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Stark K, Rowe C, Mathur A, Matossian J, Lawrie A. Drug-induced secondary haemophagocytic lymphohistiocytosis in hairy cell leukaemia. J R Coll Physicians Edinb 2024; 54:29-33. [PMID: 38160201 DOI: 10.1177/14782715231220108] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a rare, aggressive, excess immune activation syndrome. Diagnosis can be challenging due to its several clinical mimics including sepsis. There are multiple aetiologies of HLH; in adults, it is most commonly triggered by infection, malignancy, drugs and autoimmune processes. Failure to rapidly diagnose and treat this condition can be fatal. The management of HLH includes identifying and removing the trigger, supportive management and immunosuppression. Identifying the trigger is essential to inform the most appropriate type of immunosuppression. Here, we report a case of likely drug-induced HLH in a patient recently treated for hairy cell leukaemia. The culprit drug was thought to be co-trimoxazole and this case report highlights a very rare complication of this commonly used drug. We discuss our management approach with steroid monotherapy and withdrawal of co-trimoxazole.
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Affiliation(s)
- Katherine Stark
- Department of Haematology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Cormac Rowe
- Department of Haematology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Abhinav Mathur
- Department of Haematology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - James Matossian
- Department of Pathology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Alastair Lawrie
- Department of Haematology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
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2
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Stanton DJ, Quadri NZ, Tanabe MB. Concomitantly Diagnosed Disseminated M kansasii Infection and Hairy Cell Leukemia With Review of Pathophysiology. J Investig Med High Impact Case Rep 2024; 12:23247096241253343. [PMID: 38767131 DOI: 10.1177/23247096241253343] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
The association between Hairy Cell Leukemia (HCL) and non-tuberculous mycobacterial infections (NTMs) is well described, most notably Mycobacterium kansasii. The exact pathophysiology is not known. We report a case of a 31-year-old male with concomitantly diagnosed HCL and disseminated M kansasii infection who presented with rash, pancytopenia, and bulky axillary lymphadenopathy. The M kansasii was initially diagnosed through use of cell-free DNA detection and confirmed by bone marrow and lymph node cultures. Hairy Cell Leukemia was diagnosed with peripheral flow cytometry and confirmed via the same bone marrow sample. His HCL was put into remission with a single course of cladribine and rituximab chemotherapy; however, his M kansasii infection persisted for 6 months despite aggressive antimicrobial and surgical therapy. It was finally controlled using high-dose rifampin in combination with azithromycin and ethambutol. This case highlights the known link between HCL and M kansasii. Furthermore, it hints at potential causes beyond chemotherapy-induced immunocompromise. Notable possibilities include HCL cells acting as sanctuary sites for M kansasii to evade the immune system, and subclinical M kansasii infections causing NLRP3 inflammasome overactivation to trigger the oncogenic transformation to HCL. More research into the pathophysiologic link between HCL and M kansasii infections would allow for more effective prevention, diagnosis, and treatment of these severe atypical infections which are the major cause of morbidity in the cladribine era of HCL treatment.
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Affiliation(s)
| | - Nadia Z Quadri
- The University of Texas Medical Branch at Galveston, USA
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3
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Ecsiova D, Kamaradova K, Nova M, Hoffmann P, Rozsivalova P, Simkovic M, Zak P. Pulmonary damage in a patient with hairy cell leukemia - infectious involvement or hematological disease activity? Case report. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:385-389. [PMID: 35713332 DOI: 10.5507/bp.2022.026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hairy cell leukemia (HCL) is a rare indolent lymphoproliferative disease with an accumulation of mature B lymphocytes with fine reticular chromatin and cytoplasm with typical hairy-like cytoplasmic projections. Rarely, hairy cell leukemia manifests as a lung infiltration. The differential diagnosis between infection and malignant involvement with hairy cell leukemia is often challenging in such situations. METHODS AND RESULTS We present a 53-year-old female with an uncommon pulmonary involvement with hairy cell leukemia. In addition, we discuss the complicated differential diagnosis of pulmonary disease in patients with hairy cell leukemia and the treatment approach to these patients. CONCLUSION This case report describes the successful therapy management of a patient with pulmonary involvement by hairy cell leukemia. Therapy with interferon-alfa and cladribine resulted in long-term remission of the underlying disease.
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Affiliation(s)
- Dominika Ecsiova
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital, Hradec Kralove, Czech Republic
| | - Katerina Kamaradova
- The Fingerland Department of Pathology, University Hospital Hradec Kralove, Czech Republic
| | - Marketa Nova
- The Fingerland Department of Pathology, University Hospital Hradec Kralove, Czech Republic
| | - Petr Hoffmann
- Department of Radiology, University Hospital Hradec Kralove, Czech Republic
| | - Petra Rozsivalova
- Department of Clinical Pharmacy, Hospital Pharmacy, University Hospital Hradec Kralove, Czech Republic
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University in Hradec Kralove, Czech Republic
| | - Martin Simkovic
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital, Hradec Kralove, Czech Republic
| | - Pavel Zak
- 4th Department of Internal Medicine - Haematology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital, Hradec Kralove, Czech Republic
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4
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Gozzetti A, Bacchiarri F, Raspadori D, Sicuranza A, Sammartano V, Bocchia M. Cladribine Efficacy in a Patient with Hairy Cell Leukemia and Severe Renal Insufficiency. Rev Recent Clin Trials 2023; 18:300-303. [PMID: 37779396 DOI: 10.2174/0115748871241817230919062313] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Hairy cell leukemia commonly presents with pancytopenia, indolent course, and predisposition as infectious complications. Current first-line therapeutic options are purine analogues, particularly cladribine, with a high percentage of complete responses and durable remissions. However, their use is poorly investigated in patients affected by severe chronic renal insufficiency. CASE PRESENTATION Here, we describe a case of HCL in a 68-year-old man affected by multiple comorbidities, including severe chronic renal failure. After a course of interferon-α, the patient received therapy with Cladribine every other week, obtaining a complete hematological remission and improvement of renal function. DISCUSSION With a different soft schedule of cladribine, the patient was treated adequately, obtaining a complete remission. CONCLUSION Cladribine can be administered with caution, even in patients with renal failure, with good results.
