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Graft-versus-host disease as an unusual complication following autologous stem cell transplantation
Affiliations- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland
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Abstract
Introduction
Graft-versus-host disease (GVHD) is a common and serious complication after allogeneic stem cell transplantation (allo-SCT). However, a similar syndrome has been reported after autologous stem cell transplantation (ASCT) as well.
Case report
A 61-year-old female diagnosed with immunoglobulin (Ig) G lambda multiple myeloma completed 10 cycles of bortezomib, thalidomide, and dexamethasone (VTD) and 2 cycles of cyclophosphamide, thalidomide, and dexamethasone (CTD). High-dose of melphalan (200 mg/kg) was given as conditioning, followed by an infusion of 2.5 × 10 CD34+ cells/kg. Three months later, she received her second ASCT. On Day +25 after tandem ASCT, the patient developed a maculopapular, itchy skin rash, which covered her face, trunk, and limbs. A skin biopsy was in line with the diagnosis of GVHD. The other organs were not involved. Treatment with systemic and local corticosteroids (CSs) resulted in the improvement of skin lesions, but the CSs were slowly tapered due to toxicity. In the following weeks, she developed symptoms of liver and gut involvement, which were resistant to steroids. The introduction of other immunosuppressive agents failed to achieve a response. As a consequence, she had cytomegalovirus (CMV) reactivation, as well as pancytopenia, and eventually, she died of infectious complications.
Conclusions
GVHD after ASCT remains a rare but life-threatening complication with poor prognosis.
Abstract
Introduction
Graft-versus-host disease (GVHD) is a common and serious complication after allogeneic stem cell transplantation (allo-SCT). However, a similar syndrome has been reported after autologous stem cell transplantation (ASCT) as well.
Case report
A 61-year-old female diagnosed with immunoglobulin (Ig) G lambda multiple myeloma completed 10 cycles of bortezomib, thalidomide, and dexamethasone (VTD) and 2 cycles of cyclophosphamide, thalidomide, and dexamethasone (CTD). High-dose of melphalan (200 mg/kg) was given as conditioning, followed by an infusion of 2.5 × 10 CD34+ cells/kg. Three months later, she received her second ASCT. On Day +25 after tandem ASCT, the patient developed a maculopapular, itchy skin rash, which covered her face, trunk, and limbs. A skin biopsy was in line with the diagnosis of GVHD. The other organs were not involved. Treatment with systemic and local corticosteroids (CSs) resulted in the improvement of skin lesions, but the CSs were slowly tapered due to toxicity. In the following weeks, she developed symptoms of liver and gut involvement, which were resistant to steroids. The introduction of other immunosuppressive agents failed to achieve a response. As a consequence, she had cytomegalovirus (CMV) reactivation, as well as pancytopenia, and eventually, she died of infectious complications.
Conclusions
GVHD after ASCT remains a rare but life-threatening complication with poor prognosis.
Keywords
multiple myeloma; graft-versus-host disease; autologous hematopoietic stem cell transplantation; immunosuppression; outcome
About this articleTitle
Graft-versus-host disease as an unusual complication following autologous stem cell transplantation
Journal
Issue
Pages
47-50
Published online
2020-03-01
Page views
270
Article views/downloads
550
DOI
10.2478/ahp-2020-0010
Bibliographic record
Acta Haematol Pol 2020;51(1):47-50.
Keywords
multiple myeloma
graft-versus-host disease
autologous hematopoietic stem cell transplantation
immunosuppression
outcome
Authors
Martyna Włodarczyk
Adam Wachowiak
Kaya Wieczorek
Mateusz Toborek
Agata Wieczorkiewicz-Kabut
Dariusz Kata
Grzegorz Helbig