Improvement in erythropoieis-stimulating agent-induced pure red-cell aplasia by introduction of darbepoetin-α when the anti-erythropoietin antibody titer declines spontaneously.
Anti-erythropoietin antibodies usually cross-react with all kinds of recombinant erythropoietins; therefore, erythropoiesis-stimulating agent (ESA)-induced pure red-cell aplasia (PRCA) is not rescued by different ESAs. Here, we present a case of ESA-induced PRCA in a 36-yr-old woman with chronic kidney disease, whose anemic condition improved following reintroduction of darbepoetin-α. The patient developed progressive, severe anemia after the use of erythropoietin-α. As the anemia did not improve after the administration of either other erythropoietin-α products or erythropoietin-β, all ESAs were discontinued. Oxymetholone therapy failed to improve the transfusion-dependent anemia and a rechallenge with ESAs continuously failed to obtain a sustained response. However, her anemia improved following reintroduction of darbepoetin-α at 3 yr after the initial diagnosis. Interestingly, anti-erythropoietin antibodies were still detectable, although their concentration was too low for titration. In conclusion, darbepoetin-α can improve ESA-induced PRCA when the anti-erythropoietin antibody titer declines and its neutralizing capacity is lost.
Divison of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Hajeong
H
Lee
Jaeseok
J
Yang
Hyosang
H
Kim
Ju Won
JW
Kwon
Kook-Hwan
KH
Oh
Kwon Wook
KW
Joo
Yon Su
YS
Kim
Curie
C
Ahn
Jin Suk
JS
Han
Suhnggwon
S
Kim
D000328:Adult; D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D000906:Antibodies / Q000097:blood* / Q000276:immunology; D001854:Bone Marrow Cells / Q000473:pathology; D000068256:Darbepoetin alfa; D004342:Drug Hypersensitivity / Q000276:immunology; D004921:Erythropoietin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000276:immunology* / Q000627:therapeutic use; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications; D006397:Hematinics / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D010110:Oxymetholone / Q000627:therapeutic use; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced / Q000188:drug therapy* / Q000276:immunology
D000906:Antibodies; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D010110:Oxymetholone