ABSTRACT
BACKGROUND: Cancer-related thrombotic microangiopathy (CR-TMA) is a rare type of Coombs-negative hemolytic anemia, which is caused by malignancy and has a poor prognosis. CASE: A 76-year-old female was referred to our hospital due to Coombs-negative hemolytic anemia, which was causing fatigue and dyspnea on exertion, accompanied by schistocytosis. A bone marrow examination demonstrated bone marrow carcinomatosis, and the tumor cells were morphologically suspected to be signet-ring cell carcinoma cells. As we failed to find the primary tumor site before the patient died, she was diagnosed with CR-TMA due to bone marrow carcinomatosis of unknown primary origin. Thrombotic thrombocytopenic purpura (TTP) was rapidly ruled out based on her PLASMIC score. In addition, immunohistochemical staining of a clot section of the bone marrow and tumor marker data were useful for narrowing down the likely primary tumor site. CONCLUSION: Although CR-TMA is an extremely rare phenomenon, clinicians who suspect CR-TMA should quickly rule out TTP and decide whether to provide appropriate chemotherapy or plan for palliative care.
Subject(s)
Anemia, Hemolytic , Carcinoma , Disseminated Intravascular Coagulation , Neoplasms, Unknown Primary , Peritoneal Neoplasms , Purpura, Thrombotic Thrombocytopenic , Thrombotic Microangiopathies , Female , Humans , Aged , Disseminated Intravascular Coagulation/etiology , Disseminated Intravascular Coagulation/complications , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/diagnosis , Bone Marrow , Neoplasms, Unknown Primary/complications , Neoplasms, Unknown Primary/diagnosis , Thrombotic Microangiopathies/etiology , Thrombotic Microangiopathies/complications , Anemia, Hemolytic/complicationsABSTRACT
The present study reports the case of a patient with acute myeloid leukemia post-cytotoxic therapy (AML-pCT) that developed following chemotherapy for thymoma. A 64-year-old female patient underwent surgical resection for a mediastinal tumor and was diagnosed with stage IVa thymoma. She received chemotherapy, including carboplatin/etoposide, carboplatin/paclitaxel and amrubicin monotherapy. At 56 months following surgery, she developed blastosis and was diagnosed with AML-pCT. As demonstrated herein, although treatment for thymoma is associated with a markedly lower frequency of myeloid neoplasms post-cytotoxic therapy (MN-pCT) than treatment for other malignancies, such as breast carcinoma, it is important to be aware that MN-pCT may occur as a late complication of thymoma treatment.
ABSTRACT
A 72-year-old male patient, who had been on chemotherapy for the treatment of IgG-λ multiple myeloma, presented an enlargement of the testis 3 years and 5 months after the diagnosis. High orchiectomy was then performed, leading to the diagnosis of plasmacytoma. Due to residual disease, treatment with a combination of isatuximab and dexamethasone was initiated. The patient is currently under follow-up without recurrence. While testicular tumors are difficult to diagnose by imaging studies alone and extramedullary plasmacytomas rarely occur in the testis, pathological assessment is critical for treatment planning.
Subject(s)
Multiple Myeloma , Plasmacytoma , Testicular Neoplasms , Male , Humans , Aged , Plasmacytoma/surgery , Multiple Myeloma/drug therapy , Testicular Neoplasms/drug therapy , Testicular Neoplasms/surgery , Neoplasm, ResidualABSTRACT
There is currently no evidence that a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine might be associated with the development of autoimmune hemolytic anemia or disease progression in patients with mature B-cell neoplasm. Our patient was a 71-year-old man with indolent mature B-cell neoplasm who had been monitored for many years without treatment. After receiving the second dose of the BNT162b2 mRNA COVID-19 vaccine, he developed severe warm autoimmune hemolytic anemia. Although steroid therapy improved his anemia, he continued to develop IgM-monoclonal gammopathy, renal insufficiency, and splenomegaly. He was diagnosed with splenic marginal zone lymphoma after undergoing splenectomy. The splenectomy improved the patient's symptoms. We assessed his SARS-CoV-2 specific antibody response, but the patient's serologic response to the vaccine was impaired. In patients with mature B-cell neoplasm, a non-specific immune response after vaccination might be associated with paraneoplastic syndromes.
Subject(s)
Anemia, Hemolytic, Autoimmune , COVID-19 Vaccines , COVID-19 , Leukemia, Lymphocytic, Chronic, B-Cell , Lymphoma, B-Cell , Paraproteinemias , Splenic Neoplasms , Aged , Humans , Male , Anemia, Hemolytic, Autoimmune/etiology , Anemia, Hemolytic, Autoimmune/complications , BNT162 Vaccine , COVID-19/complications , COVID-19 Vaccines/adverse effects , Immunoglobulin M , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Lymphoma, B-Cell/drug therapy , Paraproteinemias/complications , SARS-CoV-2 , Splenic Neoplasms/complications , mRNA VaccinesSubject(s)
COVID-19 , Hematopoietic Stem Cell Transplantation , Herpes Zoster , Varicella Zoster Virus Infection , COVID-19 Vaccines/adverse effects , Hematopoietic Stem Cell Transplantation/adverse effects , Herpes Zoster/diagnosis , Herpesvirus 3, Human , Humans , Stem Cell Transplantation/adverse effects , Vaccination , Varicella Zoster Virus Infection/diagnosis , Varicella Zoster Virus Infection/drug therapyABSTRACT
The phase 3 ICARIA-MM trial showed that the addition of isatuximab improved the progression-free survival compared with pomalidomide/dexamethasone. However, the safety and efficacy of isatuximab for end-stage renal failure remains unclear. A 67-year-old man who started hemodialysis 5 years ago for diabetic nephropathy was diagnosed with International Staging System stage III multiple myeloma (MM) of IgD-λ type 3 years ago. After receiving a total of 7 treatment regimens, his free light chain (FLC) λ level increased from 419 to 2,070 mg/L, indicating progressive disease. Twelve days after starting isatuximab plus pomalidomide (3 mg daily) and dexamethasone (IsaPd), his FLC λ level rapidly decreased to 412 mg/L. The patient has now completed 7 courses of IsaPd with no adverse events, including infusion reactions and neutropenia. Isatuximab requires a lower dilution volume than daratumumab and can be safely and effectively administered to hemodialysis-dependent MM patients.
