Severe Aplastic Anemia Concurrent with Lymphoplasmacytic Lymphoma/Waldenström's Macroglobulinemia.
Takehiro Okuda, Yuta Hanyu, Hana Mineshige et al.
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Case in brief
A 79-year-old woman presented with progressive dyspnea. Bone marrow biopsy showed hypoplastic marrow containing abnormal lymphoid cells, and genetic analysis identified a MYD88 p.V204F mutation supporting lymphoplasmacytic lymphoma/Waldenström’s macroglobulinemia (LPL/WM). Further evaluation also established aplastic anemia (AA). Treatment was directed first at AA with cyclosporine and eltrombopag, followed by rituximab monotherapy for LPL/WM. The sequential approach was associated with symptomatic improvement.
What made this case unusual
The diagnostic challenge was distinguishing and recognizing concurrent AA and LPL/WM in a patient with hypoplastic marrow and abnormal lymphoid cells; the report notes that AA is a diagnosis of exclusion and its coexistence with lymphoma is rare.
Diagnostic / clinical pearl
When marrow hypoplasia coexists with abnormal lymphoid cells, evaluate for both aplastic anemia and an underlying lymphoid malignancy rather than assuming one diagnosis accounts for all findings.
Why it matters
The case illustrates the complexity of treating overlapping AA and LPL/WM and reports symptomatic improvement after prioritizing AA treatment before treating the lymphoma.