Graft Versus Host Disease after Granulocyte Infusion.

INTRODUCTION

Graft versus host disease (GVHD) occurs when immunologycally competent cells are introduced into an immunoincompetent host. GVHD refers to both the immunologic insult and the consequences to the organism. The leading cause of GVHD is hematopoietic cell transplantation (HCT), other causes like solid organ transplants, blood transfusions, and maternal-fetal transfusions also reportedly cause GVHD.

CASE

We present a 33 years old man, who was diagnosed in October 1997 of acute myeloid leukemia, treated with idarrubicin, etoposid and citarabine (IDICE), with complete remission; after that he received intensification treatment with mitoxanthrone and citarabine, and consolidation with an allogeneic HSCT from a sibling donor.

The chimerism was 100% of the donor since first month.

There wasn’t any important complications after HSCT; except a GVHD skin, resolved with corticoids.

Seven years after HCST, in November 2004, a routine control detected donor’s chimerism 34% with a medullar relapse. Leukemia characteristics were the same than the initials, and a new treatment with IDICE was administrated, showing no response, therefore, a second cycle was administrated.

One week after the first treatment fever appeared, which persisted besides large spectre antibiotics, so empiric antifungal treatment was added. Two months after the relapse the patient remained febrile, and skin lesions appeared in head, arms, legs, abdomen and oral mucosa. A biopsy was performed and diagnosed with Fusarium sp.

The neutropenia persisted, and the overall status was worsening, so we decided donor granulocyte infusions from two HLA identical sisters; ten days later, neutropenia disappeared, the bone marrow hadn’t blastic cells, and chimerism was 100% donor. A month later, new skin lesions appeared, the biopsy confirmed GVHD and severe liver affectation was also demonstrated by biopsy. It was treated with corticoids and cyclosporine, with rapid resolution.

The patient left hospital, and until now chimerism remains 100% donor with complete remission, without treatment for GVHD.

CONCLUSION: Graft versus Host disease is usually presented after hematopoietic stem cells infusion but other causes are been reported as lymphocytes infusion, where is not a rare event, and in other cases as granulocytes infusion as in our patient.

GVHD after granulocyte infusion is not a common complication even though it has to be taken in mind in patients that show skin or liver affectation after infusion.