Subcutaneous bortezomib is highly effective for pure red cell aplasia after ABO-incompatible haematopoietic stem cell transplantation

摘要

Pure red cell aplasia (PRCA) is an uncommon complication of ABO-incompatible haematopoietic stem cell transplantation. It is characterised by anaemia, reticulocytopenia and absence of erythroid precursors in a morphologically normal-appearing bone marrow (Sawada et al, 2009). Most cases of PRCA resolve spontaneously within weeks to months. While a small subset of patients has a protracted disease course requiring continued red blood cell (RBC) transfusions, there is no approved standard of care for PRCA. Tapering of immunosuppressives (including steroids and calcineurin inhibitors), plasma exchange, ritux-imab and anti-thymocyte globulin have all been employed with varying success rates (Booth et al, 2013). Here we describe a case of PRCA after ABO-incompatible transplant that responded remarkably to treatment with subcutaneous administration of the proteasome inhibitor bortezomib.