Spontaneous Regression Of Chronic Lymphocytic Leukemia And Simultaneous Development Of Autoimmune Hemolytic Anemia And Autoimmune Thrombocytopenia
Wajima T. (2000). spontaneous regression of chronic lymphocytic leukemia and simultaneous development of autoimmune hemolytic anemia and autoimmune thrombocytopenia. American journal of hematology, 65(1), 88–89. https://doi.org/10.1002/1096-8652(200009)65:1<88::aid-ajh20>3.0.co;2-q
View Original Source →Case Details
Disease Location
Bone marrowithblood
Personal Characteristics
77 -year-old male blood type o, rh+
Clinical Characteristics
When initially seen, wbc was 35,000/ul with 80% blasts, absolute lymphocyte count was 28,480/ul bone marrow lymphocyte was >50% and immunophenotype of the marrow was positive for CD20, 19, 5, and was b-cell. He was diagnosed with cll, stage 0. Three years later when wbc and lymphocyte counts decline, the patient developed anemia (aiha) and thrombocytopenia (ait) after the 3 years, wbc was 3000/ul with 47% lymphocytes, absolute lymphocyte count was 1410/ul, 33% neutrophils, 17% monocytes, hgb was 8.3g/dl, hct was 23.5%, platelets were 74000/ul, mcv was 105.5 fl, mch was 37.5pg. Reticulocyte was 3.68%. Peripheral blood smear showed large platelets, spherocytes, polychromatophilic cells, hypogranular neutrophils, and a few small lymphocytes marrow aspirate was hypocellular residual foci of lymphocytes revealed CD19+ and 5+, b-cell the patient developed shortness of breath and further anemia type and cross-match of red blood cells revealed IGG warm antibodies both direct and indirect comb's tests were positive he received 2 units of blood with prednisone the last sentence in article states cll reappeared with an improvement in aiha and ait
Remission Characteristics
During 3 years of follow-up, wbc and lymphocyte counts declined gradually patient responded to prednisone, his hgb rose to 12.9g/dl, hct to 38%, and platelets normal limits. Wbc increased to 14400/ul with 74% lymphocytes, absolute lymphocyte count was 10700/ul, 18% neutrophils
Treatment & Mechanisms
Proposed Remission Mechanisms
Sr in cll is suggested to result from an altered host-tumor relationship lymphocyte production may have been under the control of a readjusted hematopoietic mechanism, the cll in marrow evidently altered stroma function and induced stromal abnormalities that selectively suppressed lymphocyte production and induced anemia and thrombocytopenia, the prednisone altered this autoimmune phenomenon
Clinical Treatment
Transfusion and prednisone
Non-Clinical Treatment
None reported