mercaptopurine and Thymoma

Pure red cell aplasia is a selective aplasia of the marrow erythroid cells. Unlike aplastic anemia, the marrow has a normal cellularity and the patients generally have normal leukocyte and platelet blood counts. The congenital form of the disease occurs in the firlst 1 1/2 years of life and is often responsive to corticosteroids. The acquired form may be secondary to infections, drugs, chemicals, or hemolytic anemia (aplastic crisis). In these cases it is often acute and self-limited with cessation of the infection or drug ingestion. It may also be secondary to systemic lupus erythematosus, rheumatoid arthritis, acute severe renal failure, severe nutritional deficiency, or diverse neoplasms, and may remit with treatment of the primary condition. When a thymoma is present, it should be resected since a remission is produced in 29 per cent of these patients. The remaining patients have an acquired primary form of the disease that tends to be chronic and in some cases may have an immune pathogenesis. A cytotoxic immunoglobulin inhibitor of the marrow erythroid cells or erythropoietin has been described and these patients may respond to prednisone and/or to cytotoxic immunosuppressive drugs such as cyclophosphamide and 6-mercaptopurine. Pure red cell aplasia appears to be more common than the literature has revealed and has stimulated much investigation into an immune pathogenesis for marrow failure.

Topics: Acute Kidney Injury; Anemia, Aplastic; Antilymphocyte Serum; Arthritis, Rheumatoid; Blood Cell Count; Blood Transfusion; Cyclophosphamide; Deficiency Diseases; Erythropoietin; Humans; Immune System Diseases; Infections; Lupus Erythematosus, Systemic; Mercaptopurine; Prednisone; Remission, Spontaneous; Splenectomy; Thymoma; Thymus Neoplasms

Topics: Adult; Anemia, Aplastic; Animals; Antibodies, Antinuclear; Antigen-Antibody Complex; Bone Marrow; Bone Marrow Cells; Child, Preschool; Cyclophosphamide; Erythrocytes, Abnormal; Erythropoiesis; Erythropoietin; Heme; Humans; Immunoglobulin G; Infant; Mercaptopurine; Prednisone; Stimulation, Chemical; Thymectomy; Thymoma

A patient, a 46-year-old female, with a malignant thymoma spreading to the extrathoracic region is described. She underwent a thoracotomy and received radiation therapy, but the myasthenic symptoms did not disappear. A metastatic thymoma of the right mandibula was removed 9 months after thoracotomy. Further examination revealed metastatic thymomas of the bone and liver. After the operation the patient received combination chemotherapy (vincristine, cyclophosphamide, 6-mercaptopurine, prednisone) and remained asymptomatic for 31 months. She was found to have a metastatic thymoma in the occipital lobe of the brain 3.5 years after thoracotomy, and died from infection of the lung. Distant metastases and chemotherapy in malignant thymoma are reviewed.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Brain Neoplasms; Cyclophosphamide; Female; Humans; Liver Neoplasms; Mandibular Neoplasms; Mercaptopurine; Middle Aged; Neoplasm Metastasis; Prednisone; Thymoma; Thymus Neoplasms; Vincristine

Topics: Anemia, Aplastic; Azathioprine; Cyclophosphamide; Hemangiosarcoma; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Skin Neoplasms; Thymoma; Thymus Gland; Thymus Neoplasms

Topics: Adrenocorticotropic Hormone; Adult; Antibodies; Antilymphocyte Serum; Azathioprine; Cholinesterase Inhibitors; Drug Resistance; Female; Fluorescent Antibody Technique; Humans; Immunity, Cellular; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Muscle Proteins; Myasthenia Gravis; Myosins; Remission, Spontaneous; Thymoma; Thymus Hyperplasia; Thymus Neoplasms

Topics: Anemia, Aplastic; Antibodies, Antinuclear; Azathioprine; Bone Marrow; Cyclophosphamide; Erythropoiesis; Heme; Humans; Immunosuppressive Agents; In Vitro Techniques; Male; Mercaptopurine; Middle Aged; Muscular Diseases; Prednisone; Splenectomy; Thymectomy; Thymoma