Epoetin-α

Reactions 1179 - 24 Nov 2007 S Epoetin-α Pure red cell aplasia: case report A 56-year-old man developed anti-erythropoietin (EPO) antibody-mediated pure red cell aplasia during treatment with epoetin-α. The man, who had undergone liver transplantation, started receiving peginterferon-α and ribavirin for hepatitis C. He developed anaemia. Treatment with SC epoetin-α [Procrit] 40 000U weekly was started. About 2 months later, his haemoglobin level decreased to 7.9 g/dL. Peginterferon-α and ribavirin were discontinued. He remained anaemic, with a haemoglobin nadir of 4.5 g/dL. His reticulocyte count was 0.7%. Iron studies were consistent with ineffective erythropoiesis. The man received 2U of packed red blood cell transfusions biweekly to maintain a haemoglobin level of about 7.0 g/dL. Eight months after withdrawal of peginterferon-α and ribavirin, a bone marrow biopsy and aspirate revealed hypocellular marrow with nearly absent erythroid precursors. The results suggested pure red cell aplasia. A diagnosis of EPO antibody- mediated pure red cell aplasia was considered. Epoetin-α was discontinued. About 1 month later, he had a serum EPO antibody level of 9.8% counts per minute and a serum EPO level of 82.9 mU/mL. About 6 weeks later, he had an EPO level of 54.6 mU/L, an EPO antibody titre of 17.6% counts per minute, and positive EPO-neutralising antibodies. Twelve weeks after discontinuation of epoetin-α, his anaemia improved and he no longer required red blood cell transfusions. Author comment: "[A]nti-EPO antibody-[pure red cell aplasia] can be a rare side effect of the use of recombinant EPO products used to treat anemia. . . We hypothesize that the immunomodulating effects of [interferon-α], including its ability to promote autoimmunity, are permissive in the development of EPO antibody-mediated [pure red cell aplasia] after exposure to Procrit." Schecter JM, et al. Anti-erythropoietin antibody-mediated pure red cell aplasia in a living donor liver transplant recipient treated for hepatitis C virus. Liver Transplantation 13: 1589-1592, No. 11, Nov 2007 - USA 801097685 1 Reactions 24 Nov 2007 No. 1179 0114-9954/10/1179-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Reactions 1179 - 24 Nov 2007

SEpoetin-αPure red cell aplasia: case report

A 56-year-old man developed anti-erythropoietin (EPO)antibody-mediated pure red cell aplasia during treatment withepoetin-α.

The man, who had undergone liver transplantation, startedreceiving peginterferon-α and ribavirin for hepatitis C. Hedeveloped anaemia. Treatment with SC epoetin-α [Procrit]40 000U weekly was started. About 2 months later, hishaemoglobin level decreased to 7.9 g/dL. Peginterferon-α andribavirin were discontinued. He remained anaemic, with ahaemoglobin nadir of 4.5 g/dL. His reticulocyte count was0.7%. Iron studies were consistent with ineffectiveerythropoiesis.

The man received 2U of packed red blood cell transfusionsbiweekly to maintain a haemoglobin level of about 7.0 g/dL.Eight months after withdrawal of peginterferon-α and ribavirin,a bone marrow biopsy and aspirate revealed hypocellularmarrow with nearly absent erythroid precursors. The resultssuggested pure red cell aplasia. A diagnosis of EPO antibody-mediated pure red cell aplasia was considered. Epoetin-α wasdiscontinued. About 1 month later, he had a serum EPOantibody level of 9.8% counts per minute and a serum EPOlevel of 82.9 mU/mL. About 6 weeks later, he had an EPO levelof 54.6 mU/L, an EPO antibody titre of 17.6% counts perminute, and positive EPO-neutralising antibodies. Twelveweeks after discontinuation of epoetin-α, his anaemiaimproved and he no longer required red blood celltransfusions.

Author comment: "[A]nti-EPO antibody-[pure red cellaplasia] can be a rare side effect of the use of recombinantEPO products used to treat anemia. . . We hypothesize thatthe immunomodulating effects of [interferon-α], including itsability to promote autoimmunity, are permissive in thedevelopment of EPO antibody-mediated [pure red cellaplasia] after exposure to Procrit."Schecter JM, et al. Anti-erythropoietin antibody-mediated pure red cell aplasia in aliving donor liver transplant recipient treated for hepatitis C virus. LiverTransplantation 13: 1589-1592, No. 11, Nov 2007 - USA 801097685