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Shimazu Y, Mizumoto C, Chonabayashi K, Hanyu Y, Kanda J, Takaori-Kondo A. Successful treatment with cyclosporine of pure red cell aplasia induced by obinutuzumab bendamustine therapy. Ann Hematol 2023; 102:2291-2292. [PMID: 37103614 DOI: 10.1007/s00277-023-05215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/05/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Yutaka Shimazu
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
| | - Chisaki Mizumoto
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan.
| | - Kazuhisa Chonabayashi
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
| | - Yuta Hanyu
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54, Kyoto, Kawaramachi, Shogoin, Sakyoku, 606-8507, Japan
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2
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Suzuki T, Okamoto T, Kawai F, Okuyama S, Fukuda K. Hemolytic Anemia after Acute Hepatitis B Virus Infection: A Case Report and Systematic Review. Intern Med 2022; 61:481-488. [PMID: 34433718 PMCID: PMC8907784 DOI: 10.2169/internalmedicine.7690-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hemolytic anemia and pure red cell aplasia are rare hematological complications of hepatitis B virus infection. We herein report a 24-year-old man who was diagnosed with hemolytic anemia and possible transient pure red cell anemia eight weeks after a severe episode of acute hepatitis B virus infection. Rapid recovery was observed with conservative management. Hemoglobin returned to baseline within three months. As the clinical features of hemolytic anemia associated with hepatitis B virus have not yet been elucidated, we conducted a systematic review and present an analysis of the 20 reported cases, including our present case.
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Affiliation(s)
- Takahiro Suzuki
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Fujimi Kawai
- St. Luke's International University Library, Japan
| | - Shuhei Okuyama
- Department of Gastroenterology, St. Luke's International Hospital, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Japan
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3
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Abstract
We herein report a 64-year-old man who was treated with pembrolizumab for relapsed Hodgkin lymphoma. After the third administration of pembrolizumab, he showed acute anemia with a positive direct anti-globulin test. Because of the markedly erythroid hypoplasia, he was diagnosed with pure red cell aplasia (PRCA) caused by pembrolizumab. He was initially treated with prednisolone, but the reticulocytes decreased after tapering prednisolone. He then received high-dose intravenous immunoglobulin (IVIG) with prednisolone, and PRCA was successfully treated. Although the pathogenesis of PRCA caused by immune checkpoint inhibitors (CPIs) remains unclear, IVIG treatment may be effective for some steroid-refractory CPI-induced PRCA cases.
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Affiliation(s)
- Atsushi Isoda
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Japan
- Department of Hematology, Hoshi Clinic, Japan
| | - Yuri Miyazawa
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Japan
| | - Kenichi Tahara
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Japan
| | - Masahiro Mihara
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Japan
| | - Akio Saito
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Japan
| | - Morio Matsumoto
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Japan
| | - Morio Sawamura
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Japan
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4
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Abstract
BACKGROUND Epstein-Barr virus (EBV) is a herpesvirus spread by intimate contact. It is known to cause infectious mononucleosis. Complications, including hematologic pathology and splenic rupture, are uncommon. This report is a case of EBV-induced autoimmune hemolytic anemia and biliary stasis. CASE REPORT An 18-year-old man presented to the emergency department with abdominal pain, nausea, vomiting, and jaundice. He did not have risk factors for liver injury or hepatitis. His vital signs were notable for a fever. On examination, he was obviously jaundiced, but not in distress. Laboratory evaluation showed hemolytic anemia and biliary stasis. Ultimately, his inpatient workup yielded positive EBV serology and a positive direct agglutinin test with cold agglutinins. He made a full recovery with supportive care. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: EBV is a widely disseminated herpesvirus. Infectious mononucleosis is a common presentation of acute infection, and treatment of EBV-related diseases are largely supportive. Complications, such as splenic rupture and hematologic pathology, are uncommon. Biliary stasis and autoimmune hemolytic anemia in the form of cold agglutinin disease secondary to EBV is rare, and typically resolves with supportive care and cold avoidance. More advanced treatment methods are available in the setting of severe hemolysis. Elevated transaminases, direct hyperbilirubinemia, or evidence of hemolytic anemia in the setting of a nonspecific viral syndrome should raise suspicion for EBV infection. Rapid recognition can lead to more prompt prevention and treatment of other EBV-related complications.
