title: Etanercept-associated transient bone marrow aplasia: a review of the literature and pathogenetic mechanisms.
abstract: A patient with rheumatoid arthritis presented with increasing fatigue, fever, gingival bleeding, and petechial rash. Her symptoms started 1 week after the first injection of etanercept (Enbrel). Her only other medications (methotrexate and hydroxychloroquine) had been unchanged for years. Tests revealed severe pancytopenia and bone marrow aplasia. She recovered with supportive treatment within 12 days. The literature on serious blood dyscrasias associated with anti-tumor necrosis factor-α therapy is reviewed, an intriguing postulated mechanism is discussed, and selective patient monitoring is recommended.
authors: Department of Medicine, Kaplan Medical Center, POB 1, Rehovot, 76100, Israel.
authors: Natasha
authors: N
authors: Kozak
authors: Joshua
authors: J
authors: Friedman
authors: Ami
authors: A
authors: Schattner
mesh_terms: D000741:Anemia, Aplastic / Q000175:diagnosis / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000628:therapy; D001853:Bone Marrow / Q000473:pathology*; D000068800:Etanercept; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000009:adverse effects*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010198:Pancytopenia / Q000175:diagnosis / Q000628:therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D011994:Recombinant Proteins / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000900:Anti-Bacterial Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; D016179:Granulocyte Colony-Stimulating Factor; D006886:Hydroxychloroquine; D000068800:Etanercept; D000069585:Filgrastim; D008727:Methotrexate