Department of Hematology and Oncology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
Department of Clinical Laboratory, the University of Tokyo Hospital, Tokyo, Japan.
J Clin Exp Hematop. 2023 Sep 28;63(3):187-192. doi: 10.3960/jslrt.23023. Epub 2023 Aug 28.
Thrombocytopenia is a frequent complication in chronic lymphocytic leukemia (CLL). Differentiating autoimmune thrombocytopenia from thrombocytopenia due to bone marrow infiltration is necessary for appropriate treatment, but sometimes difficult. Here we report a 60-year-old male patient with CLL who had achieved complete response after treatment with fludarabine, cyclophosphamide, and rituximab two years prior to presentation. He was admitted with severe thrombocytopenia that was unresponsive to intravenous immunoglobulin. Imaging studies revealed systemic enlarged lymph nodes and bone marrow aspiration was hypercellular with > 95% lymphocytes and scant megakaryocytes. Acalabrutinib 200 mg/day was administered for the treatment of CLL exacerbation. A gradual decrease in CLL cells and recovery of megakaryocytes in bone marrow were observed, but platelet counts remained low. Systemic administration of prednisolone 0.5 mg/kg, in addition to acalabrutinib, was started, considering the contribution of autoimmune thrombocytopenia; platelet recovery was rapid and sustained for more than a year. Even if bone marrow examination suggested thrombocytopenia due to direct leukemic infiltration, it is difficult to exclude the possibility of concomitant immunogenic thrombocytopenia. We conclude that for CLL patients with severe thrombocytopenia, repeating bone marrow examination and concurrent immunosuppressive therapies and treatment of the underlying CLL may be beneficial.
血小板减少症是慢性淋巴细胞白血病（CLL）的常见并发症。为了进行适当的治疗，有必要区分自身免疫性血小板减少症和骨髓浸润引起的血小板减少症，但有时这很困难。这里我们报告了一位 60 岁男性 CLL 患者，他在接受氟达拉滨、环磷酰胺和利妥昔单抗治疗两年后达到完全缓解。他因严重的血小板减少症入院，对静脉注射免疫球蛋白没有反应。影像学研究显示全身淋巴结肿大，骨髓抽吸显示细胞增生>95%为淋巴细胞，巨核细胞稀少。给予阿卡鲁替尼 200mg/天治疗 CLL 加重。观察到 CLL 细胞逐渐减少，骨髓中巨核细胞恢复，但血小板计数仍然较低。考虑到自身免疫性血小板减少症的可能性，除了阿卡鲁替尼外，还开始给予系统性泼尼松龙 0.5mg/kg 治疗；血小板恢复迅速且持续了一年多。即使骨髓检查提示直接白血病浸润引起的血小板减少症，也很难排除同时存在免疫性血小板减少症的可能性。我们得出结论，对于严重血小板减少症的 CLL 患者，重复骨髓检查、同时进行免疫抑制治疗和治疗基础 CLL 可能是有益的。