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Affiliation(s)
- John Teijido
- Department of Emergency Medicine, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin
| | | | - J Marc Liu
- Department of Emergency Medicine, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin
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5
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Yoshimi M, Kadowaki Y, Kikuchi Y, Takahashi T. Coombs-negative Autoimmune Hemolytic Anemia Followed by Anti-erythropoetin Receptor Antibody-associated Pure Red Cell Aplasia: A Case Report and Review of Literature. Intern Med 2016; 55:511-4. [PMID: 26935373 DOI: 10.2169/internalmedicine.55.5436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 76-year-old woman was referred to our hospital because of anemia. The laboratory findings revealed hemolysis. Although a direct Coombs test was negative, a high titer of RBC-bound IgG was detected, and a diagnosis of Coombs-negative autoimmune hemolytic anemia was made. She was successfully treated with prednisolone. One year and five months later, she again presented anemia and was diagnosed with pure red cell aplasia. Anti-erythropoietin receptor antibody was detected in the serum. She was treated with cyclosporine and obtained prompt recovery. We herein report this rare case and review the pertinent literature.
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/immunology
- Coombs Test
- Cyclosporine/therapeutic use
- Erythropoietin
- Female
- Glucocorticoids/therapeutic use
- Humans
- Immunosuppressive Agents/therapeutic use
- Prednisolone/therapeutic use
- Receptors, Erythropoietin/antagonists & inhibitors
- Red-Cell Aplasia, Pure/diagnosis
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/immunology
- Treatment Outcome
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Affiliation(s)
- Mayumi Yoshimi
- Department of Hematology, Mitsui Memorial Hospital, Japan
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6
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Qin X, Yu Y, Yan S, Wang R, Liu X, Chen C. Pure Red Cell Aplasia and Autoimmune Hemolytic Anemia Sequentially Occurring in a Patient with Large Granular T-lymphocytic Leukemia. Intern Med 2016; 55:1491-6. [PMID: 27250059 DOI: 10.2169/internalmedicine.55.5252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pure red cell aplasia (PRCA), a type of anemia, occurred in a 50-year-old man six weeks after a splenectomy. It was successfully controlled by ciclosporin A (CsA) treatment. However, the onset of acute autoimmune hemolytic anemia (AIHA) developed one week after the CsA had been tapered off. Fortunately, the AIHA responded well to a high-dose methylprednisolone and immunoglobulin treatment. Unexpectedly, the patient suffered from severe pulmonary infection three months after the AIHA therapy. Four months later, he completely stopped the methylprednisolone. The disease was diagnosed as large granular T-lymphocytic leukemia by T cell receptor gene rearrangement, a surface marker examination and immunohistochemical staining. To our knowledge, no similar cases have previously been reported in the literature.
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Affiliation(s)
- Xuemei Qin
- Department of Hematology, Qilu Hospital, Shandong University, China
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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8
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Ku M, Bazargan A, Nandurkar H, Tam C. Effective treatment of Waldenström macroglobulinemia associated pure red cell aplasia with standard antilymphomatous chemotherapy. Leuk Lymphoma 2013; 55:692-4. [PMID: 23841509 DOI: 10.3109/10428194.2013.802316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthew Ku
- Department of Haematology, St Vincent's Hospital , Melbourne , Australia
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9
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Abstract
Most of the viruses known to be associated with anemia in human tend to persistently infect their host and are noncytopathic or poorly cytopathic for blood cell progenitors. Infections with Epstein-Barr virus, cytomegalovirus, varicella-zoster virus, human herpes virus 6 (HHV-6), B19 parvovirus, human immunodeficiency virus, hepatitis A and C viruses and the putative viral agent associated with non-A-G post-hepatitis aplastic anemia have been reported in association with anemia. Nevertheless, a direct cytotoxic effect on erythroid progenitors has been clearly demonstrated only for human parvovirus B19 and evocated for HHV-6. A major role for destructive immunity is strongly suspected in the pathogenesis of anemia associated with the other viral infections. Host genes play a role in the occurrence of virus-induced anemia in animal models, and there are some evidences that genetic background could also influence the occurrence of virus-associated anemia in human.
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Affiliation(s)
- Frédéric Morinet
- Centre des Innovations Thérapeutiques en Oncologie et Hématologie, CHU Saint-Louis, Paris, France.
