Rituximab therapy for pure red cell aplasia due to anti-epoetin antibodies in a woman treated with epoetin-alfa: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pure red cell aplasia due to anti-epoetin antibodies is a known complication of epoetin therapy for anemia due to chronic kidney disease. This disease has not previously been well described in the setting of therapy for chronic hepatitis C virus infection. While treatment for pure red cell aplasia due to anti-epoetin antibodies is usually with immunosuppressive therapy such as calcineurin inhibition, the safety of this treatment in chronic hepatitis C virus infection is unknown. To date, little has been published on the efficacy of rituximab on pure red cell aplasia due to anti-epoetin antibodies.</p> <p>Case presentation</p> <p>This report describes a 65-year-old Asian-American woman who developed pure red cell aplasia from high titer neutralizing anti-epoetin antibodies after epoetin-alfa therapy during ribavirin and peg-interferon treatment for chronic hepatitis C virus infection. We describe the outcome of her treatment with rituximab. The reticulocyte count increased, and anti-epoetin antibody titer decreased with a loss of neutralizing activity <it>in vitro</it>, leading to a reduction in blood transfusions, and eventual resolution of anemia, without reactivation of hepatitis C virus.</p> <p>Conclusion</p> <p>The diagnosis of pure red cell aplasia from anti-epoetin antibodies should be considered in patients undergoing therapy for chronic hepatitis C virus infection who develop severe anemia after administration of erythropoietin or darbepoetin. Though it is currently an off-label indication, rituximab is a therapeutic option for patients with pure red cell aplasia due to anti-epoetin antibodies.</p

Нейтронно-физический расчет ядерного реактора типа УГР

Объектом исследования является ядерный реактор мощностью 1550МВт с топливом UO2 и обогащением 2,5 % и с теплоносителем углекислый газ. Цель работы – реализация нейтронно-физического расчёта реактора, состоящего в физическом обосновании конструкции и определении совокупности физических параметров, удовлетворяющих поставленным требованиям. В процессе исследования проводились расчеты нейтронно-физических характеристик реактора, на основании которых были получены таблицы и построены графики, а так же начерчен чертеж; произведен расчет финансовой составляющей работы, описаны внешние факторы, влиявшие на выполнение работы. В результате исследования произведён нейтронно-физический расчет данного реактора, в частности оценены размеры активной зоны, рассчитаны коэффициенты размножения «холодного» и «горячего» реакторов, произведен расчет реактора на конец кампании.The object of research is nuclear reactor power 1550МВт fuel and UO2 enriched to 2.5 % with the coolant carbon dioxide. Purpose – implementation of neutron-physical calculation of the reactor consisting in a physical rationale for the design and definition of a set of physical parameters that meet the requirements. In the process of investigation the calculations of neutron-physical characteristics of the reactor on the basis of which was obtained tables and graphs, and blueprint drawing. the calculation of the financial component of the operation described external factors affecting performance of the work. The study produced neutron-physical calculation of the reactor, in particular the estimated size of the active zone, coefficients were calculated propagation "cold" and "hot" reactors, calculation of reactor at the end of the campaign

Anti-Erythropoietin Antibody Associated Pure Red Cell Aplasia Resolved after Liver Transplantation

Patients undergoing antiviral therapy for chronic hepatitis C often develop anemia secondary to ribavirin and interferon. Recombinant erythropoietin has been used to improve anemia associated with antiviral therapy and to minimize dose reductions, which are associated with decreased rates of sustained virologic response. A rare potential side effect of recombinant erythropoietin is anti-erythropoietin antibody associated pure red cell aplasia. In chronic kidney disease patients with this entity, there have been good outcomes associated with renal transplant and subsequent immunosuppression. In this case, a chronic liver disease patient developed anti-erythropoietin associated pure red cell aplasia and recovered after liver transplantation and immunosuppression. It is unclear whether it is the transplanted organ, the subsequent immunosuppression, or the combination that contributed to the response. In conclusion, anti-erythropoietin associated pure red cell aplasia is a serious complication of erythropoietin therapy, but this entity should not be considered a contraindication for solid organ transplantation

Rituximab therapy for pure red cell aplasia due to anti-epoetin antibodies in a woman treated with epoetin-alfa: a case report.

IntroductionPure red cell aplasia due to anti-epoetin antibodies is a known complication of epoetin therapy for anemia due to chronic kidney disease. This disease has not previously been well described in the setting of therapy for chronic hepatitis C virus infection. While treatment for pure red cell aplasia due to anti-epoetin antibodies is usually with immunosuppressive therapy such as calcineurin inhibition, the safety of this treatment in chronic hepatitis C virus infection is unknown. To date, little has been published on the efficacy of rituximab on pure red cell aplasia due to anti-epoetin antibodies.Case presentationThis report describes a 65-year-old Asian-American woman who developed pure red cell aplasia from high titer neutralizing anti-epoetin antibodies after epoetin-alfa therapy during ribavirin and peg-interferon treatment for chronic hepatitis C virus infection. We describe the outcome of her treatment with rituximab. The reticulocyte count increased, and anti-epoetin antibody titer decreased with a loss of neutralizing activity in vitro, leading to a reduction in blood transfusions, and eventual resolution of anemia, without reactivation of hepatitis C virus.ConclusionThe diagnosis of pure red cell aplasia from anti-epoetin antibodies should be considered in patients undergoing therapy for chronic hepatitis C virus infection who develop severe anemia after administration of erythropoietin or darbepoetin. Though it is currently an off-label indication, rituximab is a therapeutic option for patients with pure red cell aplasia due to anti-epoetin antibodies

Off-Label Use of Rituximab in a Multipayer Insurance System

The frequent use of rituximab for off-label indications should lead to improved postapproval FDA surveillance of biologics so that use can be adequately studied, and will also facilitate improved regulatory mechanisms to ensure evidence-based use