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A Rare Onset of T-Lymphoid Blast Crisis in Chronic Myeloid Leukemia with Two Distinct Blast Populations. 慢性髓性白血病中罕见的 T 淋巴细胞暴发危象与两种不同的暴发群
IF 1.1 Q4 HEMATOLOGY Pub Date : 2024-06-27 DOI: 10.3390/hematolrep16030040
Alessandra Mongia, Francesca Romano, Sara Ciullini Mannurita, Benedetta Peruzzi, Sara Bencini, Daniela Parrini, Laura Fasano, Alessandra Fanelli

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by bone marrow expansion and the proliferation of one or more myeloid cell lineages, predominantly driven by the expression of the constitutively active fusion product tyrosine kinase BCR:ABL1. Rarely, CML patients directly develop a blast crisis (BC), mostly of myeloid origin. CML at blast crisis with a T-cell phenotype at diagnosis, without any prior history of CML, is extremely rare. Herein, we describe one rare CML case, in a young man showing an unusual and early T-lymphoid blastic crisis at diagnosis, as the first onset of a previously unknown CML. The multidisciplinary collaboration between laboratorians and clinicians for the diagnosis and management of this atypical case was crucial in outlining both a targeted pharmacological treatment and a successful hematopoietic stem cell transplantation.

慢性髓性白血病(CML)是一种骨髓增生性肿瘤,其特点是骨髓增生和一个或多个髓系细胞增殖,主要由组成型活性融合产物酪氨酸激酶 BCR:ABL1 的表达驱动。极少数情况下,CML 患者会直接出现鼓风危象 (BC),多数为髓系细胞来源。诊断时具有 T 细胞表型的爆发危象 CML,且之前没有任何 CML 病史,这种情况极为罕见。在此,我们描述了一个罕见的 CML 病例,患者是一名年轻男性,诊断时表现出不寻常的早期 T 淋巴细胞暴发性危象,是之前未知的 CML 首次发病。在诊断和处理这一非典型病例的过程中,实验室医生和临床医生之间的多学科合作对于制定有针对性的药物治疗方案和成功进行造血干细胞移植至关重要。
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引用次数: 0
Treatment of Immune Thrombocytopenia: Contextualization from a Historical Perspective. 免疫性血小板减少症的治疗:从历史角度看背景。
IF 1.1 Q4 HEMATOLOGY Pub Date : 2024-06-26 DOI: 10.3390/hematolrep16030039
Daniel Martínez-Carballeira, Ángel Bernardo, Alberto Caro, Inmaculada Soto, Laura Gutiérrez

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by an isolated decrease in platelet count and an increased risk of bleeding. The pathogenesis is complex, affecting multiple components of the immune system and causing both peripheral destruction of platelets and inadequate production in the bone marrow. In this article, we review the treatment of ITP from a historical perspective, discussing first line and second line treatments, and management of refractory disease.

免疫性血小板减少症(ITP)是一种自身免疫性疾病,其特点是血小板数量减少和出血风险增加。其发病机制复杂,影响免疫系统的多个组成部分,导致血小板外周破坏和骨髓生成不足。本文从历史角度回顾了 ITP 的治疗,讨论了一线和二线治疗以及难治性疾病的处理。
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引用次数: 0
Neutropenia in Childhood-A Narrative Review and Practical Diagnostic Approach. 儿童中性粒细胞减少症--叙事回顾与实用诊断方法。
IF 1.1 Q4 HEMATOLOGY Pub Date : 2024-06-16 DOI: 10.3390/hematolrep16020038
Georgios Katsaras, Silouani Koutsi, Evdokia Psaroulaki, Dimitra Gouni, Pelagia Tsitsani

