scholarly journals A case of metastatic prostate cancer and immune thrombocytopenia

2017 ◽  
Vol 24 (5) ◽  
pp. 434 ◽  
Author(s):  
D.M. Betsch ◽  
S. Gray ◽  
S.E. Zed
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Advanced Prostate Cancer ◽  
Immune Thrombocytopenia ◽  
Metastatic Prostate Cancer ◽  
Bone Marrow Involvement ◽  
Bone Marrow Infiltration ◽  
Advanced Malignancy ◽  
New Diagnosis

Prostate cancer frequently metastasizes to bone, but bone marrow involvement is relatively less common. In advanced prostate cancer, significant bone marrow infiltration can result in hematologic abnormalities such as anemia and thrombocytopenia. We report the case of a patient who presented with a new diagnosis of thrombocytopenia at the same time that he presented with prostate cancer metastatic to bone. He was found to have immune thrombocytopenia (itp) which responded to treatment with steroids. We discuss this case and review the literature on itp in the setting of advanced malignancy.

scholarly journals Metastatic prostate cancer with bone marrow infiltration mimicking multiple myeloma

2017 ◽  
Vol 6 (2) ◽  
pp. 269-273 ◽  
Author(s):  
Pankaj Mathur ◽  
Daisy Alapat ◽  
Manoj Kumar ◽  
Sharmilan Thanendrarajan
Keyword(s):  
Prostate Cancer ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Metastatic Prostate Cancer ◽  
Bone Marrow Infiltration

scholarly journals Leukoerythroblastosis in castration-resistant prostate cancer: A clue to diffuse bone marrow carcinomatosis

2019 ◽  
Vol 9 (2) ◽  
Author(s):  
Frank Sheng Fan ◽  
Chung-Fan Yang
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Disseminated Intravascular Coagulation ◽  
Advanced Prostate Cancer ◽  
Bone Marrow Involvement ◽  
Specific Antigen ◽  
Previous History ◽  
Elevated Serum ◽  
Bone Marrow Examination ◽  
Intravascular Coagulation

A 66-year-old man with a previous history of advanced prostate cancer failing complete androgen blockade, docetaxel chemotherapy, denosumab, and abiraterone acetate as judged by persistent high serum levels of prostate specific antigen presented with exertional dyspnea, normocytic anemia, and thrombocytopenia. Leukoerythroblastosis was noted in his peripheral blood. Bone marrow examination disclosed diffuse bone marrow carcinomatosis from prostate cancer. Prolonged activated partial thromboplastin time, prothrombin time, and an extremely elevated serum level of D-dimer led to a diagnosis of disseminated intravascular coagulation. Magnetic resonance imaging of spine revealed extensive bone marrow involvement but bone scan showed only scanty bony metastasis. We like to call attention to the importance of prompt bone marrow examination once recognizing leukoerythroblastosis in patients with advanced prostate cancer. Survey of a possible coexistent disseminated intravascular coagulation is as well strongly recommended in this condition.

scholarly journals microRNA expression in tumour tissue and plasma in patients with newly diagnosed metastatic prostate cancer

Tumor Biology ◽  
2018 ◽  
Vol 40 (5) ◽  
pp. 101042831877586 ◽  
Author(s):  
Ahmed Hussein Zedan ◽  
Torben Frøstrup Hansen ◽  
Jannie Assenholt ◽  
Mindaugas Pleckaitis ◽  
Jonna Skov Madsen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Plasma Level ◽  
Advanced Prostate Cancer ◽  
Metastatic Prostate Cancer ◽  
Locally Advanced ◽  
Tumour Tissue ◽  
Newly Diagnosed ◽  
Locally Advanced Prostate Cancer ◽  
Mirna 93 ◽  
Benign Prostate

