SUCCESSFUL TREATMENT OF REFRACTORY PURE RED-CELL APLASIA SECONDARY TOCHRONIC LYMPHOCYTIC-LEUKEMIA WITH CYCLOSPORINE-A - CORRELATION BETWEEN CLINICAL AND IN-VITRO EFFECTS

This report presents the case of a patient with PRCA in CLL where in v itro culture studies correlated well with successful CS-A treatment. B efore initiating CS-A therapy, coculture studies showed that T-cells f rom peripheral blood of the patient suppressed the from of CFU-E and B FU-E colonies by normal bone marrow cells. Normal erythropoiesis reapp eared in the bone marrow of the patient 3 weeks after the start of CS- A therapy. At this time, cocultures demonstrated that peripheral blood T-cells no longer inhibited the growth of normal BFU-E, although ther e was persistent suppression of CFU-E. Six months later the patient wa s in stable remission from PRCA on maintenance therapy with CS-A. More over, cocultures showed no T-cell inhibition of normal BFU-E or CFU-E colony formation. The strong correlation between in vitro culture stud ies and a beneficial clinical outcome observed in this case suggests t hat in vitro cultures could be used to monitor CS-A treatment in patie nts with PRCA in CLL.