Initial chemotherapy decreases transfusion dependence and enables definitive therapy in metastatic thymoma complicated by pure red cell aplasia: A case report.

Pure red cell aplasia (PRCA) is a rare paraneoplastic complication occurring in ~5% of patients with thymoma. The optimal management of metastatic thymoma complicated by PRCA remains unclear, particularly when immediate immunosuppressive therapy is not feasible. The present report describes the case of a 69-year-old man with type AB thymoma accompanied by multiple bilateral pulmonary metastases (cT1bN0M1b, stage IVB) and severe transfusion-dependent PRCA. Because the tumor was unresectable at presentation, systemic chemotherapy with the ADOC regimen (doxorubicin, cisplatin, vincristine and cyclophosphamide) was initiated. Prior to chemotherapy, daily blood transfusions were needed, but after the first cycle, this need was decreased, with transfusion intervals prolonged to every 7-17 days. On radiographic evaluation, there was sustained tumor reduction with stable disease. After six cycles of chemotherapy, cyclosporine was introduced and robot-assisted thymectomy was subsequently performed. A total of 2 weeks after initiating cyclosporine, the patient achieved transfusion independence with recovery of hemoglobin and reticulocyte counts. Therefore, cytotoxic chemotherapy may contribute to both tumor control and improvement of PRCA in metastatic thymoma, although further clinical evidence is required to establish optimal therapeutic strategies.