Autoaggression syndrome resembling acute graft-versus-host disease grade IV after autologous peripheral blood stem cell transplantation for breast cancer

Abstract

Summary:Acute graft-versus-host disease (aGVHD) after autologous progenitor cell transplantation has been associated with blood transfusion or cyclosporine. Mild aGVHD grades I-II, identified as autoaggression or engraftment syndrome, has recently been described in autologous progenitor transplantation. Here, we report the first case of pathologically documented grade IV aGVHD after autologous peripheral blood progenitor cell transplantation in a patient with breast cancer. The allogeneic origin was excluded by molecular techniques, and no cyclosporine or cytokines were administered. Keywords: GVHD; autologous transplantation; breast cancer Acute graft-versus-host disease (aGVHD) is a well-known complication of allogeneic bone marrow (BM) transplantation that typically presents with dermatitis, hepatitis and enteritis developing within 100 days after bone marrow infusion. 1 Less frequently, aGVHD has been reported to be associated with blood transfusion, mainly in immunocompromised patients. 2 Furthermore, particular clinical features of aGVHD have recently been described in some patients receiving syngeneic or autologous transplants. This spontaneous aGVHD after autologous BM or peripheral blood progenitor cell (PBPC) transplantation is usually less severe and has a better response to immunosuppressive treatment than allogeneic or transfusion-associated aGVHD. 3 Similarly, autologous GVHD induced by cyclosporine is usually mild, 4 although serious cases related to the concomitant administration of cytokines such as gamma-interferon have been described. 5 Although an exponential increase of autologous BM and PBPC transplantation has been observed during the last decade, cases of severe spontaneous aGVHD are extremely unusual. Here, we report the first case of fatal grade IV Correspondence: Professor V Vicente, Centro Regional de Hemodonación, C/ Ronda de Garay s/n, 30003 Murcia, Spain Received 15 June 1998; accepted 22 October 1998 aGVHD associated with autologous PBPC transplantation in a patient with breast carcinoma. Case reportA previously healthy 40-year-old female was diagnosed in November 1994 with stage III breast carcinoma. Bilateral breast silicone prostheses were implanted for cosmetic reasons in 1984. Breast cancer treatment consisted of radical mastectomy, adjuvant chemotherapy with FEC (5 fluorouracil, epirubicin, cyclophosphamide), and chest wall and axillary irradiation (50 Gy). On revaluation no evidence of disease was found, but an elevated Ca 15.3. In this setting, autologous PBPC transplantation was scheduled as consolidation therapy. Apheresis was started after the patient had received G-CSF for 3 days (8 g/kg/day) subcutaneously. Leukapheresis yield was 5.79 × 10 8 /kg white blood cells and 2.04 × 10 6 /kg CD34 + cells. In August 1995, after conditioning with STAMP-V (cyclophosphamide 6 g/m 2 , carboplatin 800 mg/m 2 , thiotepa 500 mg/m 2 ), all the material collected was infused. Cytokines were not used and the patient engrafted granulocytes (Ͼ0.5 × 10 9 /l) and platelet (Ͼ20 × 10 9 /l) by...

Engraftment syndrome: double-edged sword of hematopoietic cell transplants

“…[1][2][3] Most data suggest ES results from a proinflammatory state caused by release of diverse cytokines and other mediators of inflammation. ES was previously referred to as capillary leak syndrome, 4,5 autoaggression syndrome (after autotransplants) 6,7 and (when severe) aseptic shock syndrome. 8 ES is described after umbilical cord blood transplants and auto-, allo-and syngeneic-transplants of blood cells and BM cells.…”

Autologous graft-versus-host disease: harnessing anti-tumor immunity through impaired self-tolerance

“…50 In the post-auto-HCT setting, peripheral regulatory T cells temporarily eliminated by the preparative regimen may permit the development of auto-GVHD, even in the absence of CsA use. 27,35 The importance of Treg cells within the graft itself is evidenced by the increased rate of spontaneous auto-GVHD in patients receiving CD34 þ positively selected grafts containing low numbers of T cells, specifically Tregs. 13 Because relatively rapid immune reconstitution occurs after auto-HCT, the period of Treg cell depletion is limited; it has been proposed that the resolution of auto-GVHD is dependent upon Treg recovery.…”

Transfusion-Associated Microchimerism in Combat Casualties

“…36 Scientists then proposed the three conditions required for the development of GVHD, which have been minimally revised as: (1) the graft must contain immunologically competent cells, (2) the recipient must have autoimmunity and have major histocompatibility differences from the donor, and (3) the recipient immune response must be incapable of rejecting donor cells. [37][38][39] These three conditions are present in patients receiving blood transfusions who go on to develop TA-MC. GVHD developing as a result of transfusion is termed transfusion-associated GVHD (TA-GVHD).…”