title: Successful high-dose dexamethasone treatment of acquired pure red cell aplasia following ABO major mismatched allogeneic hematopoietic stem cell transplantation.
abstract: A 46-year-old man was diagnosed with acute myelomonocytic leukemia involving inv(16)(p13.1q22) in August 2007. He received a human leukocyte antigen-identical, ABO major-mismatched (donor: A, recipient: O) bone marrow transplantation from an unrelated donor in June 2009. Cyclosporin A (CsA) and short-course methotrexate were used for graft versus host disease prophylaxis. Although granulocyte and platelet engraftment were achieved, the patient exhibited persistent anemia and was dependent on red blood cell (RBC) transfusions. Bone marrow aspiration on day 63 revealed the near absence of erythroid precursors, a finding consistent with pure red cell aplasia. No CBFβ-MYH11 transcripts were detected. The recipient's anti-A IgM antibody titer was 1:64, and his anti-A IgG antibody titer was 1:1024. The discontinuation of CsA, and the initiation of rituximab and donor lymphocyte infusions were all ineffective against his anemia. He was treated with high-dose dexamethasone (DEXA) (40 mg/day DEXA, days 657-660, days 757-760; 20 mg/day DEXA, days 764-767, days 772-775) in April 2010. A follow-up examination performed at 7 months after the high-dose DEXA treatment showed the patient's anti-A antibody titer to have dropped to an undetectable level. His hemoglobin levels also returned to normal (Hb: 13.4 g/dl), and he no longer required RBC transfusions.
authors.affiliation: Department of Hematology, Nagano Red Cross Hospital.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hiroshima
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Shiono
authors.forename: Ikuko
authors.initials: I
authors.lastname: Suzuki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kato
authors.forename: Katsushi
authors.initials: K
authors.lastname: Tajima
authors.forename: Takeo
authors.initials: T
authors.lastname: Kato
mesh_terms: D000017:ABO Blood-Group System; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008875:Middle Aged; D012010:Red-Cell Aplasia, Pure / Q000188:drug therapy* / Q000628:therapy; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D003907:Dexamethasone