Lymphoproliferative Disorders after Immunosuppressive Therapy for Aplastic Anemia: A Case Report and Literature Review

Abstract

A 61-year-old Japanese man was referred to our hospital in 2002 due to severe pancytopenia. Bone marrow and peripheral blood findings indicated he had severe aplastic anemia (AA). A whole-body CT scan and Ga scintigraphy revealed no abnormal findings. Antithymocyte globulin and cyclosporine A (CyA) were administered and he got transfusion independently. In September 2004, he complained of abdominal fullness and a skin eruption in the lower abdomen. An abdominal CT revealed a spleen mass and lymphoadenopathy of the pancreas head. Splenectomy was done, and he was diagnosed with a diffuse large B cell lymphoma (DLBCL) of the spleen and skin. His karyotype was associated with t(14; 18). CyA was stopped, all lesions disappeared, and then his AA relapsed. In January 2007, antithymocyte globulin/CyA was readministered. In May 2007, he complained of acute swelling in his right thigh. A biopsy from the tumor revealed DLBCL. CyA was stopped again, yet the lymphoma did not regress. He was given R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone), followed by 5 cycles of R-VP (rituximab, vincristine, prednisolone) and radiation therapy, resulting in a partial remission. We report DLBCL after immunosuppressive therapy for AA. Although this is a rare complication, it should be considered before beginning immunosuppressive therapy.

An Epstein-Barr Virus-Associated Leukemic Lymphoma in a Patient Treated with Rabbit Antithymocyte Globulin and Cyclosporine for Hepatitis-Associated Aplastic Anemia

“…To determine the incidence of clinically significant EBV-LPD, we searched Medline for published articles about LPD after IST for AA. As shown in table 1, a total of 8 cases of LPD that occurred after IST have been reported [6,8,9,10,11,12,13,14]. …”

Association of aplastic anaemia and lymphoma: a report from the severe aplastic anaemia working party of the European Society of Blood and Bone Marrow Transplantation

“…Although anecdotal reports showing the uncommon association of aplastic anaemia (AA) and lymphoma have been published (Dorr et al , ; Koziner et al , ; Medinger et al , ; Suzuki et al , ; Veidt et al , ; Yoshioka et al , ; Zonder et al , ), data related to its incidence, diagnostic characteristics and centre management strategies are lacking. The Severe Aplastic Anaemia Working Party of the European Society of Blood and Bone Marrow Transplantation (SAAWP‐EBMT) aimed to evaluate the diseases characteristics and treating centre attitudes regarding the treatment and outcome of patients suffering from both AA and lymphoma.…”

A case of genital pyoderma gangrenosum successfully treated with cyclosporine without relapse of established follicular lymphoma

“… 7 The risk of cyclosporine-associated lymphoma after solid organ transplant is a well-established concept, and several case reports of non–transplant-associated hematologic malignancies in patients on cyclosporine have been published, which may raise concern. Suzuki et al 8 describe lymphoproliferative disorders after immunosuppressive therapy with a case of diffuse large B-cell lymphoma developing after cyclosporine treatment for aplastic anemia and notes that, although rare, it should be a consideration in all patients treated with this drug. Gattu et al 9 report a case of a solid B cell lymphoma occurring in a patient treated with cyclosporine even at psoriatic dosing.…”