Successful allogeneic peripheral blood stem cell transplantation with reduced intensity conditioning in a patient with severe aplastic anemia and active infection

Infection is the major cause of mortality in patients with severe aplastic anemia (SAA) and often results in postponement of immunotherapy or transplantation treatment. We report on a 23-year-old man with very SAA with almost no neutrophils who was primarily treated with peripheral blood stem cell transplantation from an HLA-identical sibling. He received reduced dose conditioning with cyclophosphamide and antithymocyte globulin during active infection with typhlitis and pneumonia. Cyclophosphamide 50. mg/kg/d was given on Day 4 and Day 3 before transplantation and antithymocyte globulin Fresenius 20. mg/kg/d was given on Day 3 and Day 2. Neutrophils and platelets were engrafted on Day +18 and Day +20 after transplantation. Symptoms and signs of acute or chronic graft versus host disease were not observed as of Day +545 after transplantation. Allogeneic hematopoietic stem cell transplantation with reduced intensity conditioning may be considered as the primary therapy for SAA complicated by severe infection.