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[Aplastic anemia associated with minimal serum M-protein treated successfully with repeated bolus methylprednisolone
Abstract:
A 61 year old woman was admitted to our hospital suffering from severe pancytopenia. Bone marrow aspiration revealed marked hypoplasia with 24.8% plasma cells. There was a small amount of IgA type M protein in serum. Multiple myeloma was ruled out on the basis that 1) the amount of serum IgA-M protein was minimal and no increase was observed, 2) no indication of monoclonality of bone marrow plasma cells was shown by immunofluorescent staining of immunoglobulins, 3) neither bone lesion nor other symptoms related to multiple myeloma were observed. Therefore, a diagnosis of aplastic anemia was made, and bolus methylprednisolone therapy (1,000 mg/day x 3 days) was performed, which brought the patient to complete remission. An oral dose of 15 mg of prednisolone is administered daily now and the remission state is being maintained. Bolus methylprednisolone therapy is performed quite often for the treatment of aplastic anemia. However, there are few reports in which remission was reached with the use of glucocorticoids alone, most having used androgens or other supportive drugs in conjunction. Here, we will discuss this case of aplastic anemia which responded to repeated bolus methylprednisolone therapy, with minimal side effects, and discuss its effectiveness. In addition, aplastic anemia associated with idiopathic monoclonal gammopathy is not reported, so this case is interesting immunologically.
Insights
Aplastic anemia in a 61-year-old woman achieved complete remission with glucocorticoids alone. This case highlights the potential effectiveness of methylprednisolone therapy for aplastic anemia.
Area of Science:
- Hematology
- Immunology
Background:
- Aplastic anemia is a rare bone marrow failure disorder.
- Idiopathic monoclonal gammopathy is typically associated with plasma cell dyscrasias like multiple myeloma.
Observation:
- A 61-year-old woman presented with severe pancytopenia and bone marrow hypoplasia with 24.8% plasma cells.
- Minimal IgA M protein was detected in serum, and bone marrow plasma cells lacked monoclonality.
- Multiple myeloma was excluded due to minimal M protein, absence of monoclonality, and lack of myeloma-related symptoms.
Findings:
- The patient was diagnosed with aplastic anemia and treated with high-dose methylprednisolone therapy (1,000 mg/day for 3 days).
- Complete remission was achieved and maintained with daily oral prednisolone.
- This is a rare case of aplastic anemia associated with idiopathic monoclonal gammopathy responding to glucocorticoids alone.
Implications:
- Glucocorticoids alone can be effective in treating aplastic anemia, challenging the conventional use of supportive drugs.
- This case offers insights into the immunological aspects of aplastic anemia associated with monoclonal gammopathy.
- Further research is warranted to explore the efficacy and mechanisms of glucocorticoid monotherapy in aplastic anemia.