title: Pure red cell aplasia after chemotherapy for Hodgkin's lymphoma: in vitro evidence for T cell mediated suppression of erythropoiesis and response to sequential cyclosporin and erythropoietin.
abstract: Acquired pure red cell aplasia (PRCA) has been associated with various lymphoproliferative conditions but its occurrence with Hodgkin's disease is rare. We report a case of PRCA occurring immediately following the completion of induction chemotherapy in a patient with Stage IIIB nodular sclerosing Hodgkin's disease. In vitro erythroid colony studies documented evidence for T cell mediated suppression of erythropoiesis and lack of a serum inhibitor. Addition of cyclosporin to the in vitro cultures stimulated erythroid colony growth. Following in vivo treatment with cyclosporin peripheral blood CD4/CD8 ratios returned to normal. However, serum erythropoietin levels were inappropriately low. Subsequent treatment with erythropoietin induced a reticulocytosis and transfusion independence. Since discontinuing the erythropoietin, the patient has been able to maintain a hemoglobin of 100 g/L. This case illustrates that red cell aplasia occurring in the setting of Hodgkin's disease may be due to T cell mediated suppression of erythropoiesis. A response to cyclosporin may be masked by inappropriately low erythropoietin levels.
authors.affiliation: Department of Hematology, Walter Reed Army Medical Institute of Research, Washington, D.C. 20307.
authors.forename: T J
authors.initials: TJ
authors.lastname: Reid
authors.forename: M
authors.initials: M
authors.lastname: Mullaney
authors.forename: L M
authors.initials: LM
authors.lastname: Burrell
authors.forename: J
authors.initials: J
authors.lastname: Redmond
authors.forename: K F
authors.initials: KF
authors.lastname: Mangan
mesh_terms: D000328:Adult; D003114:Colony-Forming Units Assay; D016572:Cyclosporine / Q000627:therapeutic use*; D015672:Erythroid Precursor Cells / Q000473:pathology; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006689:Hodgkin Disease / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D012010:Red-Cell Aplasia, Pure / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D013601:T-Lymphocytes / Q000502:physiology*
chemical_list: D004921:Erythropoietin; D016572:Cyclosporine