1988 Volume 29 Issue 11 Pages 2136-2140
A case of acute graft-versus-host disease (GVHD) following chemotherapy and platelet transfusions is presented.
This 43-year-old female with relapse of acute myeloblastic leukemia was successfully treated. After consolidation chemotherapy of high-dose cytosine arabinoside and daunorubicin, unirradiated platelets were transfused three times. Platelets were obtained from her sister, because the patient had become refractory to random donors' platelet transfusion, and direct cross match test was negative between patient's serum and sister's lymphocytes. Twenty-second days after chemotherapy or 7 days after the first platelet transfusion, high fever and diarrhea developed, and were followed by erythroderma and liver dysfunction. Drug allergy was suspected, and all the antibiotics were discontinued. After transient recovery of granulocytes, however, pancytopenia deteriorated. Biopsy of the bone marrow and skin was performed, and their histologic findings were consistent with those of transfusion-associated GVHD. High-dose methylprednisolone, cyclosporin A and antilymphocyte globulin were given, but ineffective. She died of severe pancytopenia and intestinal bleeding. HLA typing of the family members revealed that the patient had A11, A33, B15, B44, Cw4, and her sister A33, B44, DRw13. A33 and B44 homozygous in her sister were histocompatible with one of the haplotype of the patient's. This may be the most likely factor for the occurence of GVHD.