Prostate cancer is the most common cancer among men in the western world. Clinical practice is continuously challenged by the pitfalls of the available diagnostic tools. microRNAs may represent promising biomarkers in many types of human cancers, including prostate cancer. The aim of this study was to investigate microRNA expression in tumour tissue and matched plasma in a cohort of patients with primary metastatic prostate cancer. The relative expression of 12 microRNAs was assessed in diagnostic needle biopsies from the prostate and matched plasma samples in two prospective cohorts (screening cohorts) comprising 21 patients with metastatic prostate cancer and 25 control patients. An independent validation cohort of plasma samples was collected prospectively from 149 newly diagnosed patients with local/locally advanced prostate cancer. Analyses were performed using real-time polymerase chain reaction. miRNA-93 showed a significant negative correlation between expression in tumour tissue and plasma in patients with metastatic prostate cancer. Furthermore, the plasma level of miRNA-93 significantly decreased after treatment in patients with local/locally advanced prostate cancer compared to baseline plasma level. The expression of six microRNAs (let-7b, miRNA-34a, -125b, -143, -145 and -221) was downregulated, and three microRNAs (miRNA-21, -25 and miRNA-93) were upregulated in tumour tissue compared to benign prostate tissue. In plasma, six microRNAs were upregulated (miRNA-21, -125b, -126, -141, -143 and -375), while let-7b was downregulated in patients with metastatic prostate cancer compared to the control cohort. In the metastatic prostate cancer cohort, the expression of four microRNAs (miRNA-125b, -126, -143 and -221), and miRNA-141 in tissue was associated with Gleason score and prostate-specific antigen, respectively. The expression of miRNA-93 in tumour tissue was correlated with matched plasma levels and showed a significant decrease in plasma level after intervention in local prostate cancer. Differential expression between tumour and benign prostate was detected for several microRNAs in both tissue and plasma.

Erythropoietin for the treatment of anemia of malignancy associated with neoplastic bone marrow infiltration.

1990 ◽  
Vol 8 (6) ◽  
pp. 956-962 ◽  
Author(s):  
W Oster ◽  
F Herrmann ◽  
H Gamm ◽  
G Zeile ◽  
A Lindemann ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bolus Injection ◽  
Bone Marrow Involvement ◽  
Serum Levels ◽  
Underlying Disease ◽  
Bone Marrow Infiltration ◽  
Low Grade ◽  
History Of ◽  
Neoplastic Lymphocytes ◽  
Rbc Count

This clinical trial was performed to study the effects of intravenously (IV) administered recombinant human (rh) erythropoietin (EPO) at escalating doses (150, 300, and 450 U/kg, administered as an IV bolus injection, twice weekly, for 6, 4, and 4 weeks, respectively) in five patients with low-grade non-Hodgkin's lymphoma (Ig NHL) and bone marrow involvement and one patient with multiple myeloma (MM). All patients were anemic due to underlying disease. None of the patients had a history of bleeding, hemolysis, renal insufficiency, or other disorders causing anemia in addition to bone marrow infiltrating malignancy. Endogenous EPO serum levels were significantly increased in all patients (74 to 202 mU/mL). Five patients (one MM, four small-cell lymphocytic [SCLC] NHL) showed a dramatic increase of hemoglobin (Hb), hematocrit (Hk) and RBC count becoming obvious on the second EPO dose level. Initial ferritin serum values, which were high mostly due to polytransfusion, were significantly reduced in responding patients. Erythropoiesis of one patient with extensive follicular mixed (fm) NHL did not respond to EPO treatment. Platelet (PLT) count increase (greater than 75% above starting levels) during and following EPO therapy was observed in one patient with MM. Adverse events due to EPO therapy have not been recorded. These findings point out a previously unrecognized capacity of EPO given at pharmacologic doses to stimulate erythropoiesis in patients with anemia due to bone marrow infiltration by neoplastic lymphocytes in spite of enhanced endogenous EPO expression.

