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Agranulocytosis as a Part of Secondary Graft Failure after Allogenic Stem Cell Transplantation

Bimalangshu R Dey and Sidhertha Podder

Secondary graft failure after myeloablative allogeneic Stem Cell Transplantation (SCT), although rare, is a serious complication and usually requires a second allogeneic SCT to restore normal donor-derived hematopoiesis. Here, we are presenting a patient with acute myeloid leukemia who developed secondary graft failure following HLA 9/10 Ag-matched unrelated donor SCT. The clinical context and the marrow findings raised the suspicion of an immune-mediated mechanism to be the likely cause of graft failure. He received immunosuppressive therapy (Horse ATG, cyclosporine, corticosteroid) that resulted in restoration of full donor-derived hematopoiesis with essential normal peripheral blood counts, and thus obviating the need for a second allogeneic SCT.