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Erythropoietin treatment during complement inhibition with eculizumab in a patient with paroxysmal nocturnal hemoglobinuria

¹ Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom;
² Alexion Pharmaceuticals, Inc, Cheshire, Connecticut , USA

Address correspondence to Dr. Anita Hill, MBChB (Hons), MRCP, DipRCPath, Leeds General Infirmary, Department of Haematology, D Floor, Brotherton Wing, Great George Street, Leeds, LS1 3EX, UK Phone: +44.113.3925153, fax: +44.113.3926349 E-mail: anitahill{at}nhs.net

Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by intravascular hemolysis leading to anemia and other clinical manifestations. Transfusions are often required to support hemoglobin at tolerable levels. A PNH patient with aplastic anemia was treated with the complement inhibitor eculizumab, followed by concurrent treatment with recombinant human erythropoietin (rHuEpo). Eculizumab alone reduced hemolysis, increased PNH red blood cell (RBC) mass, and decreased transfusions. Addition of rHuEpo during eculizumab therapy, enhanced erythropoiesis, further increased PNH RBC mass and hemoglobin levels, and rendered the patient transfusion independent for more than two years. These data show that driving erythropoiesis during eculizumab treatment provided further benefit to a patient with PNH and underlying bone marrow failure.

Key words: Complement, eculizumab, erythropoietin, intravascular hemolysis, paroxysmal nocturnal hemoglobinuria.