Neutropenia refers to a decrease in the absolute neutrophil count according to age and race norms and poses a common concern in pediatric practice. Neutrophils serve as host defenders and act crucially in acute inflammation procedures. In this narrative review, we systematically present causes of neutropenia in childhood, mainly adopting the pathophysiological classification of Frater, thereby studying (1) neutropenia with reduced bone marrow reserve, (2) secondary neutropenia with reduced bone marrow reserve, and (3) neutropenia with normal bone marrow reserve. Different conditions in each category are thoroughly discussed and practically approached from the clinician's point of view. Secondary mild to moderate neutropenia is usually benign due to childhood viral infections and is expected to resolve in 2-4 weeks. Bacterial and fungal agents are also associated with transient neutropenia, although fever with severe neutropenia constitutes a medical emergency. Drug-induced and immune neutropenias should be suspected following a careful history and a detailed clinical examination. Cytotoxic chemotherapies treating malignancies are responsible for severe neutropenia and neutropenic shock. Rare genetic neutropenias usually manifest with major infections early in life. Our review of taxonomies clinical findings and associates them to specific neutropenia disorders. We consequently propose a practical diagnostic algorithm for managing neutropenic children.

中性粒细胞减少症是指根据年龄和种族标准,中性粒细胞绝对计数减少,是儿科常见的问题。中性粒细胞是宿主的保卫者,在急性炎症过程中起着至关重要的作用。在这篇叙述性综述中,我们系统地介绍了儿童期中性粒细胞减少症的病因,主要采用了弗雷特的病理生理学分类法,从而研究了(1)骨髓储备减少的中性粒细胞减少症;(2)骨髓储备减少的继发性中性粒细胞减少症;以及(3)骨髓储备正常的中性粒细胞减少症。从临床医生的角度出发,对每个类别中的不同情况进行了深入讨论和实际操作。继发性轻度至中度中性粒细胞减少症通常是良性的,由儿童病毒感染引起,预计会在 2-4 周内缓解。细菌和真菌感染也会导致一过性中性粒细胞减少症,但发热伴严重中性粒细胞减少症属于急症。在仔细询问病史和进行详细的临床检查后,应怀疑是药物引起的中性粒细胞减少症和免疫性中性粒细胞减少症。治疗恶性肿瘤的细胞毒性化疗可导致严重的中性粒细胞减少症和中性粒细胞减少性休克。罕见的遗传性中性粒细胞减少症通常表现为生命早期的重大感染。我们的综述对临床发现进行了分类,并将其与特定的中性粒细胞减少症联系起来。因此,我们提出了一种实用的诊断算法,用于治疗中性粒细胞减少症患儿。
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引用次数: 0
Morphological Clues of Acute Monocytic Leukemia in COVID-19-Induced Transient Leukoerythroblastic Reaction with Monocytosis. COVID-19 诱导的伴有单核细胞增多的一过性红细胞白血病反应中急性单核细胞白血病的形态学线索
IF 1.1 Q4 HEMATOLOGY Pub Date : 2024-05-28 DOI: 10.3390/hematolrep16020033
Ingrid S Tam, Mohamed Elemary, John DeCoteau, Anna Porwit, Emina E Torlakovic

Viral infections, including those caused by COVID-19, can produce striking morphologic changes in peripheral blood. Distinguishing between reactive changes and abnormal morphology of monocytes remains particularly difficult, with low consensus rates reported amongst hematopathologists. Here, we report a patient who developed transient monocytosis of 11.06 × 109/L with 32% promonocytes and 1% blasts during hospitalization that was secondary to severe COVID-19 infection. Three days later, the clinical status of the patient improved and the WBC had decreased to 8.47 × 109/L with 2.2 × 109/L monocytes. Flow cytometry studies did not reveal immunophenotypic findings specific for an overt malignant population. At no time during admission did the patient develop cytopenia(s), and she was discharged upon clinical improvement. However, the peripheral blood sample containing promonocytes was sent for molecular testing with an extended next-generation sequencing myeloid panel and was positive for pathogenic NPM1 Type A and DNMT3A R882H mutations. Subsequently, despite an essentially normal complete blood count, the patient underwent a bone marrow assessment that showed acute myeloid leukemia with 77% promonocytes. This case emphasizes the critical importance of a full work up to exclude acute leukemia when classical promonocyte morphology is encountered in the peripheral blood. Promonocytes are not a part of the reactive changes associated with COVID-19 and remain specific to myeloid neoplasia.

