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.