scholarly journals Bone Marrow Involvement in Patients with Type 1 Gaucher Disease Receiving Low-Dose Long Term Enzyme Replacement Therapy (median 18 years)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4862-4862
Author(s):  
Shoshana Revel-Vilk ◽  
Jeffrey Szer ◽  
Michal Becker Cohen ◽  
Ari Zimran
Keyword(s):  
Bone Marrow ◽  
Gaucher Disease ◽  
Research Funding ◽  
Low Dose ◽  
Bone Marrow Involvement ◽  
Bone Marrow Infiltration ◽  
Enzyme Replacement ◽  
Fat Fraction ◽  
Type 1 Gaucher Disease

Bone complications are the most dramatic and life-impairing outcomes of type 1 Gaucher disease (GD1), a common lysosomal storage disorder. Bone marrow infiltration by Gaucher cells substantially decreases the bone marrow fat fraction (FF), and the extent of this reduction correlates with the overall severity of skeletal manifestations in this disorder. Previous studies have demonstrated that the degree of infiltration can best be estimated by magnetic imaging resonance (MRI)-based quantitative chemical shift imaging (QCSI) and that the fat fraction (FF) score so derived can predict the risk of clinically important bone events. The aim of this study was to evaluate bone marrow involvement in GD1 patients who had received enzyme replacement therapy (ERT) for at least 5 years. Methods: Patients from SZMC Gaucher unit, ≥ 18 years, who were treated with ERT for ≥ 5 years, with a stable dose in the previous 6 months, were recruited. Patients taking another experimental drug, with past exposure to taliglucerase-alfa, presence of any medical, emotional, behavioral or psychological condition were excluded. Energy x-ray absorptiometry (DEXA) was performed at SZMC and the QSCI was performed at the Academic Medical Center in Amsterdam, Netherlands as previously described [Mass et al, Am J Radiol 2002:179:961-965]. A QCSI score of <0.30 was indicative of bone at risk. This investigator initiated clinical trial was approved IRB at SZMC and AMC and sponsored by Pfizer. Study number registration- MOH-2017-04-000351. Results: Thirty patients (13 females) at a median (range) age of 46 (19-71) years consented to participate in this study and to perform the QCSI test. GBA mutations of study patients included N370S homozygote (n=12), N370S compound heterozygote (n=17), and T431 homozygote (n=1). The median (range) duration of ERT was 18 (5-26) years. Thirteen patients were receiving imiglucerase as the primary ERT [median (range) duration, 19 (9-26) years], five patients were receiving velaglucerase alfa [median (range) duration, 11 ( 5-12) years], and 12 patients converted from imiglucerase to velaglucerase alfa [median (range) duration, 7 (6-10) years]. The majority of patients received low-dose regimen, i.e. 15 Units/kg/2 weeks (Table 1). The median (range) T score for lumbar spine from DEXA scans, available for 26 of 30 patients, was −1.3 (−2.8-0.0). The median (range) QCSI score was 0.42 (0.24-0.66). Seven patients, 23% (95% confidence interval 10%-42%), had abnormal QCSI FF scores (<0.30). Abnormal QSCI score was more common in female compared to male (Table 1) (p=0.025). Only one of these was menopausal. No differences were found in age, gender, genotype, history of splenectomy, duration and type of ERT and GD-related parameters between those with QSCI score of bone at risk to those with normal score (Table 1). In summary, these findings demonstrate that, despite prolonged treatment with imiglucerase and/or velalgucerase alfa, 23% of patients still had QCSI scores indicative of an inadequate response in bones. Nevertheless, most patients with prolonged low-dose ERT maintain a normal QCSI, indicative of a positive bone status. The higher prevalence of women in the cohort with low FF is not related to menopausal phase and remains unexplained. As no other patient-related nor GD-related parameter predicted abnormal bone marrow infiltration, a more widely available, quantitative measure of bone marrow infiltration is required for the assessment of response in bones to ERT for patients with GD1. The second phase of this study will evaluate the impact of a switch to a third ERT in those patients from this study with QCSI scores of <0.30. These patients will be offered treatment with taliglucerase alfa at equivalent doses and subsequent reassessment of any impact on clinical symptoms and QCSI scores evaluated. Disclosures Revel-Vilk: Takeda: Honoraria, Other: Travel, Research Funding; Prevail therapeutics: Honoraria, Other: Travel, Research Funding; Pfizer: Honoraria, Other: Travel, Research Funding; Sanofi: Honoraria, Other: Travel, Research Funding. Szer:Alexion: Honoraria, Other: Travel, Research Funding; Amgen: Honoraria, Other: Travel, Research Funding; Celgene: Honoraria, Other: Travel, Research Funding; MSD: Honoraria, Other: Travel, Research Funding; Novartis: Honoraria, Other: Travel, Research Funding; Pfizer: Honoraria, Other: Travel, Research Funding; Takeda: Honoraria, Other: Travel, Research Funding; Sanofi: Honoraria, Other: Travel, Research Funding; Prevail Therapeutics: Honoraria, Other: Travel, Research Funding. Zimran:Centogene: Other: research grant; Shire: Consultancy, Honoraria, Research Funding; TAKEDA: Honoraria; Pfize: Honoraria, Research Funding; Bio-events: Honoraria; Targeted Cell Therapies: Consultancy; Prevail Therapeutics: Consultancy.

