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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 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.

Stephen M. Nagy, Jr, MD; John J. Fisher, MD
Department of Internal Medicine
School of Medicine
University of California, Davis

1. Rosenfeld S, Follmann D, Nunez O, Young NS. Antithymocyte globulin and cyclosporine for severe aplastic anemia: association between hematologic response and long-term outcome. JAMA. 2003;289:1130-1135. FREE FULL TEXT 2. Good RA. Thymic tumor and acquired agammaglobulinemia: a clinical and experimental study of the immune response. Surgery. 1956;40:1010-1017. PUBMED

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

JAMA. 2003;290:193.

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