Pure red cell aplasia after chemotherapy for Hodgkin's lymphoma: In vitro evidence for t cell mediated suppression of erythropoiesis and response to sequential cyclosporin and erythropoietin

Abstract

OMB No. 0704-01788A DA 2 7 9 0 2 2 h o u r re w e . ,n c l lnfIo me tim e To r re v ie w in g n s .tru c tio n s, se a rcnrin o ABSTRACT (Maximum 200 words)Acquired pure red cell aplasia (PRCA) has been associated with various lymphoproliferative conditions but its occurrence with Hodgkin's disease is rare. We report a case of PRCA occurring immediately following the completion of induction chemotherapy in a patient with Stage IIIB nodular sclerosing Hodgkin's disease. In vitro erythroid colony studies documented evidence for T cell mediated suppression of erythropoiesis and lack of a serum inhibitor. Addition of cyclosporin to the in vitro cultures stimulated erythroid colony growth.Following in vivo treatment with cyclosporin peripheral blood CD4/CD8 ratios returned to normal.However, serum erythropoietin levels were inappropriately low.Subsequent treatment with erythropoietin induced a reticulocytosis and transfusion independence.Since discontinuing the erythropoietin, the patient has been able to maintain a hemoglobin of 100 g/L.This case illustrates that red cell aplasia occurring in the setting of Hodgkin's disease may be due to T cell mediated suppression of erythropoiesis.A response to cyclosporin may be masked by inappropriately low erythropoietin levels. )of a serum inhibitor. Addition of cyclosporin to the in vitro cultures stimulated erythroid colony growth. Following in vivo treatment with cyclosporin peripheral blood CD4/CD8 , ratios returned to normal. However, serum erythropoietin levels were inappropriately low.

Reticulocytosis in nonanemic dogs: increasing prevalence and potential etiologies

“…Several pharmaceutical agents, including glucocorticoids and chemotherapeutic drugs, have been shown to cause RAA in people, due to direct effects on erythropoiesis and probable deleterious consequences on the bone marrow architecture and function . Glucocorticoids and other immunosuppressant agents, such as cyclosporine and azathioprine, may also inhibit normal immune‐mediated suppression of erythropoiesis . Interestingly, glucocorticoids, in combination with HIF‐1, promote self‐renewal of the erythroid burst‐forming unit in the bone marrow .…”

Acquired pure red cell aplasia associated with malignant lymphomas: A nationwide cohort study in Japan for the PRCA Collaborative Study Group

“…We found twenty-two reported cases of lymphoma-associated with PRCA and these can be classified into two groups based on the chronological sequence in the onset of lymphoma and anemia. Twelve patients presented with lymphoma and PRCA simultaneously (Table IV) [7][8][9][10][11][12][13][14][15][16][17][18], 10 patients developed PRCA following lymphoma (Table V) [5,[19][20][21][22][23][24][25][26][27]. Histologic subtypes of lymphoma varied.…”

Late Cardio-Pulmonary Sequelae after Treatment of Hodgkin’s Disease (HD)

“…Anaemia in HD may result from impaired mobilization of iron stores or may indicate the presence of advanced disease (bone marrow infiltration and/or failure) (Munker et al, 1995). After CTH, pure red cell aplasia may occur due to T-cell mediated suppression of erythropoiesis, where the response to cyclosporin may be masked by inappropriately low erythropoietin levels (Reid et al, 1994 andMohri et al, 1997). After 40 Gy of irradiation, the maximum depression of marrow activity occur 6 month postirradiation; however, the hemopoietic activity within the irradiated area may be depressed for years.…”