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Affiliation(s)
- Alessandro Gozzetti
- Hematology, University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | | | | | - Anna Sicuranza
- Hematology, University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Vincenzo Sammartano
- Hematology, University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Monica Bocchia
- Hematology, University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
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5
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Starchenko II, Filenko BM, Royko NV, Kornilova IV, Vynnyk NI. SYNCHRONOUS HAIRY CELL LEUKEMIA AND HEPATOCELLULAR CARCINOMA: A CASE REPORT. Exp Oncol 2022; 44:259-262. [PMID: 36325711 DOI: 10.32471/exp-oncology.2312-8852.vol-44-no-3.18302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Multiple primary malignant tumors are characterized by independent occurrence and development of two or more malignant neoplasms in the same patient. We present an extremely rare case of synchronous double primary malignancies, hairy cell leukemia and hepatocellular carcinoma with lethal outcome. Diagnosis of hepatocellular carcinoma was difficult due to the presence of lymphoproliferative disease, which complicated the visualization of the process using ultrasonography. Carcinomatous emboli of hepatocellular carcinoma in small pulmonary arteries without the formation of metastatic foci have led to clinical manifestations typical of pulmonary embolism, pulmonary hypertension and severe respiratory failure. In lymphoproliferative diseases it is necessary to take into account the possibility of the development of another malignant neoplasm, which can be "buried" by tumor infiltration.
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Affiliation(s)
- I I Starchenko
- Poltava State Medical University, Poltava 36011, Ukraine
| | - B M Filenko
- Poltava State Medical University, Poltava 36011, Ukraine
| | - N V Royko
- Poltava State Medical University, Poltava 36011, Ukraine
| | - I V Kornilova
- Poltava Regional Pathoanatomical Bureau, Poltava 36011, Ukraine
| | - N I Vynnyk
- Poltava State Medical University, Poltava 36011, Ukraine
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6
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Nagy ZF, Ferenczi K, Istenes I, Eid H, Bödör C, Timár B, Demeter J. Case Report: Development of Diffuse Large B Cell Lymphoma a Long Time After Hairy Cell Leukemia. Pathol Oncol Res 2022; 28:1610338. [PMID: 35570843 PMCID: PMC9098676 DOI: 10.3389/pore.2022.1610338] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022]
Abstract
Hairy cell leukaemia (HCL) is a rare B cell malignancy with an indolent course leading to pancytopaenia due to bone marrow infiltration. It has been proposed that HCL patients are at risk of developing a secondary malignancy, with a marked likelihood of the development of other hematologic malignancies including Hodgkin lymphoma and high-grade non-Hodgkin lymphomas. Here, we present the case of two patients who developed diffuse large B cell lymphoma after a long course of hairy cell leukaemia. In the case of the female patient, we report on the occurrence of a third malignant disease, which is very uncommon. With our case descriptions we contribute to the very small number of similar cases reported.
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Affiliation(s)
- Zsófia F. Nagy
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Kata Ferenczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Ildikó Istenes
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Hanna Eid
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Bödör
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Botond Timár
- HCEMM-SE Molecular Oncohematology Research Group, 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Judit Demeter
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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7
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Oka T, Hirata H, Kitagawa T, Io K, Nagai K. [Successful surgical resection of rectal cancer in a patient with relapsed hairy cell leukemia under interferon-α treatment]. Rinsho Ketsueki 2021; 62:1672-1677. [PMID: 35022335 DOI: 10.11406/rinketsu.62.1672] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An 83-year-old man was diagnosed with hairy cell leukemia (HCL). He was treated with cladribine and achieved partial remission. However, pancytopenia due to HCL bone marrow involvement progressed slowly. Nine years later, he developed rectal cancer. Prior to the surgery, endoscopy-assisted submucosal ink injection was performed to identify the area of lower intestinal lesions. The following day, he developed septic peritonitis with shock status, perhaps due to his neutropenia and ink injection procedures. Surgical resection of the cancer was presumed unfeasible; therefore, radiation was performed. Several months later, bone marrow examination revealed HCL infiltration with reticulin fibrosis. Chemotherapy regimens with purine nucleoside analogs, which are the standard treatments for HCL, might accentuate the progression of his rectal cancer and enhance the development of severe infections. Therefore, interferon (IFN) -α was administered as an alternative therapy. Three months later, pancytopenia resolved, and bone marrow examination revealed a remarkable improvement in HCL infiltration and marrow fibrosis. With IFN-α therapy, the patient successfully underwent surgical resection of the rectal cancer. Using INF-α, a prompt recovery from pancytopenia might be expected even in a patient with advanced HCL, who requires surgical treatment for a concomitant cancer.
