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Successful Treatment of a Patient with Refractory Anemia by Immunosuppressive Therapy: Another Case of ‘Autoimmune Myelodysplasia’?

Successful Treatment of a Patient with Refractory Anemia by Immunosuppressive Therapy: Another... Letter to the Editor Acta Haematol 1995;94:58 Alessandro Bucalossi Successful Treatment of a Patient Giuseppe M arotta Piero Galieni with Refractory Anemia by Egidio Dispensa Division of Hematology, ‘A. Sclavo’ Immunosuppressive Therapy: Hospital, Siena, Italy Another Case of 'Autoimmune M yelodysplasia? We read with interest the report by Davis weekly) without any effect on the transfusion References and Farver [1] concerning the spontaneous frequency. According to previous reports recovery of anemia in a young patient with that described response to glucocorticoid 1 Davis RB, Farver ML: Pure red cell anemia therapy in myelodysplastic syndromes (3,4), an atypical pure red cell aplasia. This is with erythropoietic m aturation arrest and probably a further description of a peculiar we began treatment with high-dose metyhl- spontaneous recovery. Acta Haematol 1994; 92:29-32. disease already reported in two young pa­ prednisolone (2 g /12 h, 3 times). The same 2 Muller EW, de W olf JTM , Vellenga E: Success­ schedule was repeated after 1 week and fol­ tients by Muller et al. [2], ful immunosuppressive treatm ent after failure We observed a similar condition in a 19- lowed by prednisone (1.5 mg/kg/day) grad­ o f erythropoietin therapy in two subjects with year-old man referred to our hospital for a ually tapered off and withdrawn once the Hb refractory anaemia. Br J Haematol 1993;83: serious anemia. A complete blood count level achieved a normal value. A bone mar­ 171-172. row aspirate performed at this time showed showed: Hb, 4 g/dl; MCV, 94 fl; reticulocyte 3 Bagby GC, Gabourel JD , U n m a n JW: Gluco­ count, 0.2%; WBC, 3.5 x 109/1; platelet an almost complete resolution of dyserythro- corticoid therapy in the preleukemic syndrome (hemopoietic dysplasia). Ann Intern Med count, 247 x 109/1. Bone marrow histologic poiesis with normal granulocytic and mega- 1980;92:55-58. and cytologic examination displayed a hy- karyocytic maturation. In conclusion, the 4 Motoji T, Teram ura M. Takahashi M, Oshimi percellular picture with dysplastic erythro­ analysis of the cases reported in the literature K, Okada M, Kusakabe K. Mi/.oguchi H: Suc­ poietic hyperplasia, characterized by matu­ [ 1, 2], along with our experience, provides cessful treatm ent o f refractory anem ia with ration arrest at the level of proerythroblasts further evidence about a rare subset o f young high-dose méthylprednisolone. Am J Hematol with rare basophilic erythroblasts, nuclear- patients with dyserythropoietic anemia char­ 1990:33:8-12. cytoplasmic asynchrony, and megaloblastic acterized by a maturation block of erythro- 5 Mieschner PA, Favre H, Beris P: Autoimmune myelodysplasias. Semin Hematol 1991 ;28: features. Mild maturation defects were also poiesis, normal karyotype, good response to 322-330. immunosuppressive treatment and perhaps present in both granulocytic and megakaryo- cytic lineages, with a blast count less than liable to spontaneous remission. In this re­ 5%. No chromosomal abnormality was de­ gard, it may be appropriate to distinguish tected. Moreover, there was no serological this last subset of patients with dyserythro- evidence for parvovirus B19 infection. poiesis from clonal myelodysplastic syn­ A diagnosis of refractory anemia was dromes and to consider it as one of the made after other causes o f anemia had been ‘autoimmune myelodysplasias’ according to excluded. Therapy with erythropoietin was Mieschneret al. [5]. started for 4 weeks (200 U/kg, three times Received: Dr. Alessandro Bucalossi © 1995 S. Kargcr AG, Basel January 30,1995 Divisionc di Ematologia 0001-5792/95/0941-0058 Accepted: 'A. Sclavo’ Hospital. Siena $ 8.00/0 March 10. 1995 V iaTufi, 1 1-53100 Siena (Italy) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Acta Haematologica Karger

Successful Treatment of a Patient with Refractory Anemia by Immunosuppressive Therapy: Another Case of ‘Autoimmune Myelodysplasia’?

