Background/Purpose:

The efficacy of intravenous immunoglobulin (IVIg) therapy in patients with pure red cell aplasia (PRCA) related to human parvovirus B19 (HPV-B19) infection is mainly supported by cases reports and few small retropective studies.

Methods:

We conducted a retrospective study and reviewed all cases of HPV-B19 PRCA treated with IVIg in the Assistance Publique-Hôpitaux de Paris hospitals between January 2000 and December 2005. In addition, all published HPV-B19 PRCA cases treated with IVIg were reviewed from 1980 to 2012.

Results:

Among the 36 cases collected, PRCA was confirmed in 22, and among these 22, only 10 had proven HPV-B19 infection. 9 patients were immunocompromised including 4 who had undergone transplantation. All patients had severe anemia (hemoglobin 5.0±1.9 g/dL (mean±standard deviation (SD)). Three presented severe clinical symptoms related to anemia, and six had symptoms consistent with HPV-B19 infection. HPV-B19 PCR was positive at diagnosis on bone marrow aspiration in 7/7 patients. Patients received 2.7±2.1 IVIg courses at a dose of 1.3±0.54 g/kg/course. Hemoglobin correction was achieved in 9/10 cases within 80±54 days. The only non responsive patient had underlying myelodysplasia. Negativation of blood HPV-B19 PCR was achieved in 35 to 159 days. Side effects of IVIg were noted in 4 patients: acute reversible renal failure and pulmonary edema, 2 cases each.

Including our series, we reviewed in literature 133 patients with HPV-B19 PRCA treated with IVIg. All except 2 of them were immunocompromised, including 39 HIV infected patients and 63 solid organ transplanted. After first IVIg course, hemoglobin correction was observed in 124 cases but 42 patients relapsed, in a mean time of 4,3 months. Among the 96 patients in whom the 12 months response to IVIg treatment was available, hemoglobin correction was achieved in 45 patients while persistant anemia was noticed in 51. In univariate analysis, HIV infection and absence of anti HPV-B19 IgM at diagnosis were associated with 12 months anemia persistence. Mean first IVIg dose (2,2g/Kg) didn’t differ significantly between responders and non responders. Overall survival was significantly better in responders patients. Side effects were noticed in 18 cases, including 9 cases of acute renal failure.

Conclusion: IVIg therapy is efficient and relatively safe in immunocompromised patients with HPV-B19 PRCA. Deepness of immunosuppression seems to be an important determinant of persistence response to treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/intravenous-immunoglobulin-in-parvovirus-b19-mediated-pure-red-cell-aplasia-a-retrospective-study-in-10-patients-and-a-review-of-123-cases/