Successful Treatment of Aggressive Mature B-cell Lymphoma Mimicking Immune Thrombocytopenic Purpura

Ono, Katsumichi; Onishi, Yasushi; Kobayashi, Masahiro; Ichikawa, Satoshi; Hatta, Shunsuke; Watanabe, Shotaro; Okitsu, Yoko; Fukuhara, Noriko; Ichinohasama, Ryo; Harigae, Hideo

doi:10.2169/internalmedicine.0560-17

Cited by 4 publications

(12 citation statements)

References 27 publications

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“…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 - 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.…”

Section: Case Reportmentioning

confidence: 89%

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

et al. 2021

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Secondary immune thrombocytopenic purpura (ITP) with non-Hodgkin lymphoma (NHL) is a rare disease. Although some treatment regimens are available for primary ITP, the treatment strategy for secondary ITP remains unconfirmed. We herein report a 79-year-old man who was diagnosed with secondary ITP with mantle cell lymphoma. Although intravenous immunoglobulin (IVIG) has been considered an effective option for secondary ITP, similar to the treatment of primary ITP, our patient did not benefit from IVIG. A literature review including the current report revealed that IVIG was ineffective in all treated patients. Secondary ITP with NHL should be treated differently from primary ITP.

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Section: Case Reportmentioning

confidence: 89%

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

et al. 2021

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“…The international prognostic index (IPI) and hemoglobin platelet (HP) index have been analyzed, but the level of evidence remains to be weak and controversial [ 4 , 5 ]. It is believed that lymphoma tissues produce autoantibodies against platelets that may incite ITP [ 2 ]. Elevated IgG and IgM antiplatelets have been demonstrated in both in vitro and in vivo models supporting this hypothesis [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Elevated IgG and IgM antiplatelets have been demonstrated in both in vitro and in vivo models supporting this hypothesis [ 6 ]. Around 10 cases of ITP associated with DLBCL have been reported in literature, highlighting the uniqueness of this presentation [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…It was observed that people with NHL could increase the risk of ITP incidence, and successful treatment of the lymphoma also could improve platelet counts. In a series of 10 cases described by Ono et al, six went into remission after treatment for DLBCL with chemotherapy, three of these patients however required splenectomy [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…ITP could be triggered by a number of causes such as inherited diseases, infections, autoimmune conditions and malignancies [ 1 ]. It was reported that lymphoma could associate with ITP and successful treatment of lymphoma might resolve ITP [ 2 ]. We herein, first in the world, report a unique clinical case and our experience in curing refractory ITP on a patient who received autologous hematopoietic stem cell transplantation (HSCT) using carmustine, etoposide, cytarabine and melphalan (BEAM) conditioning regimens for refractory/relapsed diffuse large B-cell lymphoma (DLBCL).…”

Section: Introductionmentioning

confidence: 99%

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Resolution of Chronic Immune Thrombocytopenia Purpura after Autologous Hematopoietic Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma

Kumar

Wazir

2021

J Med Cases

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Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immune-mediated destruction of platelets that could be triggered by a number of causes. ITPs are usually treated with steroid, immunomodulators or immunosuppressors, and intravenous immunoglobulin therapy though refractory/relapsed status frequently occurs. It was suggested that autologous hematopoietic stem cell transplant (HSCT) after high-dose chemotherapy conditioning might improve ITP patients' peripheral blood platelet counts via reorganizing disrupted immune balance in the hematopoietic and hematologic systems. In this case report, we describe how a patient, who suffered from both severe thrombocytopenia due to chronic ITP and refractory/relapsed diffuse large B-cell lymphoma (DLBCL), was managed to successfully receive autologous HSCT using carmustine, etoposide, cytarabine and melphalan (BEAM) conditioning regimens and how his chronic ITP was eventually cured after receiving autologous HSCT. This is the first clinical case in the world demonstrating that high-dose BEAM chemotherapy conditioned autologous HSCT could cure chronic ITP while successfully managing refractory/relapse DLBCL. The clinical hematology professionals and the patients will benefit from our experience in managing severe thrombocytopenia while conducting high-dose chemotherapy conditioning and autologous HSCT for DLBCL.

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Secondary Chronic Immune Thrombocytopenia in Diffuse Large B-cell Lymphoma: A Rare Case Report

Vidyaniati

Fransisca

Rizki

et al. 2022

ijihs

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Objective: To present a case of rare secondary chronic immune thrombocytopenia in diffuse large B-cell lymphoma. Methods: A case of secondary ITP associated with diffuse large B-cell lymphoma (DLBCL) in a 58-year-old woman suffering from hemorrhagic tendencies that was refractory to conventional treatments of ITP was reported. This case is a rarity because there are not many cases of secondary chronic ITP due to DLBCL have been reported to date. Results: A 58-year-old woman was diagnosed with ITP around 11 months before she was admitted to the Emergency Room with bleeding. Previous treatment with steroid and azathioprine was only temporarily effective. During the course of treatment, splenomegaly and lymphadenopathy were identified, but lymph node biopsy was delayed by the thrombocytopenia. The drug was then replaced to the eltrombopag, which showed good response. However, the patient had to undergo splenectomy because of the mechanical effect of splenomegaly, with the biopsy result showed DLBCL. Immune thrombocytopenia then went into a complete remission after splenectomy. Conclusion: In cases of ITP that are refractory to conventional treatments, a thorough search for secondary ITP might be helpful, even if no underlying disorder is detected at the initial presentation.

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Successful Treatment of Aggressive Mature B-cell Lymphoma Mimicking Immune Thrombocytopenic Purpura

Cited by 4 publications

References 27 publications

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

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

Resolution of Chronic Immune Thrombocytopenia Purpura after Autologous Hematopoietic Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma

Secondary Chronic Immune Thrombocytopenia in Diffuse Large B-cell Lymphoma: A Rare Case Report

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