Gold-induced bone marrow aplasia: successful treatment with antithymocyte globulin

Molecular mechanisms of autoimmunity

Autoimmune diseases result from a combination of genetic susceptibility factors and exogenous influences such as infection or chemical (including drug) exposure. Germline DNA variations in genetic type as well as defects in antigen recognition acquired during thymic education of developing T-lymphocytes both contribute to impaired self: nonself discrimination and set the stage for later development of such diseases as myasthenia gravis, polymyositis, or systemic lupus erythematosus. In addition, drugs such as D-penicillamine, hydralazine, procainamide, or quinidine induce T-cell or B-cell changes which precipitate auto-reactivity and cause drug-induced disease. Intervention in autoimmune diseases with prednisone, alkylating agents or the future use of more selective monoclonal antibody reagents may be life-saving in some of these disorders.

Treatment of gold-induced aplastic anaemia with immunosuppressive therapy

Between June 1978 and August 1985 12 patients with gold-induced aplastic anaemia were treated with immunosuppressive therapy. Median age was 38.5 years for the 11 females and one male. Treatment regimens varied, but all patients received 150-160 mg/kg horse anti-human thymocyte globulin (ATG) over 4-10 d. Five patients had complete recovery of peripheral counts and one patient had a partial response. Of the six nonresponders one had a spontaneous recovery a year later and five died 6-67 d after beginning treatment. Seven patients are alive 4.3-8.9 years later. Six patients remain haematologically stable and one patient has developed a myelodysplastic syndrome. This experience confirms earlier reports of patients recovering marrow function after receiving immunosuppressive therapy for gold-related aplasia.