Hairy cell leukemia complicated by bone marrow necrosis following cladribine administration

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  • TERAO Toshiki
    National Cancer Center Hospital East, Dept. of Hematology/Oncology
  • YUDA Junichiro
    National Cancer Center Hospital East, Dept. of Hematology/Oncology
  • YAMAUCHI Nobuhiko
    National Cancer Center Hospital East, Dept. of Hematology/Oncology
  • MIYAMOTO Kenichi
    National Cancer Center Hospital East, Dept. of Hematology/Oncology
  • MINAMI Mariko
    Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine Science
  • KOJIMA Motohiro
    National Cancer Center Hospital East, Dept. of Pathology and Clinical Laboratories
  • SUGANO Masato
    National Cancer Center Hospital East, Dept. of Pathology and Clinical Laboratories
  • KUWATA Takeshi
    National Cancer Center Hospital East, Dept. of Pathology and Clinical Laboratories
  • MINAMI Yosuke
    National Cancer Center Hospital East, Dept. of Hematology/Oncology

Bibliographic Information

Other Title
  • Cladribine投与後に骨髄壊死を併発したhairy cell leukemia
  • 症例報告 Cladribine投与後に骨髄壊死を併発したhairy cell leukemia
  • ショウレイ ホウコク Cladribine トウヨ ゴ ニ コツズイ エシ オ ヘイハツ シタ hairy cell leukemia

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Abstract

<p>Classic hairy cell leukemia (classic HCL) is a rare disease associated with indolent mature B-cell lymphoma. A 50-year-old man presented with pancytopenia for 3 years and was diagnosed with classic HCL because his lymphoid cells showed a hairy morphology with oval nuclei and indistinct nucleoli both in the peripheral blood and bone marrow (BM) smears. Flow cytometric analysis revealed that these cells expressed CD11c, CD25, and CD103, and the Sanger sequence method detected BRAF V600E mutation. Cladribine (0.09 mg/kg/day) was initiated for 7 days via continuous intravenous injection. On day 13, the patient died from bloodstream infection caused by methicillin-resistant Staphylococcus epidermidis. Autopsy findings revealed BM necrosis without residual leukemia cells caused by classic HCL, severe infection, and agents, such as cladribine and granulocyte-colony stimulating factor; however, its cause remained undetermined. Both early diagnosis and immediate clinical intervention are required to improve the clinical outcomes in classic HCL. The cause of hematopoiesis disturbance should also be identified using BM biopsy or magnetic resonance imaging before initiating treatment in classic HCL with severe pancytopenia.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 60 (6), 559-564, 2019

    The Japanese Society of Hematology

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