Talc induced transfusion independence in a patient with myelodysplasia

Our plain-English summary of Talc induced transfusion independence in a patient with myelodysplasia, by S. Hirawat, A. Arunabh, P. Schulman (Leukemia Research, 2001).

The study

• Authors: S. Hirawat, A. Arunabh, P. Schulman
• Journal: Leukemia Research
• Published: 2001;25(3):263-5
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Myelodysplasia with refractory anemia is associated with transfusion dependence.

In plain English

This case report described a 66-year-old Vietnamese woman with myelodysplastic syndrome with refractory anemia, a bone marrow disorder. Several drug treatments had no effect, and she depended on red blood cell and platelet transfusions. Seven months later, a biopsy of the left pleura (the lining around the lung) showed desmoplastic mesothelioma. Later, a large right-sided fluid build-up was drained and sealed by placing talc slurry in the pleural space, a procedure called pleurodesis. The narrative stated no further transfusions were given, but the scanned table appears to list a platelet transfusion dated 10 September 1999, after the pleurodesis, and none afterward. Over the following 8 months her hemoglobin/hematocrit rose to 13/39, her platelets were about 41,000 cells/mm3 and her white cell count stabilized at 5600 cells/mm3 without other treatment. She gained about 8 pounds and remained transfusion independent. The authors offered possible explanations, such as talc acting on cell death or on signaling molecules in the marrow, and judged disease progression unlikely. They stated that their conclusions were theoretical and needed further study. The article did not discuss asbestos or the cause of the mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 66-year-old Vietnamese woman with myelodysplastic syndrome with refractory anemia, later found to have desmoplastic mesothelioma, treated at North Shore University Hospital, Manhasset, New York
• Exposure: talc slurry pleurodesis (talc placed in the right pleural space through a chest tube) used to treat a pleural effusion from mesothelioma; no asbestos exposure is described
• Main results:
  • The patient was diagnosed with myelodysplastic syndrome with refractory anemia.
  • Initial drug treatment for the myelodysplastic syndrome did not work.
  • A left pleural biopsy showed desmoplastic mesothelioma.
  • Before talc pleurodesis, the patient depended on red blood cell and platelet transfusions.
  • The case narrative states that no further transfusions were given after pleurodesis.
  • Table 1, as scanned, appears to list a platelet transfusion dated 9/10/99, after the pleurodesis recorded for 8/19/99 to 8/25/99. From 9/11/99 onward it lists no transfusion and no medications.
  • After talc pleurodesis, over 8 months without additional treatment, her hemoglobin/hematocrit rose to 13/39, platelets were approximately 41,000 cells/mm3 and white cell count stabilized at 5600 cells/mm3.
  • After pleurodesis the patient gained about 8 pounds and remained transfusion independent.
• The authors' conclusion: The authors proposed theoretical explanations for the improvement: talc may selectively enhance cell death in certain marrow cells, or may trigger a cytokine response in the marrow. They considered disease progression unlikely, and stated that their conclusions are theoretical and would require further study of a possible beneficial effect of talc.
• Limitations the authors state:
  • The authors stated that their explanations are theoretical and require further study.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc.

Related studies

• Talc slurry pleurodesis. Pleural fluid and histologic analysis — L. Kennedy, R.A. Harley, et al. (1995)
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• Intrapleural talc for the prevention of recurrent pneumothorax — J.R. Milanez, F.S. Vargas, et al. (1994)
• A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis — R. Agarwal, A.S. Paul, et al. (2011)
• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)
• Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review — I. Baiu, E. Yevudza, et al. (2020)

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