A case of lenalidomide-dependent myelodysplastic syndrome

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Presentation transcript:

A case of lenalidomide-dependent myelodysplastic syndrome by Ira J. Miller, Wei-Tong Hsu, James Weisberger, and Parameswaran Venugopal BloodAdv Volume 1(16):1238-1242 July 11, 2017 © 2017 by The American Society of Hematology

Dysplastic marrow morphology following lenalidomide therapy. Dysplastic marrow morphology following lenalidomide therapy. Representative images of the bone marrow aspirate from September 2013, showing mildly decreased cellularity for age (A; magnification ×60, hematoxylin and eosin stain) with relative erythroid hyperplasia, slightly increased frequency of blasts (B, arrows; magnification ×240, Wright-Giemsa stain), nuclear abnormalities in the erythroid precursors (C, arrows; magnification ×600, Wright-Giemsa stain), and dysplastic small megakaryocytes with binucleation and separated nuclei (D, arrow; magnification ×240, Wright-Giemsa stain). Ira J. Miller et al. Blood Adv 2017;1:1238-1242 © 2017 by The American Society of Hematology

Contemporaneous marrow karyotype showing 1 normal chromosome 7 and 1 probable ring chromosome 7. Contemporaneous marrow karyotype showing 1 normal chromosome 7 and 1 probable ring chromosome 7. The other chromosomes have a normal banding pattern (Giemsa stain, 48-hour culture). Ira J. Miller et al. Blood Adv 2017;1:1238-1242 © 2017 by The American Society of Hematology

Moderate to strong P53 expression in cells of marrow sample with P53 mutation. Moderate to strong P53 expression in cells of marrow sample with P53 mutation. P53 immunostained section of marrow from September 2013 (Leica Bond III automated stainer with manufacturer’s antibody). Magnification ×150; immunostain with diaminobenzidine chromogen and hematoxylin counterstain. Ira J. Miller et al. Blood Adv 2017;1:1238-1242 © 2017 by The American Society of Hematology

Normal appearance of marrow aspirate on follow-up examination 3 years after discontinuation of treatment with lenalidomide (September 2016). Normal appearance of marrow aspirate on follow-up examination 3 years after discontinuation of treatment with lenalidomide (September 2016). Magnification ×310; Wright-Giemsa stain. Ira J. Miller et al. Blood Adv 2017;1:1238-1242 © 2017 by The American Society of Hematology

P53 immunostaining of marrow from September 2016. P53 immunostaining of marrow from September 2016. The extracellular brown pigment is hemosiderin. Rare nuclei showed moderate intensity staining (arrow). Magnification ×140; immunostain with diaminobenzidine chromogen and hematoxylin counterstain. Ira J. Miller et al. Blood Adv 2017;1:1238-1242 © 2017 by The American Society of Hematology