[Successful treatment of intravenous cyclophosphamide pulse therapy for systemic lupus erythematosus complicated with steroid-resistant hemolytic anemia].

Abstract

(Case 1) A 13-years-old female had multiple arthralgia and butterfly rush, when she admitted in our hospital in May 2001. Nephropathy, hemolytic anemia (Hb 6.3 g/dl and direct Coombs 3+) and high titers of antinuclear antibodies and anti-ds-DNA antibody were disclosed and she was diagnosed as systemic lupus erythematosus (SLE). Although combination therapy of PSL 60 mg/day with a steroid pulse therapy, cyclosporine or an immunosorbent treatment, severe hemolytic anemia remained. However, monthly cyclophosphamide pulse therapy (IV-CY), which was started for the steroid-resistant hemolytic anemia, has gradually become effective and Hb improved up to 11.4 g/dl after 6 courses of IV-CY. (Case 2) A 53-years-old woman diagnosed as SLE in 1978 and she had PSL 5 mg for over 10 years. Severe anemia (Hb 5.9 g/dl) was disclosed with a slight fever in June 2001, and she admitted in our hospital for further examinations. Progressive hemolytic anemia was revealed with marked decrease of Hb (3.4 g/dl) and high titer of direct Coombs (3+). Neither PSL (50 mg/day) nor steroid pulse therapy were effective against hemolytic anemia. In contrast, 3 courses of monthly IV-CY (500 mg/day) resulted in the resolution of hemolysis. It is well known that the steroid-resistant hemolytic anemia is extremely hard to treat and leads to miserable prognosis, but we here propose IV-CY as an alternative and invaluable choice for the treatment of refractory hemolytic anemia complicated with SLE.

• Authors: Mikiko Tokunaga, Kazuyoshi Saito, Keisuke Nakatsuka, Shingo Nakayamada, Kazuhisa Nakano, Shizuyo Tsujimura, Toshiyuki Ota, Yoshiya Tanaka
• Journal: Nihon Rinsho Men'eki Gakkai kaishi = Japanese journal of clinical immunology (Nihon Rinsho Meneki Gakkai Kaishi) Vol. 26 Issue 5 Pg. 304-9 (Oct 2003) ISSN: 0911-4300 [Print] Japan
• PMID: 14635405 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Immunosuppressive Agents
• Cyclophosphamide

Topics

• Adolescent
• Anemia, Hemolytic, Autoimmune (drug therapy, etiology)
• Cyclophosphamide (administration & dosage)
• Female
• Humans
• Immunosuppressive Agents (administration & dosage)
• Injections, Intravenous
• Lupus Erythematosus, Systemic (complications)
• Middle Aged
• Pulse Therapy, Drug