Reversible Acceleration of Disease Progression Following Cyclosporin A Treatment in a Patient With Myelodysplastic Syndrome

Itoh, Mitsuru; Yago, Kazuo; Shimada, Hideto; Tohyama, Kaoru

doi:10.1007/bf02982046

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Therefore, such genetic instabilities may be resolved simply by discontinuation of cytotoxic (i.e., immunosuppressive) drugs or patient's innate immunity in some specific conditions. A reported case of primary MDS which was improved simply by discontinuation of cyclosporine A may also support this hypothesis [10]. While high-dose CY or IFM previously administered cannot be ruled out, the probable source drug for t-MDS in our patient is CY administered in low doses chronically until just prior to onset, since discontinuation of CY resulted in remission of t-MDS.…”

Section: Discussionsupporting

confidence: 51%

A case of treatment-related myelodysplastic syndrome spontaneously resolved by drug discontinuance

et al. 2010

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Although great advancements have been witnessed in treatment results for hematopoietic tumors in recent years, development of secondary malignant tumors induced by anti-cancer drugs still remains a serious issue. We experienced a case of secondary myelodysplastic syndrome (MDS), possibly induced by cyclophosphamide (CY), which was spontaneously resolved by discontinuance of CY. A 24-year-old woman was diagnosed with follicular lymphoma in January 1998: she had developed bulky intra-abdominal lymphadenopathy, with repeated relapse and remission by several chemotherapy treatments. Remission was induced by rituximab, administered at the time of relapse in 2001, followed by administration of 50 mg/day of CY since December 2001 for the prevention of relapse. Anemia and thrombocytopenia developed around January 2003. Bone marrow aspiration revealed abnormality in two lineages and a complicated chromosomal anomaly, and the patient was diagnosed with MDS. Discontinuance of CY and administration of an anabolic steroid improved anemia and thrombocytopenia within 2 years. Bone marrow aspiration in 2006 showed improvement in morphological abnormality and disappearance of chromosomal abnormality.

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Section: Discussionsupporting

confidence: 51%

A case of treatment-related myelodysplastic syndrome spontaneously resolved by drug discontinuance

et al. 2010

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“…Concerns have been raised about cyclosporine accelerating disease progression in some MDS patients. 15 Our case may be further evidence to this muchquestioned tumor-promoting potential of cyclosporine. 16,17 Use of cyclosporine resulting in the development of a new karyotypic abnormality, leading to progression of RA to refractory anemia with excess blasts has also been previously reported.…”

Section: Discussionmentioning

confidence: 78%

Transformation of Childhood MDS-refractory Anemia to Acute Lymphoblastic Leukemia

Goel

Kumar²,

Bakhshi³

2007

Journal of Pediatric Hematology/Oncology

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Myelodysplastic syndromes (MDS) are clonal disorders of hematopoietic stem cell. Patients have a deteriorating course with about 30% evolving into acute leukemias usually of the myeloid phenotype. Evolution into acute lymphoblastic leukemia is a rare and intriguing phenomenon seen in far less than 1% of adult cases, and extremely rare in pediatric population. We report a case of childhood MDS-refractory anemia transforming into acute lymphoblastic leukemia after an interval of 21 months since presentation and being on cyclosporine therapy for 9.5 months. The case raises further questions about the biology of MDS and the potential role of cyclosporine in leukemic transformation.

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“…Clinical trials of Immunosuppression therapy (IST) also showed that hematological response could only be achieved in part of MDS patients (response rate 30-60%). On the contrary, IST was considered to have accelerated disease evolvement in some cases (Itoh et al, 2002). So it is important to decide which group of patients may benefit from IST before the treatment start.…”

Section: Discussionmentioning

confidence: 99%

Deviation of type I and type II T cells and its negative effect on hematopoiesis in myelodysplastic syndrome

Chang

Ying

et al. 2008

Int J Lab Hematology

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Immunemediated hematopoietic suppression has been considered as one of significant pathophysiological changes in less-advanced myelodysplastic syndrome (MDS). To explore deviation of T cell subsets and its relationship to marrow cells apoptosis, measurement of helper-T (Th)/cytotoxic-T (Tc) subsets as well as the deviation situation within this two subsets (Th1/Th2 and Tc1/Tc2) in marrow was performed by flow cytometry from 39 MDS patients and 13 normal controls. Interferon (INF)-gamma and tumor necrosis factor (TNF)-alpha in marrow serum was simultaneously detected by ELISA (enzyme-linked immunosorbent assay). Furthermore, apoptosis rate of marrow cells was demonstrated by TUNEL (TdT-mediated dUTP nick end labeling). Results showed that Th and Tc subsets were unevenly activated, both deviating to type I response, which was especially obvious in patients with RCMD (according to WHO classification) and in lower-risk cases defined by International Prognosis Scoring System (IPSS). Level of INF-gamma/TNF-alpha in MDS marrow serum was markedly elevated, and so did the apoptosis rate of marrow cells. Although type I deviation was observed both in Th and Tc subsets, just Th1 cell percentage showed positive correlation with level of INF-gamma/TNF-alpha and apoptotic index of nucleated cells. In addition, cytokines level in marrow serum presented positive correlation to apoptosis. We then deduced that the increased Th1 cells in marrow may account for nucleated cells apoptosis in MDS through overproduced proapoptotic cytokines such as INF-gamma and TNF-alpha. Our results suggested that type I deviation of T cell subsets may play a role in pantocytopenia in MDS and the deviation pattern may be as a direct and effective parameter to predict response of immunosuppression therapy.

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Reversible Acceleration of Disease Progression Following Cyclosporin A Treatment in a Patient With Myelodysplastic Syndrome

Cited by 5 publications

References 9 publications

A case of treatment-related myelodysplastic syndrome spontaneously resolved by drug discontinuance

A case of treatment-related myelodysplastic syndrome spontaneously resolved by drug discontinuance

Transformation of Childhood MDS-refractory Anemia to Acute Lymphoblastic Leukemia

Deviation of type I and type II T cells and its negative effect on hematopoiesis in myelodysplastic syndrome

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