Bone marrow necrosis and lack of efficacy: case reportA 19-year-old man developed bone marrow necrosis during treatment with plerixafor and an unspecified granulocyte colonystimulating factor for classical Hodgkin's lymphoma. Additionally, he exhibited lack of efficacy following treatment with doxorubicin, bleomycin, vinblastine and dacarbazine for classical Hodgkin's lymphoma [routes and dosages not stated].The man presented with night sweat, fever, significant weight loss and neck swelling, experienced for a duration of 6 months. He was diagnosed with stage IVB bulky mediastinal classical Hodgkin's lymphoma-lymphocyte depleted (HL-LD) along with multiple Reed-Sternberg cells with positive CD15 and CD30 and pleural effusion. He received treatment with six courses of ABVD regimen including doxorubicin, bleomycin, vinblastine and dacarbazine. However, after the last course, a positive fluorodeoxyglucose (FDG)-PET was detected. Thus, he was subjected to another biopsy which led to the diagnosis of the same classical HL-LD type, thus confirming refractory Hodgkin's lymphoma to the ABVD treatment regimen (lack of efficacy). Subsequently, he received salvage therapy and an autologous stem cell marrow transplantation. Following treatment with salvage BeGEF chemotherapy regimen including bendamustine, gemcitabine and fluorouracil, he achieved partial remission. He then received treatment with plerixafor and an unspecified granulocyte colony-stimulating factor for 10 days. After 10 days, stem cells were harvested and collected. Following complete collection of stem cells, he was discharged in a good condition. A week later, he was presented to the hospital a second time with headache and fever. Upon examination, he exhibited blurred vision, ecchymosis, purpura, epistaxis and bleeding from gum. A full blood count indicated leucopenia, anaemia and thrombocytopenia along with an ophthalmoscope eye examination confirming vitreous haemorrhage.The man was admitted in the ICU for 35 days. He underwent multiple blood cultures and received different unspecified antimicrobials modalities. However, he showed no response and was later placed on blood and platelets transfusion. A repeat blood culture was negative but a chest CT indicated signs of pneumonia. On day 28 of ICU admission, a biopsy and bone marrow aspiration confirmed a diagnosis of bone marrow necrosis (BMN) secondary to plerixafor and unspecified granulocyte colonystimulating factor use. The bone marrow biopsy was particularly significant of disturbed marrow architecture and diffuse bone marrow necrosis with cells exhibiting coagulative necrosis along with the loss of normal staining cells embedded in an amorphous eosinophilic background. It was also reported that he developed BMN after 1 week of plerixafor treatment. However, on day 35 of ICU admission, he died following stem cell harvesting.Khoshnaw N, et al. Bone marrow necrosis in a patient with advanced Hodgkin's lymphoma after G-CSF and Plerixafor treatment during harvesting for autologous bone marrow transpl...
