Pure red cell aplasia (PRCA) is increasingly recognised as a T-cell-mediated bone marrow failure syndrome, yet its immunogenetic drivers remain poorly defined. In their paper, Yamashita et al. integrate human leucocyte antigen (HLA) typing, T-cell receptor repertoire analysis and mutational profiling to reveal enriched HLA alleles, signal transducer and activator of transcription 3 (STAT3)-mutated T-cell clones and a shared T cell receptor beta (TCRβ) motif in PRCA patients. These findings suggest that antigen-driven cytotoxic T-cell responses represent a central mechanism underlying erythroid suppression. Commentary on: Yamashita et al. Immunological features of acquired PRCA: Specific HLA alleles, STAT3 mutations and a unique TCRβ motif. Br J Haematol 2026 (Online ahead of print). doi: 10.1111/bjh.70475.
Spataro et al. (2026) studied this question.