CD56+ angioimmunoblastic T-cell lymphoma with evans syndrome : a case report and review of the literature.

A 67-year-old man was diagnosed with CD56(+) angioimmunoblastic T cell lymphoma (AITL), which was associated with autoimmune thrombocytopenic purpura (ATP) and autoimmune hemolytic anemia (AIHA) (Evans syndrome). The ATP was refractory to Helicobacter pylori eradication therapy and steroid. Complete remission (CR) of both AITL and AIHA was achieved with THP-COP chemotherapy (pirarubicin, cyclophosphamide, vincristine, and prednisolone), but ATP was not improved promptly. AITL associated with ATP has been reported in only 14 cases. The present case was not related to the serum interleukin-6 levels, suggesting the possibility of an association with other factors. This case is the first report of Evans syndrome associated with AITL. The AITL relapsed 2 months after CR. The AITL tumor were CD56-positive at initial diagnosis and CD56-negative at relapse, and showed complex additional chromosomal abnormalities, and the morphological characteristics of blast cells. CD56(+) AITL are rare, although CD56 expression has not been investigated in many cases ; our observations suggest that CD56 expression and its significance in AITL should be investigated in the future. There has been only one other case of CD56(+) AITL, the patient died 4 months after the diagnosis. Our patient reported showed early relapse, central nervous system infiltration and was refractory to treatment, suggesting that CD56 positivity may be a poor prognostic marker in patients with AITL. [J Clin Exp Hematop 53(1): 37-47, 2013].