Severe acute graft-versus-host disease after T-cell depleted allogeneic stem cell graft from a second donor caused by persisting T-cells from the first donor

A Wiesmann; P Bader; M Bamberg; C Faul; L Kanz; H Einsele

doi:10.1038/sj.bmt.1704170

Severe acute graft-versus-host disease after T-cell depleted allogeneic stem cell graft from a second donor caused by persisting T-cells from the first donor

Bone Marrow Transplant. 2003 Sep;32(5):511-3. doi: 10.1038/sj.bmt.1704170.

Authors

A Wiesmann¹, P Bader, M Bamberg, C Faul, L Kanz, H Einsele

Affiliation

¹ Department of Haematology, Oncology, Immunology and Rheumatology, University of Tübingen, Tübingen, Germany.

PMID: 12942098
DOI: 10.1038/sj.bmt.1704170

Abstract

HLA disparity is a major risk factor for graft rejection and GVHD. We report a patient with CML (accelerated phase) who underwent allogeneic SCT from a mismatched unrelated donor and developed acute GVHD. With immunosuppression, GVHD symptoms improved but graft rejection occurred. After a second conditioning regimen, the patient received a second graft from a haploidentical related donor. Engraftment occurred, but the patient died from GVHD and pulmonary aspergillosis. Chimeric analysis revealed that all leukocytes were of donor 2 origin apart from CD3+ T cells, which were 100% donor 1 type. Thus, in spite of intensified immunosuppression and successful transplantation of a second graft, T cells from the first donor persisted and induced severe acute GVHD.

Publication types

Case Reports

MeSH terms

Acute Disease
Adult
Fatal Outcome
Graft vs Host Disease / etiology
Graft vs Host Disease / immunology*
Hematopoietic Stem Cell Transplantation / methods*
Histocompatibility Testing
Humans
Lymphocyte Depletion*
T-Lymphocytes / immunology*
Tissue Donors*
Transplantation Chimera
Transplantation, Homologous