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Publisher
Karger
Copyright
© 1995 S. Karger AG, Basel
ISSN
0001-5792
eISSN
1421-9662
DOI
10.1159/000203974
Publisher site
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Abstract

Letter to the Editor Acta Haematol 1995;94:58 Alessandro Bucalossi Successful Treatment of a Patient Giuseppe M arotta Piero Galieni with Refractory Anemia by Egidio Dispensa Division of Hematology, ‘A. Sclavo’ Immunosuppressive Therapy: Hospital, Siena, Italy Another Case of 'Autoimmune M yelodysplasia? We read with interest the report by Davis weekly) without any effect on the transfusion References and Farver [1] concerning the spontaneous frequency. According to previous reports recovery of anemia in a young patient with that described response to glucocorticoid 1 Davis RB, Farver ML: Pure red cell anemia therapy in myelodysplastic syndromes (3,4), an atypical pure red cell aplasia. This is with erythropoietic m aturation arrest and probably a further description of a peculiar we began treatment with high-dose metyhl- spontaneous recovery. Acta Haematol 1994; 92:29-32. disease already reported in two young pa­ prednisolone (2 g /12 h, 3 times). The same 2 Muller EW, de W olf JTM , Vellenga E: Success­ schedule was repeated after 1 week and fol­ tients by Muller et al. [2], ful immunosuppressive treatm ent after failure We observed a similar condition in a 19- lowed by prednisone (1.5 mg/kg/day) grad­ o f erythropoietin therapy in two subjects with year-old man referred to our hospital for a ually tapered off and withdrawn once the Hb refractory anaemia. Br J Haematol 1993;83: serious anemia. A complete blood count level achieved a normal value. A bone mar­ 171-172. row aspirate performed at this time showed showed: Hb, 4 g/dl; MCV, 94 fl; reticulocyte 3 Bagby GC, Gabourel JD , U n m a n JW: Gluco­ count, 0.2%; WBC, 3.5 x 109/1; platelet an almost complete resolution of dyserythro- corticoid therapy in the preleukemic syndrome (hemopoietic dysplasia). Ann Intern Med count, 247 x 109/1. Bone marrow histologic poiesis with normal granulocytic and mega- 1980;92:55-58. and cytologic examination displayed a hy- karyocytic maturation. In conclusion, the 4 Motoji T, Teram ura M. Takahashi M, Oshimi percellular picture with dysplastic erythro­ analysis of the cases reported in the literature K, Okada M, Kusakabe K. Mi/.oguchi H: Suc­ poietic hyperplasia, characterized by matu­ [ 1, 2], along with our experience, provides cessful treatm ent o f refractory anem ia with ration arrest at the level of proerythroblasts further evidence about a rare subset o f young high-dose méthylprednisolone. Am J Hematol with rare basophilic erythroblasts, nuclear- patients with dyserythropoietic anemia char­ 1990:33:8-12. cytoplasmic asynchrony, and megaloblastic acterized by a maturation block of erythro- 5 Mieschner PA, Favre H, Beris P: Autoimmune myelodysplasias. Semin Hematol 1991 ;28: features. Mild maturation defects were also poiesis, normal karyotype, good response to 322-330. immunosuppressive treatment and perhaps present in both granulocytic and megakaryo- cytic lineages, with a blast count less than liable to spontaneous remission. In this re­ 5%. No chromosomal abnormality was de­ gard, it may be appropriate to distinguish tected. Moreover, there was no serological this last subset of patients with dyserythro- evidence for parvovirus B19 infection. poiesis from clonal myelodysplastic syn­ A diagnosis of refractory anemia was dromes and to consider it as one of the made after other causes o f anemia had been ‘autoimmune myelodysplasias’ according to excluded. Therapy with erythropoietin was Mieschneret al. [5]. started for 4 weeks (200 U/kg, three times Received: Dr. Alessandro Bucalossi © 1995 S. Kargcr AG, Basel January 30,1995 Divisionc di Ematologia 0001-5792/95/0941-0058 Accepted: 'A. Sclavo’ Hospital. Siena $ 8.00/0 March 10. 1995 V iaTufi, 1 1-53100 Siena (Italy)

Journal

Acta Haematologica – Karger

Published: Jan 1, 1995

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