Avtor/Urednik		Bervar, Mojca; Černelč, Peter
Naslov		Zdravljenje čiste aplastične anemije pri bolniku s kronično limfocitno levkemijo
Prevedeni naslov		Treatment of pure red cell aplastic anemia in patient with chronic lymphocytic leukemia
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 67, št. Suppl 1
Leto izdaje		1998
Obseg		str. I-47-9
Jezik		slo
Abstrakt		Background. Pure red cell aplastic anaemia is a very rare complication of chronic lymphocytic leukaemia (CLL). It is probably caused by humoral and/or T lymphocytic interferance with the growth and differentiation of red cell precursors. Most patients with CLL-associated pure red cell aplastic anaemia are treated with immunosuppressive drugs, such as glucocorticoids, cyclosporine or antilymphocyte globulin, and less frequently with androgen steroids. Case report. A 68-year-old patient with CLL developed pure red cell aplastic anaemia after 3 years of treatment with chlorambucil and methylprednisolone. Because of advanced CLL, fludarabine was instituted. Two months later, the lymph nodes became smaller and the lymphocyte count decreased, but the anaemia and reticulopoenia persisted. The patient was given cyclosporine (Sandimmun-Neoral) in a dose of 200 mg/day. After a month of this treatment, the reticulocyte count increased and the haemoglobin rise to 100 g/L. As no further improvement was noted over the next month, cyclosporine was substituted with oxymetholone (Anapolon) 100 mg/day. After a month, the reticulocyte count increased, the haemoglobin reached 126 g/L, and oxymetholone was withdrawn. Conclusion. Since pure red cell aplastic anaemia mostly occus in association with advanced CLL, simultanous treatment of both disorders is advisable. Our patient experienced a prolonged remission of the anaemia after treatment with a combination of cyclosporine, androgen steriods and fludarabine.
Izvleček		Izhodišča. Čista aplastična anemija (ČAA) je redek zaplet kronične limfocitne levkemije (KLL) in je posledica protitelesnega in celičnega zaviralnega delovanja na dozorevanje usmerjene matične celice rdeče vrste. Za zdravljenje ČAA pri bolnikih s KLL najpogosteje uporabljamo učinkovine z zaviralnih delovanjem na imunski odziv, kot so glukokortikoidi, ciklosporin in protilimfocitni globulin, redkeje pa androgene steroide. Naš primer. 68-letnemu bolniku, ki se je tri leta zdravil zaradi KLL, smo marca 1996 ugotovili ČAA. Zaradi razširjene KLL in neuspešnega zdravljenja s klorambucilom in metilprednizolonom smo ga začeli zdraviti s fludarabinom. Po zdravljenju so se zmanjšale bezgavke in število limfocitov v krvi, medtem ko se anemija ni popravila. Na osnovi hude anemije, zelo zmanjšanega števila retikulocitov v krvi, odsotnosti celic rdeče vrste v kostnem mozgu in kopičenju limfocitov ob še ohranjeni granulopoezi in megakariopoezi smo menili, da gre za ČAA. Ker se po zdravljenju s glukokortikoidi anemija ni popravila, smo začeli zdralvjenje s ciklosporinom (Sandimmun Neoral) 200 mg/dan. Po mesecu dni se je povečalo Število retikulocitov in koncentracija Hb do 100 g/L vendar, ker nadaljnega porast nismo zasledili, smo ciklosporin ukinili in se odločili za zdravljenje z oksimetolonom (Anapolon) 100 mg/dan. Po enomesečnem zdravljenju se je povečalo Število retikulocitov in koncentracija hemoglobina na 126 g/L, zato smo oksimetolon ukinili.
Deskriptorji		LEUKEMIA, LYMPHOCYTIC, CHRONIC ANEMIA, APLASTIC AGED CYCLOSPORINE OXYMETHOLONE PURINES