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Horse anti‐thymocyte globulin and eculizumab as concomitant therapeutic approach in an aplastic paroxysmal nocturnal hemoglobinuria patient: go or no‐go?

We present the case of a 64‐yr‐old female paroxysmal nocturnal hemoglobinuria (PNH) patient with subsequent transition to severe aplastic anemia in whom a concomitant successful immunosuppressive therapy (horse anti‐thymocyte globulin (hATG) and cyclosporin A) in addition to an ongoing long‐term treatment with the terminal complement inhibitor eculizumab was initiated. No reduced ATG efficacy or severe adverse events were observed in the presence of eculizumab. In addition, the possible reoccurrence of PNH symptoms (thromboembolic events and/or intravascular hemolysis) was prevented, while T‐cell depletion was similar to non‐eculizumab‐treated patients with partial remission being evident by day 83.