Successful treatment of anti-erythropoietin antibody-mediated pure red cell aplasia with low-dose prednisolone.
The standard therapy for anti-erythropoietin (EPO) antibody-mediated pure red cell aplasia (PRCA) is cyclosporine (CyA) or prednisolone (PSL) 0.5-1.0 mg/kg. However, many patients with severe chronic kidney disease (CKD) and chronic heart failure cannot tolerate such an immunosuppressive regimen. An 86-year-old man with anemia related to CKD and chronic heart failure, who had received recombinant human erythropoietin subcutaneously, developed anti-EPO antibody-mediated PRCA. The patient was treated with CyA followed by PSL (1.0 mg/kg); however, he was unable to tolerate this drug regimen. The PSL dose was reduced to 0.2 mg/kg. Surprisingly, his reticulocyte count increased 3 months later, and RBC transfusion was no longer required. Low-dose PSL is a treatment option for patients with anti-EPO antibody-mediated PRCA who cannot tolerate CyA and PSL (0.5-1.0 mg/kg).
Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minami-machi, Chuo-ku, Kobe 650-0047, Japan. kazunariaoki0911@gmail.com
Kazunari
K
Aoki
Yuichiro
Y
Ono
Sumie
S
Tabata
Akiko
A
Matsushita
Takayuki
T
Ishikawa
D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood / Q000276:immunology*; D004921:Erythropoietin / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage*; D012010:Red-Cell Aplasia, Pure / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D016896:Treatment Outcome
D000906:Antibodies; D007166:Immunosuppressive Agents; D004921:Erythropoietin; D011239:Prednisolone