title: Pure red cell aplasia induced by anti-erythropoietin antibodies, well-controlled with tacrolimus.
abstract: Anti-erythropoietin (anti-EPO) antibody-related pure red cell aplasia (PRCA) is a rare but serious complication that can occur during the administration of erythropoiesis-stimulating agents. Treatment with the calcineurin inhibitor cyclosporine has shown benefits in patients with anti-EPO PRCA. The efficacy of tacrolimus, another calcineurin inhibitor, in patients with anti-EPO PRCA has not been determined. The present report is the first our knowledge to describe the successful treatment of a patient with anti-EPO PRCA using tacrolimus. A 73-year-old man was markedly anemic 8 months after starting epoetin beta treatment. He was diagnosed with anti-EPO PRCA. Cyclosporine was started, but he experienced side effects. He was switched from cyclosporine to tacrolimus. No side effects were observed, and his anti-EPO PRCA was improved 6 months later, despite the persistence of anti-EPO antibodies. Tacrolimus was continued until the disappearance of the antibodies. Following the cessation of tacrolimus, PRCA did not relapse. Antibody remained detectable at the time of clinical remission, indicating that immunosuppressive therapy should be continued while monitoring the antibody titer. When the antibody titer decreases to the negative range, cessation of the immunosuppressive therapy does not result in disease relapse.
authors.affiliation: Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan. khashi@shinshu-u.ac.jp.
authors.forename: Koji
authors.identifier: http://orcid.org/0000-0002-8854-2810
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Harada
authors.affiliation: Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kamijo
mesh_terms: D000368:Aged; D000906:Antibodies / Q000009:adverse effects*; D004921:Erythropoietin / Q000276:immunology; D006397:Hematinics / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced / Q000188:drug therapy*; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D000906:Antibodies; C554270:EPO protein, human; D006397:Hematinics; D007166:Immunosuppressive Agents; D004921:Erythropoietin; D016559:Tacrolimus
keywords: Anti-erythropoietin antibody; Pure red cell aplasia; Tacrolimus