title: Successful management of multilineage autoimmune cytopenia complicated with severe infection and deep vein thrombosis in a patient with Hodgkin lymphoma post-autologous hematopoietic stem cell transplantation.
abstract: Autoimmune cytopenia (AIHA, AITP or AIN) were uncommon paraneoplastic manifestations of HL and have been recognized in patients after HSCT with dismal outcome. We presented a case of 16-yr-old male with Hodgkin's lymphoma who developed severe AIC involving all three cell lineages after autologus bone marrow transplantation. No disease relapse was noted. Treatments with steroid, IVIG and immunosuppresants were in vain and the disease course was complicated with sepsis and deep vein thrombosis. Rituximab was administered along with broad-spectrum antibiotics and low-molecular weight heparin. The condition became stable and pancytopenia recovered after four doses of rituximab treatment. Severe multi-lineage AIC post HSCT is usually refractory to first-line treatment and difficult to manage. Second-line treatment, such as rituximab, and dedicated care for pancytopenia-induced or treatment-related complications may provide a better outcome.
authors.affiliation: Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Wan-Yi
authors.initials: WY
authors.lastname: Hsu
authors.affiliation: Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Shyh-Shin
authors.initials: SS
authors.lastname: Chiou
authors.affiliation: Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Liao
authors.affiliation: Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Hsiu-Lan
authors.initials: HL
authors.lastname: Shu
authors.affiliation: Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Sheng
authors.initials: YS
authors.lastname: Zeng
authors.affiliation: Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Cheong-Chew
authors.initials: CC
authors.lastname: Wong
authors.affiliation: Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Pei-Chin
authors.initials: PC
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D001327:Autoimmune Diseases / Q000628:therapy*; D001379:Azathioprine / Q000008:administration & dosage; D016026:Bone Marrow Transplantation; D019070:Cell Lineage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D010198:Pancytopenia / Q000628:therapy; D000069283:Rituximab / Q000627:therapeutic use; D018805:Sepsis / Q000503:physiopathology; D013921:Thrombocytopenia / Q000628:therapy*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000628:therapy*
chemical_list: D000069283:Rituximab; D003520:Cyclophosphamide; D001379:Azathioprine
keywords: Hodgkin's disease; anemia; autologous PBSCT; neutropenia; rituximab; thrombocytopenia