PMC8517987_01
Changes of hemogram during BRD (Bortezomib 2mg weeklyx4, DXM 20mg weeklyx4 and Rituximab 375mg/m2 monthly) chemotherapy. The proposal of BRD chemotherapy was present in (A). The platelet counts increased to normal after first two rounds of BD, but decreased to 12x109/L after the third round, and became refractory to platelet transfusion (B). Additional, the hemoglobin also decreased 8 days after third round of BD (C).
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The platelet counts increased to normal after the first two rounds of DXM, but decreased to 12x109/L after the third dose of DXM, and became refractory to platelet transfusion (Figure 1).
Changes of platelet count after multiple managements on thrombocytopenia. The response of platelet was not sufficient after second round DXM (20mg qd for 3 days). With the consequence treatment including methylprednisolone, intravenous immunoglobulin (IVIG), recombinant human thrombopoietin (TPO) and TPO receptor agonist, no response was observed as well, and patient suffered from with platelet transfusion refractoriness.
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Rituximab was continued during the course (500 mg qwx3) considering the primary WM disease (Figure 2).
Severe hemolytic anemia occurred during the management of thrombocytopenia. During the management of refractory thrombocytopenia, the patient suffered from severe hemolytic anemia (hemoglobin decreased from 104 g/L to 41g/L, (A)), with high level serum indirect bilirubin (IBIL maximum to 119.7mumol/L, (B)), increased reticulocyte (C), and lactic dehydrogenase (LDH maximum to 559U/L, (D)).
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During the management of refractory thrombocytopenia, the patient suffered from severe hemolytic anemia (hemoglobin decreased from 104 g/L to 41 g/L), with increased serum indirect bilirubin (IBIL maximum was 119.7 mumol/L), LDH (maximum was 559U/L) and reticulocyte (maximum was 25.25%) (Figure 3).
PCR and Sanger test for polymorphism of FcgammaR. Results showed that this patient is FcgammaRIIalpha 131H/R (A) and FcgammaRIIIalpha 158F/V (B).
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The results showed that the patient was FcgammaRIIalpha 131H/R and FcgammaRIIIalpha 158F/V (Figure 4), which indicated that the hemolysis may not have developed from the progression of WM.
Changes of hemoglobin, platelet, and hemolysis indexes after Eltrombopag withdraw. Results shows that LDH (B), IBIL (D) and Ret (E) improved immediately within 3 days after eltrombopag withdrawal, and decreased to almost normal within 10 days. The hemoglobin recovered in 50 days (A) and platelet count recovered to normal in 20 days later (C).
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IBIL, LDH and absolute value of reticulocyte decreased to almost normal within 10 days, and the hemoglobin recovered in 50 days (Figure 5).