Agranulocytosis as a Part of Secondary Graft Failure after Allogenic Stem Cell Transplantation

Abstract

The etiology was unclear but differential included drug, toxin, and infection or enhanced immune activity while he was on reduced dose of immunosuppression. The modest rise in platelet counts on adjusted (increased) dose of steroid and tacrolimus would support an immune hypothesis. The onset of severe anemia may point to bone marrow failure or secondary engraftment failure. Testing for donor specific antibodies (DSA) to HLA A2 (locus of mismatch) was 0%, DSA was 95% for DR10, DQ6, DR53, DQ5, DQ1, and weak DQ2. He was maintained on a low dose of prednisone (10 mg daily) and Tacrolimus (0.5 mg daily) for the first several days. Subsequent Bone marrow findings were remarkable for 20% marrow cellularity, preserved erythroid and megakaryocytic compartment, but marked