Epoetin Treatment May Evoke Antibody Response, Leading to Pure Red-Cell Aplasia

NEW YORK (Reuters Health) – In patients with chronic renal failure treated with recombinant human erythropoietin, the formation of neutralizing antierythropoietin antibodies can result in the development of pure red-cell aplasia, European investigators report in The New England Journal of Medicine for February 14.
Dr. Nicole Casadevall, of the Hopital Hotel-Dieu in Paris, and colleagues identified 13 chronic dialysis patients who developed severe transfusion-dependent anemia between 1998 and 2000 following an initial hematologic response to epoetin. The diagnosis of red-cell aplasia was based on the absence of erythroid cells in bone marrow or of circulating reticulocytes.

Twelve of the patients had been treated with epoetin-alpha and one with epoetin-beta. The severe anemia developed after 3 to 67 months of treatment.

After epoetin treatment was discontinued, six patients recovered some erythropoietic function of their own after being treated with immunosuppressants or a renal allograft. Three remain dependent on transfusions more than 2 years later. The remaining four patients also still require transfusions, but their followup has been too short to determine their clinical course. …

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