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Affiliation(s)
- Tomomi Oka
- Department of Hematology, Kansai Electric Power Hospital
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University
| | | | | | - Katsuhiro Io
- Department of Hematology, Kansai Electric Power Hospital
| | - Kenichi Nagai
- Department of Hematology, Kansai Electric Power Hospital
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8
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Robak P, Jesionek-Kupnicka D, Kupnicki P, Polliack A, Robak T. Multifocal osteolytic lesions in hairy cell leukemia-the importance of PET/CT in diagnosis and assessment. Ann Hematol 2020; 100:1641-1645. [PMID: 32533250 DOI: 10.1007/s00277-020-04121-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Pawel Robak
- Department of Experimental Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland
| | | | - Piotr Kupnicki
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz and Copernicus Memorial Hospital, Lodz, Poland
| | - Aaron Polliack
- Department of Hematology, Hadassah - Hebrew University Medical Center|, Jerusalem, Israel
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz and Copernicus Memorial Hospital, Ul. Ciolkowskiego 2, Lodz, Poland.
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9
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Singh AG, Tchanque-Fossuo CN, Elwood H, Durkin JR. BRAF inhibitor and hairy cell leukemia-related transient acantholytic dermatosis. Dermatol Online J 2020; 26:13030/qt3ps33564. [PMID: 32239892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023] Open
Abstract
Grover disease (GD) is an acquired, nonfamilial, nonimmune mediated, transient or persistent acantholytic dermatosis. Herein, we present a 72-year-old man who had clinical and histopathologic findings of GD following two weeks of treatment with vemurafenib without MEK inhibitor. The patient was successfully treated with topical emollients and a high-potency corticosteroid. Meanwhile, vemurafenib was temporarily discontinued. Drug-induced GD has increasingly been reported in patients on BRAF inhibitor monotherapy as an immune-related adverse event. The cutaneous side effects seem to arise secondary to a paradoxical activation of the mitogen-activated protein kinase signaling of BRAF inhibitor treatment, leading to keratinocyte proliferation. Although the pathogenesis of GD has not been delineated, there is suggestion of activation of T lymphocytes, particularly helper cells under the action of pro-inflammatory cytokines, resulting in proliferation of keratinocytes. Combination therapy with a MEK inhibitor appears to prevent BRAF-induced GD. Given that there is a higher prevalence of GD in patients with hematologic malignancy, a direct causal relationship between the initiation of vemurafenib therapy and development of GD in this case may be difficult to establish.
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Affiliation(s)
| | | | | | - John R Durkin
- Department of Dermatology, University of New Mexico, School of Medicine, Albuquerque, NM.
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10
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Boilève A, Contejean A, Barreau S, Sourdeau É, Friedrich C, Kosmider O, Burroni B, Dupin N, Lheure C, Rossignol J, Bouscary D, Grignano É. Mastocytosis onset in a patient with treated hairy cell leukemia: Just a coincidence? Blood Cells Mol Dis 2019; 81:102392. [PMID: 31794934 DOI: 10.1016/j.bcmd.2019.102392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/21/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022]
Abstract
Mastocytosis is a mast cell disease caused by functionally defective infiltrating mast cells and CD34+ mast cell precursors. The heterogeneous group of mast cell disorders is categorized into five variants in the updated 2017 World Health Organization (WHO) classification among those systemic mastocytosis with an associated neoplasm (SM-AHN). Except for myeloid neoplasia, lymphoproliferative disorders associated to SM-AHN are more scarce. Here, we report the second case ever described of associated mastocytosis and hairy-cell disease. A 38-year-old female patient without any specific medical history was diagnosed a hairy cell leukemia and BRAFV600E mutation was found in hairy cells. Since purine-analogs were avoided to prevent prolonged myelosuppression, she was treated with vemurafenib and rituximab. Despite early discontinuation due to vemurafenib-induced agranulocytosis, a partial response was observed. Strikingly, bone marrow biopsy performed one month after vemurafenib discontinuation revealed a nodular infiltration by 30% tumoral mastocytes. Along with elevated tryptase level, KITD816V mutation on mastocytes and clinical exam, the patient was diagnosed with systemic mastocytosis with an associated hematological neoplasm (SM-AHN). No BRAFV600E mutation was found on mastocytes. The physiopathology of this association is not known and might be only a coincidence or a common genetic driver mutation enhancing mast and hairy cells.
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Affiliation(s)
- Alice Boilève
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France.
| | - Adrien Contejean
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France; Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France
| | - Sylvain Barreau
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - Élise Sourdeau
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - Chloé Friedrich
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - Olivier Kosmider
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Biologique, Paris, France
| | - Barbara Burroni
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'anatomopathologie, Paris, France
| | - Nicolas Dupin
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de dermatologie, Paris, France
| | - Coralie Lheure
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service de dermatologie, Paris, France
| | - Julien Rossignol
- Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Ouest, Service d'Hématologie Clinique, Paris, France
| | - Didier Bouscary
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France; Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France
| | - Éric Grignano
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Service d'Hématologie Clinique, Paris, France; Université Paris Descartes, Faculté de Médecine Sorbonne Paris Cité, Paris, France
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11
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Colovic N, Marisavljevic D, Kraguljac-Kurtovic N, Bogdanovic A, Gotic M. CD56-Positive Acute Myeloid Leukemia Following Treatment of Hairy Cell Leukemia with Cladribine - Report of 2 Cases and Review of the Literature. Arch Iran Med 2019; 22:269-271. [PMID: 31256601] [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] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 04/07/2019] [Indexed: 06/09/2023]
Abstract
Treatment of hairy cell leukemia (HCL) with alfa-interferon and purine analogs significantly prolongs survival in these patients. However, with life prolongation, an increased risk of secondary malignancies has been reported. Acute myeloid leukemia (AML), as a second malignancy after HCL treatment is extremely rare and has been reported in only 12 cases so far. We here report additional 2 cases of CD56+ AML developed after sustained clinical remission of HCL achieved with cladribine (2 and 6 years after, respectively). The first patient refused chemotherapy and shortly thereafter died. The second patient responded to chemotherapy and was successfully allo-transplanted. Three years later, the patient is in stable clinical remission, which is a unique case in the literature. In conclusion, it is not clear whether development of AML in HCL patients is caused by mutagenic potential of the applied chemotherapy or by immune suppression/ perturbations as a characteristic of the underlying disease.
