Abstract
Seven patients, 3 with severe aplastic anemia (SAA) and 4 with pure red cell aplasia (PRCA), none suitable for bone marrow transplantation, were treated with cyclosporin A (CsA). CsA was given orally at 200-300mg everyday. Short case records are presented. Aplastic anemia: AA 1: Male aged 20. The patient was first shown to be refractory to anti-lymphocyte globulin (ALG) and bolus methylprednisolone (b-MP). Treatment with danazol was temporarily effective. AA 2: Female aged 66. The patient was refractory to ALG, prednisolone and mepitiostane. Her clinical and hematological status improved after two months of therapy with CsA alone. AA 3: Female aged 22 with pregnancy. She was treated with ALG and b-MP without effect after delivery. In case 1 and case 3, CsA combined with mepitiostane was used. Pure red cell aplasia: PRCA 1: Female aged 49. The patient had a refractory PRCA of 4 years' duration, treated with prednisolone, cyclophosphamide and lymphocytapheresis. Temporarily reticulocytosis after ALG was noted. PRCA 2: Female aged 52 with thymoma and hypo-gammaglobulinemia. She was shown to be refractory to ALG and b-MP after thymectomy. PRGA 3: Female aged 53 with Sjogren syndrome, treated with prednisolone without effect. PRCA 4: Female aged 69. A temporary remission was noted after prednisolone and cyclophosphamide. All four patients with PRCA showed a significant reticulocytosis after 16-39 days of CsA therapy. There have been no CsA-related toxicities.
It is suggested that CsA appear to have a place as a primary form of treatment for the patients with PRCA and may be beneficial in patients with AA who are refractory to conventional therapy.
