Relapse of Aplastic Anemia with Majority Donor Chimerism (Donor-Type Aplasia) Occurring Late after Bone Marrow Transplantation

Recurrent aplastic anemia with donor-type aplasia

“…It is also of importance to note that although SAA is usually idiopathic, some cases of recurrence has been noted among MSDs. [ 8 ] Thus there is a possibility of a genetic role in such cases which warrants further investigations by whole genome sequencing. Patients after HSCT are also less responsive to indigenous erythropoietin, thereby worsening the state of anemia.…”

“…Occasional cases may even require a third transplant. [ 8 ] However, caution should be exercised because in spite of protective treatments, HSCT itself can cause a plethora of complications including GvHD, organ damage, infections, failure of stem cell transplant (primary and secondary) and rarely, hemolytic uremic syndrome and myelodysplasia.…”

Donor-type aplasia after stem cell transplantation in aplastic anaemia

“…What is the pathogenesis of DTA? This is not known with any degree of certainty but following conjectures have been made:[ 6 ]…”

“…It seems more than 40 units of prior blood product transfusion, low number of infused CD34 + ve cells (<3 × 10 6 cells/kg), elderly patient >40 years, fludarabine-based conditioning regime with reduced dose of cyclophosphamide to be more often associated with DTA. [ 6 ] There is a need to dissect each of these components operative for production of DTA through culture and co-culture experiments and see if there is loss of CD34 +ve donor cells or haemopoietic differentiation block in these cases.…”

“…There are reports of eltrombopag reversing DTA. [ 6 ] This therapy can be tried in these patients while waiting for second transplantation, or CD34 cell boost from the donor with augmented immunosuppression.…”