病毒感染(包括由 COVID-19 引起的感染)可在外周血中产生显著的形态变化。区分单核细胞的反应性变化和异常形态仍然特别困难,血液病理学家之间的共识率很低。在此,我们报告了一名因严重 COVID-19 感染而在住院期间出现一过性单核细胞增多症的患者,其单核细胞为 11.06 × 109/L,原核细胞占 32%,1% 为血泡。三天后,患者的临床状况有所改善,白细胞降至 8.47 × 109/L,其中单核细胞为 2.2 × 109/L。流式细胞术研究没有发现明显恶性肿瘤的特异免疫表型。患者在入院期间从未出现细胞减少症,临床症状好转后便出院了。然而,含有原核细胞的外周血样本被送去进行分子检测,经扩展的新一代测序骨髓细胞面板检测,发现致病性 NPM1 A 型和 DNMT3A R882H 突变呈阳性。随后,尽管全血细胞计数基本正常,但患者接受了骨髓评估,结果显示其患有急性髓性白血病,原核细胞占 77%。该病例强调,当外周血中出现典型的原核细胞形态时,全面检查以排除急性白血病至关重要。原核细胞不属于与 COVID-19 相关的反应性变化,仍然是髓细胞瘤的特异性表现。
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引用次数: 0
Phase II Trial of Romidepsin as Consolidation Therapy after Gemcitabine, Dexamethasone, and Cisplatin in Elderly Transplant-Ineligible Patients with Relapsed/Refractory Peripheral T-Cell Lymphoma. 罗米地平作为吉西他滨、地塞米松和顺铂治疗后的巩固疗法,用于不符合移植条件的老年复发性/难治性外周T细胞淋巴瘤患者的II期试验。
IF 1.1 Q4 HEMATOLOGY Pub Date : 2024-05-28 DOI: 10.3390/hematolrep16020034
Satoshi Yamasaki, Hiroatsu Iida, Akio Saito, Morio Matsumoto, Yoshiaki Kuroda, Tohru Izumi, Akiko M Saito, Hiroaki Miyoshi, Koichi Ohshima, Hirokazu Nagai, Hiromi Iwasaki

Romidepsin is an important therapeutic option for patients with peripheral T-cell lymphoma (PTCL). However, the timing of romidepsin administration remains controversial. The objective of this study was to characterize the safety and efficacy of romidepsin as consolidation therapy after gemcitabine, dexamethasone, and cisplatin (GDP) therapy (GDPR). This study of patients treated between March 2019 and March 2021 was registered with the Japan Registry of Clinical Trials (registration number: jRCT0000000519). If complete response, partial response, or stable disease was confirmed after 2-4 GDP cycles, romidepsin was administered every 4 weeks for 1 year. Seven patients with relapsed/refractory (R/R) PTCL (T-follicular helper phenotype [n = 1] and angioimmunoblastic T-cell lymphoma [n = 6]) were included in this prospective study (PTCL-GDPR). After a median follow-up of 34 months of patients in PTCL-GDPR, the 2-year overall survival rate was 71%, and the overall response rate after treatment was 57%. Common adverse events in patients with PTCL-GDPR included hematological toxicities such as neutropenia, which improved with supportive treatment. There were no treatment-related mortalities. GDPR might be safe and effective in elderly transplant-ineligible patients with R/R PTCL; however, further investigation is required.

