Case 148: update 2

The patient is admitted for broad spectrum antibiotics and red cell transfusion. A bone marrow biopsy is performed, which demonstrates 10% cellularity with no dysplastic features, no excess of blasts, no abnormal infiltrate and no fibrosis. Cytogenetics demonstrate a normal karyotype. CT chest, abdomen and pelvis is unremarkable.

The patient is diagnosed with aplastic anaemia. Flow cytometry on peripheral blood did not demonstrate a PNH clone, and chromosomal breakage analysis excluded Fanconi anaemia. The patient is monitored over the course of the next month and supported with transfusions as required. Unfortunately, his blood counts continue to plummet with undetectable neutrophil count and ongoing red cell and platelet transfusion dependence.

What treatment options are available to this patient?
What are the pros and cons of these treatment options?

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