Secondary pure red cell aplasia in multiple myeloma treated with lenalidomide

Abstract

Pure red cell aplasia (PRCA) is a rare disorder characterized by marked erythroid hypoplasia with maturation arrest in the bone marrow. Secondary acquired PRCA may be associated with hematologic disorders. A few case reports have described PRCA associated with multiple myeloma (MM). However, the clinical course and mechanism of PRCA associated with MM remain unknown. We herein report two cases of PRCA associated with MM in patients undergoing treatment with lenalidomide.

Keywords: Lenalidomide; Multiple myeloma; Pure red cell aplasia.

Fig. 1

Case 1: A 77-year-old woman diagnosed with MM (IgG λ type). She underwent treatment with two cycles of an Ld regimen (lenalidomide and dexamethasone). She subsequently developed severe anemia. Cyclosporine was begun at 140 mg/day, and the anemia improved within 1 month.

Fig. 2

Case 2: A 73-year-old man diagnosed with MM (IgA λ type). He underwent treatment with a BD regimen (bortezomib and dexamethasone). After nine cycles of the BD regimen, he was switched to the Ld regimen (lenalidomide at 5 mg/day and dexamethasone at 20 mg/day). After 11 cycles of Ld, he suddenly developed anemia. He began treatment with cyclosporine at 200 mg/day. The anemia slowly improved. However, the MM gradually progressed and he died 6 months after the development of PRCA.