Spontaneous Remission Of Epstein-barr Virus-negative Non-hodgkin's Lymphoma After Withdrawal Of Cyclosporine In A Patient With Refractory Anemia
Ogata, M., Kikuchi, H., Ono, K., Ohtsuka, E., Gamachi, A., Kashima, K., & Nasu, M. (2004). spontaneous remission of Epstein-Barr virus-negative non-Hodgkin's lymphoma after withdrawal of cyclosporine in a patient with refractory anemia. International journal of hematology, 79(2), 161–164. https://doi.org/10.1532/ijh97.03095
View Original Source →Abstract
A 70-year-old man presented with pancytopenia in August 2000, and the results of a bone marrow examination performed in January 2001 confirmed the diagnosis of refractory anemia. He was treated with cyclosporine (CsA) at 3.3 mg/kg per day, and the pancytopenia improved. The patient complained of epigastralgia 21 months later, and a gastric endoscopic examination showed an ulcer with a cleaved bank. A biopsy revealed diffuse large B-cell lymphoma. In situ hybridization analysis detected no Epstein-Barr virus (EBV) in the lymphoma. CsA treatment was discontinued, and a gastrectomy was performed 31 days later. A detailed histologic examination revealed no infiltration of abnormal B-cells in the resected stomach. Although EBV-positive lymphoma is a known complication of immunosuppressive therapy, no causal association between immunosuppressants and EBV-negative lymphoma has been established. The spontaneous remission observed after the withdrawal of CsA treatment suggests that immunosuppressive therapy can be a pathogenic factor in a subset of EBV-negative lymphomas.
Case Details
Disease Location
Stomach
Personal Characteristics
70 -year-old male one months history of anemia august 2000
Clinical Characteristics
Physical exam revealed nothing of significance except for anemic conjunctiva complete blood count with differential were wbc count 2700/microl (40% neutrophils, 51% lymphocytes, 8% monocytes, and 1% eosinophils), hemoglobin concentration 7.6 g/dl, rbc count 180x10^4/microl, platelet count 2.8x10^4/microl pancytopenia gradually worsened and the patient was hospitalized in jan 2001. His hemoglobin concentration decreased to 2.9g/dl. There was no evidence of hemolytic anemia test results for immunoglobulin m antibodies to human paravovirus b19 were negative. Bone marrow was hypocellular with 4.5% myeloblasts and 2.5% erythroblasts chromosomal analysis of bone marrow revealed normal karyotype dysplastic changes in the myeloid lineage, including pseudo-pelger-huet anomaly were confirmed. CT scan revealed no thymoma. Myelodysplastic syndrome of the refractory anemia type was diagnosed, cyclosporine was prescribed in jan 2001. Treatment gradually improved the pancytopenia in oct 2002, the patient complained of epigastralgia and a gastric endoscopy revealed an ulcer with a partially cleaved bank at the angular region of the stomach 4/6 biopsy specimens showed diffuse infiltration of large atypical lymphoid cells that were positive for immunoperoxidase for the leukocyte common antigens and CD20. The large atypical b-cells stained positively for lambda light chain but negative for kappa light chains. Dlbcl was diagnosed, h. Pylori was negative hybridization signals for eber and lmp-1 were negative serologic tests showed abnormalities: lactate dehydrogenase 714 iu/l, c-reactive protein 2.1mg/dl, and soluble interleukin 2 receptor 3340 u/ml chest and abdomen cts, bone marrow exam, and gallium scintigram revealed no other lymphoma sites gastrectomy was planned and chemo was held off because of fear of prolonged pancytopenia. Cyclosporine was discontinued in nov 2002 because of increased risk of infection with the operation after withdrawal from cyclosporine, serum lactate dehydrogenase levels gradually decreased distal gastrectomy was performed in dec 2002, no neighboring lymph nodes were swollen an ulcer was identified at the angle of the stomach on surgical specimen exam, a delayed histologic exam of the specimen revealed no infiltration of the CD20+ malignant cells, unexpectedly
Remission Characteristics
After cyclosporine withdrawal, serum lactate dehydrogenase levels decreased, hemoglobin concentration and platelet count were mainted, no transfusions were required 10 months after the withdrawal the patients nhl remained in complete remission
Treatment & Mechanisms
Proposed Remission Mechanisms
Stopping of cyclosporine treatment
Clinical Treatment
Cyclosporine gastrectomy
Non-Clinical Treatment
None reported