Intravenous Immunoglobulin Therapy for Pure Red Cell Aplasia Related to Human Parvovirus B19 Infection: A Retrospective Study of 10 Patients and Review of the Literature

Abstract

We evaluated the efficacy of intravenous immunoglobulin (IVIG) therapy in patients with pure red cell aplasia (PRCA) related to human parvovirus B19 (HPV-B19) infection. We retrospectively reviewed all HPV-B19 PRCA cases treated with IVIG between January 2000 and December 2005 in the Assistance Publique-Hôpitaux de Paris hospitals and reviewed all cases of HPV-B19 PRCA cases treated with IVIG in the literature. Among our 36 patients, PRCA was confirmed in 22, including 10 with proven HPV-B19 infection. Nine patients were immunocompromised, including 4 who had undergone transplant. All patients had severe anemia (mean hemoglobin level, 5.0 ± 1.9 g/dL). Seven patients who underwent bone-marrow aspiration had positive HPV-B19 polymerase chain reaction (PCR) results at diagnosis. Patients received a mean of 2.7 ± 2.1 IVIG courses (1.3 ± 0.5 g/kg/course). Hemoglobin level was corrected in 9 of the 10 patients within a mean of 80 ± 54 days. The only nonresponsive patient had underlying myelodysplasia. Blood HPV-B19 PCR results were negative from 35 to 159 days after treatment. Four patients showed side effects of IVIG treatment: acute reversible renal failure (n = 2) and pulmonary edema (n = 2). Among 133 patients with HPV-B19 PRCA who received IVIG (our 10 patients and 123 from the literature), 63 had undergone solid-organ transplant and 39 had human immunodeficiency virus infection. Hemoglobin level was corrected after the first IVIG course in 124 patients (93%); disease relapsed in 42 (33.9%), at a mean of 4.3 months. IVIG therapy appears to be effective in the short term in immunocompromised patients with HPV-B19 PRCA.