{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:07:00Z","timestamp":1788858420816,"version":"build-2803163510"},"reference-count":10,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"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":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,6]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Pure red cell aplasia (PRCA) is a rare but clinically significant complication of allogeneic hematopoietic stem cell transplantation (HSCT), particularly in patients with major ABO incompatibility. Although mixed chimerism is usually evaluated using whole\u2010blood or T\u2010cell\u2013based assays, these approaches may fail to detect lineage\u2010specific immune dysregulation relevant to posttransplant immune complications.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We report a pediatric case of late\u2010onset PRCA after reduced\u2010intensity allogeneic HSCT. Clinical course and lineage\u2010specific chimerism analyses were retrospectively reviewed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Lineage\u2010specific chimerism analysis demonstrated persistent recipient B\u2010cell mixed chimerism, whereas T\u2010cell and granulocyte fractions showed complete donor chimerism. Given the suspected pathogenic role of residual recipient B cells, rituximab was administered as a targeted B\u2010cell\u2013directed therapy. This resulted in reticulocyte recovery, resolution of transfusion dependence, and conversion to complete donor B\u2010cell chimerism.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This case suggests that recipient B\u2010cell persistence may contribute to the pathogenesis of posttransplant PRCA and highlights the potential value of lineage\u2010specific chimerism analysis in clarifying the underlying mechanism and guiding mechanism\u2010based therapy, including rituximab.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/petr.70352","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T06:39:12Z","timestamp":1780123152000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pure Red Cell Aplasia Associated With Recipient B\u2010Cell Mixed Chimerism Successfully Treated With Rituximab"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2491-9150","authenticated-orcid":false,"given":"Norifumi","family":"Yokoyama","sequence":"first","affiliation":[{"name":"Department of Pediatrics\u30fbPediatric Hematology\/Oncology Gifu Municipal Hospital Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6571-5651","authenticated-orcid":false,"given":"Taichi","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\u30fbPediatric Hematology\/Oncology Gifu Municipal Hospital Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Hirate","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\u30fbPediatric Hematology\/Oncology Gifu Municipal Hospital Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4411-7831","authenticated-orcid":false,"given":"Ikko","family":"Ohshiro","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\u30fbPediatric Hematology\/Oncology Gifu Municipal Hospital Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\u30fbPediatric Hematology\/Oncology Gifu Municipal Hospital Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaori","family":"Kanda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\u30fbPediatric Hematology\/Oncology Gifu Municipal Hospital Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8656-6673","authenticated-orcid":false,"given":"Kunihiro","family":"Shinoda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\u30fbPediatric Hematology\/Oncology Gifu Municipal Hospital Gifu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2016.02.008"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.829670"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.17463"},{"key":"e_1_2_7_5_1","article-title":"Successful Treatment of Pure Red Cell Aplasia With Rituximab After Major ABO\u2010Mismatched Stem Cell Transplantation","volume":"90","author":"Helbig G.","year":"2005","journal-title":"Haematologica"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humimm.2021.07.013"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtct.2021.05.020"},{"key":"e_1_2_7_8_1","first-page":"145","article-title":"Rituximab for Treatment of Pure Red Cell Aplasia After Major ABO Incompatible Stem Cell Transplantation","volume":"91","author":"Jung J.","year":"2012","journal-title":"Annals of Hematology"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/omcr\/omaf225"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.14341"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1212007"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70352","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.70352","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70352","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:11:02Z","timestamp":1788855062000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,29]]},"references-count":10,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/petr.70352"],"URL":"https:\/\/doi.org\/10.1111\/petr.70352","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,29]]},"assertion":[{"value":"2026-04-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70352"}}