Acquired Pure Red Cell Aplasia in patients with plasma cell neoplasm and long term remission with bortezomib therapy

Abstract

We report two cases of Pure Red Cell Aplasia (PRCA) associated with plasma cell dyscrasia. The first case is of an elderly woman with PRCA and light chain disease (LCD)/multiple myeloma (MM). She received multiple blood transfusions and was refractory to conventional therapies. Subsequent bortezomib therapy resulted in symptomatic improvement and normalization of her bone marrow and transfusion independence. This unique case of LCD/MM and PRCA treated with bortezomib induced long lasting remission of myeloma and resulted in reversal of PRCA and hence transfusion independence. This novel therapy is useful in elderly patients even with a high tumour burden of multiple myeloma. PRCA can also be associated in patients with low tumour bulk plasma cell disorders such as Monoclonal Gammopathy of Uncertain Significance (MGUS) as evidenced by the second case. Combination of prednisolone and oral cyclo - phosphamide therapies controlled her anaemia. Hence, a tailored therapy approach is recommended. Furthermore, patients with PRCA would benefit from thorough investigation to exclude plasma cell disorders.