Efficacy of bendamustine on thrombocytopenia and hemolytic anemia secondary to CD5-positive B-cell lymphoma with massive splenomegaly in a patient with rheumatoid arthritis

Abstract

Abstract. Chemotherapy for lymphoma may be avoided in the presence of coincident cytopenia. In case of immune cytopenia secondary to lymphoma, treatment of cytopenia is the same for primary cases, however, chemotherapy for lymphoma may be effective at the cost of severe hematological toxicity. The present study reports a complex case of thrombocytopenia and direct antiglobulin test-negative hemolytic anemia, thus mimicking Evans syndrome, secondary to cluster of differentiation 5-positive B-cell lymphoma with massive splenomegaly, in a patient suffering from rheumatoid arthritis for two decades. Treatment with prednisolone, high-dose dexamethasone, eltrombopag and rituximab for cytopenia were not effective. Chemotherapy with bendamustine subsequently resolved the cytopenia, additionally resulting in a complete remission of lymphoma. Thus, bendamustine may have a role in the management of lymphoma complicated with severe cytopenia.

Treatment of Secondary Immune Thrombocytopenia with Non-Hodgkin Lymphoma: A Case Report and Literature Review

“…The reason for the failure of IVIG to increase the platelet count was not clear ( 3 - 5 , 13 , 15 ) but might be related to the etiology of the reduction in the platelet count ( 2 ). IVIG is only intended to provide a temporary increase in the platelet count, as it does not treat the primary disease mimicking thrombocytopenia.…”

“…IVIG is commonly used for the treatment of primary ITP with severe thrombocytopenia. Over the last decade, 16 patients with NHL-associated ITP have been described, excluding patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (Table 2) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In these case reports, severe thrombocytopenia in patients with secondary ITP and NHL was also treated with IVIG; this approach was ineffective in eight patients.…”

“…Therefore, MCL was diagnosed after the first administration of rituximab, so we changed the primary disease target to MCL and administered VR-CAP chemotherapy (bortezomib 1.3 mg/m 2 days 1, 4, 8, and 11; rituximab 375 mg/m 2 day 0; cyclophosphamide 500 mg/m 2 day 1; doxorubicin 33 mg/m 2 day 1; and prednisolone 60 mg/m 2 days 1-5); we modified the dose based on the patient's age. A review of the related literature (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) over the past decade confirmed that chemotherapy did not result in severe bleeding in any patients with ITP secondary to NHL. We explained to the patient that previous reports had shown no critical adverse events associated with this chemotherapy but noted that his platelet count was already low (<1.0×10 4 /μL) and might be further reduced as a result of chemotherapy-related bone marrow suppression.…”