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Prepublished online as a Blood First Edition Paper on July 18, 2002; DOI 10.1182/blood-2002-03-0857.
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Blood, 1 December 2002, Vol. 100, No. 12, pp. 3903-3907
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Hepatitic variant of graft-versus-host disease after donor
lymphocyte infusion
Görgün Akpek,
John K. Boitnott,
Linda A. Lee,
Jason P. Hallick,
Michael Torbenson,
David A. Jacobsohn,
Sally Arai,
Viki Anders, and
Georgia B. Vogelsang
From the Department of Oncology, Pathology, and
Medicine, The Johns Hopkins University School of Medicine, Baltimore,
MD.
Graft-versus-host disease (GVHD) of the liver is characterized by
bile duct damage and portal lymphocytic infiltrate. We report acute
hepatitislike presentation of GVHD after donor lymphocyte infusion
(DLI). Between April 1998 and September 2001, 73 patients received 94 DLI treatments. Liver GVHD developed after DLI in 22 (30%) patients
whose median age was 43 years (range, 21 to 61 years). Onset of liver
dysfunction was at 35 days (range, 11 to 406 days) after DLI. Fifteen
patients underwent liver biopsy, and the diagnosis of liver GVHD was
confirmed in 13 (87%) patients. After viral hepatitis and recent drug
exposure were excluded, 11 (50%) patients were given a diagnosis of a
hepatitic variant of GVHD based on histologic evidence of lobular
hepatitis (n = 5), elevation of maximum serum alanine
aminotransferase (ALT) or aspartate aminotransferase (AST) level more
than 10 times the upper normal limit (n = 9), or both. There was a
significant difference in maximum ALT (P = .002) and AST
(P = .01) level between the hepatitic-variant and
classical GVHD groups. GVHD progressed in 14 (64%) patients, and 10 patients died after a median follow-up of 221 days (range, 31-1284 days). These observations suggest that GVHD that occurs after DLI may
have distinct clinical features. Hepatitic-variant GVHD should be
considered in the differential diagnosis in DLI recipients with
unexplained hepatitis.
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