Lymphoproliferative disorders after immunosuppressive therapy for aplastic anemia: a case report and literature review.

Abstract

A 61-year-old Japanese man was referred to our hospital in 2002 due to severe pancytopenia. Bone marrow and peripheral blood findings indicated he had severe aplastic anemia (AA). A whole-body CT scan and Ga scintigraphy revealed no abnormal findings. Antithymocyte globulin and cyclosporine A (CyA) were administered and he got transfusion independently. In September 2004, he complained of abdominal fullness and a skin eruption in the lower abdomen. An abdominal CT revealed a spleen mass and lymphoadenopathy of the pancreas head. Splenectomy was done, and he was diagnosed with a diffuse large B cell lymphoma (DLBCL) of the spleen and skin. His karyotype was associated with t(14; 18). CyA was stopped, all lesions disappeared, and then his AA relapsed. In January 2007, antithymocyte globulin/CyA was readministered. In May 2007, he complained of acute swelling in his right thigh. A biopsy from the tumor revealed DLBCL. CyA was stopped again, yet the lymphoma did not regress. He was given R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone), followed by 5 cycles of R-VP (rituximab, vincristine, prednisolone) and radiation therapy, resulting in a partial remission. We report DLBCL after immunosuppressive therapy for AA. Although this is a rare complication, it should be considered before beginning immunosuppressive therapy.

• Authors: Yuhko Suzuki, Nozomi Niitsu, Miyuki Hayama, Takuji Katayama, Ryuji Ishii, Manabu Osaka, Koji Miyazaki, Mikio Danbara, Ryouichi Horie, Tsutomu Yoshida, Naoya Nakamura, Masaaki Higashihara
• Journal: Acta haematologica (Acta Haematol) Vol. 121 Issue 1 Pg. 21-6 ( 2009) ISSN: 1421-9662 [Electronic] Switzerland
• PMID: 19295190 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: (c) 2009 S. Karger AG, Basel.

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Antilymphocyte Serum
• Immunosuppressive Agents
• Rituximab
• Vincristine
• Doxorubicin
• Cyclosporine
• Cyclophosphamide
• Prednisolone

Topics

• Anemia, Aplastic (complications, pathology, therapy)
• Antibodies, Monoclonal (administration & dosage)
• Antibodies, Monoclonal, Murine-Derived
• Antilymphocyte Serum (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Asian People
• Cyclophosphamide (administration & dosage)
• Cyclosporine (administration & dosage, adverse effects)
• Doxorubicin (administration & dosage)
• Humans
• Immunosuppression Therapy (adverse effects)
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Japan
• Lymphoma, Large B-Cell, Diffuse (etiology, pathology, therapy)
• Male
• Middle Aged
• Prednisolone (administration & dosage)
• Radionuclide Imaging
• Radiotherapy (methods)
• Rituximab
• Skin Neoplasms (etiology, pathology, therapy)
• Splenectomy
• Splenic Neoplasms (etiology, pathology, therapy)
• Tomography, X-Ray Computed
• Vincristine (administration & dosage)