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Affiliation(s)
- Natasa Colovic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Dragomir Marisavljevic
- Faculty of Medicine, University of Belgrade, Serbia
- Department of Hematology, Medical Center Bezanijska Kosa, Belgrade, Serbia
| | | | - Andrija Bogdanovic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
| | - Mirjana Gotic
- Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Serbia
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12
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Lopez Luis BA, Valdivia-Cayoja AR, Belaunzaran-Zamudio PF, Soto-Ramírez LE. An immunocompromised patient & multiorgan cystic echinococcosis. QJM 2019; 112:215-217. [PMID: 30605541 DOI: 10.1093/qjmed/hcy306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/21/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- B A Lopez Luis
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Mexico City, Mexico
| | - A R Valdivia-Cayoja
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Mexico City, Mexico
| | - P F Belaunzaran-Zamudio
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Mexico City, Mexico
| | - L E Soto-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez Secc 16, Mexico City, Mexico
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13
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Affiliation(s)
- Christiana A Iyasere
- From the Departments of Medicine (C.A.I., R.W.T.), Radiology (F.J.S.), and Pathology (B.J.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.I., R.W.T.), Radiology (F.J.S.), and Pathology (B.J.S.), Harvard Medical School - both in Boston
| | - Ronald W Takvorian
- From the Departments of Medicine (C.A.I., R.W.T.), Radiology (F.J.S.), and Pathology (B.J.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.I., R.W.T.), Radiology (F.J.S.), and Pathology (B.J.S.), Harvard Medical School - both in Boston
| | - F Joseph Simeone
- From the Departments of Medicine (C.A.I., R.W.T.), Radiology (F.J.S.), and Pathology (B.J.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.I., R.W.T.), Radiology (F.J.S.), and Pathology (B.J.S.), Harvard Medical School - both in Boston
| | - Bradford J Siegele
- From the Departments of Medicine (C.A.I., R.W.T.), Radiology (F.J.S.), and Pathology (B.J.S.), Massachusetts General Hospital, and the Departments of Medicine (C.A.I., R.W.T.), Radiology (F.J.S.), and Pathology (B.J.S.), Harvard Medical School - both in Boston
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14
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Affiliation(s)
- S C Tayal
- Department of Medicine for the Elderly, Ryhope General Hospital, Sunderland
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15
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Senatore FJ, Dasanu CA. Synchronous gastric and ampullary adenocarcinomas in a hairy cell leukemia patient treated with pentostatin eight years prior. J Oncol Pharm Pract 2016; 22:543-7. [PMID: 25712625 DOI: 10.1177/1078155215574140] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hairy cell leukemia patients are at increased risk for second malignancies, including both solid and lymphoid neoplasms. Along with other factors, multiple immune defects present in hairy cell leukemia likely contribute to subsequent carcinogenesis. We report herein a case of synchronous high-grade gastric and ampullary adenocarcinomas in a patient with a history of hairy cell leukemia treated eight years prior with pentostatin. We include a review of immune alterations induced by both hairy cell leukemia and its therapies, and link them with the occurrence of second cancers in these patients.
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Affiliation(s)
- Frank J Senatore
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Constantin A Dasanu
- Lucy Curci Cancer Center, Eisenhower Medical Center/University of Southern California, Rancho Mirage, CA, USA
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16
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Affiliation(s)
- Selina J Chavda
- Department of Haemato-Oncology, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - Claire Dearden
- Department of Haemato-Oncology, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
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17
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Abstract
Toxoplasmic encephalitis is a rare infectious complication in patients with hematological malignancy except for allogeneic hematopoietic stem cell transplantation (HSCT). We herein report a case of possible toxoplasmic encephalitis with untreated hairy cell leukemia variant. Magnetic resonance imaging showed multiple nodules with surrounding edema in the entire cerebrum. A polymerase chain reaction analysis for Toxoplasma gondii was negative. Her signs and symptoms fully recovered by empirical therapy with sulfadiazine and pyrimethamine. Toxoplasmic encephalitis may occur in patients who undergo non-allogeneic HSCT for hematological malignancies, even in those who have not been treated.
