Cyclosporin-A for the treatment of pure red cell aplasia in a patient with chronic lymphocytic leukemia.
A 62-year-old man with B-cell chronic lymphocytic leukemia had three separate episodes of pure red cell aplasia (PRCA). The last episode was treated with cyclosporin-A (CyA) and prednisone. After the patient was on the therapy for 2 weeks, erythropoietic recovery was observed and with continued therapy the hematocrit (Hct) became normal. The PRCA remission was associated with a fall in the blood lymphocyte count, and a reduction in the spleen and lymph node size and bone marrow lymphocyte density. At diagnosis of PRCA the blood T-cells bearing IgG Fc receptors (T gamma cells) were increased, and the marrow contained very few or no late-stage erythroid progenitors. After remission of PRCA the T gamma cell fraction decreased, and the marrow erythroid progenitor's number became normal. We speculate that therapy with CyA and prednisone inhibited the production of interleukins-1 and -2 from monocytes and T-cells, respectively, and was responsible for the reduction of the T gamma cell fraction and B-cell leukemic mass in this patient. Further, we believe that normalization of T gamma cells in association with the therapy was responsible for the PRCA remission.
D003524:Cyclosporins / Q000627:therapeutic use*; D004920:Erythropoiesis; D006412:Hematopoietic Stem Cells / Q000473:pathology; D006801:Humans; D007375:Interleukin-1 / Q000096:biosynthesis; D007376:Interleukin-2 / Q000096:biosynthesis; D007945:Leukemia, Lymphoid / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000494:pharmacology; D012010:Red-Cell Aplasia, Pure / Q000188:drug therapy*; D013601:T-Lymphocytes / Q000145:classification
D003524:Cyclosporins; D007375:Interleukin-1; D007376:Interleukin-2; D011241:Prednisone