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In Reply: Good and colleagues^1-2 described inhibition of myelopoiesis by lymphocytes from patients with aplastic anemia. Furthermore, an important experimental link between the immune system and hematopoiesis was the observation of fatal aplastic anemia in "runt disease," due to inoculation of parental lymphocytes into a host and subsequent graft vs host disease, reported by Hilgard et al,³ among others. We have used this model to demonstrate the role of type I cytokines⁴ and "bystander" killing of innocent hematopoietic stem cells.⁵

However, in our experience the association of acquired aplastic anemia with other autoimmune diseases is sporadic. Among many hundreds of patients enrolled in studies of this disease, we have only rarely seen a patient with concurrent thymoma. Vitiligo and hypothyroidism are sufficiently frequent in the general population that their occasional association with aplastic anemia may be only coincidental.

Neal S. Young, MD; Stephen Rosenfeld, MD
Hematology Branch
National Heart, Lung, . . . [Full Text of this Article]

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