title: Myelodysplastic syndrome complicated by autoimmune hemolytic anemia: remission of refractory anemia following mycophenolate mofetil.
abstract: Autoimmune hemolytic anemia (AIHA) rarely occurs in myelodysplastic syndrome (MDS). A 36-year-old Asian female was diagnosed with MDS (refractory cytopenia with multilineage dysplasia, RCMD) and complicated by AIHA 7 months later. Secondary myelofibrosis developed at the same time. Steroid therapy was ineffective and cyclosporin A (CsA) was discontinued due to its neurotoxicity with the development of leukoencephalopathy. However, the patient achieved a good hematological response after the use of mycophenolate mofetil (MMF, CellCept) with a dose of 1 g/day and prednisolone (15 mg/day). Prednisolone was tapered off over the next 3 weeks. The patient did not require any blood support 4 weeks after the use of MMF and has been hematologically stable for 4 months. To our knowledge, this is the first report of using MMF in treating MDS complicated by AIHA. MMF might be considered as a salvage therapy for patients with refractory anemia complicated by AIHA.
authors.affiliation: Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, #201, Sec. 2, Shi-Pai Road, Taiwan.
authors.forename: J-T
authors.initials: JT
authors.lastname: Lin
authors.forename: W-S
authors.initials: WS
authors.lastname: Wang
authors.forename: C-C
authors.initials: CC
authors.lastname: Yen
authors.forename: T-J
authors.initials: TJ
authors.lastname: Chiou
authors.forename: J-H
authors.initials: JH
authors.lastname: Liu
authors.forename: L-T
authors.initials: LT
authors.lastname: Hsiao
authors.forename: M-H
authors.initials: MH
authors.lastname: Yang
authors.forename: T-C
authors.initials: TC
authors.lastname: Chao
authors.forename: C-J
authors.initials: CJ
authors.lastname: Tai
authors.forename: P-M
authors.initials: PM
authors.lastname: Chen
mesh_terms: D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy* / Q000209:etiology; D000753:Anemia, Refractory / Q000188:drug therapy / Q000209:etiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D009173:Mycophenolic Acid / Q000008:administration & dosage* / Q000031:analogs & derivatives; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage; D055728:Primary Myelofibrosis / Q000209:etiology; D012074:Remission Induction / Q000379:methods; D016879:Salvage Therapy
chemical_list: D011239:Prednisolone; D009173:Mycophenolic Acid