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 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.
Maeda
Toyoki
T
Division of Molecular and Clinical Genetics, Department of Molecular Genetics, Shin-Beppu Hospital. maedat@beppu.kyushu-u.ac.jp <maedat@beppu.kyushu-u.ac.jp>
Shiokawa
Satoshi
S
Yoshikawa
Yasuji
Y
Hiroyama
Takashi
T
Nakajima
Yasuhiro
Y
Muta
Hiromi
H
Nakayama
Masaharu
M
Nakazaki
Yukoh
Y
Akizuki
Shinichiro
S
Shimizu
Kanako
K
Mutoh
Toshitaka
T
Somada
Shinichi
S
Kurita
Ryo
R
Shiratsuchi
Motoaki
M
Makino
Naoki
N
Nishimura
Junji
J
Tani
Kenzaburo
K
D000369:Aged, 80 and over; D001854:Bone Marrow Cells / Q000473:pathology; D016572:Cyclosporine / Q000627:therapeutic use*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000188:drug therapy*; D013934:Thymectomy / Q000009:adverse effects*; D013945:Thymoma / Q000473:pathology / Q000601:surgery*
D011994:Recombinant Proteins; D004921:Erythropoietin; D016572:Cyclosporine