{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:04:03Z","timestamp":1789585443353,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T00:00:00Z","timestamp":1707782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pure red cell aplasia (PRCA) following allogeneic hematopoietic stem cell transplantation (allo\u2010HSCT) with ABO major incompatibility is characterized by transfusion dependent anemia. No standard treatment existed for PRCA following allo\u2010HSCT yet.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>We conducted a retrospective study, and reported our experience with the use of avatrombopag and lower dose rituximab to treat five patients with PRCA subsequent to major ABO\u2010incompatible allo\u2010HSCT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Five cases of PRCA were identified from 72 patients who underwent allo\u2010HSCT with major or bidirectional ABO mismatch. Cumulative incidence at Day +60 was 6.9% (5\/72) at our center. All donor and recipient blood groups were A<jats:sup>+<\/jats:sup>\u00a0and O<jats:sup>+<\/jats:sup>, respectively. In the first three cases we reported, patients received erythropoietin, plasma exchange, and donor lymphocyte infusion, but none of them had any effect. After 4\u2009weeks of treatment with low dose rituximab (100\u2009mg\/week) combined with avatrombopag (40\u2009mg\/day), favorable outcomes were obtained. According to the aforementioned experience, Cases 4 and 5 were administered low\u2010dose rituximab and avatrombopag in 3\u2009months after transplantation, and erythroid response was observed on 3\u2009weeks after treatment. Our patients tolerated low\u2010dose rituximab and avatrombopag well and experienced rapid efficacy, with a median duration of 3\u2009weeks. Furthermore, no severe infection or thrombocytosis necessitated a dose adjustment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Low\u2010dose rituximab and avatrombopag may be an effective treatment for patients with PRCA after major ABO\u2010incompatible allo\u2010HSCT. The patients should be treated at least 90\u2009days post transplantation if conventional erythropoietin therapy fails.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.17743","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T07:45:23Z","timestamp":1707896723000},"page":"510-516","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Successful treatment pure red cell aplasia after <scp>ABO<\/scp> major mismatched allogeneic hematopoietic stem cell transplantation with avatrombopag and low dose rituximab"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0997-4293","authenticated-orcid":false,"given":"Junjie","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Hematology The Affiliated People's Hospital of Ningbo University  Ningbo China"},{"name":"Institute of Hematology Ningbo University  Ningbo 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