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July 9, 2003

Aplastic Anemia and Immunosuppression—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(2):193. doi:10.1001/jama.290.2.193-a

To the Editor: In their article about antithymocyte globulin and cyclosporine for severe aplastic anemia, Dr Rosenfeld and colleagues1 did not discuss Good and colleagues'2 1956 description of an associated syndrome of gammaglobulinemia, presumably due to immune suppression, in patients with benign thymic tumors. In our clinical experience, we have found that this syndrome can be associated with severe aplastic anemia and vitiligo. Although these findings do not necessarily respond to intravenous γ globulin or antithymocyte globulin, we have found that cyclosporine may lead to a dramatic response. Rosenfeld et al, however, did not indicate whether their patients had signs of immunosuppression, such as hypogammaglobulinemia, hypothyroidism, pernicious anemia, or vitiligo.