case_images: PMC6736335_01
case_images: The diagram illustrates modifications in hemoglobin (Hb) and IgAk monoclonal spike (left Y axis), platelets (PLT) and symptoms (right Y axis) by treatment in our patient. Symptom Scale: 0-100-point scale, based on patient's reported symptoms. Higher scores indicate more severe symptoms. RCD: Rituximab-Cyclophosphamide-Dexamethasone; CHOP: Cyclophosphamide-Doxorubicin-Vincristine-Prednisone. Red arrow: initiation of ibrutinib.
case_images: mjhid-11-1-e2019057f1.jpg
case_images: PMC6736335_01_mjhid-11-1-e2019057f1.jpg
case_images: f1-mjhid-11-1-e2019057
case_images: In September 2014 a 66-year-old woman presented with symptomatic anemia (Hemoglobin, Hb: 9 g/dl), with IgA/k monoclonal spike (1.6 g/dl) (Figure 1) and an otherwise unremarkable serum chemistry profile. The patient was treated with rituximab-cyclophosphamide-dexamethasone (RCD regimen) with Partial Response (PR) (Figure 1). Thus, cyclophosphamide-doxorubicin-vincristine-prednisone (CHOP) was started and, after three cycles, the patient developed thrombocytopenia (Platelets, PLT: 30 x 10^9/L), transfusion-dependent anemia (Hb 7.7 g/dl), persistent lymphocytosis (Lymphocytes: 7.15 x 109/L) in the peripheral blood (PB) and clinical deterioration (Figure 1). In February 2018, our patient started ibrutinib off-label, 420 mg once daily (Figure 1).