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MESH Headings
- Aged
- Animals
- Antiprotozoal Agents/therapeutic use
- Diagnosis, Differential
- Drug Therapy, Combination
- Female
- Hemiplegia/etiology
- Humans
- Infectious Encephalitis/complications
- Infectious Encephalitis/diagnosis
- Infectious Encephalitis/diagnostic imaging
- Infectious Encephalitis/drug therapy
- Leukemia, Hairy Cell/complications
- Leukemia, Hairy Cell/diagnosis
- Leukemia, Hairy Cell/diagnostic imaging
- Leukemia, Hairy Cell/drug therapy
- Magnetic Resonance Imaging
- Pyrimethamine/therapeutic use
- Sulfadiazine/therapeutic use
- Toxoplasma/isolation & purification
- Toxoplasmosis, Cerebral/complications
- Toxoplasmosis, Cerebral/diagnosis
- Toxoplasmosis, Cerebral/diagnostic imaging
- Toxoplasmosis, Cerebral/drug therapy
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Affiliation(s)
- Taichi Ikebe
- Department of Hematology, Almeida Memorial Hospital, Japan
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18
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Tombak A, Aygün S, Serinsöz E, Tiftik EN. Complete recovery of pyoderma gangrenosum after successful treatment of underlying hairy cell leukemia with cladribine. Korean J Intern Med 2015; 30:739-41. [PMID: 26354071 PMCID: PMC4578019 DOI: 10.3904/kjim.2015.30.5.739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/22/2014] [Accepted: 07/07/2014] [Indexed: 12/03/2022] Open
Affiliation(s)
- Anıl Tombak
- Department of Hematology, Mersin University Faculty of Medicine, Mersin, Turkey
- Correspondence to Anil Tombak, M.D. Department of Hematology, Mersin University Faculty of Medicine, Zeytinlibahçe Caddesi, Mersin 33079, Turkey Tel: +90-532-346-0767 Fax: +90-324-241-0092 E-mail:
| | - Sinan Aygün
- Department of Internal Medicine, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ebru Serinsöz
- Department of Pathology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Eyüp Naci Tiftik
- Department of Hematology, Mersin University Faculty of Medicine, Mersin, Turkey
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20
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Karadurmus N, Erdem G, Basaran Y, Naharci I, Tasci C, Dogan T, Ifran A, Kaptan K, Saglam K, Beyan C. A Very Rare Case - Hairy Cell Leukemia in Patient with Sarcoidosis. Klin Onkol 2015; 28:215-7. [PMID: 26062623 DOI: 10.14735/amko2015215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although the coexistence of hairy cell leukemia with sarcoidosis has been reported in a few cases in the literature, in our case the patient had been diagnosed and followed about 10 years with sarcoidosis and massive splenomegaly. It has been demonstrated that T helper 1 cells exist in organs influenced by sarcoidosis. These cells produce IL-2 and IFN-γ and induce a nonspecific inflammatory response and granuloma formation. Also these cytokines may play a role in the development of hairy cell leukemia.Key words: hairy cell leukemia - sarcoidosis - massive splenomegaly.
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Abstract
BACKGROUND For a number of decades, hairy cell leukemia (HCL) has been linked with polyarthritis, vasculitis, symptomatic cytopenias and thrombosis in the medical literature. Notwithstanding, the significance of these associations has not been well understood. Therefore, we have decided to analyze them further. METHODS We provide herein a comprehensive literature review of the prevalence of autoimmune disorders in patients with HCL. Most relevant publications were identified through searching the PubMed/Medline database for articles published from inception to February 2014. FINDINGS Perhaps due to the rarity of HCL, scientific literature on autoimmune conditions in patients with HCL consists mainly of published case series and isolated reports. Our analysis identified increased prevalence of various autoimmune conditions in patients with HCL, including various vasculitides, immune cytopenias and antiphospholipid antibody syndrome (APS) among others. CONCLUSIONS Presence of certain autoimmune disorders should increase the suspicion of HCL in an appropriate clinico-laboratory context. Conversely, the diagnosis of HCL should prompt early recognition of certain autoimmune disorders if clinical suspicion exists. While some of these autoimmune diseases are thought to be secondary to the dysfunctional immune response associated with underlying malignant process, others could be primary and might even play a role in the HCL pathogenesis. The autoimmune complications can pose important clinical problems for the HCL patients. Therefore, a catalogue of these problems is important for alerting physicians to watch for them and diagnose them promptly.
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Affiliation(s)
- Constantin A Dasanu
- Lucy Curci Cancer Center, Eisenhower Medical Center , Rancho Mirage, CA , USA
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22
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Saes L, van Lom K, Slobbe L. [A man with upper abdominal pain and a pancytopenia]. Ned Tijdschr Geneeskd 2015; 159:A8502. [PMID: 25850450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 41-year-old man visited his general practitioner because of upper abdominal pain. Physical examination revealed splenomegaly. Laboratory testing showed pancytopenia with a striking monocytopenia with hairy cells. Immunological and molecular analysis confirmed the diagnosis hairy cell leukemia.
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Affiliation(s)
- Lotte Saes
- Haven Ziekenhuis, afd. Interne Geneeskunde, Rotterdam
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23
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Dagogo-Jack I, Vaidya A, Geller B, Baden LR, Stone R. Interactive medical case. A man with fever, cough, and rash. N Engl J Med 2014; 371:e11. [PMID: 25140977 DOI: 10.1056/nejmimc1310796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ebara S, Kagosima M, Marumo M, Ito Y, Tatumi E, Mitsutani S. [Hairy cell leukemia accompanied by Evans syndrome]. Rinsho Ketsueki 2014; 55:466-468. [PMID: 24850460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report a case of Western type hairy cell leukemia (HCL), a very rare leukemia in Japan. In this malignancy, leukemic cells in a peripheral blood film may be missed due in part to accompanying pancytopenia and in part to loss of typical cytoplasmic projections if prepared in a conventional Japanese way using forced air-drying. Our present patient also had a variety of autoantibodies and the clinical picture was primarily that of Evans syndrome (ES), suggesting disturbed immune responses associated with the HCL. Although HCL accompanied by either AIHA or ITP has been reported, the occurrence of ES in HCL is extremely rare.
