Development of acute pure red cell aplasia after deferasirox administration in two cases of myelodysplastic syndrome.

Cases 1 and 2 were 55- and 68-year-old males, respectively. Both were administered deferasirox (DFX) because they received red blood cell transfusions regularly as treatment for myelodysplastic syndrome refractory anemia. DFX administrations were stopped on the 22nd day in case 1 and on the 78th day in case 2 because significantly reduced hemoglobin values and reticulocyte counts were observed. Bone marrow examinations showed pure red cell aplasia in both cases. In case 1, the reticulocyte ratio recovered to the value before drug administration 21 days after drug withdrawal. In case 2, it started increasing on the 14th day, and had recovered to the value before drug administration by the 42nd day after drug withdrawal. Human parvovirus B19 infections were negative in both cases. Both cases were thought to have drug-induced pure red cell aplasia, probably due to DFX. This drug should be used carefully with regular follow-ups of the reticulocyte count.