Lymphoproliferative disorders after immunosuppressive therapy for aplastic anemia: a case report and literature review.
A 61-year-old Japanese man was referred to our hospital in 2002 due to severe pancytopenia. Bone marrow and peripheral blood findings indicated he had severe aplastic anemia (AA). A whole-body CT scan and Ga scintigraphy revealed no abnormal findings. Antithymocyte globulin and cyclosporine A (CyA) were administered and he got transfusion independently. In September 2004, he complained of abdominal fullness and a skin eruption in the lower abdomen. An abdominal CT revealed a spleen mass and lymphoadenopathy of the pancreas head. Splenectomy was done, and he was diagnosed with a diffuse large B cell lymphoma (DLBCL) of the spleen and skin. His karyotype was associated with t(14; 18). CyA was stopped, all lesions disappeared, and then his AA relapsed. In January 2007, antithymocyte globulin/CyA was readministered. In May 2007, he complained of acute swelling in his right thigh. A biopsy from the tumor revealed DLBCL. CyA was stopped again, yet the lymphoma did not regress. He was given R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone), followed by 5 cycles of R-VP (rituximab, vincristine, prednisolone) and radiation therapy, resulting in a partial remission. We report DLBCL after immunosuppressive therapy for AA. Although this is a rare complication, it should be considered before beginning immunosuppressive therapy.
Suzuki
Yuhko
Y
Department of Hematology, School of Medicine, Kitasato University, Sagamihara, Japan. ysuzuki-hki@umin.ac.jp
Niitsu
Nozomi
N
Hayama
Miyuki
M
Katayama
Takuji
T
Ishii
Ryuji
R
Osaka
Manabu
M
Miyazaki
Koji
K
Danbara
Mikio
M
Horie
Ryouichi
R
Yoshida
Tsutomu
T
Nakamura
Naoya
N
Higashihara
Masaaki
M
D000741:Anemia, Aplastic / Q000150:complications* / Q000473:pathology / Q000628:therapy; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D044466:Asian People; D003520:Cyclophosphamide / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007564:Japan; D016403:Lymphoma, Large B-Cell, Diffuse / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D011877:Radionuclide Imaging; D011878:Radiotherapy / Q000379:methods; D000069283:Rituximab; D012878:Skin Neoplasms / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D013156:Splenectomy; D013160:Splenic Neoplasms / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014750:Vincristine / Q000008:administration & dosage
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D016572:Cyclosporine; D003520:Cyclophosphamide; D011239:Prednisolone