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MESH Headings
- Aged, 80 and over
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/immunology
- Autoantibodies
- Blood Platelets/immunology
- Female
- Humans
- Leukemia, Hairy Cell/complications
- Leukemia, Hairy Cell/immunology
- Prednisolone/therapeutic use
- Thrombocytopenia/diagnosis
- Thrombocytopenia/drug therapy
- Thrombocytopenia/etiology
- Thrombocytopenia/immunology
- Thyroglobulin/immunology
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Abstract
The case of a patient with the aplastic variant of hairy cell leukaemia, successfully treated with the drug Deoxycoformycin(Pentostatin), is presented. It is very important to be aware of this rare variant of a rare disease so that the right treatment can be offered.
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Affiliation(s)
- J-P Ng
- Department of Haematology and Pathology, Barnsley District General Hospital, Barnsley, South Yorkshire, UK
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26
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Urnova ES, Al'-Radi LS, Kuz'mina LA, Kariakina AA, Kovrigina AM, Dvirnyk VN, Iakutik IA, Sudarikov AB, Parovichnikova EN, Savchenko VG. [Successful use of vemurafenib in a patient with resistant hairy cell leukemia]. TERAPEVT ARKH 2013; 85:76-78. [PMID: 24137951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The paper describes a case of a patient with refractory hairy cell leukemia. In spite of the absence of CD25 expression, the disease was classified as a classical form according to the WHO classification (2008), as also confirmed by the detection of BRAFV600E mutation. The disease was characterized by resistance to all lines of therapy (interferon-a, splenectomy, cladribin). Clinical and hematological remission was achieved within 2 months of administration of the BRAF kinase inhibitor vemurafenib.
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27
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28
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Dobrick N, Müller N, Franzen D. [Legionnaires disease (legionella pneumonia)]. Praxis (Bern 1994) 2012; 101:1459-1467. [PMID: 23147600 DOI: 10.1024/1661-8157/a001135] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- N Dobrick
- Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
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29
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Li PP, Li X, Feng LL. [A case of hairy cell leukemia complicated by breast cancer in remission]. Zhonghua Xue Ye Xue Za Zhi 2012; 33:315. [PMID: 22781726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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30
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Fino P, Fioramonti P, Onesti MG, Passaretti D, Scuderi N. Skin metastasis in patient with hairy cell leukemia: case report and review of literature. In Vivo 2012; 26:311-314. [PMID: 22351675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The reported case of Hairy cell leukemia (HCL) refers to a 47-year-old man with pancytopenia, splenomegaly, a month and a half history of dyspnea on mild effort and in common daily activities and a purplish-brown cutaneous node on the back of the left hand at the time of hospital admission. Bone marrow aspiration showed an infiltration by a lymphoproliferative malignancy and the following cytochemical studies on bone marrow sample led to diagnosis of HCL. The biopsy of the skin lesion revealed a infiltrate of medium and large-size cells in the dermis with the the same cytologic features of leukemic blasts appearing in the bone marrow, upon which the diagnosis of Leukemia cutis was established. The differential diagnosis of leukemia includes other neoplastic hematopoietic disorders, such as lymphoma, myelodysplastic syndromes, multiple myeloma, aplastic anemia, severe megaloblastic anemia, severe lymphocytosis, severe monocytosis, and bone marrow failure. In our case, the skin lesion was surgically removed and then left to heal by secondary intention due to the presence of bacterial infection by Staphylococcus aureus and Streptococcus pyogenes. The wound was finally medicated to total healing with Promogran®, an advanced dressings which consists of a sterile, freeze-dried matrix composed of collagen and oxidised regenerated cellulose. The importance of our case lies in the fact that cases with association of HCL with leukemia cutis are very rare, and furthermore that after the excision of the skin lesion of the left hand, the surgeons heal to let the wound close by secondary intention.
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Affiliation(s)
- Pasquale Fino
- Department of Dermatology and Plastic, Reconstructive and Aesthetic Surgery, La Sapienza University of Rome, Umberto I Polyclinics, Rome, Italy.
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31
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Boury S, Morgeson JS. Dyspnea, pancytopenia, and splenomegaly. J Fam Pract 2011; 60:593-596. [PMID: 21977486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An extensive initial laboratory assessment, including testing for viral disorders, left the diagnosis unsolved.
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Affiliation(s)
- Sheena Boury
- University of Cincinnati/The Christ Hospital Family Medicine Residency, Cincinnati, OH, USA.
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32
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Filho RJDLC, de Carvalho Portela N, Neto AMP, Teixeira Henderson MNR, Pinheiro RF. Nontuberculous mycobacterium genital infection mimicking donovanosis in a patient with hairy cell leukemia. Leuk Res 2011; 35:e44-5. [PMID: 21295854 DOI: 10.1016/j.leukres.2011.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/31/2010] [Accepted: 01/10/2011] [Indexed: 11/29/2022]
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Affiliation(s)
- Abdullah Ozkok
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Turkey.
