PMC3420688_01
This figure illustrates the improvement in bone marrow biopsy findings with rituximab therapy. Pictures were taken under 40x magnification. The top figure shows the aplastic marrow on diagnosis in March 2007. The lower figure shows restoration of trilineage hematopoiesis with decreased megakaryocytes in July 2008, 6 months after the first cycle of rituximab.
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fig1
Bone marrow biopsy showed a normocellular marrow (40%) with erythroid predominant hematopoiesis and decreased megakaryocytes (Figure 1).
The reduction in PNH clone size over time. In March 2008, the CD59-deficient clone of WBCs and RBCs was detected when Budd-Chiari syndrome and intestinal ischemia were diagnosed. In April 2010, about 2 years after the first cycle of rituximab and 10 months after the second cycle of rituximab, there was significant decrease in size of the PNH clone in all cell lines.
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fig2
In April 2010, only 17% of the leukocytes, 0% of the granulocytes, and 5% of the red cells were deficient in CD59 (Trend of CD59, deficient cells in Figure 2).
The improvement in blood counts from the time of diagnosis to most recent. (a) white cell and neutrophil counts, (b) describes the hemoglobin trend, and (c) the platelet trend. The x axis is not drawn to scale and shows various time points and therapy administered. ATG: antithymocyte globulin, R: rituximab, and E: eculizumab.
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fig3
In November 2011, 2.5 years after the second course of rituximab, the patient remained in a complete hematological response (CBC results shown in Figure 3).