罗米地辛是外周T细胞淋巴瘤(PTCL)患者的重要治疗选择。然而,罗米地平的用药时机仍存在争议。本研究旨在确定罗米地平作为吉西他滨、地塞米松和顺铂(GDP)治疗(GDPR)后巩固治疗的安全性和有效性。这项针对 2019 年 3 月至 2021 年 3 月期间接受治疗的患者的研究已在日本临床试验注册中心注册(注册号:jRCT0000000519)。如果2-4个GDP周期后确认完全应答、部分应答或病情稳定,则每4周给予一次罗米地平,持续1年。这项前瞻性研究(PTCL-GDPR)共纳入了七名复发/难治性(R/R)PTCL(T-滤泡辅助表型[n = 1]和血管免疫母细胞T细胞淋巴瘤[n = 6])患者。PTCL-GDPR患者的中位随访时间为34个月,2年总生存率为71%,治疗后总反应率为57%。PTCL-GDPR患者常见的不良反应包括中性粒细胞减少等血液学毒性反应,这些反应在接受支持性治疗后有所改善。没有出现与治疗相关的死亡病例。GDPR可能对不符合移植条件的老年R/R PTCL患者安全有效,但仍需进一步研究。
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引用次数: 0
Appropriate Treatment Intensity for Diffuse Large B-Cell Lymphoma in the Older Population: A Review of the Literature. 老年弥漫性大 B 细胞淋巴瘤的适当治疗强度:文献综述。
IF 1.1 Q4 HEMATOLOGY Pub Date : 2024-05-24 DOI: 10.3390/hematolrep16020032
Satoshi Yamasaki

Most patients with diffuse large B-cell lymphoma (DLBCL) are >65 years of age, with the number of patients expected to increase in the coming years. A comprehensive geriatric assessment that carefully evaluates fitness status and comorbidities is essential for selecting the appropriate treatment intensity. Although generally healthy patients or those <80 years of age may benefit from standard immunochemotherapy, unfit/frail patients or patients >80 years old may require reduced-intensity chemotherapy or less-toxic drugs. Some new drugs are currently being tested as single or combined agents for first-line treatment, aiming to improve the outcomes of conventional chemotherapy. This review systematically collates and discusses the outcomes associated with the use of immunochemotherapy in older patients with DLBCL, as well as considering the impact of full-dose immunochemotherapy on quality of life in older and frail patients, summarizing the rationale for reduced dosing in the older population, and presenting recommendations for selecting patients likely to benefit from reduced dosing. If preliminary efficacy and safety data are confirmed in future clinical trials, non-chemotherapy-based immunotherapy approaches could become an alternative potentially curative option in frail patients and those >80 years of age with DLBCL.

大多数弥漫大 B 细胞淋巴瘤(DLBCL)患者年龄大于 65 岁,预计未来几年患者人数还会增加。要选择适当的治疗强度,必须进行全面的老年病评估,仔细评估身体状况和合并症。虽然一般健康的患者或 80 岁的患者可能需要降低化疗强度或使用毒性较低的药物。目前,一些新药正作为单药或联合用药进行一线治疗试验,旨在改善传统化疗的疗效。本综述系统地整理和讨论了老年DLBCL患者使用免疫化疗的相关结果,并考虑了全剂量免疫化疗对老年和体弱患者生活质量的影响,总结了在老年人群中减少剂量的理由,并提出了选择可能从减少剂量中获益的患者的建议。如果初步的疗效和安全性数据在未来的临床试验中得到证实,非化疗免疫疗法可能成为体弱患者和年龄大于80岁的DLBCL患者的另一种潜在治疗选择。
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引用次数: 0
Current Therapeutic Sequencing in Chronic Lymphocytic Leukemia. 当前慢性淋巴细胞白血病的治疗排序。
IF 0.9 Q4 HEMATOLOGY Pub Date : 2024-04-30 DOI: 10.3390/hematolrep16020027
Samir Mouhssine, Nawar Maher, Sreekar Kogila, Claudio Cerchione, Giovanni Martinelli, Gianluca Gaidano

The treatment landscape of chronic lymphocytic leukemia (CLL), the most frequent leukemia in adults, is constantly changing. CLL patients can be divided into three risk categories, based on their IGHV mutational status and the occurrence of TP53 disruption and/or complex karyotype. For the first-line treatment of low- and intermediate-risk CLL, both the BCL2 inhibitor venetoclax plus obinutuzumab and the second generation BTK inhibitors (BTKi), namely acalabrutinib and zanubrutinib, are valuable and effective options. Conversely, venetoclax-based fixed duration therapies have not shown remarkable results in high-risk CLL patients, while continuous treatment with acalabrutinib and zanubrutinib displayed favorable outcomes, similar to those obtained in TP53 wild-type patients. The development of acquired resistance to pathway inhibitors is still a clinical challenge, and the optimal treatment sequencing of relapsed/refractory CLL is not completely established. Covalent BTKi-refractory patients should be treated with venetoclax plus rituximab, whereas venetoclax-refractory CLL may be treated with second generation BTKi in the case of early relapse, while venetoclax plus rituximab might be used if late relapse has occurred. On these grounds, here we provide an overview of the current state-of-the-art therapeutic algorithms for treatment-naïve patients, as well as for relapsed/refractory disease.

