Abstract
Cyclosporine A (CyA), an immunosuppressive drug, has shown a potency in pure red cell aplasia (PRCA). However, the effective blood level is not known in PRCA treatment. In a PRCA patient (53-year-old male) who responded to CyA, we carefully monitored CyA trough levels over a 4-year period. In the first 6 months, the hemoglobin level was about 11 g/dl and the CyA trough level was over 150 ng/ml ; the dose of CyA was then tapered to prevent renal toxicity. The trough level was controlled between 100 and 150 ng/ml, and he remained in continuous remission for the subsequent year. However, after that time, the hemoglobin level gradually decreased and PRCA recurred. We then increased the CyA trough level to over 150 ng/ml and his anemia improved. This case report illustrates that a CyA trough level of at least 150 ng/ml is necessary to maintain remission.
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