Vasculitis Associated with Malignancy EXPERIENCE WITH 13 PATIENTS AND LITERATURE REVIEW

Greer, J. M.; Longley, Selden; Edwards, N. Lawrence; Elfenbein, Gerald J.; Panush, Richard S.

doi:10.1097/00005792-198807000-00003

Cited by 210 publications

(77 citation statements)

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“…1988). Improvement in the severity of the vasculitis as the bone marrow function deteriorates has been reported (Greer et al, 1988), although this was not observed in one of our cases (case 2 ) whose disease transformed from refractory anaemia to refractory anaemia with an excess of blasts.…”

Section: Prodromal Cutaneous Vasculitis In Myelodysplastic Syndromescontrasting

confidence: 51%

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Prodromal Cutaneous Vasculitis in Myelodysplastic Syndromes

et al. 1990

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Correspondence MDS or AL secondary to chemoradiotherapy for malignancy ( 1 9 patients) or rheumatoid arthritis (one patient). Three patients with end-stage, therapy-resistant disease were excluded from this analysis. Since no patient had therapylinked refractory anaemia (RA) at the time of BMT, only data of patients with AL, refractory anaemia with excess of blasts in transformation (RAEBt) or RAEB were analysed. Six out of the 17 patients with therapy-linked MDS or AL died from transplant-related complications, compared to 1 3 out of 45 patients without previous cytotoxic therapy ( P > 0.5). Also the incidence of GVHD and interstitial pneumonia was not significantly increased. No spontaneous report was made of GVHD restricted to previously exposed areas, but this information was not specifically sought for.The second major issue of Dr Bandini's letter is whether a patient with therapy-linked AL or MDS should be induced into complete remission (CR) prior to BMT or not. Ten out of 20 therapy-linked MDS or AL (AL 3 , KAEBt: 4, RAEB: 3 ) have not received chemotherapy with the option to induce CR. Three patients relapsed, three died from transplantrelated complications, and four are alive without evidence of disease at 7 2 + , 59+, 56' and 1.5+ months after BMT. Only one patient transplanted with overt untreated AL is alive without evidence of leukaemia for more than a year. This patient was transplanted with a hypocellular marrow and she is one of the cases mentioned by Dr Bandini (Marmont & Tura, 1986). Seven patients received a transplant early after initiation of chemotherapy (five AML in CR and two RAEB with therapy-induced hypoplasia). None of these patients relapsed: four are alive without evidence of disease at 6 + , 44+, 50+ and 91 + months after BMT and three patients died from transplant-related complications. Three patients with therapy-resistant AML died from interstitial pneumonitis.The numbers are small, but patients transplanted for overt therapy-linked AL fared less well after BMT compared to patients transplanted in CK, similar to the results observed in the overall population transplanted for MDS or s-AML. More data and more follow-up will be needed to substantiate these observations. At present, data from 119 patients transplanted for MDS or secondary AL have been collected and future analyses will be directed at these issues.

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Section: Prodromal Cutaneous Vasculitis In Myelodysplastic Syndromescontrasting

confidence: 51%

“…Vasculitis is well recognized amongst both lymphoproliferative and myeloproliferative disorders (Greer et al 1988):…”

Section: Prodromal Cutaneous Vasculitis In Myelodysplastic Syndromesmentioning

confidence: 99%

Prodromal Cutaneous Vasculitis in Myelodysplastic Syndromes

et al. 1990

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“…1,2 Several proposed mechanisms for PAVS include: (i) ischemia from tumor antigen immune complex deposition in the small vessels of the digits, (ii) tumor infiltration into the cervical plexus resulting in the release of vasoconstrictor substances, (iii) direct endothelium invasion by the tumor cells, and (iv) hypersensitivity reaction. 4,7 However, these mechanisms are not consistent between patients. In one study, the pathology of the digits showed leukocytoclastic small vessels, which was histologically different from the vascular involvement normally seen in other diseases such as Rheumatoid arthritis, SLE, and Takayasu vasculitis.…”

Section: Discussionmentioning

confidence: 99%

“…1 The mean age of onset is 54.4 years old and vasculitis precedes the diagnosis of malignancy by an interval of 1-38 months with a mean of 10 months. 3,7 A number of authors have previously described atypical features that may raise suspicion for an underlying neoplastic versus primary rheumatologic pathology. Age greater than 50 years at presentation, atypical involvement of the digits, as well as poor response to steroids and vasodilating agents may indicate an underlying malignancy.…”

Section: Discussionmentioning

confidence: 99%

Paraneoplastic Acral Vascular Syndrome

Kopolovich¹,

Lagonosky²,

Greco³

et al. 2013

TMF

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“…Vasculitis is reported to occur during the course of malignancies in 2.3%-8% of patients (23). The incidence of vasculitis in cancer is estimated to be 1 in 1,800 for hemopathies and 1 in 80,800 for solid tumors (24). The relationship between vasculitis and malignancy remains unclear: e.g.…”

Section: Discussionmentioning

confidence: 99%