Hutchinson Kendra, Kopko Patricia M, Muto Kathryn N, Tuscano Joseph, O'Donnell Robert T, Holland Paul V, Richman Carol, Paglieroni Teresa G, Wun Theodore
Division of Hematology Oncology, University of California-Davis School of Medicine, USA.
Transfusion. 2002 Dec;42(12):1567-72. doi: 10.1046/j.1537-2995.2002.00253.x.
Transfusion-associated GVHD (TA-GVHD) is an uncommon complication of blood transfusion. Diagnosis of TA-GVHD is difficult, and it is usually rapidly fatal. There are few documented sur- vivors of TA-GVHD.
A 61-year-old woman with chronic lymphocytic leukemia (CLL) was treated with fludarabine followed by combination chemotherapy and high-dose radioimmunotherapy and peripheral blood progenitor cell (PBPC) rescue. She was transfused with nonirradiated blood components at an outside hospital and presented 10 days later with rash, elevated liver enzymes, and progressive pancytopenia. Skin biopsy was consistent with GVHD, and HLA typing of lymphocytes from the patient demonstrated mixed chimerism. The patient was treated with solumedrol and cyclosporin A, followed by high-dose cyclophosphamide and antithymocyte globulin and autologous PBPC infusion. She had rapid engraftment, resolution of skin rash, and normalization of liver function abnormalities. She is in good health with normal blood counts and no evidence of CLL 34 months after transplantation.
TA-GVHD occurs in the setting of an immunocompromised recipient receiving nonirradiated blood components. A typical presentation includes skin rash, liver function abnormalities, and pancytopenia. Demonstration of mixed chimerism by HLA typing facilitated diagnosis in this patient. High-dose immunosuppression, facilitated by the availability of autologous PBPCs, resulted in a successful outcome.
输血相关移植物抗宿主病（TA-GVHD）是一种罕见的输血并发症。TA-GVHD的诊断困难，且通常会迅速致命。TA-GVHD的存活者记录很少。
一名61岁的慢性淋巴细胞白血病（CLL）女性患者接受了氟达拉滨治疗，随后进行联合化疗、大剂量放射免疫疗法及外周血祖细胞（PBPC）解救。她在外院输注了未经辐照的血液成分，10天后出现皮疹、肝酶升高及进行性全血细胞减少。皮肤活检结果符合移植物抗宿主病，对患者淋巴细胞进行的HLA分型显示存在混合嵌合体。患者接受了甲强龙和环孢素A治疗，随后接受了大剂量环磷酰胺和抗胸腺细胞球蛋白治疗及自体PBPC输注。她迅速实现了造血重建，皮疹消退，肝功能异常恢复正常。移植后34个月，她身体健康，血细胞计数正常，无CLL迹象。
TA-GVHD发生于免疫功能低下的受者接受未经辐照的血液成分时。典型表现包括皮疹、肝功能异常及全血细胞减少。通过HLA分型证实混合嵌合体有助于该患者的诊断。自体PBPC的可得性使得大剂量免疫抑制治疗获得了成功结果。
