|
|
 Previous Article | Table of Contents | Next Article 
Hyperacute graft-v-host disease in patients not given immunosuppression
after allogeneic marrow transplantation
KM Sullivan, HJ Deeg, J Sanders, A Klosterman, D Amos, H Shulman, G Sale, P Martin, R Witherspoon and F Appelbaum
Sixteen patients with leukemia in relapse or second to third remission, 5
to 27 years old (median, 17), were given cyclophosphamide (60 mg/kg X 2)
and total body irradiation (2.25 Gy for each of seven days) followed by
unmodified marrow grafts from HLA-identical siblings. Patients did not
receive posttransplant immunosuppression and were followed a median of nine
months (range, 5-17). Prompt engraftment was sustained in 12 patients with
a median time of 16 days (range, 10 to 63) to achieve 500 neutrophils/mm3.
One patient failed to engraft, one had delayed engraftment, and two had
late poor graft function. All 15 with engraftment developed moderate to
life-threatening graft-v-host disease (GVHD, eight grade II and seven grade
III-IV). This syndrome was hyperacute (median onset eight days [range, 7 to
29] posttransplant) and manifest by severe skin disease (14 patients at
stage 3 and one at stage 4), fever (ten patients), and liver (four
patients, stage 3-4) or gut (four patients, stage 3-4) involvement. Serial
tissue biopsies confirmed acute GVHD in 13 of 15 patients. Ten were treated
with antithymocyte globulin and cyclosporine (four survive), and four with
corticosteroids (two survive). Actuarial survival to 17 months was 37%.
Causes of death included interstitial pneumonia (four), infection (three),
graft failure (one), venocclusive disease (one), and relapse of leukemia
(one). Age-matched controls receiving standard methotrexate after
transplant had comparable relapse-free survival but only a 25% incidence of
grade II-IV acute GVHD (P less than .0001). We conclude that deleting
posttransplant immunosuppression is associated with frequent and severe
hyperacute GVHD, infectious complications, and occasional poor graft
function.
Volume 67,
Issue 4,
pp. 1172-1175,
04/01/1986
Copyright © 1986 by The American Society of Hematology
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
R. M. Saliba, M. de Lima, S. Giralt, B. Andersson, I. F. Khouri, C. Hosing, S. Ghosh, J. Neumann, Y. Hsu, J. De Jesus, et al.
Hyperacute GVHD: risk factors, outcomes, and clinical implications
Blood,
April 1, 2007;
109(7):
2751 - 2758.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. A. Copelan
Hematopoietic stem-cell transplantation.
N. Engl. J. Med.,
April 27, 2006;
354(17):
1813 - 1826.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Valks, J. Fernandez-Herrera, B. Bartolome, J. Fraga, E. Dauden, and A. Garcia-Diez
Late Appearance of Acute Graft-vs-Host Disease After Suspending or Tapering Immunosuppressive Drugs
Arch Dermatol,
January 1, 2001;
137(1):
61 - 65.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. C. Guinan, V. A. Boussiotis, D. Neuberg, L. L. Brennan, N. Hirano, L. M. Nadler, and J. G. Gribben
Transplantation of Anergic Histoincompatible Bone Marrow Allografts
N. Engl. J. Med.,
June 3, 1999;
340(22):
1704 - 1714.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Fernandez-Herrera, R. Valks, C. Feal, J. Fraga, J. F. Tomas, and A. Garcia-Diez
Induction of Hyperacute Graft-vs-Host Disease After Donor Leukocyte Infusions
Arch Dermatol,
March 1, 1999;
135(3):
304 - 308.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. B. Miller and F. M. Graeme-Cook
Case 19-1996- Multisystem failure in a 33-year-old man after bone marrow transplantation
N. Engl. J. Med.,
June 20, 1996;
334(25):
1655 - 1662.
[Full Text]
[PDF]
|
|
|
|
|
