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Case Reports
. 2022 Feb 24:12:842620.
doi: 10.3389/fonc.2022.842620. eCollection 2022.

Case Report: Hematologic Recovery Following Stereotactic Ablative Radiotherapy in a Patient With Early-Stage Non-Small Cell Lung Cancer and Paraneoplastic Myelofibrosis

Lindsey Sloan  1   2 , Rakhi P Naik  3 , Kavita Umrau  4 , Rena Ruiyu Xian  4 , Kristen A Marrone  5 , Khinh Ranh Voong  2
Affiliations
Case Reports

Case Report: Hematologic Recovery Following Stereotactic Ablative Radiotherapy in a Patient With Early-Stage Non-Small Cell Lung Cancer and Paraneoplastic Myelofibrosis

Lindsey Sloan et al. Front Oncol. .

Abstract

Herein, we report the first case presentation of paraneoplastic myelofibrosis associated with cancer. Paraneoplastic syndromes occur in some patients with thoracic malignancies; however, myelofibrosis is not commonly seen in non-small cell lung cancer (NSCLC). We report a case of myelofibrosis in a patient with a new diagnosis of NSCLC that resolved after stereotactic ablative radiotherapy (SABR). In conclusion, NSCLC may evoke unexpected systemic effects that resolve with treatment.

Keywords: NSCLC; SAbR; case; paraneoplastic; report.

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Conflict of interest statement

KAM is on the advisory boards of Amgen, AstraZeneca, and Mirati Therapeutics. KRV disclosures include the following: honorarium—Physicians’ Education Resource, Consultant—AstraZeneca. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Normocytic anemia on blood smear. Peripheral blood smear at the time initial diagnosis with findings of normocytic anemia with reticulocytopenia, but notable absence of teardrop forms (dacrocytes).
Figure 2
Figure 2
Myelofibrosis on bone marrow biopsy. Bone marrow biopsy showing markedly hypercellular and fibrotic marrow with trilineage hematopoiesis. The megakaryocytes are adequate in number but show atypical forms including, large hypo-lobated cells (black arrow), cells with hyperchromatic nuclei, as well as small mono-lobated forms (white arrowhead) (A) (×10) and (B) (×40): H&E). Reticulin stain demonstrates moderate–to–severe reticulin fibrosis, MF-2 to MF-3 based on WHO grading (C) (×40): reticulin).
Figure 3
Figure 3
Clinical timeline of the case report. The case report of our patient with a lung adenocarcinoma who was found to have new-onset dyspnea during his visit to our Thoracic Multi-disciplinary Clinic (MDC) for treatment recommendations. Because he was noticeably unwell at this appointment, he underwent urgent evaluation and was found to have normocytic anemia. The patient’s workup was significant for myelofibrosis on bone marrow biopsy (BMBx). He was found to have steroid-refractory disease, and his anemia persisted on complete blood count (CBC). Following treatment of his lung cancer with stereotactic ablative radiotherapy (SABR), the patient had no evidence of disease (NED) on CT chest. Unexpectedly, following SABR, his CBC normalized and blood counts returned to values within normal limits (WNL). No additional treatment was needed for his symptomatic anemia over 1 year after SABR, and he continues to be surveilled for his lung cancer. This figure was created with BioRender.com.
See this image and copyright information in PMC

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