Pure red cell aplasia after major or bidirectional abo incompatible hematopoietic stem cell transplantation: to treat or not to treat, that is the question

ABSTRACT Pure red cell aplasia (PRCA) is a complication related to major or bidirectional ABO mismatched hematopoietic stem cell transplantation. This disorder is characterized by anemia,

reticulocytopenia, and the absence or virtual absence of erythroid progenitors, other causes such as infections, hemolysis, disease relapse, or drug toxicity having been excluded. Patients

with PRCA may become RBC transfusion dependent for long periods, suffering an important long-term iron overload, alloimmunization, and transfusion reactions. The persistence of recipient

isoagglutinins against donor ABO antigens produced by host residual plasmatic cells has been considered as the immunological cause of the prolonged erythroid aplasia. PRCA behaves in many

cases as a self-limited condition and resolution may occur spontaneously within weeks, months, and even years. Many different therapeutic approaches have been reported for posttransplant

PRCA as plasmapheresis, high doses of erythropoietin, donor lymphocyte infusions, anti-thymocyte globulin, Rituximab and steroids, among others. However, to date there is no standard of care

and the question if patients with PRCA should be treated and at which point remains. The objective of this article is to review the natural evolution of PRCA, and the treatments that have

been used over time focusing on their suitability and efficacy. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS

OPTIONS Access through your institution Subscribe to this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on

SpringerLink * Instant access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about

institutional subscriptions * Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS RITUXIMAB ADDED TO CONDITIONING REGIMEN SIGNIFICANTLY IMPROVES ERYTHROID

ENGRAFTMENT IN MAJOR INCOMPATIBLE ABO-GROUP HEMATOPOIETIC STEM CELL TRANSPLANTATION Article Open access 24 February 2024 THE ROLE OF DARATUMUMAB IN COMPLICATIONS POST-ALLOGENEIC

HEMATOPOIETIC STEM CELL TRANSPLANTATION: A SINGLE-CENTER PROSPECTIVE STUDY ON PRCA AND AIHA Article 20 November 2024 SIROLIMUS IS EFFECTIVE FOR REFRACTORY/RELAPSED/INTOLERANT ACQUIRED PURE

RED CELL APLASIA: RESULTS OF A PROSPECTIVE SINGLE-INSTITUTIONAL TRIAL Article 07 March 2022 REFERENCES * Yamamoto F. Review: ABO blood group system-ABH oligosaccharide antigens, anti-A and

anti-B, A and B glycosyltransferases, and ABO genes. Immunohematology. 2004;20:3–22. CAS  PubMed  Google Scholar  * Booth GS, Gehrie EA, Bolan CD, Savani BN. Clinical guide to

ABO-incompatible allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2013;19:1152–8. CAS  PubMed  Google Scholar  * Rowley SD, Donato ML, Bhattacharyya P. Red blood

cell-incompatible allogeneic hematopoietic progenitor cell transplantation. Bone Marrow Transplant. 2011;46:1167–85. CAS  PubMed  Google Scholar  * Blin N, Traineau R, Houssin S, de Latour

RP, Petropoulou A, Robin M, et al. Impact of donor-recipient major ABO mismatch on allogeneic transplantation outcome according to stem cell source. Biol Blood Marrow Transplant.

2010;16:1315–23. PubMed  Google Scholar  * Damodar S, Shanley R, MacMillan M, Ustun C, Weisdorf D. Donor-to-recipient ABO mismatch does not impact outcomes of allogeneic hematopoietic cell

transplantation regardless of graft source. Biol Blood Marrow Transplant. 2017;23:795–804. PubMed  PubMed Central  Google Scholar  * Worel N, Kalhs P, Keil F, Prinz E, Moser K, Schulenburg

A, et al. ABO mismatch increases transplant-related morbidity and mortality in patients given nonmyeloablative allogeneic HPC transplantation. Transfusion. 2003;43:1153–61. PubMed  Google

Scholar  * Petz LD. Immunohematologic problems associated with bone marrow transplantation. Transfus Med Rev. 1987;1:85–100. CAS  PubMed  Google Scholar  * Gmür JP, Burger J, Schaffner A,

Neftel K, Oelz O, Frey D, et al. Pure red cell aplasia of long duration complicating major ABO-incompatible bone marrow transplantation. Blood. 1990;75:290–5. PubMed  Google Scholar  * Bolan

CD, Leitman SF, Griffith LM, Wesley RA, Procter JL, Stroncek DF, et al. Delayed donor red cell chimerism and pure red cell aplasia following major ABO-incompatible nonmyeloablative

hematopoietic stem cell transplantation. Blood. 2001;98:1687–94. CAS  PubMed  Google Scholar  * Aneke JC, Sondi N, Thyagu S, Cserti-Gazdewich CM, Pendergrast J. Donor-specific isoagglutinin

clearance in ABO mismatched stem cell transplant recipients: how long should it normally take?. Blood. 2018;132 Suppl 1:1260–0. * Lee J-H, Lee J-H, Choi S-J, Kim S, Seol M, Kwon S-W, et al.

Changes of isoagglutinin titres after ABO-incompatible allogeneic stem cell transplantation. Br J Haematol. 2003;120:702–10. CAS  PubMed  Google Scholar  * Griffith LM, McCoy JPJ, Bolan CD,

Stroncek DF, Pickett AC, Linton GF, et al. Persistence of recipient plasma cells and anti-donor isohaemagglutinins in patients with delayed donor erythropoiesis after major ABO incompatible

non-myeloablative haematopoietic cell transplantation. Br J Haematol. 2005;128:668–75. CAS  PubMed  Google Scholar  * Sahovic EA, Flick J, Graham CD, Stuart RK. Case report: isoimmune

inhibition of erythropoiesis following ABO-incompatible bone marrow transplantation. Am J Med Sci. 1991;302:369–73. CAS  PubMed  Google Scholar  * Helbig G, Stella-Holowiecka B, Wojnar J,

Krawczyk M, Krzemien S, Wojciechowska-Sadus M, et al. Pure red-cell aplasia following major and bi-directional ABO-incompatible allogeneic stem-cell transplantation: recovery of

donor-derived erythropoiesis after long-term treatment using different therapeutic strategies. Ann Hematol. 2007;86:677–83. PubMed  Google Scholar  * Lee J-H, Lee K-H, Kim S, Lee J-S, Kim

SH, Kwon S-W, et al. Anti-A isoagglutinin as a risk factor for the development of pure red cell aplasia after major ABO-incompatible allogeneic bone marrow transplantation. Bone Marrow

Transplant. 2000;25:179–84. CAS  PubMed  Google Scholar  * Mielcarek M, Leisenring W, Torok-Storb B, Storb R. Graft-versus-host disease and donor-directed hemagglutinin titers after

ABO-mismatched related and unrelated marrow allografts: evidence for a graft-versus-plasma cell effect. Blood. 2000;96:1150–6. CAS  PubMed  Google Scholar  * Zhu K-E, Li J-P, Zhang T, Zhong

J, Chen J. Clinical features and risk factors of pure red cell aplasia following major ABO-incompatible allogeneic hematopoietic stem cell transplantation. Hematology. 2007;12:117–21. PubMed

  Google Scholar  * Aung FM, Lichtiger B, Bassett R, Liu P, Alousi A, Bashier Q, et al. Incidence and natural history of pure red cell aplasia in major ABO-mismatched haematopoietic cell

transplantation. Br J Haematol. 2013;160:798–805. CAS  PubMed  PubMed Central  Google Scholar  * Mehta P, Ramprakash S, Raghuram C, Trivedi D, Marwah P, Soni R, et al. In-vivo adsorption of

iso-haemagglutinin (IHA) antibodies by donor type red cell transfusion during conditioning is a safe and effective method to overcome major ABO incompatibility-related acute hemolytic

reactions in stem cell transplant using bone marrow as stem cell graft source. Blood. 2019;134:4467–7. Google Scholar  * Stussi G, Halter J, Bucheli E, Valli PV, Seebach L, Gmür J, et al.

Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor

isoagglutinins. Haematologica. 2009;94:239–48. PubMed  PubMed Central  Google Scholar  * Heyll A, Aul C, Runde V, Arning M, Schneider W, Wernet P. Treatment of pure red cell aplasia after

major ABO-incompatible bone marrow transplantation with recombinant erythropoietin. Blood. 1991;77:906. CAS  PubMed  Google Scholar  * Tsai H-J, Lin S-F, Liu T-C, Chang C-S, Hsiao H-H, Chen

T-P. Pure red cell aplasia after ABO major-mismatched allogeneic peripheral blood stem cell transplantation successfully treated with plasma exchange and low-dose steroid: two case reports.

Kaohsiung J Med Sci. 2004;20:128–32. PubMed  Google Scholar  * Labar B, Bogdanić V, Nemet D, Kovacević-Metelko J, Mrsić M, Pavletić Z, et al. Antilymphocyte globulin for treatment of pure

red cell aplasia after major ABO incompatible marrow transplant. Bone Marrow Transplant. 1992;10:471–2. CAS  PubMed  Google Scholar  * Sorà F, De Matteis S, Piccirillo N, Chiusolo P,

Laurenti L, Putzulu R, et al. Rituximab for pure red cell aplasia after ABO-mismatched allogeneic peripheral blood progenitor cell transplantation. Transfusion. 2005;45:643–5. PubMed  Google

Scholar  * Hirokawa M, Fukuda T, Ohashi K, Hidaka M, Ichinohe T, Iwato K, et al. Efficacy and long-term outcome of treatment for pure red cell aplasia after allogeneic stem cell

transplantation from major ABO-incompatible donors. Biol Blood Marrow Transplant. 2013;19:1026–32. PubMed  Google Scholar  * Tomac G, Bojanic I, Mazic S, Vidovic I, Raos M, Cepullic BG, et

al. Haemolysis, pure red cell aplasia and red cell antibody formation associated with major and bidirectional ABO incompatible haematopoietic stem cell transplantation. Blood Transfus.

2018;16:397–404. PubMed  PubMed Central  Google Scholar  * Busca A, Dellacasa C, Giaccone L, Manetta S, Biale L, Godio L, et al. Eltrombopag for the treatment of refractory pure RBC aplasia

after major ABO incompatible hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2018;24:1765–70. CAS  PubMed  Google Scholar  * Aung FM, Lichtiger B, Rondon G, Yin CC,

Alousi A, Ahmed S, et al. Pure red cell aplasia in major ABO-mismatched allogeneic hematopoietic stem cell transplantation is associated with severe pancytopenia. Biol Blood Marrow

Transplant. 2016;22:961–5. PubMed  PubMed Central  Google Scholar  * Atilla E, Topcuoglu P, Akkus E, Ataca Atilla P, Civriz Bozdag S, Kurt Yuksel M, et al. Impact of ABO mismatch on outcomes

of allogeneic hematopoietic stem cell recipients: 30 years of experience with 1016 patients. Blood. 2018;132 Suppl 1:3472–2. * Maciej Zaucha J, Mielcarek M, Takatu A, Little M-T, Gooley T,

Baker J, et al. Engraftment of early erythroid progenitors is not delayed after non-myeloablative major ABO-incompatible haematopoietic stem cell transplantation. Br J Haematol.

2002;119:740–50. CAS  PubMed  Google Scholar  * Sniecinski IJ, Oien L, Petz LD, Blume KG. Immunohematologic consequences of major ABO-mismatched bone marrow transplantation. Transplantation.

