Successful treatment of pure red cell aplasia with cyclosporin A and erythropoietin after thymectomy in a 88-year old woman

An 88-year old Japanese female with pure red cell aplasia was treated safely and effectively by a combination of thymectomy, cyclosporin A, and erythropoietin. The thymoma was histologically classified as lymphocytic type or cortical type, which are uncommon in cases of a thymoma accompanied by pure...

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Published in:Haematologica (Roma) 2004-06, Vol.89 (6 Suppl), p.ECR17-ECR17
Main Authors: Maeda, Toyoki, Shiokawa, Satoshi, Yoshikawa, Yasuji, Hiroyama, Takashi, Nakajima, Yasuhiro, Muta, Hiromi, Nakayama, Masaharu, Nakazaki, Yukoh, Akizuki, Shinichiro, Shimizu, Kanako, Mutoh, Toshitaka, Somada, Shinichi, Kurita, Ryo, Shiratsuchi, Motoaki, Makino, Naoki, Nishimura, Junji, Tani, Kenzaburo
Format: Article
Language:English
Subjects:
Aged, 80 and over
Bone Marrow Cells - pathology
Cyclosporine - therapeutic use
Erythropoietin - therapeutic use
Female
Humans
Recombinant Proteins
Red-Cell Aplasia, Pure - drug therapy
Thymectomy - adverse effects
Thymoma - pathology
Thymoma - surgery
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Summary:An 88-year old Japanese female with pure red cell aplasia was treated safely and effectively by a combination of thymectomy, cyclosporin A, and erythropoietin. The thymoma was histologically classified as lymphocytic type or cortical type, which are uncommon in cases of a thymoma accompanied by pure red cell aplasia. Immunohistochemical analysis of the thymoma and bone marrow revealed a predominance of CD8(+) cells. Thymectomy alone was ineffective, but cyclosporin A treatment subsequent to thymectomy was safe and effective and resulted in the disappearance of a Vbeta12 bearing T-cell clone in the bone marrow. Additional treatment with erythropoietin enhanced the effects of cyclosporin A and restored the patient's hemoglobin to normal levels. The beneficial effect of cyclosporin A may be attributed not to a broad immunomodulatory effect, but to a local effect on a limited T-cell subset.
ISSN:1592-8721