Immunosuppressants

Immunosuppressants Reactions 1680, p171 - 2 Dec 2017 Natural killer cell lymphoproliferative disorder: case report A 65-year-old woman developed natural killer (NK) cell lymphoproliferative disorder during treatment with abatacept, golimumab, methotrexate, methylprednisolone, prednisolone, tacrolimus, cyclophosphamide, doxorubicin, vincristine and dexamethasone [durations of treatment to reaction onsets and routes not stated; not all dosages stated]. The woman was diagnosed with rheumatoid arthritis at the age of 60 years and was subsequently treated with methotrexate, prednisolone and abatacept. Subsequently, she had pancytopenia and fever, and a bone marrow test showed increase in cells positive for CD2, CD8, and CD56. The woman’s therapy with methotrexate and abatacept was stopped and her cells positive for CD2, CD8, and CD56 returned to normal. Two years later, she started receiving treatment with golimumab and tacrolimus, together with prednisolone. However, her symptoms flared up and she was hospitalised due to persistent remittent fever of 38–40°C. Her treatment with golimumab and tacrolimus was stopped, but, the fever did not reduce. A bone marrow aspiration again revealed propagation of cells positive for CD2, CD8 and CD56. The G-band method bone marrow testing and staining tests revealed the same abnormalities which were seen two years earlier. She started receiving large dosage of methylprednisolone 1 g/day for three days. Subsequently, her fever reduced, however, returned with the administration of prednisolone. In the hospital, her test findings showed pancytopenia, elevated LDH, high level of hepatobiliary oxygen and abnormally high levels of interleukin 2 receptors and ferritin. As her LDH level continued to increase and her overall performance status worsened, she started receiving treatment with CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisolone/prednisone ). Subsequently, her fever reduced and the LDH improved. However, her fever returned with increase in LDH. She was then started on methylprednisolone pulse therapy, and cyclophosphamide, vincristine, doxorubicin and dexamethasone (Hyper CVAD therapy). Inspite of all the treatment measures taken, the disease was not controlled and she developed further complications with candidaemia, and ultimately died. An autopsy from the sample and biopsy from a liver tissue taken while she was alive, resulted in a histological diagnosis of NK cell lymphoproliferative disorder [cause of death not clearly stated]. Author comment: "[I]mmunodeficiency-associated lymphoproliferative disorder," which is lymphoma that results from the use of immunosuppressant drugs that include biological agents such as [methotrexate]. [I]t was explained the relapse was due to new immune suppression. * It is not stated in the article whether the patient was administered prednisone or prednisolone as part of CHOP therapy. Uchida T, et al. Iatrogenic immunodeficiency-associated Epstein-Barr virus (EBV) -negative natural killer cell lymphoproliferative disorder in a patient undergoing rheumatoid arthritis therapy. Rinsho Ketsueki 58: 624-629, No. 6, 2017. Available from: URL: http://doi.org/10.11406/rinketsu.58.624 [Japanese; summarised from a translation] - Japan 803284239 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Immunosuppressants

Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Publisher
Springer International Publishing
Copyright
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-017-39102-9
Publisher site
See Article on Publisher Site

Abstract

Reactions 1680, p171 - 2 Dec 2017 Natural killer cell lymphoproliferative disorder: case report A 65-year-old woman developed natural killer (NK) cell lymphoproliferative disorder during treatment with abatacept, golimumab, methotrexate, methylprednisolone, prednisolone, tacrolimus, cyclophosphamide, doxorubicin, vincristine and dexamethasone [durations of treatment to reaction onsets and routes not stated; not all dosages stated]. The woman was diagnosed with rheumatoid arthritis at the age of 60 years and was subsequently treated with methotrexate, prednisolone and abatacept. Subsequently, she had pancytopenia and fever, and a bone marrow test showed increase in cells positive for CD2, CD8, and CD56. The woman’s therapy with methotrexate and abatacept was stopped and her cells positive for CD2, CD8, and CD56 returned to normal. Two years later, she started receiving treatment with golimumab and tacrolimus, together with prednisolone. However, her symptoms flared up and she was hospitalised due to persistent remittent fever of 38–40°C. Her treatment with golimumab and tacrolimus was stopped, but, the fever did not reduce. A bone marrow aspiration again revealed propagation of cells positive for CD2, CD8 and CD56. The G-band method bone marrow testing and staining tests revealed the same abnormalities which were seen two years earlier. She started receiving large dosage of methylprednisolone 1 g/day for three days. Subsequently, her fever reduced, however, returned with the administration of prednisolone. In the hospital, her test findings showed pancytopenia, elevated LDH, high level of hepatobiliary oxygen and abnormally high levels of interleukin 2 receptors and ferritin. As her LDH level continued to increase and her overall performance status worsened, she started receiving treatment with CHOP regimen (cyclophosphamide, doxorubicin, vincristine and prednisolone/prednisone ). Subsequently, her fever reduced and the LDH improved. However, her fever returned with increase in LDH. She was then started on methylprednisolone pulse therapy, and cyclophosphamide, vincristine, doxorubicin and dexamethasone (Hyper CVAD therapy). Inspite of all the treatment measures taken, the disease was not controlled and she developed further complications with candidaemia, and ultimately died. An autopsy from the sample and biopsy from a liver tissue taken while she was alive, resulted in a histological diagnosis of NK cell lymphoproliferative disorder [cause of death not clearly stated]. Author comment: "[I]mmunodeficiency-associated lymphoproliferative disorder," which is lymphoma that results from the use of immunosuppressant drugs that include biological agents such as [methotrexate]. [I]t was explained the relapse was due to new immune suppression. * It is not stated in the article whether the patient was administered prednisone or prednisolone as part of CHOP therapy. Uchida T, et al. Iatrogenic immunodeficiency-associated Epstein-Barr virus (EBV) -negative natural killer cell lymphoproliferative disorder in a patient undergoing rheumatoid arthritis therapy. Rinsho Ketsueki 58: 624-629, No. 6, 2017. Available from: URL: http://doi.org/10.11406/rinketsu.58.624 [Japanese; summarised from a translation] - Japan 803284239 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680

Journal

Reactions WeeklySpringer Journals

Published: Dec 2, 2017

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