Refractory anaemia successfully treated with thalidomide]

A 63-year-old male was admitted to our department in 2001 because of autoimmune haemolytic anaemia and splenomegaly. Bone marrow examination revealed an erythroid hyperplasia and a normal chromosome analysis. Splenectomy was performed in 2002, resulting in severe transfusion-dependent anaemia with a need for two blood transfusions each week. Treatment with prednisolone, erythropoietin and danocrine was without effect. A new bone marrow examination then showed myelodysplastic syndrome. Treatment with thalidomide, 50-150 mg/d, and prednisolone, 25 mg/d, resulted in an increase in haemoglobin to 8.9 mmol/l during the following months. The use of immunomodulatory and anti-angiogenetic agents in refractory anaemia needs more study.