慢性淋巴细胞白血病(CLL)是成人中最常见的白血病,其治疗方法也在不断变化。根据患者的 IGHV 突变状态、TP53 干扰和/或复杂核型,CLL 患者可分为三种风险类别。对于低危和中危CLL的一线治疗,BCL2抑制剂venetoclax加obinutuzumab和第二代BTK抑制剂(BTKi),即acalabrutinib和zanubrutinib,都是有价值和有效的选择。相反,以venetoclax 为基础的固定疗程疗法在高风险 CLL 患者中并未显示出显著疗效,而以 acalabrutinib 和 zanubrutinib 为基础的持续治疗则显示出良好疗效,与 TP53 野生型患者的疗效相似。对通路抑制剂产生获得性耐药性仍是一项临床挑战,复发/难治性CLL的最佳治疗顺序尚未完全确定。共价BTKi难治性患者应使用文尼考昔(venetoclax)加利妥昔单抗治疗,而文尼考昔(venetoclax)难治性CLL在早期复发时可使用第二代BTKi治疗,如果晚期复发,则可使用文尼考昔(venetoclax)加利妥昔单抗治疗。有鉴于此,我们在此概述了目前针对治疗无效患者以及复发/难治性疾病的最先进治疗算法。
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引用次数: 0
Is There an Association between a Tonsillar Diffuse Large B-Cell Lymphoma Arising after a Neck Squamous Cell Carcinoma of Occult Primary? A Case Report and Extensive Literature Review. 颈部隐匿原发鳞状细胞癌后出现扁桃体弥漫大 B 细胞淋巴瘤之间有关联吗?病例报告和广泛的文献综述。
IF 0.9 Q4 HEMATOLOGY Pub Date : 2024-04-29 DOI: 10.3390/hematolrep16020026
Dimitris Tatsis, Athena Niakou, Konstantinos Paraskevopoulos, Stavroula Papadopoulou, Konstantinos Vahtsevanos

Objectives: The aim of this review is to focus on the possibility of patients with squamous cell carcinoma to develop a second primary disease such as DLBCL, perhaps because of the irradiation of the head and neck area.

Materials and methods: A case of an 89-year-old man is reported, who initially underwent surgical and complementary treatment for neck squamous cell carcinoma of occult primary and later for tonsillar diffuse large B-cell non-Hodgkin lymphoma.

Results: The second primary was considered a recurrence in the neck of the original cancer of unknown primary, so a new surgical management was decided. The final pathology report described a diffuse large B-cell non-Hodgkin lymphoma.

Conclusions: The importance of maintaining follow-ups for patients with occult primary cancers who are at an elevated risk of developing a metastasis or a second primary carcinoma outbreak is highlighted.

目的:本综述旨在关注鳞状细胞癌患者可能因头颈部受到照射而发展为第二种原发性疾病(如 DLBCL)的可能性:报告了一例 89 岁的男性患者,他最初因颈部隐匿原发鳞状细胞癌接受了手术和辅助治疗,后来又因扁桃体弥漫大 B 细胞非霍奇金淋巴瘤接受了手术和辅助治疗:结果:第二原发癌被认为是原发灶不明的颈部癌症复发,因此决定采取新的手术治疗。最终病理报告显示为弥漫大 B 细胞非霍奇金淋巴瘤:结论:对于原发癌隐匿、发生转移或爆发第二原发癌风险较高的患者,坚持随访非常重要。
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引用次数: 0
Indolent T Cell Lymphoproliferation of the Gastrointestinal Tract: An Evolving Disease Entity. 胃肠道的懒惰 T 细胞淋巴细胞增生:一种不断演变的疾病实体。
IF 0.9 Q4 HEMATOLOGY Pub Date : 2024-03-22 DOI: 10.3390/hematolrep16020018
Luke Wang, Elaine Koh, Beena Kumar, Michael S Y Low

