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Prepublished online as a Blood First Edition Paper on July 18, 2002; DOI 10.1182/blood-2002-03-0857.
Submitted March 27, 2002
Accepted July 3, 2002
Hepatitic variant of graft-versus-host disease after donor lymphocyte infusion
Gorgun Akpek, John K Boitnott, Linda A Lee, Jason P Hallick, Michael Torbenson, David A Jacobsohn, Sally Arai, Viki Anders, and Georgia B Vogelsang*
Division of Hematologic Malignancies, Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA
Department of Pathology, The Johns Hopkins University, Baltimore, MD, USA
Deaprtment of Medicine, The Johns Hopkins University, Baltimore, MD, USA
* Corresponding author; email: vogelge{at}jhmi.edu.
Graft-versus-host disease (GVHD) of the liver is characterized by bile duct damage and portal lymphocytic infiltrate. We report acute hepatitis-like presentation of GVHD after donor lymphocyte infusion (DLI). Between 4/1998 and 9/2001, a total of 73 patients received 94 DLI treatments. Of these, 22 (30%) patients with a median age of 43 (range 21 to 61) developed liver GVHD after DLI. Onset of liver dysfunction was at 35 days (range 11 to 406) post-DLI. Fifteen patients underwent a liver biopsy and the diagnosis of liver GVHD was confirmed in 13 (87%). After the exclusion of viral hepatitis and recent drug exposure, eleven (50%) patients were diagnosed with hepatitic-variant of GVHD based on either the presence of histologic evidence of lobular hepatitis (n=5) and/or elevation of maximum serum ALT or AST levels greater than 10 times of upper normal limit (n=9). There was a significant difference in maximum ALT (p=0.002) and AST (p=0.01) between hepatitic-variant and classical GVHD groups. GVHD progressed in 14 (64%) patients and 10 patients expired after a median follow-up of 221 days (31-1284). These observations suggest that GVHD occurring after DLI may have distinct clinical features. Hepatitic-variant of GVHD should be considered in differential diagnosis in DLI recipients with unexplained hepatitis.
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