First report of a B cell lymphoproliferative disorder arising in a patient treated with immune suppressants for severe aplastic anemia.
Aplastic anemia is a disorder characterized by pancytopenia and bone marrow hypocellularity. There is some evidence that aplastic anemia may be due to suppression of hematopoiesis by activated T-suppressor cells. Thus, immunosuppressive agents have been used as an alternative to bone marrow transplantation for treatment. We report on a unique case of a patient with aplastic anemia who was treated with a course of immunosuppression including cyclosporine (CSA), anti-thymocyte globulin (ATG), and prednisone. Five months after this treatment, the patient developed a B cell lymphoproliferative disorder which was successfully treated with radiation therapy. Prior reports of CSA-associated lymphoproliferative disorders have appeared in the literature as potential side effects of immunosuppression following transplantation. This is the first report of a lymphoproliferative disorder associated with immunosuppressive treatment of aplastic anemia in a nontransplant setting. Thus, when presenting options for treatment of aplastic anemia, lymphoproliferative disorders should be included as a rare complication of immunosuppressive therapy.
Dorr
V
V
Division of Oncology, Department of Internal Medicine, University Kansas Medical Center, Kansas City, USA.
Doolittle
G
G
Woodroof
J
J
D000293:Adolescent; D000741:Anemia, Aplastic / Q000188:drug therapy*; D000961:Antilymphocyte Serum / Q000009:adverse effects; D001402:B-Lymphocytes; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007958:Leukocyte Count; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D010976:Platelet Count
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine