Late graft failure 8 years after first bone marrow transplantation for severe acquired aplastic anemia

A 14-year-old patient with acquired very severe aplastic anemia (VSAA) unde rwent bone marrow transplantation (BMT) from his HLA-identical brother. Pre parative therapy was cyclophosphamide (CY) 200 mg/kg over 4 days. GVHD prop hylaxis was with cyclosporin A (CsA) for a year. After an 8 year follow-up during which the patient was well with normal blood counts, graft failure o ccurred. At this time marrow chimerism studies demonstrated that 85% of hem opoiesis was of recipient origin. The patient was re-engrafted from the sam e donor after conditioning with CY 200 mg/kg over 4 days plus rabbit antith ymocyte globulin (ATG) 3.5 mg/kg/day for 3 days. After 140 days follow-up h e has a normal blood count. The possible causes of the graft failure are di scussed. This case demonstrates that, although rarely, very late graft fail ure may occur after BMT for AA and highlights the need for long-term monito ring even in apparently successfully transplanted patients.