On day + 47, graft rejection was detected, followed by prolonged pancytopenia with absolute neutrophil count 0, high dependence on blood transfusions (daily platelet and one in 2–3 days red blood cell transfusions), and no response to hematopoietic stimulating factors (G-CSF – filgrastim and thrombopoietin receptor agonist – romiplostim). Here, MPL is linked to Pancytopenia.