title: Successful treatment of pure red cell aplasia with cyclosporin A and erythropoietin after thymectomy in a 88-year old woman.
abstract: 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.
authors.affiliation: 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>
authors.forename: Toyoki
authors.initials: T
authors.lastname: Maeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shiokawa
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Yoshikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Hiroyama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Hiromi
authors.initials: H
authors.lastname: Muta
authors.forename: Masaharu
authors.initials: M
authors.lastname: Nakayama
authors.forename: Yukoh
authors.initials: Y
authors.lastname: Nakazaki
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Akizuki
authors.forename: Kanako
authors.initials: K
authors.lastname: Shimizu
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Mutoh
authors.forename: Shinichi
authors.initials: S
authors.lastname: Somada
authors.forename: Ryo
authors.initials: R
authors.lastname: Kurita
authors.forename: Motoaki
authors.initials: M
authors.lastname: Shiratsuchi
authors.forename: Naoki
authors.initials: N
authors.lastname: Makino
authors.forename: Junji
authors.initials: J
authors.lastname: Nishimura
authors.forename: Kenzaburo
authors.initials: K
authors.lastname: Tani
mesh_terms: 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*
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin; D016572:Cyclosporine