1988;45:530–4. CAS  PubMed  Google Scholar  * Paltiel O, Cournoyer D, Rybka W. Pure red cell aplasia following ABO-incompatible bone marrow transplantation: response to erythropoietin.

Transfusion. 1993;33:418–21. CAS  PubMed  Google Scholar  * Ohashi K, Akiyama H, Takamoto S, Tanikawa S, Sakamaki H, Onozawa Y. Treatment of pure red cell aplasia after major

ABO-incompatible bone marrow transplantation resistant to erythropoietin. Bone marrow transplantation team. Bone Marrow Transplant. 1994;13:335–6. CAS  PubMed  Google Scholar  * Santamaría

A, Sureda A, Martino R, Domingo-Albós A, Muñiz-Díaz E, Brunet S. Successful treatment of pure red cell aplasia after major ABO-incompatible T cell-depleted bone marrow transplantation with

erythropoietin. Bone Marrow Transplant. 1997;20:1105–7. PubMed  Google Scholar  * Bavaro P, Di Girolamo G, Olioso P, Papalinetti G, Iacone A, Accorsi P, et al. Donor lymphocyte infusion as

therapy for pure red cell aplasia following bone marrow transplantation. Br J Haematol. 1999;104:930–1. CAS  PubMed  Google Scholar  * Yamaguchi M, Sakai K, Murata R, Ueda M. Treatment of

pure red cell aplasia after major ABO-incompatible peripheral blood stem cell transplantation by induction of chronic graft-versus-host disease. Bone Marrow Transplant. 2002;30:539–41. CAS 

PubMed  Google Scholar  * Badros A, Tricot G, Toor A, Morris C, Guo C, Munshi N, et al. ABO mismatch may affect engraftment in multiple myeloma patients receiving nonmyeloablative

conditioning. Transfusion. 2002;42:205–9. PubMed  Google Scholar  * Zhu K-E, Xu Y, Wu D, Zhong J. Pure red cell aplasia following major ABO-incompatible allogeneic hematopoietic stem cell

transplantation. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2002;10:61–5. PubMed  Google Scholar  * Zhidong W, Hongmin Y, Hengxiang W. Successful treatment of pure red cell aplasia with a single

low dose of rituximab in two patients after major ABO incompatible peripheral blood allogeneic stem cell transplantation. Transfus Med. 2012;22:302–4. CAS  PubMed  Google Scholar  * Ohta S,

Yokoyama H, Ise T, Takasawa K, Wada T, Nakao S, et al. Apheresis therapy for prolonged red cell aplasia after major ABO-mismatched bone marrow transplantation. Intern Med. 1997;36:487–91.

CAS  PubMed  Google Scholar  * Worel N, Greinix HT, Schneider B, Kurz M, Rabitsch W, Knöbl P, et al. Regeneration of erythropoiesis after related- and unrelated-donor BMT or peripheral blood

HPC transplantation: a major ABO mismatch means problems. Transfusion. 2000;40:543–50. CAS  PubMed  Google Scholar  * Nussbaumer W, Schwaighofer H, Gratwohl A, Kilga S, Schonitzer D,

Nachbaur D, et al. Transfusion of donor-type red cells as a single preparative treatment for bone marrow transplants with major ABO incompatibility. Transfusion. 1995;35:592–5. CAS  PubMed 

Google Scholar  * Or R, Naparstek E, Mani N, Slavin S. Treatment of pure red-cell aplasia following major ABO-mismatched T-cell-depleted bone marrow transplantation. Two case reports with

successful response to plasmapheresis. Transpl Int. 1991;4:99–102. CAS  PubMed  Google Scholar  * Ustün C, Celebi H, Arat M, Ozcan M, Dilek I, Gürman G, et al. Treatment of aregeneratoric

anemia following an ABO-incompatible allogeneic peripheral blood stem cell transplantation: a case report. Ther Apher. 1999;3:275–7. PubMed  Google Scholar  * Dellacasa CM, D’Ardia S,

Allione B, Aydin S, Tassi V, Francisci T, et al. Efficacy of plasmapheresis for the treatment of pure red blood cell aplasia after allogeneic stem cell transplantation. Transfusion.

