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

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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.