Chronic myelogenous leukemia occurring in a chronic lymphocytic leukemia patient

International audienceOccurrence of two different hematological malignancies is very infrequent, and it is nevertheless important not to neglect basic examinations in patients follow-up. A 65-year-old patient was referred to our institution for his chronic lymphocytic leukemia (CLL) checkup; we report the different steps leading to the diagnosis of a second hematological malignancy

Antineoplastic Drugs as a Cause of Drug Induced-Immune Hemolytic Anemia, Resulting in Major Intravascular Hemolysis Leading to Acute Kidney Injury Requiring Renal Replacement Therapy

Abstract Background Drug-induced immune hemolysis (DIIHA) is rare and may involve antineoplastic agent. Life threatening DIIHA complicated with severe acute kidney injury (AKI) has hitherto seldom been reported and had yet to be scrutinized from a clinical standpoint. Methods Over a five-month period we admitted in our intensive care unit three patients with KDIGO stage 3 AKI along with, hemolytic anemia and thrombocytopenia within 24-hours following the administration of antineoplastic agent. These three women underwent anti-neoplastic treatment for metastatic colorectal cancer. Results All three patients presented with 1) abrupt immune intravascular hemolysis along with thrombocytopenia 2) a positive direct antiglobulin test (DAT) positive for IgG 3) absence of schistocytes 4) and AKI requiring replacement therapy. All patients had multiple previous exposure to the drugs received. Kidney biopsy was performed for patient 1, displaying acute tubular necrosis lesions interpreted as pigment nephropathy. Investigations in patients 2 and 3 highlighted high-titers of specific oxaliplatin-dependent antibodies. Hemolysis resolved within 14 days post-chemotherapy for all three patients. The renal outcome was favorable. Conclusions Antineoplastic drugs can elicit abrupt immune hemolysis and thrombocytopenia, resulting in severe AKI. Thorough explorations are warranted to confirm DIHA, incriminate the offending drug on proper grounds while exonerating other pharmacological therapies, a chief concern in the setting of cancer therapy so not to needlessly reduce anti-cancer treatment options. The outlook for renal recovery seems favorable.</jats:p