{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:06:39Z","timestamp":1790690799240,"version":"4.1.0"},"reference-count":10,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["eJHaem"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Pure red cell aplasia (PRCA) is usually managed as a disorder driven predominantly by cellular immune mechanisms, but plasma cell\u2010directed therapy may be relevant in selected cases associated with monoclonal gammopathy. We report a case of refractory PRCA associated with IgG\u2010kappa monoclonal gammopathy of undetermined significance (MGUS). A 64\u2010year\u2010old woman remained transfusion\u2010dependent despite multiple therapies and subsequently underwent allogeneic hematopoietic cell transplantation from an 8\/8 HLA\u2010matched unrelated donor. Despite prompt donor engraftment, PRCA persisted, and kappa\u2010restricted plasma cells were detected in the bone marrow, although their recipient origin could not be confirmed by plasma cell\u2010specific chimerism analysis. Daratumumab, bortezomib, and dexamethasone therapy, followed by daratumumab monotherapy, was associated with reticulocyte recovery, transfusion independence, disappearance of the monoclonal protein, and erythroid recovery in the bone marrow. Approximately 3 years and 3 months after discontinuation of daratumumab, anemia recurred with reappearance of M\u2010protein and kappa\u2010restricted plasma cells, and again improved after daratumumab monotherapy. This case supports the possibility that a plasma\u2010cell\u2010associated mechanism may contribute to PRCA in selected patients with monoclonal gammopathy and suggests that plasma cell\u2010directed therapy may be considered before proceeding to allogeneic transplantation.<\/jats:p>\n                  <jats:p>Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission<\/jats:p>","DOI":"10.1002\/jha2.70415","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:20:47Z","timestamp":1790688047000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Repeated Response to Daratumumab in Refractory MGUS\u2010Associated Pure Red Cell Aplasia Persisting After Allogeneic Transplantation: A Case Report"],"prefix":"10.1002","volume":"7","author":[{"given":"Kyoko","family":"Yoshihara","sequence":"first","affiliation":[{"name":"Department of Hematology Hyogo Medical University School of Medicine  Nishinomiya Japan"},{"name":"Department of Transfusion Medicine and Cellular Therapy Hyogo Medical University Hospital  Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshimitsu","family":"Matsui","sequence":"additional","affiliation":[{"name":"Department of Hematology Nishiwaki Municipal Hospital  Nishiwaki Japan"},{"name":"Department of Hematology Meiwa Hospital  Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikuo","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Department of Surgical Pathology Hyogo Medical University School of Medicine  Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mami","family":"Samori","sequence":"additional","affiliation":[{"name":"Department of Hematology Hyogo Medical University School of Medicine  Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Hematology Hyogo Medical University School of Medicine  Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saki","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Hematology Hyogo Medical University School of Medicine  Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuyuki","family":"Yamagata","sequence":"additional","affiliation":[{"name":"Department of Hematology Hyogo Medical University School of Medicine  Nishinomiya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuto","family":"Utsunomiya","sequence":"additional","affiliation":[{"name":"Department of Hematology Hyogo Medical University School of Medicine  Nishinomiya 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2017.175810"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2023010587"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277\u2010025\u201006565\u2010x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2024.02.013"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408\u2010025\u201001315\u20108"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.14341"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2022.281398"},{"issue":"5","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.exphem.2006.01.011","article-title":"Kinetics of Plasma\u2010Cell Chimerism After Allogeneic Stem Cell 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