I have a patient who was on Adalimumab and developed pancytopenia and hypoplastic bone marrow. His severe neutropenia improved with using G-CSF and his pancytopenia resolved after 1 month. Has any body observed pancytopenia and severe hypoplastic bone marrow with Adalimumab? I have also seen severe aplastic anemia with Etanercept, and it was irreversible. I wonder if the myelosuppression can be a class effect of TNF inhibitors.
Was the patient tested (serology/PCR) for CMV, EBV, HBV, HIV upon admission? In our center we have seen patients who developed ET and AIHA on Adalimumab therapy but this could not be related to Adalimumab alone. Moderate anemia is abandunt but this to cannot be blamed on Adalimumab alone. As these phenomena you seen had been described with Adalimumab and other similar drugs this is probably a class effect . It would be interesting to gather bone marrow biopsies from such cases to analyse expression of NFkB, p50, p 65 etc in these specimens?
The patient was negative for CMV, EBV, Parvo, HBV, HCV and HIV. BM asp/bx showed panhypoplasia.