Weiden P L, Zuckerman N, Hansen J A, Sale G E, Remlinger K, Beck T M, Buckner C D
Blood. 1981 Feb;57(2):328-32.
A woman with lymphoblastic lymphoma was treated with combination chemotherapy. She subsequently became febrile while granulocytopenic and was given unirradiated granulocyte transfusions from normal, unrelated donors. She recovered, but 12 days later noted the onset of progressive skin rash, hepatic dysfunction, diarrhea and pancytopenia and, 22 days after her last granulocyte transfusion, died of gram negative septicemia. Histologic examination of multiple tissues including the skin, liver, and intestinal tract showed changes characteristic of acute graft-versus-hose disease (GVHD). Y-chromatin analysis of the patient's peripheral blood just before death indicated the presence of male cells. HLA typing of lymphocytes and skin fibroblasts from the patient and lymphocytes from the family and granulocyte donors was also consistent with engraftment of cells from one of the male granulocyte donors. This donor most likely was homozygous for one of the patient's halotypes, perhaps facilitating engraftment of his cells and subsequent development of transfusion-induced acute GVHD. Until more precise guidelines can be established, we recommend that all cellular blood products given to patients receiving intensive chemotherapy be irradiated with 1500 rad.
一名患有淋巴细胞性淋巴瘤的女性接受了联合化疗。随后，在粒细胞缺乏期间她出现发热，并接受了来自正常、无关供者的未照射粒细胞输注。她康复了，但12天后出现进行性皮疹、肝功能障碍、腹泻和全血细胞减少，在最后一次粒细胞输注后22天，死于革兰阴性菌败血症。对包括皮肤、肝脏和肠道在内的多个组织进行组织学检查，显示出急性移植物抗宿主病（GVHD）的特征性变化。患者死亡前外周血的Y染色体分析表明存在男性细胞。对患者的淋巴细胞和皮肤成纤维细胞以及其家庭成员和粒细胞供者的淋巴细胞进行HLA分型，也与来自一名男性粒细胞供者的细胞植入一致。该供者很可能与患者的一种单倍型纯合，这可能促进了他的细胞植入以及随后输血诱导的急性GVHD的发生。在能够制定更精确的指导方针之前，我们建议给予接受强化化疗患者的所有细胞血液制品都用1500拉德进行照射。
