Successful treatment of transfusion‐associated graft‐versus‐host disease

Abstract

We present an immunocompetent patient with transfusion-associated graft-versus-host disease (GVHD), in which chimaerism of peripheral blood lymphocytes was demonstrated by analysis of a highly polymorphic genome. The patient was treated successfully with anti-CD3 monoclonal antibody, OKT3 and cyclosporin A. Although it is undoubtedly important to prevent transfusion-associated GVHD by irradiation of cellular blood components, intensive therapy with OKT3 and cyclosporin A in the early phase of onset may be effective for treatment of this potentially fatal condition. The mechanism of the effectiveness of this treatment for transfusion-associated GVHD is discussed.

Transfusion-Associated Graft Versus Host Disease in the Immunocompetent Patient

“…In Japan, a 32-year-old pregnant female with placenta previa underwent cesarean section; intraoperatively, she required 4 units of nonirradiated PRBCs from random donors. 24 These units were less than 4 days old. She developed TA-GVHD 9 days following transfusion.…”

Transfusion‐associated graft‐versus‐host disease

“…In contrast with GVHD post BMT, these patients do not respond to corticosteroids, antithymocyte globulin, cyclosporine and/or growth factors. However, there are reports in the literature of spontaneous resolution of the disease (Mori et al , 1995), and of successful treatment with a combination of cyclosporine and the anti‐CD3 monoclonal antibody OKT3 (Yasukawa et al , 1994) or antithymocyte globulin and steroids (Prince et al , 1991). Nafmostat mesilate, a serine protease inhibitor that inhibits cytotoxic T cells, has been used with transient improvement (Ryo et al , 1999).…”

GVHD after transfusion of stored RBC concentrates in asolution of mannitol, adenine, phosphate, citrate, glucose,and NaCl following trauma

“…TA‐GVHD usually occurs when blood from a donor who is homozygous for a certain haplotype is transfused to a patient who is heterozygous for that haplotype 17–21 . Therefore, HLA typing has been used to document the presence of allogeneic lymphocytes in patients with TA‐GVHD.…”