overall, autoimmune conditions were not associated with chronic myeloid leukaemia (OR 1.09) or chronic myeloproliferative disorders (OR 1.15). Medications used to treat autoimmune conditions, shared genetic predisposition and/or direct infiltration of bone marrow by autoimmune conditions, could explain these excess risks of myeloid malignancies.
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Affiliation(s)
- L A Anderson
- Centre for Public Health, Queen's University Belfast, Northern Ireland, UK.
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12
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Then Bergh F, Niklas A, Strauss A, von Ahsen N, Niederwieser D, Schwarz J, Wagner A, Al-Ali HK. Rapid progression of Myelodysplastic syndrome to acute myeloid leukemia on sequential azathioprine, IFN-beta and copolymer-1 in a patient with multiple sclerosis. Acta Haematol 2006; 116:207-10. [PMID: 17016041 DOI: 10.1159/000094683] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 11/04/2005] [Indexed: 11/19/2022]
Abstract
A woman with relapsing-remitting multiple sclerosis (MS) was treated with oral azathioprine (AZA) for 4 years and subsequently switched to interferon-beta1a. Five years later, leukopenia developed and resolved after interferon was discontinued; MS treatment was changed to copolymer-1. Recurrent pancytopenia subsequently led to diagnosis of myelodysplastic syndrome (MDS) with deletion of the long arm of chromosome 5 (MDS 5q-). Within several months, unusually rapid for this subtype, MDS progressed to secondary acute myeloid leukemia. While AZA is the probable cause for the chromosomal deletion and MDS, combined or sequential immunomodulatory therapies may permit clonal expansion of malignant hematopoietic progenitors.
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Pinheiro RF, Silva MRR, Chauffaille MDLLF. The 5q- syndrome and autoimmune phenomena: report of three cases. Leuk Res 2005; 30:507-10. [PMID: 16219353 DOI: 10.1016/j.leukres.2005.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Revised: 08/19/2005] [Accepted: 08/22/2005] [Indexed: 11/16/2022]
Abstract
Myelodysplastic syndrome is a clonal hematopoietic stem cell disorder characterized by ineffective hematopoiesis, peripheral cytopenias and an additional risk to evolve to acute leukemia in up to 30% of the cases. Autoimmune manifestations as vasculitis, pyoderma gangrenosum, hemolytic anemia, immune thrombocytopenia, rheumatoid arthritis as well as positive anti-nuclear factor and rheumatoid factor have been reported in 13-30% of MDS patients. The aim of this report is to present three patients with 5q- syndrome who presented different autoimmune serological and clinical phenomena and review the literature. Patient 1 showed a focal and segmental glomerulosclerosis (FSGE) in the course of a MDS. Renal involvement in MDS as autoimmune phenomenon is rare and few reports have documented different forms of glomerular diseases in adults with MDS. Patients 2 and 3 showed a rheumatoid factor of 1/140 and the direct Coomb's test positive (3+), respectively, but without evidence of clinical autoimmune manifestation. In conclusion, patients with the 5q- syndrome experience a relative benign disease course extending over several years. We believe that careful follow-up of patients with autoimmune manifestations as here reported is important to detect any unexpected outcome.
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Affiliation(s)
- Ronald Feitosa Pinheiro
- Disciplina de Hematologia e Hemoterapia, Universidade Federal de São Paulo-UNIFESP-EPM, Rua Botucatu 740, 3 andar, Hematologia-CEP: 04023-900, São Paulo-SP, Brazil.
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