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Long-term outcome of patients with acquired primary idiopathic pure red cell aplasia receiving cyclosporine A. A nationwide cohort study in Japan for the PRCA Collaborative Study Group

From the Division of Haematology, Dept. of Medicine III, Akita University School of Medicine, Akita, Akita 010-8543, Japan (K-iS, MH, NF); Dept. of Haematology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan (MT); Haematology Division, Dept. of Internal Medicine, Saitama Medical University, Saitama 350-0495, Japan (MB); Dept. of Haematology, Nippon Medical School, Tokyo 113-8602, Japan (KD); First Dept. of Internal Medicine, Gifu University School of Medicine, Gifu 501-1194, Japan (HT); Dept. of Cellular Transplantation Biology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8641, Japan (SN); Division of Haematology, NTT Kanto Medical Center, Tokyo 141-0022, Japan (AU); Division of Haematology, Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan (MO); Division of Haematology, Department of Medicine, Jichi Medical School, Tochigi 329-0498, Japan (KO)

Correspondence: Kenichi Sawada, M.D., Division of Haematology and Oncology, Department of Medicine, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan. E-mail: ksawada{at}doc.med.akita-u.ac.jp

Background and Objectives: Cyclosporine A (CsA) has become one of the leading agents for the treatment of pure red cell aplasia (PRCA). However, further studies are necessary to determine the relapse-free survival (RFS) and overall survival (OS) of patients treated with this drug, the minimum duration of therapy for induction of remission, and whether or not there is need for maintenance treatment.

Design and Methods: We conducted a nationwide survey in Japan. From a total of 185 patients (with 73 primary idiopathic PRCA and 112 with secondary PRCA), we evaluated 62 patients with primary idiopathic PRCA for this report.

Results: The remission induction therapy for these patients included CsA (n=31), corticosteroids (CS) (n=20) or other drugs (n=11). CsA and CS produced remissions in 23 (74%) and 12 (60%) patients, respectively. The salvage treatment produced remissions in 58 patients (94%). Forty-one and 15 patients were maintained on CsA±CS (CsA-containing group) or CS alone (CS group), respectively. The median RFS in the CsA-containing group was 103 months, longer than that seen in the CS group (33 months) (p<0.01). Of 14 patients whose CsA was discontinued, 12 patients (86%) relapsed after a median of 3 months (range 1.5 to 40 months), while only 3 of 27 patients (11%) relapsed during CsA-containing maintenance therapy. Thus, the discontinuance of maintenance therapy was strongly correlated with relapse (p<0.001). Four patients in the CsA-containing group died; however, the OS of this group was not significantly different from that of the CS-groups (p=0.104).

Interpretation and Conclusions: CsA-containing regimens sustain prolonged RFS more effectively than CS in primary idiopathic PRCA and seem to be important to prevent relapse.

Key words: pure red cell aplasia, cyclosporine A, relapse-free survival, maintenance therapy.

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				N. Fujishima, K.-i. Sawada, M. Hirokawa, K. Oshimi, K. Sugimoto, A. Matsuda, M. Teramura, M. Karasawa, A. Arai, Y. Yonemura, et al. Long-term responses and outcomes following immunosuppressive therapy in large granular lymphocyte leukemia-associated pure red cell aplasia: a Nationwide Cohort Study in Japan for the PRCA Collaborative Study Group Haematologica, October 1, 2008; 93(10): 1555 - 1559. [Abstract] [Full Text] [PDF]

				M. Hirokawa, K.-i. Sawada, N. Fujishima, S. Nakao, A. Urabe, K. Dan, S. Fujisawa, Y. Yonemura, F. Kawano, M. Omine, et al. Long-term response and outcome following immunosuppressive therapy in thymoma-associated pure red cell aplasia: a nationwide cohort study in Japan by the PRCA collaborative study group Haematologica, January 1, 2008; 93(1): 27 - 33. [Abstract] [Full Text] [PDF]