Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minami-machi, Chuo-ku, Kobe 650-0047, Japan.
Int J Hematol. 2013 Feb;97(2):272-4. doi: 10.1007/s12185-013-1258-3. Epub 2013 Jan 26.
The standard therapy for anti-erythropoietin (EPO) antibody-mediated pure red cell aplasia (PRCA) is cyclosporine (CyA) or prednisolone (PSL) 0.5-1.0 mg/kg. However, many patients with severe chronic kidney disease (CKD) and chronic heart failure cannot tolerate such an immunosuppressive regimen. An 86-year-old man with anemia related to CKD and chronic heart failure, who had received recombinant human erythropoietin subcutaneously, developed anti-EPO antibody-mediated PRCA. The patient was treated with CyA followed by PSL (1.0 mg/kg); however, he was unable to tolerate this drug regimen. The PSL dose was reduced to 0.2 mg/kg. Surprisingly, his reticulocyte count increased 3 months later, and RBC transfusion was no longer required. Low-dose PSL is a treatment option for patients with anti-EPO antibody-mediated PRCA who cannot tolerate CyA and PSL (0.5-1.0 mg/kg).
抗红细胞生成素 (EPO) 抗体介导的纯红细胞再生障碍性贫血 (PRCA) 的标准治疗方法是环孢素 (CyA) 或泼尼松龙 (PSL) 0.5-1.0mg/kg。然而，许多患有严重慢性肾脏病 (CKD) 和慢性心力衰竭的患者无法耐受这种免疫抑制方案。一位 86 岁的男性因 CKD 和慢性心力衰竭导致贫血，曾接受过皮下重组人促红细胞生成素治疗，随后发生了抗 EPO 抗体介导的 PRCA。该患者接受了 CyA 随后是 PSL（1.0mg/kg）治疗；然而，他无法耐受该药物方案。PSL 剂量减少至 0.2mg/kg。令人惊讶的是，他的网织红细胞计数在 3 个月后增加，不再需要输血。对于不能耐受 CyA 和 PSL（0.5-1.0mg/kg）的抗 EPO 抗体介导的 PRCA 患者，低剂量 PSL 是一种治疗选择。