Background: Indolent T cell lymphoproliferation of the gastrointestinal tract is a novel entity recently added to the 2016 WHO classification of lymphoid neoplasms. Classically, these patients demonstrate an immunophenotype consistent with T cell proliferation and can be either CD4-positive or CD8-positive but with a low Ki67 index, highlighting the indolent nature of this disease compared to its more aggressive T cell lymphoma counterparts such as enteropathy-associated T cell lymphoma and monomorphic epitheliotropic intestinal T cell lymphoma. Methods: Here, we describe one rare case of such a neoplasm under our care, initially presenting with non-specific signs and symptoms and requiring extensive investigations to diagnose. Available cases in the literature reflect a wide variety of ages and ethnicities affected, and any part of the gastrointestinal sites can be affected, which makes diagnosis difficult and prolonged; however, progression beyond lymph nodes is rare, and prognosis is otherwise favourable, particularly if CD8-positive. The optimal management of these patients remains yet to be defined, given the paucity of available cases currently. The current evidence suggests the utility of steroids, cyclosporine, radiotherapy, and a potential role for JAK inhibitors. Conclusions: Our case showed an excellent response to the initial course of steroids, with a subsequent successful transition to cyclosporine, keeping symptoms at bay with ongoing stable disease.

背景:胃肠道惰性T细胞淋巴细胞增生是最近被列入2016年世界卫生组织淋巴肿瘤分类的一个新实体。通常,这些患者表现出与 T 细胞增生一致的免疫表型,可为 CD4 阳性或 CD8 阳性,但 Ki67 指数较低,与更具侵袭性的 T 细胞淋巴瘤(如肠病相关 T 细胞淋巴瘤和单形上皮细胞性肠 T 细胞淋巴瘤)相比,这种疾病的性质更为缓和。方法:我们在此描述了一例罕见的此类肿瘤病例,该病例最初表现为非特异性症状和体征,需要进行大量检查才能确诊。现有文献中的病例反映出患者的年龄和种族差异很大,胃肠道的任何部位都可能受累,这给诊断带来了困难并延长了诊断时间;不过,淋巴结以外的进展很少见,预后良好,尤其是在 CD8 阳性的情况下。鉴于目前可用病例较少,这些患者的最佳治疗方法仍有待确定。目前的证据表明,类固醇、环孢素、放疗是有用的,JAK 抑制剂也可能发挥作用。结论:我们的病例对类固醇的初始疗程反应良好,随后成功过渡到环孢素,症状得到控制,病情持续稳定。
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引用次数: 0
Uncommon Presentation of Sarcoidosis with Severe Thrombocytopenia and Hemorrhagic Diathesis. 肉样瘤病伴有严重血小板减少和出血症状的罕见表现。
IF 0.9 Q4 HEMATOLOGY Pub Date : 2024-03-04 DOI: 10.3390/hematolrep16010013
Dorela Lame, Michelangelo Pianelli, Shahram Kordasti, Erika Morsia, Attilio Olivieri, Antonella Poloni

