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Epoetin-Induced Autoimmune Pure Red Cell Aplasia

Nicole Casadevall^*, Kai-Uwe Eckardt and Jérôme Rossert

^* Department of Hematology, Hotel Dieu and INSERM U362, Paris, France; Division of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany; and Department of Nephrology, Tenon Hospital (AP-HP) and Pierre and Marie Curie University, Paris, France

Address correspondence to: Dr. Nicole Casadevall, Department of Hematology, Hotel Dieu, 1 place du Parvis de Notre Dame, 75004 Paris, France. Phone: +33–132-348266; Fax: +33–142-348254; E-mail: nicole.casadevall{at}htd.ap-hop-paris.fr

During the first 10 yr of therapy with recombinant human erythropoietin ([EPO]), only three cases of antibody-associated pure red cell aplasia have been described in patients who were treated with EPO, whereas several millions of patients have received this treatment. Thus, the possibility for epoetin to induce the formation of anti-EPO antibodies was considered extremely low. However, since 1998, a significant increase in the number of cases of EPO-induced pure red cell aplasia has been found in patients with chronic kidney disease with a peak in 2001 and 2002. The incidence rate seems now to be back to the baseline level. The change in formulation of epoetin sold outside the United States seems to be the cause of these antibodies.

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Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673