Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia
A 34-year-old woman was diagnosed with acute promyelocytic leukemia. Chemotherapy was administered following the JALSG APL204 protocol. Induction therapy with all-trans retinoic acid resulted in complete remission on day 49. She developed coccygeal pain from day 18, which spread to the spine and che...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-01-01
|
| Series: | Case Reports in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2019/1616237 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832559450938933248 |
|---|---|
| author | Yuta Inagawa Yukiko Komeno Satoshi Saito Yuji Maenohara Tetsuro Yamagishi Hiroyuki Kawashima Taku Saito Keiko Abe Kuniko Iihara Yasumasa Hatada Tomiko Ryu |
| author_facet | Yuta Inagawa Yukiko Komeno Satoshi Saito Yuji Maenohara Tetsuro Yamagishi Hiroyuki Kawashima Taku Saito Keiko Abe Kuniko Iihara Yasumasa Hatada Tomiko Ryu |
| author_sort | Yuta Inagawa |
| collection | DOAJ |
| description | A 34-year-old woman was diagnosed with acute promyelocytic leukemia. Chemotherapy was administered following the JALSG APL204 protocol. Induction therapy with all-trans retinoic acid resulted in complete remission on day 49. She developed coccygeal pain from day 18, which spread to the spine and cheekbones and lasted 5 weeks. She had similar bone pain on days 7–10 of the first consolidation therapy and on days 4–12 of the second consolidation therapy. Oral loxoprofen was prescribed for pain relief. On day 33 of the third consolidation, white blood cell and neutrophil counts were 320/μL and 20/μL, respectively. After she developed epigastralgia and hematemesis, she developed septic shock. Gastroendoscopy revealed markedly thickened folds and diffusely damaged mucosa with blood oozing. Computed tomography revealed thickened walls of the antrum and the pylorus. Despite emergency treatments, she died. Bacterial culture of the gastric fluid yielded Enterobacter cloacae and enterococci growth. Collectively, she was diagnosed with phlegmonous gastritis. Retrospective examination of serial bone marrow biopsy specimens demonstrated progressive bone marrow fibrosis, which may have caused prolonged myelosuppression. Thus, evaluation of bone marrow fibrosis by bone marrow biopsy after each treatment cycle might serve as a predictor of persistent myelosuppression induced by chemotherapy. |
| format | Article |
| id | doaj-art-d5a7c518c8bf478fa932d2a09fab2b1e |
| institution | Kabale University |
| issn | 2090-6560 2090-6579 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hematology |
| spelling | doaj-art-d5a7c518c8bf478fa932d2a09fab2b1e2025-02-03T01:30:07ZengWileyCase Reports in Hematology2090-65602090-65792019-01-01201910.1155/2019/16162371616237Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic LeukemiaYuta Inagawa0Yukiko Komeno1Satoshi Saito2Yuji Maenohara3Tetsuro Yamagishi4Hiroyuki Kawashima5Taku Saito6Keiko Abe7Kuniko Iihara8Yasumasa Hatada9Tomiko Ryu10Department of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Tokyo, JapanDepartment of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Tokyo, JapanDepartment of Gastroenterology, JCHO Tokyo Yamate Medical Center, Tokyo, JapanDepartment of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, JapanDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, JapanDivision of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, JapanDepartment of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, JapanDepartment of Pathology, JCHO Tokyo Yamate Medical Center, Tokyo, JapanDepartment of Pathology, JCHO Tokyo Yamate Medical Center, Tokyo, JapanDepartment of Gastroenterology, JCHO Tokyo Yamate Medical Center, Tokyo, JapanDepartment of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Tokyo, JapanA 34-year-old woman was diagnosed with acute promyelocytic leukemia. Chemotherapy was administered following the JALSG APL204 protocol. Induction therapy with all-trans retinoic acid resulted in complete remission on day 49. She developed coccygeal pain from day 18, which spread to the spine and cheekbones and lasted 5 weeks. She had similar bone pain on days 7–10 of the first consolidation therapy and on days 4–12 of the second consolidation therapy. Oral loxoprofen was prescribed for pain relief. On day 33 of the third consolidation, white blood cell and neutrophil counts were 320/μL and 20/μL, respectively. After she developed epigastralgia and hematemesis, she developed septic shock. Gastroendoscopy revealed markedly thickened folds and diffusely damaged mucosa with blood oozing. Computed tomography revealed thickened walls of the antrum and the pylorus. Despite emergency treatments, she died. Bacterial culture of the gastric fluid yielded Enterobacter cloacae and enterococci growth. Collectively, she was diagnosed with phlegmonous gastritis. Retrospective examination of serial bone marrow biopsy specimens demonstrated progressive bone marrow fibrosis, which may have caused prolonged myelosuppression. Thus, evaluation of bone marrow fibrosis by bone marrow biopsy after each treatment cycle might serve as a predictor of persistent myelosuppression induced by chemotherapy.http://dx.doi.org/10.1155/2019/1616237 |
| spellingShingle | Yuta Inagawa Yukiko Komeno Satoshi Saito Yuji Maenohara Tetsuro Yamagishi Hiroyuki Kawashima Taku Saito Keiko Abe Kuniko Iihara Yasumasa Hatada Tomiko Ryu Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia Case Reports in Hematology |
| title | Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia |
| title_full | Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia |
| title_fullStr | Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia |
| title_full_unstemmed | Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia |
| title_short | Prolonged Myelosuppression due to Progressive Bone Marrow Fibrosis in a Patient with Acute Promyelocytic Leukemia |
| title_sort | prolonged myelosuppression due to progressive bone marrow fibrosis in a patient with acute promyelocytic leukemia |
| url | http://dx.doi.org/10.1155/2019/1616237 |
| work_keys_str_mv | AT yutainagawa prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT yukikokomeno prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT satoshisaito prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT yujimaenohara prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT tetsuroyamagishi prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT hiroyukikawashima prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT takusaito prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT keikoabe prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT kunikoiihara prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT yasumasahatada prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia AT tomikoryu prolongedmyelosuppressionduetoprogressivebonemarrowfibrosisinapatientwithacutepromyelocyticleukemia |