Sarcoidosis, a multi-organ system disease, often presents insidiously. Thrombocytopenia in sarcoidosis is frequent because of hypersplenism, granulomas infiltrating the bone marrow, or immune thrombocytopenia (ITP). The diagnosis of ITP relies on exclusionary criteria, given the absence of a definitive laboratory diagnostic feature. In the era prior to modern ITP management, sarcoidosis-associated ITP was known to manifest severely, often showing resistance to treatment and an increased risk of mortality. In this case, we present a young male who was admitted to a district hospital's emergency room, displaying symptoms of hematuria, gingival bleeding, and a petechial rash. Blood tests revealed severe thrombocytopenia with a platelet count of 0, while all other metabolic and serological exams returned normal results. Infectious and autoimmune causes were ruled out, and a bone marrow examination excluded any hematological disorder. Initial management, including platelet transfusion and presumptive treatment for ITP with dexamethasone and Human Immunoglobulin IV (IVIG), failed to improve the patient's platelet count or alleviate the hemorrhagic diathesis. Second-line therapy with Rituximab and Methylprednisolone was initiated with no benefit. Considering the hemorrhagic signs and the delayed response of Rituximab, we shifted to third-line therapy with Romiplostim at the maximal dose and continued Methylprednisolone. The platelet count recovered completely after the second Romiplostim administration (over 350 × 109 platelets/L) and Methylprednisolone was rapidly tapered. To further study the causes of thrombocytopenia a total body CT scan was performed and it identified non-homogeneously hypodense tissue in the bilateral hilar area extending medially to the subcarinal area, suggesting possible lymphatic origin and raising suspicion of sarcoidosis. Further investigations, including Angiotensin Converting Enzyme (ACE) titration, bronchoscopy, bronchoalveolar lavage, and EndoBronchial UltraSound-guided TransBronchial Needle Aspiration (EBUS-TBNA), confirmed the diagnosis of sarcoidosis. Despite a mild restrictive insufficiency noted in spirometry, the patient remained asymptomatic with only a mild respiratory insufficiency, and hence, was enlisted for follow-up. As for the ITP, the platelet count remained normal over a year. Notably, while sarcoidosis onset often predates ITP onset by an average of 48 months, in our case the onset of the two diseases was simultaneously. Our case adds valuable information to the limited body of knowledge regarding the treatment of sarcoidosis-associated ITP.

肉样瘤病是一种多器官系统疾病,常常隐匿发病。由于脾功能亢进、骨髓肉芽肿浸润或免疫性血小板减少症(ITP),肉样瘤病中经常出现血小板减少症。由于缺乏明确的实验室诊断特征,ITP 的诊断依赖于排除性标准。在现代 ITP 治疗之前的时代,肉样瘤病相关的 ITP 表现严重,常常表现出抗药性,死亡风险增加。在本病例中,我们介绍了一名在地区医院急诊室住院的年轻男性,他表现出血尿、牙龈出血和瘀点皮疹等症状。血液化验显示血小板严重减少,血小板计数为 0,而其他代谢和血清学检查结果均正常。排除了感染和自身免疫原因,骨髓检查排除了任何血液病。最初的治疗包括输注血小板以及使用地塞米松和人免疫球蛋白IV(IVIG)对ITP进行假定性治疗,但未能改善患者的血小板计数或缓解出血症状。开始使用利妥昔单抗和甲泼尼龙进行二线治疗,但没有任何效果。考虑到出血症状和利妥昔单抗的延迟反应,我们转而使用最大剂量的罗米波司汀进行三线治疗,并继续使用甲泼尼龙。第二次使用 Romiplostim 后,血小板计数完全恢复(超过 350 × 109 个血小板/升),甲基强的松龙也迅速减量。为了进一步研究血小板减少症的病因,患者接受了全身 CT 扫描,结果发现双侧肝区有非均质性低密度组织,向内侧延伸至心包下区,这表明可能存在淋巴来源,并引起了对肉样瘤病的怀疑。进一步的检查,包括血管紧张素转换酶(ACE)滴定、支气管镜检查、支气管肺泡灌洗和支气管内超声引导下经支气管针吸术(EBUS-TBNA),证实了肉样瘤病的诊断。尽管肺活量检查发现患者有轻度限制性呼吸功能不全,但患者仍无症状,仅有轻度呼吸功能不全,因此被要求进行随访。至于 ITP,血小板计数在一年内保持正常。值得注意的是,肉样瘤病的发病时间通常比 ITP 的发病时间平均早 48 个月,而在我们的病例中,两种疾病是同时发病的。我们的病例为治疗肉样瘤病相关 ITP 的有限知识库增添了宝贵的信息。
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Hematology Reports
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