Anaplastic large-cell lymphoma which showed severe inflammatory status andmyelodysplasia with increased VEGF and IL-6 serum levels after long-term immunosuppressive therapy

We report a patient with anaplastic large-cell lymphoma (ALCL) who has been given immunosuppressive therapy for Evens syndrome for 10 years. He was ad mitted with spike fever, intra-abdominal lymphadenopathy, and multiple live r masses. Examination of biopsy specimens obtained by para-aortic lymph nod es and liver masses resulted in a diagnosis of ALCL, Immunohistochemically, these cells were reactive to anti-CD30 antibody but were not of B- or T-li neage. Bone marrow aspiration demonstrated the invasion of giant neoplastic cells and trilineage myelodysplasia, Because the patient showed severe inf lammatory symptoms, we examined serum levels of various cytokines. Pretreat ment levels of IL-6 and VEGF in this patient were significantly elevated co mpared to those of normal controls. He was treated with combination chemoth erapy (ABVD regimen), achieving complete remmesion. Myelodysplasia and seru m IL-6 and VEGF also normalized after treatment. We assumed that ALCL resul ted from long-term immunosuppressive therapy and that the up-regulation of IL-6 and VEGF played a role in pathogenesis of this type of lymphoma. (C) 2 001 Wiley-Liss, Inc.