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The present study describes the case of a 56‑year‑old male who was admitted to hospital due to pancytopenia. He was diagnosed as having acquired severe aplastic anemia (SAA). Immunosuppressive therapy with cyclosporine was transiently effective; however, the pancytopenia recurred. Bone marrow aspiration did not reveal an increased number of blasts, although it revealed trilineage dysplasia. Chromosomal analysis of the bone marrow demonstrated der(1;7) with abnormalities on chromosome 1. A diagnosis of a transformation from SAA to myelodysplastic syndrome (MDS) was made. High‑grade fever and lower abdominal pain developed at approximately the same time. The patient was diagnosed as having Crohn's disease (CD). Treatment consisting of mesalazine and adalimumab was commenced. After two courses of azacitidine treatment, allogeneic bone marrow transplantation was performed, preceded by a reduced‑intensity conditioning regimen, including fludarabine, cytarabine and cyclophosphamide. Tacrolimus and short‑term methotrexate were used as prophylaxis against graft‑versus‑host disease. Chromosomal analysis of the bone marrow revealed a 100% donor‑derived abnormal karyotype. The patient has since then remained in complete remission of both MDS and CD. On the whole, the present study demonstrates that allogeneic hematopoietic stem cell transplantation may be a promising treatment strategy for patients with combined MDS and CD. However, its use should be carefully considered. [ABSTRACT FROM AUTHOR]

Both hypocellular leukemia and Philadelphia (Ph) chromosome-positive mixed-phenotype acute leukemia (MPAL) are rare subtypes of leukemia showing unfavorable outcomes and lacking established optimal management. Ph-positive leukemia most often presents with hypercellularity and hypoplasia is a rare condition. The present study reports an extremely rare case of hypocellular biclonal Ph-positive MPAL, which was diagnosed by biopsy and genetic analysis of bone marrow, and successfully treated with dasatinib and steroids. Briefly, a 77-year-old man presented with pancytopenia and flow cytometry of bone marrow could not be evaluated due to hypocellularity. The patient was finally diagnosed with hypocellular Ph-positive MPAL by genetic analysis and immunostaining of bone marrow biopsy. Although blood cells recovered with methylprednisolone pulse administration alone for concurrent optic neuritis, hematopoietic function rapidly normalized with dasatinib administered after definitive diagnosis of Ph-positive leukemia. Dasatinib and oral prednisolone were continued following methylprednisolone pulse administration and the patient achieved molecular complete remission (CR) on day 140 of treatment; molecular CR was maintained thereafter without any severe adverse events. In conclusion, the combination of dasatinib and a steroid may be one of the tolerable treatment options for elderly patients with hypocellular biclonal Ph-positive MPAL. Furthermore, genetic analysis and immunostaining of bone marrow biopsy can help with the diagnosis of leukemia with hypocellular bone marrow. [ABSTRACT FROM AUTHOR]

Tumor lysis syndrome (TLS) is a life-threatening oncological emergency, in which control of serum uric acid (S-UA) levels is important. S-UA-lowering efficacy of a new xanthine oxidase inhibitor, febuxostat, was retrospectively evaluated in seven patients with hematological malignancies who were at an intermediate risk of developing TLS. A 10-mg dose of febuxostat was initiated and chemotherapy was started within 24 h of administering the first dose of febuxostat. Febuxostat was continued until at least day 7 of chemotherapy treatment. The UA-lowering treatment was considered effective if febuxostat reduced S-UA levels to ≤7.5 mg/dl by day 5. The mean S-UA level at base line was 6.4±2.6 mg/dl and, on day 5, the mean S-UA level was 4.7±1.8 mg/dl. All the patients achieved S-UA levels ≤7.5 mg/dl. Serum creatinine levels decreased from 0.93±0.25 to 0.85±0.25 mg/dl. The estimated glomerular filtration rate values increased from 69.7±24.5 to 76.9±26.2 ml/min. No adverse reactions were noted during the study period and no patients experienced progressive TLS. Successful control of S-UA and improved renal function were obtained in response to febuxostat treatment in cancer patients at a risk of TLS. [ABSTRACT FROM AUTHOR]