Cyclosporin-A for the treatment of pure red cell aplasia in a patient with chronic lymphocytic leukemia

Am J Hematol. 1987 Oct;26(2):179-89. doi: 10.1002/ajh.2830260209.

Abstract

A 62-year-old man with B-cell chronic lymphocytic leukemia had three separate episodes of pure red cell aplasia (PRCA). The last episode was treated with cyclosporin-A (CyA) and prednisone. After the patient was on the therapy for 2 weeks, erythropoietic recovery was observed and with continued therapy the hematocrit (Hct) became normal. The PRCA remission was associated with a fall in the blood lymphocyte count, and a reduction in the spleen and lymph node size and bone marrow lymphocyte density. At diagnosis of PRCA the blood T-cells bearing IgG Fc receptors (T gamma cells) were increased, and the marrow contained very few or no late-stage erythroid progenitors. After remission of PRCA the T gamma cell fraction decreased, and the marrow erythroid progenitor's number became normal. We speculate that therapy with CyA and prednisone inhibited the production of interleukins-1 and -2 from monocytes and T-cells, respectively, and was responsible for the reduction of the T gamma cell fraction and B-cell leukemic mass in this patient. Further, we believe that normalization of T gamma cells in association with the therapy was responsible for the PRCA remission.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cyclosporins / therapeutic use*
  • Erythropoiesis
  • Hematopoietic Stem Cells / pathology
  • Humans
  • Interleukin-1 / biosynthesis
  • Interleukin-2 / biosynthesis
  • Leukemia, Lymphoid / complications*
  • Male
  • Middle Aged
  • Prednisone / pharmacology
  • Red-Cell Aplasia, Pure / drug therapy*
  • T-Lymphocytes / classification

Substances

  • Cyclosporins
  • Interleukin-1
  • Interleukin-2
  • Prednisone