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

Tso-Fu Wang^{a, b}, Yi-Feng Wu^a, Yu-Huai Ho^c, Shih-Che Huang^{b, d}, Sung-Chao Chu^a, Ruey-Ho Kao^{a, b}

^a Department of Hematology and Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^b Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
^c Department of Infection, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^d Department of Gastroenterology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan

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Abstract
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.

Keywords
Hematopoietic stem cell transplantation; Infection; Reduced intensity conditioning; Severe aplastic anemia