Factor VIII inhibitor prior to and during secondary acute nonlymphocytic leukemia in a patient with cured Hodgkin's disease

Leukemia & Lymphoma
M BendandiS Tura

Abstract

We report a 54-year-old patient with Hodgkin's disease who achieved a complete remission after combined modality treatment. Three years later the patient developed a severe hemorrhagic syndrome, concomitant with the onset of a factor VIII inhibitor in plasma. The control of very proteiform bleedings was extremely difficult, even with plasmaphereses, as well as with immunosuppressive and substitutive therapies. Two years later, a secondary acute nonlymphocytic leukemia (ANLL) was diagnosed. Two courses of chemotherapy with fludarabine, cytosine arabinoside and G-CSF (FLAG) were able to obtain a complete remission. Hemorrhagic complications were mainly linked to thrombocytopenia and continued until recovery of thrombopoiesis. Factor VIII inhibitor levels and related clinical symptoms decreased progressively. In conclusion, we suggest that FLAG succeeded in inhibiting an abnormal lymphoid clone responsible for factor VIII inhibitor production, suggesting a possible role for intensive chemotherapy in similar situations, which are often refractory to conventional immunosuppressive and depletive therapy.

References

Aug 1, 1993·Annals of Oncology : Official Journal of the European Society for Medical Oncology·P L ZinzaniR Fanin

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Citations

Sep 14, 2001·Haemophilia : the Official Journal of the World Federation of Hemophilia·S ReginaY Gruel
Oct 21, 2015·La Revue de médecine interne·V Le Cam-Duchez
Sep 16, 2010·Pediatric Blood & Cancer·Cheryll Clark, Vinod K Gidvani

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