2015;55:2979–82. CAS  PubMed  Google Scholar  * Sackett K, Cohn CS, Fahey-Ahrndt K, Smith AR, Johnson AD. Successful treatment of pure red cell aplasia because of ABO major mismatched stem

cell transplant. J Clin Apher. 2018;33:108–12. PubMed  Google Scholar  * Rabitsch W, Knöbl P, Greinix H, Prinz E, Kalhs P, Hörl WH, et al. Removal of persisting isohaemagglutinins with

Ig-Therasorb immunoadsorption after major ABO-incompatible non-myeloablative allogeneic haematopoietic stem cell transplantation. Nephrol Dial Transplant. 2003;18:2405–8. PubMed  Google

Scholar  * Verholen F, Stalder M, Helg C, Chalandon Y. Resistant pure red cell aplasia after allogeneic stem cell transplantation with major ABO mismatch treated by escalating dose donor

leukocyte infusion. Eur J Haematol. 2004;73:441–6. CAS  PubMed  Google Scholar  * Zhu K, Chen J, Chen S. Treatment of Epstein-Barr virus-associated lymphoproliferative disorder (EBV-PTLD)

and pure red cell aplasia (PRCA) with Rituximab following unrelated cord blood transplantation: a case report and literature review. Hematology. 2005;10:365–70. CAS  PubMed  Google Scholar 

* Fang B, Song Y, Li N, Li J, Han Q, Zhao RC. Mesenchymal stem cells for the treatment of refractory pure red cell aplasia after major ABO-incompatible hematopoietic stem cell

transplantation. Ann Hematol. 2009;88:261–6. PubMed  Google Scholar  * Roychowdhury DF, Linker CA. Pure red cell aplasia complicating an ABO-compatible allogeneic bone marrow

transplantation, treated successfully with antithymocyte globulin. Bone Marrow Transplant. 1995;16:471–2. CAS  PubMed  Google Scholar  * Furuya H, Wakayama T, Tanaka J, Tsumori M, Hatazoe T,

Ohguni S, et al. Treatment with bolus methylprednisolone for pure red cell aplasia after ABO incompatible bone marrow transplantation in a patient with chronic myelocytic leukemia. Rinsho

Ketsueki. 1995;36:1279–83. CAS  PubMed  Google Scholar  * Yang M-H, Hsu H-C. Pure red cell aplasia after ABO-incompatible allogeneic stem cell transplantation in severe aplastic anemia with

response to steroids: a case report and literature review. Ann Hematol. 2001;80:299–301. CAS  PubMed  Google Scholar  * Deotare UR, Vishwabandya A, Mathews V, George B, Srivastava A, Chandy

M. Response to high-dose dexamethasone for acquired pure red cell aplasia following ABO-mismatched allogeneic stem cell transplantation. Bone Marrow Transplant. 2006;37:1149–50. CAS  PubMed

  Google Scholar  * Yang X, Levis M. Pulsed-high-dose dexamethasone as a treatment for pure red cell aplasia following ABO-incompatible allogeneic stem cell transplantation. Transfus Med.

2014;24:246–8. CAS  PubMed  PubMed Central  Google Scholar  * Hiroshima Y, Shiono Y, Suzuki I, Yamamoto M, Kato Y, Tajima K, et al. Successful high-dose dexamethasone treatment of acquired

pure red cell aplasia following ABO major mismatched allogeneic hematopoietic stem cell transplantation. Rinsho Ketsueki. 2016;57:760–4. PubMed  Google Scholar  * Varela Gómez R, Vázquez

Vázquez G, Noriega Concepción V, Galego García A, Andón Saavedra C. Successful treatment of pure red cell aplasia with high-dose dexamethasone after ABO-incompatible allogeneic hematopoietic

stem cell transplantation. Hematol Oncol Stem Cell Ther. 2018;11:44–6. PubMed  Google Scholar  * Maschan AA, Skorobogatova EV, Balashov DN, Pashanov ED, Trakhtman PE, Schipitzina IP, et al.

