• Nan Zhang, Xiao Wang, Xiao-Juan Miao, Xu-Pai Zhang, Xin-Yu Xia, Li Li, and Hao-Ping Sun.
• Department of Hematology, People's Liberation Army The General Hospital of Western Theater Command, Chengdu, China.
• Medicine (Baltimore). 2023 Jun 16; 102 (24): e34036e34036.

RationaleBone marrow failure (BMF) includes inherited and acquired BMFs. Acquired BMF can be secondary to various factors, such as autoimmune dysfunction, benzene, drugs, radiation, viral infection and so on. Fanconi anemia (FA) complementation group L (FANCL) is an E3 ubiquitin ligase that participates in the repair of DNA damage. Homozygous or compound heterozygous mutations of FANCL can lead to the onset of FA, which is one of the most common inherited BMFs.Patient Concerns And DiagnosesHere, we report a case of acquired BMF. This patient had a history of benzene exposure for half a year before the onset of the disease, and presented with progressive pancytopenia, especially the reduction of erythrocytes and megakaryocyte, without malformation. Interestingly, this patient and his brother/father had a heterozygous (non-homozygous/compound heterozygous) mutation (Exon9, c.745C > T, p.H249Y) in the FANCL gene.Interventions And OutcomesThe patient successfully underwent unrelated and fully compatible umbilical cord blood hematopoietic stem cell transplantation.Lessons SubsectionsWe report for the first time an acquired BMF case with FANCL gene heterozygous mutation, and the mutation site (Exon9, c.745C > T, p.H249Y) has never been reported. This case suggests that heterozygous mutations in FANCL gene may be associated with increased susceptibility to acquired BMF. Based on current reports and this case, we speculate that heterozygous mutations in the FA complementation gene may exist in a certain proportion of tumor and acquired BMF patients, but have not been detected. We recommend routine screening for FA complementation gene mutations in tumor and acquired BMF patients in clinical practice. If positive results are found, further screening can be conducted on their families.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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