Predicting positive bone marrow biopsies (BMBs) in patients (PTS) with advanced prostate cancer (APC).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 180-180
Author(s):  
David Lorente ◽  
Aurelius Gabriel Omlin ◽  
Carmel Jo Pezaro ◽  
Nina Tunariu ◽  
Roberta Ferraldeschi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Multivariate Analysis ◽  
Advanced Prostate Cancer ◽  
Bone Scan ◽  
Iliac Crest ◽  
Univariate Analysis ◽  
Specific Antigen ◽  
P Value ◽  
Bone Marrow Biopsies

180 Background: Advanced prostate cancer (APC) is a molecularly heterogeneous disease, with evidence of clonal evolution that could be responsible for resistance to treatment. About 90% of patients (pts) with APC have bone metastases. The acquisition of a bone marrow biopsies (BMBs) is a safe and feasible technique for obtaining tissue, with a low rate of complications. We hypothesized that pre-biopsy clinical variables may increase the success rate of BMBs in APC. Methods: Standard BMBs of the iliac crest were performed in APC pts between October 2011 and June 2013. All pts signed ethics approved consent. In the control cohort (n=10) BMBs were collected in pts with normal CT and bone scan appearance. Minimum, maximum, and mean Hounsfield Units (HU) of the iliac crest on pre-biopsy CTs were determined. Clinical and laboratory variables were collected from the electronic record system. Biopsies were defined as containing 50 or more or 1 to 50 malignant cells or none (negative). Univariate analysis was performed to determine variables associated with biopsy positivity with 50 or more cells. For variables with p value<0.1, the optimal cut-off point was determined by ROC curve analysis. A multivariate analysis with optimal cut-off points was then performed. Results: A total of 71 BMBs were performed in 57 pts. None of the control biopsies in pts with normal CT and bone scan (10 of 10) contained tumor. A total of 46 of 61 BMBs (75.4%) were positive. 38 of 61 (62.3%) contained 50 or more cells. Prior treatments were docetaxel in 57 (79.2%) and abiraterone in 42 (58%) pts. Bisphosphonates had been used in 21 (28.8%) pts. The significant variables on univariate analysis were ALP more than or equal to 200 IU/L (p=0.059), prostate-specific antigen (PSA) more than or equal to 225 ng/mL (p=0.008), lactate dehydrogenase (LDH) more than or equal to 200 IU/L (p=0.09), mean HU more than or equal to 125 (p=0.000) and maximum HU more than or equal to 550 (p=0.001). These factors were tested in multivariate analysis. Only PSA and mean HU were significant in multivariate analysis. The combined PSA and mean HU score had an ROC AUC of 0.79. Conclusions: A combination of PSA and mean HU on CT could assist physicians in selecting APC patients/ iliac crest site more likely to have a positive BMB. Prospective evaluation is ongoing in a validation set.

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