{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:17:54Z","timestamp":1790983074903,"version":"4.1.0"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Pure red cell aplasia (PRCA) is a rare disorder characterized by severe reticulocytopenia and absence of erythroid precursors. Its association with multiple myeloma (MM) therapy is uncommon. We report a 73-year-old man with MM (IgG\u03bb, stage IIIA) who achieved complete remission after five cycles of VRd (bortezomib, lenalidomide, dexamethasone). During lenalidomide maintenance, he developed severe anemia (hemoglobin 45 g\/L, reticulocytes 0.01%). Bone marrow biopsy showed absent erythroid precursors with preserved granulocytic and megakaryocytic lineages, consistent with PRCA. Following discontinuation of lenalidomide, cyclosporine therapy increased hemoglobin to 92 g\/L within one month. This case highlights that PRCA can occur after MM treatment and underscores the importance of early detection by monitoring reticulocytes. A comprehensive approach including withdrawal of offending agents and immunosuppressive therapy is critical.<\/jats:p>","DOI":"10.3389\/fonc.2026.1904201","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T04:35:39Z","timestamp":1787114139000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: From complete remission to severe anemia: pure red cell aplasia emerged after VRd regimen in multiple myeloma"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiaoqing","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Nephrology and Hematology, Yunyang County People\u2019s Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hematology, Yunyang County People\u2019s Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hematology, Yunyang County People\u2019s Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hematology, Yunyang County People\u2019s Hospital","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.70323","article-title":"Somatic mutations in acquired pure red cell aplasia: incidence and implications","volume":"101","author":"Means","year":"2026","journal-title":"Am J Hematol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14012","article-title":"Monoclonal gammopathy-associated pure red cell aplasia","volume":"173","author":"Korde","year":"2016","journal-title":"Br J Haematol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-025-06218-z","article-title":"Rare case of pure red cell aplasia secondary to smoldering multiple myeloma successfully treated with daratumumab \u2013 case report and review of the literature","volume":"104","author":"Alharbi","year":"2025","journal-title":"Ann Hematol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"10131","DOI":"10.1038\/s41467-024-54571-w","article-title":"Lenalidomide-induced pure red cell aplasia is associated with elevated expression of MHC-I molecules on erythrocytes","volume":"15","author":"Hu","year":"2024","journal-title":"Nat Commun"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021010898","article-title":"How I manage acquired pure red cell aplasia in 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of POEMS syndrome: a case report and brief review of the literature","volume":"5","author":"Dai","year":"2025","journal-title":"Med Int (Lond)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"99","DOI":"10.4274\/tjh.2013.0207","article-title":"Lenalidomide-induced pure red cell aplasia","volume":"31","author":"Dolai","year":"2014","journal-title":"Turk J Haematol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.46883\/2023.25921006","article-title":"Secondary pure red cell aplasia during daratumumab\/ hyaluronidase therapy for multiple myeloma","volume":"37","author":"Saba","year":"2023","journal-title":"Oncol (Williston Park)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/cdt3.81","article-title":"Pure red cell aplasia and minimal residual disease conversion associated with immune reconstitution in a patient with high\u2010risk multiple myeloma","volume":"9","author":"Jin","year":"2023","journal-title":"Chronic Dis Transl 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