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Response to high-dose dexamethasone for acquired pure red cell aplasia following ABO-mismatched allogeneic stem cell transplantation

Bone Marrow Transplantation volume 37, pages 1149–1150 (2006)Cite this article

We report a case of pure red cell aplasia (PRCA) following allogeneic peripheral blood stem cell transplantation (PBSCT) for aplastic anemia with major ABO mismatch that proved resistant to all standard treatment options including oral prednisolone, reduction in immunosuppressive treatment, erythropoietin (EPO) and Rituximab. Finally, high-dose dexamethasone for 4 days resolved the PRCA in our patient, 388 days after SCT and 40 days after the first dose of dexamethasone.

A 38-year-old male with severe aplastic anemia underwent allogeneic PBSCT in October 2003 from an HLA-matched sibling donor. The preparative regimen consisted of fludarabine 180 mg/m2 over 6 days, ATGAM (Pharmacia & Upjohn Company, Kalamozoo, Michigan, USA) 40 mg/kg over 4 days and busulphan 8 mg/kg over 2 days. Peripheral blood stem cell transplantation was performed on 17 November 2003 and 18 November 2003. The recipient was B Rh positive while the donor was A Rh positive; other minor blood groups antigens were not tested. The recipient's pre-transplant anti-A IgM (saline) titer was 1:64 and IgG (Coombs) titer was 1:128. A total of 200 ml of PBSC was infused with a cell dose of 3.79 × 108 mononuclear cells/kg. No manipulation of the graft was carried out and there were no hemolytic complications. Cyclosporine and short course methotrexate were used as GVHD prophylaxis. An absolute neutrophil count of >500/mm3 was achieved on day +14, whereas an unsupported platelet count of >20 000/mm3 was achieved on day +13.

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  1. Department of Hematology, Christian Medical College, Vellore, Tamil Nadu, India

    U R Deotare, A Vishwabandya, V Mathews, B George, A Srivastava & M Chandy

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  1. U R Deotare
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  2. A Vishwabandya
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Correspondence to M Chandy.

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Deotare, U., Vishwabandya, A., Mathews, V. et al. Response to high-dose dexamethasone for acquired pure red cell aplasia following ABO-mismatched allogeneic stem cell transplantation. Bone Marrow Transplant 37, 1149–1150 (2006). https://doi.org/10.1038/sj.bmt.1705378

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