Temple Bone Marrow Transplant Program, Philadelphia, PA, USA.
Am J Hematol. 2012 Feb;87(2):219-21. doi: 10.1002/ajh.22227. Epub 2011 Dec 21.
Graft versus host disease (GVHD) is a common complication of allogeneic transplant. Acute GVHD primarily affects the skin, liver, and GI tract generally within the first 100 days after transplant. GVHD following an allogeneic transplant occurs as a result of donor T-cell recognition of host alloantigens. In contrast, patients undergoing ASCT are not subjected to the genetic disparity that occurs with allogeneic transplant, and in principal, should not develop this proinflammatory response. A clinical syndrome, however, has been described in patients following autologous transplant that shares the same features as GVHD occurring in recipients post-allogeneic transplant [1-3]. Previously reported cases have described skin, liver, and GI tract manifestations consistent with what is seen in allogeneic GVHD. Biopsies of the skin and GI tract mucosa have demonstrated similar histological features as well. Interestingly, the majority of reported cases seem to occur in patients with multiple myeloma undergoing consolidative ASCT. Historically, however, these patients have been described as having a relatively benign course with mild skin rash, nausea, vomiting, and/or diarrhea that is responsive to immunosuppression. In this article, we present a case of fatal, spontaneous GVHD in a patient with multiple myeloma following ASCT.
移植物抗宿主病（GVHD）是同种异体移植的常见并发症。急性 GVHD 主要影响皮肤、肝脏和胃肠道，通常发生在移植后 100 天内。同种异体移植后发生的 GVHD 是由于供体 T 细胞识别宿主同种抗原所致。相比之下，接受 ASCT 的患者不会经历与同种异体移植相关的遗传差异，并且原则上不应发生这种促炎反应。然而，在接受自体移植的患者中已经描述了一种临床综合征，其具有与同种异体移植后受者发生的 GVHD 相同的特征[1-3]。以前报道的病例描述了皮肤、肝脏和胃肠道表现与同种异体 GVHD 所见一致。皮肤和胃肠道黏膜的活检也显示出相似的组织学特征。有趣的是，大多数报道的病例似乎发生在接受巩固性 ASCT 的多发性骨髓瘤患者中。然而，从历史上看，这些患者被描述为具有相对良性的病程，表现为轻度皮疹、恶心、呕吐和/或腹泻，对免疫抑制有反应。在本文中，我们报告了一例多发性骨髓瘤患者在接受 ASCT 后发生致命性自发性 GVHD 的病例。
