ABSTRACT
Mitoxantrone is a DNA-topoisomerase 2 inhibitor used as a single agent for treatment of relapsing-remitting or progressive multiple sclerosis (MS). We present here two patients treated with mitoxantrone for MS who subsequently developed acute promyelocytic leukemia (APL). These constitute, to our knowledge, the eighth and ninth reports of APL in patients treated with mitoxantrone for MS. Topoisomerase 2 inhibitors are associated with therapy-related acute myeloid leukemia (t-AML) with 11q23 abnormalities, but therapy-related APL (t-APL) is less common, and documentation of nine cases of t-APL after mitoxantrone therapy for MS suggests a specific association.
Subject(s)
Antineoplastic Agents/adverse effects , Leukemia, Promyelocytic, Acute/chemically induced , Mitoxantrone/adverse effects , Multiple Sclerosis/drug therapy , Chromosomes, Human, Pair 11/genetics , Female , Humans , In Situ Hybridization, Fluorescence , Karyotyping , Leukemia, Promyelocytic, Acute/drug therapy , Male , Middle Aged , Remission Induction , Translocation, GeneticABSTRACT
Post-transplant lymphoproliferative disorders (PTLD) complicate up to 10% of solid organ transplants. This retrospective study was conducted to review the PTLD experience among 2,300 recipients of solid organ or allogeneic bone marrow transplants from a single institution. Twenty-seven cases of PTLD were identified, leading to an overall incidence of 1.2%. Polymorphic B cell hyperplasia/lymphoma was the most common type. The median time to development of PTLD was 8.4 months. Ten patients had localized (stage I or II) disease, and 12 patients presented with B symptoms. Nine patients each were treated with systemic chemotherapy or surgical resection as part of the initial therapy. After a median follow-up duration of 2.6 years, the median survival has not been reached. There were no late relapses of PTLD, and 17 patients remain alive. Age, sex, organ source, LDH, stage, presence of extranodal disease, or presentation with B symptoms did not influence overall survival when examined by Cox proportional hazard model. Thirteen patients retained their graft function throughout PTLD treatment. This study confirms the ability to treat a significant proportion of PTLD patients with chemotherapy or surgical resection (depending on presentation), without sacrificing graft function in those receiving chemotherapy.
Subject(s)
Lymphoproliferative Disorders , Organ Transplantation/adverse effects , Adult , Aged , Antineoplastic Agents/therapeutic use , Antiviral Agents/administration & dosage , Antiviral Agents/therapeutic use , Disease-Free Survival , Female , Graft Rejection/complications , Graft Rejection/prevention & control , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Lymphoproliferative Disorders/etiology , Lymphoproliferative Disorders/mortality , Lymphoproliferative Disorders/therapy , Male , Middle Aged , Radiotherapy , Reoperation , Retrospective Studies , Treatment OutcomeABSTRACT
We describe a case of severe coagulopathy after mesenteric revascularization. Laboratory investigation results revealed the presence of plasma inhibitors of factor V believed to result from exposure to bovine thrombin used for intraoperative hemostasis. Vascular and cardiothoracic surgeons commonly use topical thrombin for surgical hemostasis, and many patients undergo multiple exposure. More patients likely have factor V inhibitors develop than has previously been realized, and this may account for some otherwise unexplained postoperative coagulation disorders. This report may alert surgeons to coagulation disturbances that can result from exposure to bovine thrombin and provide guidelines for diagnosis and management.