Immune pancytopenia after chemotherapy in a patient with diffuse large B-cell lymphoma

Nagashima, Kazuyo; Tanaka, Hiroaki; Nagai, Yurie; Sugita, Yoshiaki

doi:10.1136/bcr-2016-216880

Cited by 4 publications

(1 citation statement)

References 24 publications

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“…After reviewing the literature, we found very few cases of aplastic anaemia caused by bendamustine. For example, Nagashima et al (2016) reported a case of severe pancytopenia in a patient who underwent rituximab and bendamustine therapy for a second relapse of diffuse large B-cell lymphoma [4] . Another paper described a case of haemolytic anaemia resulting from bendamustine exposure, which was successfully treated with prednisolone [5] .…”

Section: Discussionmentioning

confidence: 99%

Aplastic anaemia associated with bendamustine therapy – a rare side effect

Khan,

Yetiskul,

Khan

et al. 2024

European Journal of Case Reports in Internal Medicine

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Introduction: During treatment for malignant lymphoma, cytopenia can develop for several reasons. This can range from mild cytopenias leading to infection and bleeding to full-blown drug-induced aplastic anaemia. While aplastic anaemia affects individuals of all genders and ages, here, we describe aplastic anaemia after chemotherapy exposure to bendamustine in a 65-year-old female with non-Hodgkin’s lymphoma. Case description: A 65-year-old woman with recurrent indolent marginal zone lymphoma and post-chemotherapy with bendamustine and rituximab, presented with a neutropenic fever and was admitted with a leading diagnosis of sepsis. In the previous two weeks, the patient required regular transfusions of packed red blood cells and platelets and maintained a daily ZARXIO® regimen. Laboratory results revealed pancytopenia, and broad-spectrum antibiotics (cefepime/vancomycin) were given. The patient was subsequently admitted to the hospital under the care of the haematology/oncology team and was ultimately diagnosed with aplastic anaemia, likely as a consequence of bendamustine chemoimmunotherapy. She elicited a positive response to the triple immunosuppressive therapy (IST) regimen (two immunotherapeutic agents plus one anti-thymocyte globulin (ATG), after which her cell counts returned to normal. Conclusions: This case underscores the importance of recognising haematologic complications linked to bendamustine and advocates for further research to increase the understanding among healthcare professionals of drug-induced aplastic anaemia. Bendamustine can cause severe autoimmune haemolytic anaemia and aplastic anaemia and may require multiple transfusions and a multidrug regimen for treatment. The use of ATG as a therapeutic intervention is appropriate because it has been effective in treating aplastic anaemia.

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Section: Discussionmentioning

confidence: 99%

Aplastic anaemia associated with bendamustine therapy – a rare side effect

Khan,

Yetiskul,

Khan

et al. 2024

European Journal of Case Reports in Internal Medicine

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Bendamustine/rituximab

2017

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Autoimmune pancytopenia occurring late after simultaneous pancreas and kidney transplantation

et al. 2020

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A 35-year-old woman presented with a widespread petechial rash and pancytopenia. She underwent simultaneous pancreas and kidney transplantation for type 1 diabetes 8 years previously followed by a renal transplant 1 year prior to presentation, and was taking tacrolimus as long-term immunosuppression. The full blood count showed haemoglobin 97 g/L, platelet count 2×109/L and neutrophil count 0.22×109/L. Peripheral blood film examination confirmed genuine thrombocytopenia in the absence of any haemolytic or malignant features. Serological testing identified autoantibodies against all three blood lineages, consistent with a diagnosis of autoimmune pancytopenia. Treatment with steroids, intravenous immunoglobulins, romiplostim and mycophenolate mofetil achieved only fleeting remissions. Blood counts eventually normalised following the administration of rituximab and a change from tacrolimus to ciclosporin immunosuppression. Cytopenias are a well-recognised complication of post-transplantation care but we believe this to be the first reported case of autoimmune pancytopenia following solid organ transplantation. In this case report, we discuss the approach to investigation of haematological abnormalities post-transplant and the rationale for, and outcome of, the management of this rare case.

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Immune pancytopenia after chemotherapy in a patient with diffuse large B-cell lymphoma

Cited by 4 publications

References 24 publications

Aplastic anaemia associated with bendamustine therapy – a rare side effect

Aplastic anaemia associated with bendamustine therapy – a rare side effect

Bendamustine/rituximab

Autoimmune pancytopenia occurring late after simultaneous pancreas and kidney transplantation

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