Hairy cell leukemia responsive to anti-thymocyte globulin used as immunosuppressive therapy for aplastic anemia.
Hairy cell leukemia (HCL) is occasionally misdiagnosed as aplastic anemia when only a few leukemic cells are present in the circulation. Here, we describe a patient with HCL who initially presented with pancytopenia and received a diagnosis of aplastic anemia. The patient was treated with immunosuppressive therapy including cyclosporine A and anti-thymocyte globulin (ATG). No blood cell transfusion was required for approximately 3 years after ATG therapy. She was referred to our hospital because of an abdominal mass and requiring periodic blood transfusions. A bone marrow biopsy at this time revealed proliferation of lymphocytes with a fried egg appearance and an increase in reticulin fibers that are typical findings of HCL. It is notable that our patient with a presumably long history of HCL and an increase in marrow reticulin fibers showed good recovery of hematopoiesis after cladribine therapy. Some HCL patients may receive an initial diagnosis of aplastic anemia and may show a good response to ATG masking the underlying HCL.
Fujiwara
Shiho
S
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Miyake
Hirosada
H
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Nosaka
Kisato
K
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Yoshida
Minoru
M
Department of Medical Oncology, Kumamoto Red Cross Hospital, Kumamoto, Japan.
Ishihara
Sonoko
S
Department of Pathology, Kumamoto University Hospital, Kumamoto, Japan.
Horikawa
Kentaro
K
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Yonemura
Yuji
Y
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Iyama
Kenichi
K
Department of Pathology, Kumamoto University Hospital, Kumamoto, Japan.
Mitsuya
Hiroaki
H
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Asou
Norio
N
Department of Hematology, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-8556, Japan. ktcnasou@gpo.kumamoto-u.ac.jp.
D000368:Aged; D000741:Anemia, Aplastic / Q000175:diagnosis / Q000188:drug therapy*; D019162:Anesthetics, Combined; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D044466:Asian People; D017338:Cladribine / Q000627:therapeutic use; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007943:Leukemia, Hairy Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D010198:Pancytopenia / Q000209:etiology; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D000961:Antilymphocyte Serum; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D017338:Cladribine; D016572:Cyclosporine