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Transfusion-associated graft-versus-host disease in immunocompetent patients: report of a fatal case associated with transfusion of blood from a second-degree relative, and a survey of predisposing factors

Authors

  • L.D. Petz,

    Corresponding author
    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 5

      Lawrence D. Petz, MD, Professor, Department of Pathology and Laboratory Medicine

  • L. Calhoun,

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 7

      Loni Calhoun, BA, MT (ASCP) SBB, Senior Technical Specialist, Blood Bank, Department of Pathology and Laboratory Medicine, UCLA Medical Center.

  • P. Yam,

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 8

      Priscilla Yam, MS, FIMLS, Research Specialist, Department of Pathology and Laboratory Medicine, UCLA Medical Center.

  • M. Cecka,

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 9

      J. Michael Cecka, PhD, Adjuvant Associate Professor, Division of General Surgery Tissue Typing Laboratory, Department of Surgery, UCLA Medical Center.

  • G. Schiller,

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 10

      Gary J. Schiller, MD, Assistant Professor, Division of Hematology-Oncology, Department of Medicine, UCLA Medical Center.

  • A.R. Faitlowicz,

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 12

      Secretaria de Estado da Saúde, Hospital Brigadeiro, Department of Pathology and Laboratory Medicine, Hematology-Oncology Service, São Paulo, Brazil.

    • 11

      Ana R. Faitlowicz, MD, Visiting Assistant Professor, Division of Hematology-Oncology, Department of Medicine, UCLA Medical Center

  • R. Herron,

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 13

      Ross M. Herron, Jr., MD, Fellowship in Transfusion Medicine, Department of Pathology and Laboratory Medicine, UCLA Medical Center; current address: Assistant Medical Director, Blood and Tissue Services, American Red Cross, Southern California Region, Los Angeles, CA 90006.

  • D. Sayah,

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 14

      David R. Sayah, BS, Third-Year Student, UCLA School of Medicine.

  • R.B. Wallace Research Manager,

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 16

      Molecular Diagnostics, Bio-Rad Laboratories, Hercules, CA 94547.

    • 15

      R. Bruce Wallace, PhD, Director, Division of Biology, City of Hope Medical Center, Duarte, CA

  • A. Belldegrun

    1. Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
    2. Division of General Surgery (Tissue Typing Laboratory) and the Division of Urology, Department of Surgery, University of California Los Angeles, Los Angeles, California
    3. Division of Hematology/Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
    4. Division of Biology, City of Hope Medical Center, Duarte, California.
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    • 17

      Arie Belldegrun, MD, Associate Professor of Surgery and Urology and Director, Cancer Immunotherapy Program, Division of Urology, UCLA Medical Center.


Director of Transfusion Medicine, UCLA Medical Center, 10833 LeConte Avenue, Los Angeles, CA 90024-1713

Abstract

A patient without evident immune deficiency who received a transfusion of blood from a second-degree family member developed fatal transfusion- associated graft-versus-host disease (TA-GVHD). The donor was homozygous for an HLA haplotype for which the recipient was heterozygous (one-way HLA match). All 39 reported cases of TA-GVHD in immunocompetent patients were reviewed to ascertain the predisposing factors and to define the indications for irradiating blood for this population. HLA typing was described in 15 cases; in 13, including seven related and six unrelated donors, a one-way HLA match was present. Thirty-one (79%) of the 39 cases were reported from Japan (and 196 other cases are cited in the Japanese literature), but a one-way HLA match among unrelated donors at HLA-A, -B, -DR loci is only approximately two to four times more likely in Japanese persons than in whites. Fresh blood (< 96 hours old) was used in 29 (94%) of the 31 cases reported from Japan and in 33 (87%) of 38 cases overall (in one case, the age of the blood used was not reported). Thus, factors that appear to predispose to TA-GVHD in immunocompetent patients are a one- way HLA match, fresh blood, and, possibly, Japanese ancestry. Irradiating cellular blood components from all blood relatives of transfusion recipients will not completely eliminate the risk of TA- GVHD.

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