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34
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Teodorescu M, Engebjerg MC, Johansen P, Nørgaard M, Gregersen H. Incidence, risk of infection and survival of hairy cell leukaemia in Denmark. Dan Med Bull 2010; 57:A4216. [PMID: 21122460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Few population-based studies exist on incidence, risk of infection and mortality in hairy cell leukaemia (HCL). MATERIAL AND METHODS We used population-based medical databases to identify 209 patients who were diagnosed with HCL in the period from January 1997 to August 2007 in Denmark. An age- and sex-matched comparison cohort of 2,090 persons was selected from the general population. We computed the incidence of HCL using demographic data. Hospitalizations with pneumonia and bacteraemia were determined from the Danish National Patient Registry. Cox regression analysis was used to estimate the relative risk (RR) of infection and mortality ratios (MRR) adjusting for age, sex and comorbidity. RESULTS The HCL incidence rates were 1.97 (95% confidence interval 1.51-2.53) and 5.37 (4.57-6.28) per million person-years for women and men, respectively. During a median follow-up of 4.5 years, 48 HCL patients were hospitalized with pneumonia or bacteraemia. The adjusted RR of infection was 8.04 (4.99-12.95) the first year after diagnosis and 1.17 (0.71-1.94) for the remaining follow-up period. The adjusted MRRs were 4.26 (2.61-6.96) and 1.12 (0.75-1.65) the first year after diagnosis and the remaining follow-up period, respectively. CONCLUSION In the second and subsequent years after HCL diagnosis, the risk of infection and mortality was similar to that of the general population.
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Affiliation(s)
- Manuela Teodorescu
- Department of Haematology, Aalborg Hospital, Aarhus University Hospital, Denmark.
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Sever M, Verstovsek S, Erasmus J, Mattiuzzi GN. Mycotic pulmonary artery aneurysm due to Aspergillus infection in a patient with leukemia: case report and review of the literature. Leuk Res 2010; 34:e133-6. [PMID: 20045559 DOI: 10.1016/j.leukres.2009.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 11/10/2009] [Accepted: 11/13/2009] [Indexed: 02/03/2023]
Abstract
We present a case of a patient with hairy cell leukemia and pulmonary aspergillosis who developed a cycotic pulmonary artery aneurysm despite prolonged antifungal therapy. A review of the literature in regards to incidence, etiology, clinical manifestations and treatment options is included.
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39
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Hassan R, Gupta M, Kern W, Ozer H. Acute Myeloid Leukemia Following Treatment with Cladribine for Hairy Cell Leukemia: A Case Report and Review of the Literature. Leuk Lymphoma 2009; 45:2149-52. [PMID: 15370263 DOI: 10.1080/10428190410001714070] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 10/26/2022]
Abstract
The overall survival of patients with hairy cell leukemia (HCL) has significantly increased in recent years because of the development of effective treatments such as interferon alpha and purine analogs. Several reports have described an increased risk of secondary cancers, particularly solid tumors, in patients with HCL. We describe a case of a patient with HCL, who had prolonged pancytopenia after a single course of cladribine. Fifteen months after the diagnosis of HCL the patient developed acute myeloid leukemia (AML) and died shortly afterwards. Review of the literature shows few reports of acute leukemia in HCL patients. All of the 11 reported cases of leukemia in patients with HCL have been in patients who have been treated with either interferon alpha or purine analogs, and developed several years (mean 4.3 years; range 1.6-6.4 years) after the diagnosis of HCL. Our case is unusual in that the patient developed AML shortly (1.2 years) after the diagnosis and treatment of HCL. Further studies are needed to clarify whether leukemias seen in patients following the treatment of their HCL are incidental findings or related to HCL and its treatments.
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Affiliation(s)
- R Hassan
- Department of Medicine Hematology/Oncology Section, University of Oklahoma Health Sciences Center, Oklahoma City, USA.
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40
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Ozkan A, Taskapilioglu O, Bican A, Ozkocaman V, Ozturk H, Ozkalemkas F, Ali R. Hairy cell leukemia presenting with Guillain-Barre syndrome. Leuk Lymphoma 2009; 48:1048-9. [PMID: 17487755 DOI: 10.1080/10428190701253850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Multifocal leukoencephalopathy and sensory-motor polyneuropathy have not been reported as side-effects of long-lasting interferon alpha therapy in a single patient. In a 77-year-old man interferon alpha2b and interferon alpha2a were administered subsequently but continuously since 1984 for hairy cell leukemia. Since early 2000, left-sided hemi-hypesthesia occurred and the patient developed gait disturbance, proximal weakness of the lower limbs, bilateral stocking-type sensory disturbances, and restless leg syndrome. Repeated cerebral magnetic resonance images showed multifocal T2-hyperintense white matter lesions supratentorially. The nerve conduction velocity of the peroneal and sural nerve was reduced. After exclusion of various differential diagnoses of leukoencephalopathy and application of a screening program for polyneuropathy, central and peripheral nervous system abnormalities were attributed to the long-lasting interferon alpha therapy. In single patients abnormally long-lasting interferon alpha therapy may cause multifocal white matter lesions supratentorially and sensory-motor polyneuropathy.
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Affiliation(s)
- J Finsterer
- Neurological Department, KA Rudolfstiftung, Vienna, Austria.
