Transitory Spontaneous Remission Of Myelodysplasia In An Elderly Man While Receiving Intravesical Bacillus Calmette-guérin For Bladder Cancer: A Case Report And Review Of The Literature
Murray, N. P., Fuentealba, C., Salazar, I., Salazar, A., Lopez, M. A., & Minzer, S. (2018). Transitory Spontaneous Remission of Myelodysplasia in an Elderly Man while Receiving Intravesical Bacillus Calmette-Guérin for Bladder Cancer: A Case Report and Review of the Literature. Case reports in hematology, 2018, 9750532. https://doi.org/10.1155/2018/9750532
View Original Source →Abstract
Myelodysplasia is a clonal disorder characterized by progressive cytopenias. Intravescial BCG is standard immunotherapy for superficial bladder cancer. We present a patient with transfusion-dependent myelodysplasia whose blood counts normalized during treatment with intravesical BCG for bladder cancer. After finishing treatment, the patient became transfusion dependent once more. We discuss possible mechanisms to explain this case report.
Case Details
Disease Location
Blood
Personal Characteristics
69-year-old man. Transurethral resection for benign prostatic hyperplasia in 1996
Clinical Characteristics
Presented with a macrocytic anemia. Bone marrow biopsy was consistent with refractory anemia and blasts <5%. He was treated with a trial of anabolic steroids without success. Repeat bone marrow biopsy, after red cell and platelet transfusions, revealed a hypercellular bone marrow, with dysplastic features, including micro-megakaryocytes and blasts <5%. The diagnosis remained that of myelodysplasia of refractory anemia. To alleviate the symptoms of anemia, monthly transfusions of red cells were needed to maintain the hemoglobin level above 8. The platelet count continued to decrease. 2 years later, the patient noted painless macroscopic hematuria lasting for two days, his full blood count showed a hemoglobin level of 7.5 gr/dl; a platelet count of 13,000. Urine analysis confirmed hematuria. CT scan of the urinary system revealed a lobulated lesion in the region of the left ureteral meatus. Cystoscopy revealed five bladder tumors, which were resected. Pathological analysis revealed a low-grade superficial urothelial papillary carcinoma without evidence of bladder wall infiltration. After resection of the tumor, the patients’ transfusional requirements decreased, but he remained transfusion dependent. He was treated with intravesical bacillus calmette-guérin (bcg), weekly for 6 weeks, then two-weekly for 4 doses, and then monthly for 1 year. One month after completing bcg treatment, both the hemoglobin level and platelet counts were decreasing
Remission Characteristics
While receiving bcg, the hemoglobin and platelet counts increased, achieving normal levels, and the patient became transfusion independent.
Treatment & Mechanisms
Proposed Remission Mechanisms
Bcg stimulates trail/apo-2l secretion, which recruits macrophages and cytotoxic t-cells. These could decrease myelodysplastic cells permitting more normal hematopoiesis.
Clinical Treatment
Transfusion, transurethral resection bladder tumor,
Non-Clinical Treatment
Intravesical bacillus calmette-guérin (bcg)