On 8 April 2013, Multan Khan, at 58 years of age, underwent allogeneic bone marrow transplant for severe aplastic anemia. Till now, he is the oldest patient to undergo allogeneic HSCT at our centre.

Multan Khan was diagnosed one year before his transplant and had been heavily transfused with blood components. Before the transplant he has received over 100 red cell concentrate/whole blood units and over 200 random donor platelet units. Other than platelet refractoriness, there was no comorbidity.

Donor was patient’s grand multiparous sister who was about 10 years younger than him. Pretransplant conditioning was given with Flu120/Cy120/ATG20. Post-transplant cyclosporine was used for GVHD prophylaxis. Stem cells source consisted of un-primed bone marrow harvest (BMH) on day zero and GCSF mobilized peripheral blood stem cell (PBSC) harvest on day +4. 8 Cell dose was TNC 2.4 x 10 /kg from 8 BMH and MNC 1.7 x 10 /kg from PBSC. Facility for CD34 positive cells was not available. Neutrophil engraftment was on day +13 & platelet engraftment on day +28.

During early post-transplant period, Multan Khan had an episode of neutropenic fever prior to engraftment. Later on, there was a spell of abnormal behavior and grade II gut GVHD which promptly responded to treatment. After first 3 months, Multan Khan remained generally well with stable blood counts and no chronic GVHD. Immunosuppression was tapered off at one year followed by routine vaccination.

Now 5 years after transplant, at 63 years of age, Multan Khan is fully fit and leading an active life. He is working full time and running a small general store in his village.

Contributed By: Dr Muhammad Farhan, FCPS (Clinical Haem)