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10
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McGovern K, Lascola K, Davis E, Fredrickson R, Tan R. T-Cell Lymphoma with Immune-Mediated Anemia and Thrombocytopenia in a Horse. J Vet Intern Med 2011; 25:1181-5. [DOI: 10.1111/j.1939-1676.2011.00777.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 03/24/2011] [Accepted: 07/05/2011] [Indexed: 11/27/2022] Open
Affiliation(s)
- K.F. McGovern
- From the College of Veterinary Medicine, University of Illinois; Urbana; IL (McGovern, Lascola, Fredrickson, Tan)
| | - K.M. Lascola
- From the College of Veterinary Medicine, University of Illinois; Urbana; IL (McGovern, Lascola, Fredrickson, Tan)
| | - E. Davis
- College of Veterinary Medicine, Kansas State University; Manhattan; KS (Davis)
| | - R.L. Fredrickson
- From the College of Veterinary Medicine, University of Illinois; Urbana; IL (McGovern, Lascola, Fredrickson, Tan)
| | - R. Tan
- From the College of Veterinary Medicine, University of Illinois; Urbana; IL (McGovern, Lascola, Fredrickson, Tan)
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11
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Eve HE, Rule SAJ. Autoimmune haemolytic anaemia associated with mantle cell lymphoma. Int J Hematol 2010; 91:322-5. [PMID: 20063131 DOI: 10.1007/s12185-009-0489-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 10/07/2009] [Accepted: 12/27/2009] [Indexed: 10/20/2022]
Abstract
Autoimmune haemolytic anaemia (AIHA) is a well-recognised complication of lymphoproliferative disorders, and has been reported in association with all B and T cell non-Hodgkin lymphoma subtypes with the exception of mantle cell lymphoma (MCL). We describe herein a case of MCL diagnosed in an initially asymptomatic 66-year-old woman who developed transfusion-dependent AIHA 6 months later coincident with lymphoma progression. The AIHA failed to respond satisfactorily to conventional treatment (high-dose oral prednisolone) but rapidly resolved following commencement of non-rituximab-containing combination chemotherapy in parallel with complete remission of the lymphoma. This is the first of such cases to be described in the literature and confirms that the immune environment of MCL can predispose to AIHA in the same way as in other lymphoma subtypes. Despite this being an infrequent occurrence, clinicians should be aware that AIHA is a potential complication of MCL and may be more successfully controlled by treating the underlying lymphoma rather than relying on conventional anti-haemolytic strategies such as steroids.
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Affiliation(s)
- Heather E Eve
- Department of Haematology, Derriford Hospital, Plymouth PL6 8DH, UK.
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12
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Arai A, Imadome KI, Fujiwara S, Miura O. Autoimmune hemolytic anemia accompanied by reactivation of an Epstein-Barr virus infection with suppressed CTL response to EBV-infected cells in an elderly man. Intern Med 2010; 49:325-9. [PMID: 20154439 DOI: 10.2169/internalmedicine.49.2829] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 88-year-old man with autoimmune hemolytic anemia (AIHA) who had been treated with low dose prednisolone developed a sudden worsening of his anemia accompanied by reactivation of Epstein-Barr virus (EBV). We established EBV-infected spontaneous lymphoblastoid cell lines (LCL), performed an enzyme-linked immunosorbent spot assay, and confirmed a significantly suppressed EBV-specific cytotoxic T-cell (CTL) response to the LCL. EBV reactivation might have been brought about by suppressed CTL activity which could have been due to low dose PSL administration or aging. Since the EBV-DNA titer decreased as AIHA improved, we concluded that EBV might have played a role in the development of anemia.
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MESH Headings
- Aged
- Aged, 80 and over
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/immunology
- Anemia, Hemolytic, Autoimmune/virology
- Anti-Inflammatory Agents/administration & dosage
- Anti-Inflammatory Agents/adverse effects
- Cell Line
- DNA, Viral/isolation & purification
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/immunology
- Epstein-Barr Virus Infections/virology
- Herpesvirus 4, Human/immunology
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 4, Human/pathogenicity
- Humans
- Immune Tolerance
- Male
- Prednisolone/administration & dosage
- Prednisolone/adverse effects
- Recurrence
- T-Lymphocytes, Cytotoxic/immunology
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Affiliation(s)
- Ayako Arai
- Department of Hematology, Tokyo Medical and Dental University, Tokyo.
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Affiliation(s)
- Alexander W Hauswirth
- Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Austria.