Successful treatment of pure red cell aplasia with a single dose of rituximab in a child after major ABO incompatible peripheral blood allogeneic stem cell transplantation for acquired

aplastic anemia. Bone Marrow Transplant. 2002;30:405–7. CAS  PubMed  Google Scholar  * Al-Okk H, Diaz B, Stives S, Parumog N, Conway M, Nath R. Successful resolution of pure red cell aplasia

(PRCA) following major ABO incompatible unrelated donor stem cell transplantation using rituximab. Blood. 2003;102:437B–8B. Google Scholar  * Helbig G, Stella-Holowiecka B, Krawczyk-Kulis

M, Wojnar J, Markiewicz M, Wojciechowska-Sadus M, et al. Successful treatment of pure red cell aplasia with repeated, low doses of rituximab in two patients after ABO-incompatible allogeneic

haematopoietic stem cell transplantation for acute myeloid leukaemia. Haematologica. 2005;90:ECR33. PubMed  Google Scholar  * Woo H-Y, Min C-K, Lee S-M, Cho H-S, Kim S-Y, Lee S, et al.

Resistant pure red cell aplasia after allogeneic bone marrow transplantation with major ABO mismatch treated by purified CD34+ cell infusion. Eur J Haematol. 2006;76:160–3. PubMed  Google

Scholar  * Bierman PJ, Warkentin P, Hutchins MR, Klassen LW. Pure red cell aplasia following ABO mismatched marrow transplantation for chronic lymphocytic leukemia: response to antithymocyte

globulin. Leuk Lymphoma. 1993;9:169–71. CAS  PubMed  Google Scholar  * Ebihara Y, Manabe A, Tsuruta T, Ishikawa K, Hasegawa D, Ohtsuka Y, et al. The effect of donor leukocyte infusion on

refractory pure red blood cell aplasia after allogeneic stem cell transplantation in a patient with myelodysplastic syndrome developing from Kostmann syndrome. Int J Hematol. 2007;86:446–50.

PubMed  Google Scholar  * Selleri C, Raiola A, De Rosa G, Luciano L, Pezzullo L, Picardi M, et al. CD34+-enriched donor lymphocyte infusions in a case of pure red cell aplasia and late

graft failure after major ABO-incompatible bone marrow transplantation. Bone Marrow Transplant. 1998;22:605–7. CAS  PubMed  Google Scholar  * Corcione A, Benvenuto F, Ferretti E, Giunti D,

Cappiello V, Cazzanti F, et al. Human mesenchymal stem cells modulate B-cell functions. Blood. 2006;107:367–72. CAS  PubMed  Google Scholar  * Fang B, Song Y, Zhao RC, Han Q, Cao Y.

Treatment of resistant pure red cell aplasia after major ABO-incompatible bone marrow transplantation with human adipose tissue-derived mesenchymal stem cells. Am J Hematol. 2007;82:772–3.

PubMed  Google Scholar  * Robak P, Robak T. Bortezomib for the treatment of hematologic malignancies: 15 years later. Drugs R D. 2019;19:73–92. CAS  PubMed  PubMed Central  Google Scholar  *

Poon L-M, Koh LP. Successful treatment of isohemagglutinin-mediated pure red cell aplasia after ABO-mismatched allogeneic hematopoietic cell transplant using bortezomib. Bone Marrow

Transplant. 2012;47:870–1. CAS  PubMed  Google Scholar  * Khan F, Linden MA, Zantek ND, Vercellotti GM. Subcutaneous bortezomib is highly effective for pure red cell aplasia after

