1
|
Castaño-Bonilla T, Mata R, Láinez-González D, Gonzalo R, Castañón S, Díaz de la Pinta FJ, Blas C, López-Lorenzo JL, Alonso-Domínguez JM. Spontaneous Remission of Blastic Plasmacytoid Dendritic Cell Neoplasm: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:807. [PMID: 38792990 PMCID: PMC11122931 DOI: 10.3390/medicina60050807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Spontaneous remissions (SRs) in blastic plasmacytoid dendritic cell neoplasms (BPDCNs) are infrequent, poorly documented, and transient. We report a 40-year-old man presenting with bycitopenia and soft tissue infection. The bone marrow exhibited 3% abnormal cells. Immunophenotyping of these cells revealed the antigens CD45+ (dim), CD34+, CD117+, CD123+ (bright), HLA-DR+ (bimodal), CD56+ (bright), CD33+, CD13+, CD2+, and CD22+ (dim) and the partial expression of the CD10+, CD36+, and CD7+ antigens. All other myeloid, monocytic, and lymphoid antigens were negative. Genetic studies showed a complex karyotype and mutations in the TP53R337C and KRASG12D genes. On hospital admission, the patient showed a subcutaneous nodule on the right hand and left lower limb. Flow cytometry multiparameter (FCM) analysis showed the presence of 29% abnormal cells with the previously described immunophenotype. The patient was diagnosed with BPDCN. The patient was treated with broad-spectrum antibiotics for soft tissue infection, which delayed therapy for BPDCN. No steroids or chemotherapeutic or hypomethylating agents were administered. His blood cell counts improved and skin lesions disappeared, until the patient relapsed five months after achieving spontaneous remission. About 60% of abnormal cells were identified. No changes in immunophenotype or the results of genetic studies were observed. The patient underwent a HyperCVAD chemotherapy regimen for six cycles. Consolidation therapy was performed via allogeneic bone marrow transplantation with an HLA-unrelated donor. One year after the bone marrow transplant, the patient died due to the progression of his underlying disease, coinciding with a respiratory infection caused by SARS-CoV-2. In the available literature, SRs are often linked to infections or other stimulators of the immune system, suggesting that powerful immune activation could play a role in controlling the leukemic clone. Nevertheless, the underlying mechanism of this phenomenon is not clearly understood. We hypothesize that the immune system would force the leukemic stem cell (LSC) to undergo a state of quiescence. This loss of replication causes the LSC progeny to die off, resulting in the SR of BPDCN.
Collapse
Affiliation(s)
- Tamara Castaño-Bonilla
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Raquel Mata
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Daniel Láinez-González
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Raquel Gonzalo
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Susana Castañón
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | | | - Carlos Blas
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - José L. López-Lorenzo
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Juan Manuel Alonso-Domínguez
- Hematology Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| |
Collapse
|
2
|
Yoshioka K, Kurokawa R, Amemiya S, Koyamaa H, Matsuda K, Honda A, Kurokawa M, Shinozaki-Ushiku A, Abe O. Rapidly progressing blastic plasmacytoid dendritic cell neoplasm causing diffuse skin thickening: A case report with sequential computed tomography examinations. Radiol Case Rep 2021; 16:2929-2933. [PMID: 34401028 PMCID: PMC8350179 DOI: 10.1016/j.radcr.2021.07.010] [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: 06/19/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/05/2022] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm is a rare aggressive myeloid malignancy thought to be derived from precursor plasmacytoid dendritic cells. Rapid progression and poor prognosis have been known. We herein present a case of BPDCN in a previously healthy man who presented with suddenly developed multiple deep purple skin rashes, with sequential computed tomography examinations. The follow-up computed tomography demonstrated that multiple skin nodules observed in the initial MRI fused, resulting in a thickening of the entire skin, with some surface erosions and crusting. Blastic plasmacytoid dendritic cell neoplasm should be considered in the differentials in patients with a sudden onset and rapidly progressing skin rash or thickening.
Collapse
Affiliation(s)
- Kyohei Yoshioka
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiori Amemiya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Koyamaa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kensuke Matsuda
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akira Honda
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Aya Shinozaki-Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|