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14
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Hirokawa M, Sawada KI, Fujishima N, Kawano F, Kimura A, Watanabe T, Arai A, Matsui T, Nakao S, Urabe A, Omine M, Ozawa K. Acquired pure red cell aplasia associated with malignant lymphomas: a nationwide cohort study in Japan for the PRCA Collaborative Study Group. Am J Hematol 2009; 84:144-8. [PMID: 19195037 DOI: 10.1002/ajh.21354] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pure red cell aplasia (PRCA) has been reported in association with lymphoma as one of the autoimmune diseases seen during the course of lymphoid malignancies. However, the relation of PRCA with the underlying lymphomas remains unclear. The aim of this study was to clarify the histologic subtypes of lymphomas, the chronological sequence of anemia and lymphoma, and the response to treatment. We conducted a nationwide survey in Japan. From a cohort of 185 PRCA patients, 8 patients with lymphoma were evaluated. Histologic subtypes varied and the lymphoma was of the B-cell type in four cases and of the T-cell type in four. Four patients simultaneously developed PRCA and lymphoma. Three patients developed PRCA following lymphoma, two of whom developed anemia during remission of lymphoma. PRCA preceded lymphoma in one patient. Effective chemotherapy was associated with remission of anemia in concurrent lymphoma and PRCA. Overall, anemia responded to chemotherapy and/or immunosuppressive therapy in seven patients. In four responding patients, PRCA remained in durable remission without maintenance immunosuppressive therapy, which is different from a recurrent feature of idiopathic PRCA. We suggest that the mechanism of lymphoma-associated PRCA is heterogeneous and that durable maintenance-free remission of anemia can be obtained in some patients.
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Affiliation(s)
- Makoto Hirokawa
- Division of Hematology and Oncology, Department of Medicine, Akita University School of Medicine, Akita, Japan.
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15
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Sung HJ, Kim SJ, Lee JH, Lee G, Lee KA, Choi CW, Kim BS, Kim JS. Persistent anemia in a patient with diffuse large B cell lymphoma: pure red cell aplasia associated with latent Epstein-Barr virus infection in bone marrow. J Korean Med Sci 2007; 22 Suppl:S167-70. [PMID: 17923747 PMCID: PMC2694371 DOI: 10.3346/jkms.2007.22.s.s167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
We report a case of pure red cell aplasia (PRCA), which was initially suspected as a result of bone marrow involvement of diffuse large B cell lymphoma. Persistent anemia without an obvious cause was observed in a 47-yr-old man diagnosed with relapsed diffuse large B cell lymphoma. The bone marrow study showed only erythroid hypoplasia without the evidence of bone marrow involvement with lymphoma cells, thus PRCA was suggested. However, parvovirus infection was excluded as a potential cause of PRCA because of negative IgM anti-parvovirus B19 antibody and negative parvovirus PCR in the serum. Latent Epstein-Barr virus (EBV) infection of bone marrow was suggested by in situ hybridization with EBV-encoded small RNA (EBER) that showed a strong positive expression in bone marrow cells. Thus, PRCA was thought to be associated with latent EBV infection in bone marrow cells. Although the finding of unexplained anemia is a possible predictor of bone marrow involvement with lymphoma cells, PRCA as a result of a viral infection including EBV should be considered in lymphoma patients. This is the first report of the occurrence of PRCA associated with latent EBV infection in a patient with non-Hodgkin's lymphoma.
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Affiliation(s)
- Hwa Jung Sung
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Ji-Hye Lee
- Department of Pathology, Korea University Medical Center, Seoul, Korea
| | - Goeun Lee
- Department of Laboratory Medicine, Korea University Medical Center, Seoul, Korea
| | - Kyung A Lee
- Department of Laboratory Medicine, Hallym University Chunchon Sacred Heart Hospital, Chunchon, Korea
| | - Chul Won Choi
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Byung Soo Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jun Suk Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
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16
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Hatta Y, Kura Y, Yano T, Ushiyama H, Sugitani M, Okano T, Ishizuka H, Sawada U, Adachi Y, Horie T. Pure red cell aplasia and myelofibrosis in B-cell neoplasm. J Int Med Res 2005; 33:460-6. [PMID: 16104450 DOI: 10.1177/147323000503300412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe an unusual case of B-cell neoplasm accompanied by pure red cell aplasia (PRCA) and myelofibrosis in a 67-year-old male presenting with severe anaemia. A few unclassified, myeloperoxidase-negative blastoid cells were seen on bone marrow aspiration, and erythroid cell hypoplasia and myelofibrosis on bone marrow biopsy. An autoimmune PRCA was suspected, as serum CH50, C3 and C4 levels were consistently low. Ciclosporin was effective in treating the anaemia, but anaemia returned when the drug was discontinued. Thirteen months later, the patient was admitted with pleural effusion and ascites that contained monoclonal CD19+ CD20+ immature blast cells with a complex karyotype, thought to be neoplastic B-cells. The unclassified blastoid cells seen earlier may therefore have been from the same origin. The patient deteriorated rapidly and died. Only one case of non-Hodgkin's lymphoma with PRCA and myelofibrosis has been reported previously. We discuss the possibility that dysregulated T-cells induced by neoplastic B-cells may have given rise to concomitant PRCA and myelofibrosis.
