ABSTRACT
What is known and objective : To explore the clinical characteristics, diagnosis, and treatment of chronic lymphocytic leukemia (CLL) with secondary pancytopenia.
Case summary : Here, a case of pancytopenia secondary to CLL is reported. Additionally, a review of relevant CLL literature was conducted to summarize its diagnosis, clinical characteristics, treatment history, and experience. After treatment with cyclosporin A (CsA), the patient’s CLL continued to resolve and hematopoiesis returned to normal.
What is new and Conclusion : CsA therapy resulted in improved patient outcomes. However, the mechanism by which CSA rebuilds the immune microenvironment and its anti-leukemia effect in the body remains to be studied.
Keyword s: case report, chronic lymphoblastic leukemia, Cyclosporin-A, immune micro-environment
What is known and objective
Chronic lymphoblastic leukemia (CLL) is a chronic B-cell proliferative disorder. The median age of patients suffering from CLL is 67-72 years and the incidence rate is higher in males than in females (2:1).1 Although autoimmune cytopenia (AIC) frequently co-occurs with chronic CLL, its relationship to pancytopenia is rarely reported and its pathogenesis remains unknown. Recently, the treatment of CLL-related pancytopenia using Cyclosporin-A (CsA) induced a prolonged remission of CLL. We hypothesize that CsA may have the dual effect of acting as an immunosuppressant whilst simultaneously being able to induce immune micro-environment reconstruction which, together, may facilitate its anti-leukemia potential; however, this need to be verified. In the current case study, a CLL patient presented with secondary pancytopenia and did not respond adequately to treatment using stimulating factors and was reliant on blood transfusion. After CsA treatment, routine blood indices rose to the normal range indicating that CLL has been remitted.