ABO-incompatible haematopoietic stem cell transplantation. Transfus Med. 2014;24:187–8. CAS  PubMed  PubMed Central  Google Scholar  * Shahan JL, Hildebrandt GC. Successful treatment of

refractory pure red cell aplasia with bortezomib after allogeneic haematopoietic cell transplantation in a patient with alpha-beta subcutaneous panniculitis-like T cell lymphoma. Transfus

Med. 2015;25:342–4. CAS  PubMed  Google Scholar  * Bathini S, Holtzman NG, Koka R, Singh Z, Wilding E, Zou Y, et al. Refractory postallogeneic stem cell transplant pure red cell aplasia in

remission after treatment with daratumumab. Am J Hematol. 2019;94:E216–9. PubMed  Google Scholar  * Salas MQ, Alahmari A, Lipton JH. Successful treatment of refractory red cell aplasia after

allogeneic hematopoietic cell transplantation with daratumumab. Eur J Haematol. 2020;104:145–7. CAS  PubMed  Google Scholar  * Desmond R, Townsley DM, Dunbar C, Young NS. Eltrombopag in

aplastic anemia. Semin Hematol. 2015;52:31–7. CAS  PubMed  Google Scholar  * Nishida H, Yamada T. Monoclonal antibody therapies in multiple myeloma: a challenge to develop novel targets. J

Oncol. 2019;2019:6084012. PubMed  PubMed Central  Google Scholar  * Chapuy CI, Kaufman RM, Alyea EP, Connors JM. Daratumumab for delayed red-cell engraftment after allogeneic

transplantation. N Engl J Med. 2018;379:1846–50. CAS  PubMed  Google Scholar  * Rautenberg C, Kaivers J, Germing U, Haas R, Ackerstaff S, Hoffmann T, et al. Daratumumab for treatment of pure

red cell aplasia after allogeneic stem cell transplantation. Bone Marrow Transplant. 2020;55:1191–3. PubMed  Google Scholar  * Jeyaraman P, Borah P, Rajput P, Dayal N, Pathak S, Naithani R.

Daratumumab for pure red cell aplasia post ABO incompatible allogeneic hematopoietic stem cell transplant for aplastic anemia. Blood Cells Mol Dis. 2020;102464. Download references AUTHOR

INFORMATION AUTHORS AND AFFILIATIONS * Hospital Universitario y Politécnico La Fe, Valencia, Spain Javier Marco-Ayala, Inés Gómez-Seguí, Guillermo Sanz & Pilar Solves * Centro de

Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain Inés Gómez-Seguí, Guillermo Sanz & Pilar Solves Authors * Javier Marco-Ayala View author

publications You can also search for this author inPubMed Google Scholar * Inés Gómez-Seguí View author publications You can also search for this author inPubMed Google Scholar * Guillermo

Sanz View author publications You can also search for this author inPubMed Google Scholar * Pilar Solves View author publications You can also search for this author inPubMed Google Scholar

CORRESPONDING AUTHOR Correspondence to Javier Marco-Ayala. ETHICS DECLARATIONS CONFLICT OF INTEREST The authors declare that they have no conflict of interest. ADDITIONAL INFORMATION

PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT

THIS ARTICLE CITE THIS ARTICLE Marco-Ayala, J., Gómez-Seguí, I., Sanz, G. _et al._ Pure red cell aplasia after major or bidirectional ABO incompatible hematopoietic stem cell

transplantation: to treat or not to treat, that is the question. _Bone Marrow Transplant_ 56, 769–778 (2021). https://doi.org/10.1038/s41409-020-01124-6 Download citation * Received: 08 May

2020 * Revised: 19 October 2020 * Accepted: 30 October 2020 * Published: 14 November 2020 * Issue Date: April 2021 * DOI: https://doi.org/10.1038/s41409-020-01124-6 SHARE THIS ARTICLE Anyone

you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by

the Springer Nature SharedIt content-sharing initiative