Acute myeloid leukemia developed through myeloproliferative features during immunosuppressive therapy for juvenile idiopathic arthritis

Masahiro Oura; Ryohei Sumitani; Yusaku Maeda; Hikaru Yagi; Mamiko Takahashi; Takeshi Harada; Shiro Fujii; Hirokazu Miki; Taiki Hori; Jumpei Murai; Kumiko Kagawa; Masahiro Abe; Shingen Nakamura

doi:10.2152/jmi.71.335

Masahiro Oura, Ryohei Sumitani, Yusaku Maeda, Hikaru Yagi, Mamiko Takahashi, Takeshi Harada, Shiro Fujii, Hirokazu Miki, Taiki Hori, Jumpei Murai, Kumiko Kagawa, Masahiro Abe, Shingen Nakamura

Author information

Masahiro Oura
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
Ryohei Sumitani
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
Yusaku Maeda
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
Hikaru Yagi
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
Mamiko Takahashi
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
Takeshi Harada
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
Shiro Fujii
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
Hirokazu Miki
Division of Transfusion Medicine and Cell Therapy, Tokushima University Hospital, Tokushima, Japan
Taiki Hori
Department of Internal Medicine, Tokushima Prefectural Kaifu Hospital, Tokushima, Japan
Jumpei Murai
Department of Internal Medicine, Anan Medical Center, Tokushima, Japan
Kumiko Kagawa
Department of Hematology, Tokushima Prefectural Central Hospital, Tokushima, Japan
Masahiro Abe
Department of Hematology, Endocrinology and Metabolism, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
Department of Hematology, Kawashima Hospital, Tokushima, Japan
Shingen Nakamura
Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

Keywords: juvenile idiopathic arthritis, acute myeloid leukemia, myelodysplastic syndrome, tocilizumab, myeloproliferative neoplasm

JOURNAL FREE ACCESS

2024 Volume 71 Issue 3.4 Pages 335-339

DOI https://doi.org/10.2152/jmi.71.335

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Abstract

A 17-year-old male with thrombocytosis and exacerbation of arthralgia during intensified immunosuppressive therapy with tocilizumab, prednisolone, and methotrexate for juvenile idiopathic arthritis (JIA) was referred to our department. Bone marrow examination revealed myelodysplastic syndrome/myeloproliferative neoplasm, unclassifiable (MDS/MPN-U). Peripheral myeloblasts disappeared temporarily after discontinuation of tocilizumab but progressed to acute myeloid leukemia six months after the development of MDS/MPN-U. The patient sustained complete remission after unrelated bone marrow stem cell transplantation, followed by chemotherapy. The arthralgia also improved after chemotherapy. The possibility of developing malignancies during immunosuppressive therapy in patients with JIA should be considered. J. Med. Invest. 71 : 335-339, August, 2024

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