Anaplastic large-cell lymphoma which showed severe inflammatory status and myelodysplasia with increased VEGF and IL-6 serum levels after long-term immunosuppressive therapy.
We report a patient with anaplastic large-cell lymphoma (ALCL) who has been given immunosuppressive therapy for Evans syndrome for 10 years. He was admitted with spike fever, intra-abdominal lymphadenopathy, and multiple liver masses. Examination of biopsy specimens obtained by para-aortic lymph nodes and liver masses resulted in a diagnosis of ALCL. Immunohistochemically, these cells were reactive to anti-CD30 antibody but were not of B- or T-lineage. Bone marrow aspiration demonstrated the invasion of giant neoplastic cells and trilineage myelodysplasia. Because the patient showed severe inflammatory symptoms, we examined serum levels of various cytokines. Pretreatment levels of IL-6 and VEGF in this patient were significantly elevated compared to those of normal controls. He was treated with combination chemotherapy (ABVD regimen), achieving complete remission. Myelodysplasia and serum IL-6 and VEGF also normalized after treatment. We assumed that ALCL resulted from long-term immunosuppressive therapy and that the up-regulation of IL-6 and VEGF played a role in pathogenesis of this type of lymphoma.
Shimamoto
T
T
First Department of Internal Medicine, Tokyo Medical University, Japan.
Hayashi
S
S
Ando
K
K
Yguchi
M
M
Miyazawa
K
K
Kimura
Y
Y
Mukai
K
K
Serizawa
H
H
Ohyashiki
K
K
D015746:Abdominal Pain / Q000209:etiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000150:complications / Q000188:drug therapy*; D001761:Bleomycin / Q000008:administration & dosage; D001853:Bone Marrow / Q000473:pathology; D016516:CD4-CD8 Ratio; D019070:Cell Lineage; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D004273:DNA, Neoplasm / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D003606:Dacarbazine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D016228:Endothelial Growth Factors / Q000097:blood*; D005334:Fever / Q000209:etiology; D016222:Fibroblast Growth Factor 2 / Q000097:blood; D015322:Gene Rearrangement, B-Lymphocyte; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood*; D008198:Lymph Nodes / Q000473:pathology; D008222:Lymphokines / Q000097:blood*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000209:etiology*; D010198:Pancytopenia / Q000150:complications / Q000188:drug therapy*; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D012074:Remission Induction; D013156:Splenectomy; D013577:Syndrome; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D014747:Vinblastine / Q000008:administration & dosage
D004273:DNA, Neoplasm; D004279:DNA, Viral; D016228:Endothelial Growth Factors; D007166:Immunosuppressive Agents; D015850:Interleukin-6; D008222:Lymphokines; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D016222:Fibroblast Growth Factor 2; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D016572:Cyclosporine; D011239:Prednisolone