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42
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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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Nielsen H, Bangsborg J, Rechnitzer C, Jacobsen N, Busk HE. Defective monocyte function in Legionnaires' disease complicating hairy cell leukaemia. Acta Med Scand 2009; 220:381-3. [PMID: 3799244 DOI: 10.1111/j.0954-6820.1986.tb02783.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We describe a case of Legionnaires' disease in a 64-year-old man, in which hairy cell leukaemia was diagnosed after the onset of the infection. Immunological studies revealed a complete suppression of blood monocyte chemotactic and oxidative burst activities. We suggest that in hairy cell leukaemia both monocytopenia and defective functions of monocytes underlie the increased susceptibility to intracellular infections including Legionnaires' disease.
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Juarez M, Marshall R, Denton C, Evely R. Paraneoplastic scleroderma secondary to hairy cell leukaemia successfully treated with cladribine. Rheumatology (Oxford) 2008; 47:1734-5. [PMID: 18812428 DOI: 10.1093/rheumatology/ken367] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Szotkowski T, Szotkowska R, Pikalova Z, Tichy T, Flodr P, Tichy M, Houserkova D, Benysek V, Zlamalova N, Ruzicka V, Indrak K. Spontaneous splenic rupture in two patients with hematologic malignancy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 151:113-6. [PMID: 17690752 DOI: 10.5507/bp.2007.021] [Citation(s) in RCA: 4] [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: 11/23/2022] Open
Abstract
BACKGROUND Spontaneous splenic rupture (SSR) is a very rare complication described in several hundred patients, mainly as case reports. It is defined as a splenic rupture without antecedent injury. The authors of the present paper describe the only two SSR cases diagnosed at the Hemato-oncology department, coincidentally in one year. PATIENTS The first patient was admitted to hospital because of planned chemotherapy for relapsed hairy cell leukemia. The second was directed to the Hemato-oncology outpatient department because of anemia and painful splenomegaly diagnosed by a physician. The diagnose of hematologic malignancy (diffuse large B-cell lymphoma) was determined subsequently on the basis of histological examination of the spleen. CONCLUSION It is necessary to consider SSR not only in patients with known diagnosis of malignant disease but in the patients with negative anamnesis, too. The aim of the paper is to draw attention to the existence of this complication.
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Affiliation(s)
- Tomas Szotkowski
- Department of Hemato-oncology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Czech Republic.
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Hamadani M, Kraut EH. Review: isolated skeletal involvement in hairy cell leukemia. Clin Adv Hematol Oncol 2008; 6:294-296. [PMID: 18496496] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Mehdi Hamadani
- Department of Hematology and Oncology, Arthur G. James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
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Karmali R, Farhat M, Leslie W, McIntire MG, Gregory S. Localized bone disease as a presentation of hairy cell leukemia. Clin Adv Hematol Oncol 2008; 6:290-294. [PMID: 18496495] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Reem Karmali
- Rush University Medical Center, Chicago, Ill., USA. reem
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Svecová D, Pallová A, Chmurová N, Babal P. Paraneoplastic vasculitis associated with hairy cell leukemia. Prague Med Rep 2008; 109:83-87. [PMID: 19097393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Hairy cell leukemia (HCL) is a rare B-cell lymphoproliferative disease, accounting for about 2-3% of all leukemias in adults. The skin lesions were described in about 10-12% of patients. Vasculitis in lymphoproliferative disease is relatively uncommon and may predate the diagnosis of lymphoproliferative disease. A 54-year old female with one month history of general symptoms and sudden onset of maculopapular exanthema on the skin, suffered from anemia, leukopenia and thrombocytopenia. Examination of the skin biopsy revealed lymphocytic vasculitis. Immunophenotyping of the skin biopsy revealed cell population with CD45RO, and small groups with CD20, partly DBA44 positivity. Bone marrow trepanobiopsy showed 50% infiltration with medium-sized lymphoid cells with clear cytoplasm and immunophenotypic coexpression of CD20 and DBA-44 antigens. The diagnosis of HCL was confirmed by flow cytometry of the bone marrow and of the peripheral blood cells that revealed pathological cell population with expression of CD11c, CD19, CD25, CD103. The patient was successfully treated with a single dose of cladribrine. The patient with acute vasculitis should be screened and monitored for possible lymphoproliferative diseases. Skin manifestation of acute vasculitis accompanied with hairy cells may be the first manifestation of HCL. Purine nucleoside analogue cladribrine is considered as the first line of therapy for HCL and induces a total response in more than 80% of cases with HCL.
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Affiliation(s)
- D Svecová
- Comenius University in Bratislava, Faculty of Medicine, Department of Dermatovenerology, Bratislava, Slovak Republic.
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Filippi AR, Franco P, Marinone C, Tarella C, Ricardi U. Treatment options in skeletal localizations of hairy cell leukemia: a systematic review on the role of radiation therapy. Am J Hematol 2007; 82:1017-21. [PMID: 17654508 DOI: 10.1002/ajh.20785] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/11/2022]
Abstract
Skeletal localizations are a rare complication in hairy cell leukaemia patients, with an estimated incidence of 3%. These lesions, mainly osteolytic, can occur at various sites and are almost always symptomatic. Localized radiation therapy (RT) has been extensively used as effective palliative treatment in such cases, with different total doses and fractionation schedules. In this article, a systematic review of all reported cases with osseous complications is presented, to underline the role of RT and to define the most appropriate approach in this subset of patients.
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Affiliation(s)
- Andrea R Filippi
- Radiation Oncology Unit, Department of Medical and Surgical Sciences, University of Turin, Ospedale S. Giovanni Battista, Torino, Italy.
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