Enfermedad por crioaglutinina del subtipo IgA como manifestación temprana de mieloma múltiple y resolución tras tratamiento con nuevos fármacos anti-mieloma

Acevedo, Carolina; Torres, E; Rivas, Miguel Ángel Álvarez

doi:10.1016/j.medcli.2016.09.010

Cited by 3 publications

(5 citation statements)

References 4 publications

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“…Some Authors warned that, despite rarity, clinical suspicion should be high, since AICy may confound and delay the initial ALL diagnosis [17,22,27]. Finally, some reports described the onset of AICy (including AIHA, ITP, AIN and ES) before, concomitantly or after multiple myeloma (MM), mainly resolving after MM treatment [18,23,24,28].…”

Section: Aicy In Other Lpdmentioning

confidence: 99%

Autoimmune Complications in Hematologic Neoplasms

Barcellini

Giannotta

Fattizzo

2021

Cancers

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Autoimmune cytopenias (AICy) and autoimmune diseases (AID) can complicate both lymphoid and myeloid neoplasms, and often represent a diagnostic and therapeutic challenge. While autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) are well known, other rarer AICy (autoimmune neutropenia, aplastic anemia, and pure red cell aplasia) and AID (systemic lupus erythematosus, rheumatoid arthritis, vasculitis, thyroiditis, and others) are poorly recognized. This review analyses the available literature of the last 30 years regarding the occurrence of AICy/AID in different onco-hematologic conditions. The latter include chronic lymphocytic leukemia (CLL), lymphomas, multiple myeloma, myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), myeloproliferative neoplasms, and acute leukemias. On the whole, AICy are observed in up to 10% of CLL and with higher frequencies in certain subtypes of non-Hodgkin lymphoma, whilst they occur in less than 1% of low-risk MDS and CMML. AID are described in up to 30% of myeloid and lymphoid patients, including immune-mediated hemostatic disorders (acquired hemophilia, thrombotic thrombocytopenic purpura, and anti-phospholipid syndrome) that may be severe and fatal. Additionally, AICy/AID are found in about 10% of patients receiving hematopoietic stem cell transplant or treatment with new checkpoint inhibitors. Besides the diagnostic difficulties, these AICy/AID may complicate the clinical management of already immunocompromised patients.

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Section: Aicy In Other Lpdmentioning

confidence: 99%

Autoimmune Complications in Hematologic Neoplasms

Barcellini

Giannotta

Fattizzo

2021

Cancers

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“…According to a fourth report, an IgA-CA was found to be an early manifestation of MM; this patient had clinical features of CAD, however, with marked symptoms of agglutination and only mild hemolysis [24]. A more recent paper described MM of the IgA type in a patient with CAD, but this report did not include sufficient data to determine whether the patient had one or two cell clones and whether the monoclonal IgA actually was the CA [9]. Römer et al further characterized an IgA-CA from a subject without clinical CAD and found that this CA was not able to initiate the classical or alternative complement pathway [25].…”

Section: Discussionmentioning

confidence: 99%

“…The involved autoantibodies, known as cold agglutinins (CAs), are monoclonal and directed against the erythrocyte surface carbohydrate antigen termed I [2, 5]. CAs in CAD are almost invariably of the immunoglobulin (Ig) Mk class, whereas descriptions of IgG or IgA immune phenotypes are rare, as it is λ light chain restriction [6–9]. CAD mainly affects elderly or middle-aged people with a median age of 72 years [7].…”

Section: Introductionmentioning

confidence: 99%

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Development of Multiple Myeloma of the IgA Type in a Patient with Cold Agglutinin Disease: Transformation or Coincidence?

Sefland

Randen

Berentsen

2019

Case Reports in Hematology

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Cold agglutinin disease (CAD) is an autoimmune hemolytic anemia and a distinct, clonal bone marrow lymphoproliferative disorder, characterized in most cases by a monoclonal IgMκ serum protein. We describe a CAD patient presenting with a monoclonal immunoglobulin of the IgAλclass. For years, she remained asymptomatic apart from the hemolytic anemia until eventually she developed multiple myeloma (MM) of the IgAλphenotype. Prior to the development of MM, her hemolytic anemia responded to rituximab monotherapy. After she was diagnosed with MM, both conditions responded well to bortezomib-based therapy. We performed further investigations to determine whether her MM represented a progression/transformation of CAD or an independent disease. Flow cytometry and biopsy findings convincingly confirmed two unrelated clonal B-cell disorders. On this background, we also discuss previously published reports on cold agglutinin activity in patients with IgA gammopathy. In conclusion, cold agglutinins of the IgA class do probably not result in CAD. If a monoclonal immunoglobulin other than IgMκ is found in a patient with CAD, the coexistence of two unrelated B-cell clones should be suspected.

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“…Most commonly, CAS is associated with CD5-negative/CD10-negative low-grade B-cell lymphomas with IgM monoclonal gammopathies, such as lymphoplasmacytic lymphoma. However, other non-Hodgkin’s lymphomas and more rarely plasma cell neoplasms can also be involved 2 3…”

Section: Introductionmentioning

confidence: 99%

IgA plasma cell myeloma presenting as cold agglutinin-induced haemolytic transfusion reaction

Mehdipour Dalivand,

Woddor,

Makuria

et al. 2024

BMJ Case Rep

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Cold agglutinins produced in the setting of B cell neoplasms, such as lymphoplasmacytic lymphoma and plasma cell myeloma, can mediate autoimmune haemolytic anemia. Transfusion of these patients can exacerbate cold agglutinin-mediated haemolysis. Moreover, the workup for these reactions represents a diagnostic challenge due in part to false negative direct antiglobulin tests (DATs). Here, we report an anaemic patient who after a red blood cell (RBC) transfusion performed without blood warming, experienced a DAT-negative haemolytic transfusion reaction, and was later diagnosed with IgA-multiple myeloma, which showed an uncommon granular pattern by CD138 immunohistochemistry. Extensive workup excluded other diagnostic possibilities, including the presence of Donath-Landsteiner antibodies and cryoglobulins. Successful treatment with CyBorD (cyclophosphamide, bortezomib and dexamethasone) achieved complete remission, and additional RBC transfusions using warmers were completed uneventfully.

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Enfermedad por crioaglutinina del subtipo IgA como manifestación temprana de mieloma múltiple y resolución tras tratamiento con nuevos fármacos anti-mieloma

Cited by 3 publications

References 4 publications

Autoimmune Complications in Hematologic Neoplasms

Autoimmune Complications in Hematologic Neoplasms

Development of Multiple Myeloma of the IgA Type in a Patient with Cold Agglutinin Disease: Transformation or Coincidence?

IgA plasma cell myeloma presenting as cold agglutinin-induced haemolytic transfusion reaction

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