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Affiliation(s)
- Y Hatta
- Department of Haematology and Rheumatology, Nihon University School of Medicine, Tokyo, Japan.
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17
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Abstract
Pure red cell aplasia (PRCA) is a relatively rare disease although multiple factors are implied in the pathogenesis of its development. A slow progressive normocytic-normochromic anemia and reticulocytopenia, without leukopenia and thrombocytopenia in a patient who, except pallor, does not show abnormal findings on physical examination, should arise the suspicion that he has PRCA. Search for underlying diseases or infections and intake of drugs may help for the establishment of the diagnosis of acquired PRCA. Lack of erythroblasts in the bone marrow with normal development of the other hemopoietic series, as well as high level of serum erythropoietin are important clues for the diagnosis. Elimination of potentially causative factors, administration of immunosuppressive agents and/or recombinant erythropoietin, preferably epoetin beta, may induce remission and complete recovery.
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Affiliation(s)
- M Djaldetti
- Research Laboratory Unit, Rabin Medical Center, Golda Campus, 7, Keren Kayemet Street, Petah Tiqva, The Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.
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18
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Abstract
I hypothesize that human chronic autoimmune diseases are based on infection of autoreactive B lymphocytes by Epstein-Barr virus (EBV), in the following proposed scenario. During primary infection, autoreactive B cells are infected by EBV, proliferate and become latently infected memory B cells, which are resistant to the apoptosis that occurs during normal B-cell homeostasis because they express virus-encoded anti-apoptotic molecules. Genetic susceptibility to the effects of B-cell infection by EBV leads to an increased number of latently infected autoreactive memory B cells, which lodge in organs where their target antigen is expressed, and act there as antigen-presenting cells. When CD4(+) T cells that recognize antigens within the target organ are activated in lymphoid organs by cross-reactivity with infectious agents, they migrate to the target organ but fail to undergo activation-induced apoptosis because they receive a co-stimulatory survival signal from the infected B cells. The autoreactive T cells proliferate and produce cytokines, which recruit other inflammatory cells, with resultant target organ damage and chronic autoimmune disease.
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Affiliation(s)
- Michael P Pender
- Department of Medicine, The University of Queensland, Clinical Sciences Building, Royal Brisbane Hospital, 4029, Herston, Queensland, Australia.
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19
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Abstract
A patient with chronic lymphocytic leukaemia (CLL) progressive on fludarabine therapy and life-threatening anaemia related to immune haemolysis and pure red cell aplasia was treated with Campath-1H. The patient had sustained complete remission of both CLL and anaemia, but died of recurrent sepsis and cachexia 10 months after completion of the treatment. Campath-1H (alemtuzumab), a humanised anti-CD52 monoclonal antibody, is a potent therapeutic agent against advanced CLL and immune cytopenias. It could be indicated in the treatment of severe immune complications of CLL unresponsive to corticosteroids. Prolonged immunosuppression is a serious side-effect leading to severe infectious complication.
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MESH Headings
- Aged
- Alemtuzumab
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/therapy
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/adverse effects
- Antibodies, Neoplasm/therapeutic use
- Cachexia/etiology
- Fatal Outcome
- Humans
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Male
- Recurrence
- Red-Cell Aplasia, Pure/etiology
- Red-Cell Aplasia, Pure/therapy
- Remission Induction
- Sepsis/etiology
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Affiliation(s)
- Philippe Rodon
- Department of Internal Medicine and Haematology, Centre Hospitalier Général, Blois, France.
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