FACTOR-VIII INHIBITOR PRIOR TO AND DURING SECONDARY ACUTE NONLYMPHOCYTIC LEUKEMIA IN A PATIENT WITH CURED HODGKINS-DISEASE

We report a 54-year-old patient with Hodgkin's disease who achieved a complete remission after combined modality treatment. Three years late r the patient developed a severe hemorrhagic syndrome, concomitant wit h the onset of a factor VIII inhibitor in plasma. The control of very proteiform bleedings was extremely difficult, even with plasmaphereses , as well as with immunosuppressive and substitutive therapies. Two ye ars later, a secondary acute nonlymphocytic leukemia (ANLL) was diagno sed. Two courses of chemotherapy with fludarabine, cytosine arabinosid e and G-CSF (FLAG) were able to obtain a complete remission. Hemorrhag ic complications were mainly linked to thrombocytopenia and continued until recovery of thrombopoiesis. Factor VIII inhibitor levels and rel ated clinical symptoms decreased progressively. In conclusion, we sugg est that FLAG succeeded in inhibiting an abnormal lymphoid clone respo nsible for factor VIII inhibitor production, suggesting a possible rol e for intensive chemotherapy in similar situations, which are often re fractory to conventional immunosuppressive and depletive therapy.