title: Treatment of pure red-cell aplasia and aplastic anaemia with ciclosporin: long-term clinical effects.
abstract: 6 patients with pure red-cell aplasia were treated with Ciclosporin (Cyclosporine A; CS) alone or combined with prednisolone for a period of 9-46 (median 27) months. Prior to study, 5 cases had refractory disease, steroids were contraindicated in 1, and 4/6 patients, including 2 cases with congenital disease, had a disease duration exceeding 11 years. A complete haematological response was obtained in 5/6 subjects, and a partial response in 1. When the pre-treatment Hb levels (mean +/- S.D. = 64 +/- 13 g/l, range 41-80) for all 6 PRCA patients were compared with the Hb levels after 6 months of CS therapy (104 +/- 17 g/l, 80-125), a significant improvement was registered (p less than 0.005). In half of the patients, remission is maintained with CS as single drug in a dose-dependent manner. We also treated 5 patients with refractory severe aplastic anaemia with CS (1 case) or CS plus prednisolone (4 cases) for 3-27 (median 10) months. Only 1 patient responded. In this case, a complete haematological remission was induced with CS alone, and remission has been maintained for 27 months. Side effects of CS therapy were common but were dose-dependent and reversible, with the exception of persistent nephrotoxicity in 1 patient with pure red-cell aplasia. Based on our present results and a survey of the literature, we conclude that CS therapy is effective and indicated in refractory pure red-cell aplasia. In severe aplastic anaemia resistant to conventional immunosuppression, the response rate is lower, but a small proportion (around 15%) of patients may benefit from CS therapy. Longer treatment periods may, however, be needed to evaluate the role of CS in aplastic anaemia.
authors.affiliation: Department of Medicine, University Hospital, Uppsala, Sweden.
authors.forename: T H
authors.initials: TH
authors.lastname: Tötterman
authors.forename: M
authors.initials: M
authors.lastname: Höglund
authors.forename: M
authors.initials: M
authors.lastname: Bengtsson
authors.forename: B
authors.initials: B
authors.lastname: Simonsson
authors.forename: D
authors.initials: D
authors.lastname: Almqvist
authors.forename: A
authors.initials: A
authors.lastname: Killander
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000741:Anemia, Aplastic / Q000097:blood / Q000188:drug therapy*; D003524:Cyclosporins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012010:Red-Cell Aplasia, Pure / Q000097:blood / Q000188:drug therapy*; D012156:Reticulocytes
chemical_list: D003524:Cyclosporins; D006454:Hemoglobins; D011239:Prednisolone