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International Journal of Hematology

, Volume 75, Issue 5, pp 514–518 | Cite as

Pure Red Cell Aplasia Developing into Myeloproliferation with Myelodysplasia and Subsequent Leukemia after Cyclosporin A Therapy

  • Takahiro Yamauchi
  • Haruhisa Shirasaki
  • Atsushi Kuwata
  • Taro Yamashita
  • Shin Imamura
  • Hiroshi Tsutani
  • Takanori Ueda
Case Report

Abstract

We describe a very rare case of a patient who presented with red cell aplasia that later developed into myeloproliferation with myelodysplasia and eventually leukemia. A 63-year-old man presented with anemia and reticulocytopenia in May 1997. A bone marrow examination revealed erythroid aplasia with normal production of myeloid cells and megakaryocytes with a normal karyotype. After the diagnosis of pure red cell aplasia was made, the patient was treated with prednisolone and then with cyclosporin A (CyA). Two weeks after the initiation of CyA treatment, the peripheral reticulocyte count began to increase with a regrowth of erythroid cells in the bone marrow. Meanwhile, the peripheral white blood cell and platelet counts also increased to more than 10,000/μL and 1,000,000/μL, respectively. Examination of a bone marrow aspirate in December 1997 revealed myelodysplastic changes with trisomy 8. Despite the discontinuation of CyA and the administration of 1-β-D-arabinofuranosylcytosine stearyl monophosphate, leukemia developed in August 1998. In September 1998, the patient died of sepsis during a neutropenic period that followed remission-induction therapy. In the mechanism of pathogenesis, CyA may induce upon pure red cell aplasia a secondary myeloproliferative disorder with myelodysplasia and leukemia. An alternative possibility is that CyA reduces autoimmune-mediated suppression of the underlying stem cell disorder and that the result of this reduction is the manifestation of myeloproliferation and leukemia.

Key words

Pure red cell aplasia Myelodysplastic syndrome Acute leukemia Cyclosporin A Autoimmune reaction 

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Copyright information

© The Japanese Society of Hematology 2002

Authors and Affiliations

  • Takahiro Yamauchi
    • 1
  • Haruhisa Shirasaki
    • 1
  • Atsushi Kuwata
    • 1
  • Taro Yamashita
    • 1
  • Shin Imamura
    • 1
  • Hiroshi Tsutani
    • 1
  • Takanori Ueda
    • 1
  1. 1.First Department of Internal MedicineFukui Medical UniversityMatsuoka, FukuiJapan

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