Acute graft-versus-host disease in a nonhematopoietic stem cell transplantation candidate treated with decitabine followed by granulocyte colony-stimulating factor–primed peripheral blood stem cells infusion: a special entity of the disease?

Authors

  • Lei Yuan,

    1. Department of Hematology, Chinese PLA General Hospital, Beijing, China
    2. Department of Pathology, Chinese PLA General Hospital, Beijing, China
    3. The Cyrus Tang Hematology Center, Soochow University, Suzhou, Jiangsu Province, China
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  • Lu Sun,

    1. Department of Hematology, Chinese PLA General Hospital, Beijing, China
    2. Department of Pathology, Chinese PLA General Hospital, Beijing, China
    3. The Cyrus Tang Hematology Center, Soochow University, Suzhou, Jiangsu Province, China
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  • Lin Yang,

    1. Department of Hematology, Chinese PLA General Hospital, Beijing, China
    2. Department of Pathology, Chinese PLA General Hospital, Beijing, China
    3. The Cyrus Tang Hematology Center, Soochow University, Suzhou, Jiangsu Province, China
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  • Yu Jing

    Corresponding author
    1. Department of Hematology, Chinese PLA General Hospital, Beijing, China
    2. Department of Pathology, Chinese PLA General Hospital, Beijing, China
    3. The Cyrus Tang Hematology Center, Soochow University, Suzhou, Jiangsu Province, China
    • Address reprint requests to: Yu Jing, MD, Department of Hematology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; e-mail: jingyu301@yahoo.com.cn.

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Abstract

Background

With a well-developed strategy of acute graft-versus-host disease (aGVHD) prophylaxis, the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients who develop aGVHD has improved considerably. Meanwhile, transfusion-associated GVHD (TA-GVHD) can be fatal. Recent advancements in immune cellular therapy are being adopted in clinical practice, although many concerns including TA-GVHD remain. This report describes a 64-year-old male non-HSCT candidate diagnosed with acute myeloid leukemia who had received decitabine followed by an infusion of granulocyte–colony-stimulating factor–primed peripheral blood stem cells (G-PBSCs) from his daughter, who carried haploidentical human leukocyte antigen. The patient developed aGVHD on the 20th day after infusion.

Study Design and Methods

This study is a single case report of a non-HSCT candidate who developed skin aGVHD with mild clinical course after decitabine and G-PBSCs combination. The clinical course, chimerism, and aGVHD pathology studies are detailed.

Results

Compared with conventional aGVHD in allo-HSCT recipients and TA-aGVHD, the presentation of this case followed a self-limited clinical course without marrow aplasia or severe progression. However, the patient eventually died of leukemia without a significant graft-versus-leukemia effect.

Conclusion

First, the results demonstrate the existence of aGVHD in elderly non-HSCT candidates receiving adoptive cellular immune therapy. Second, aGVHD occurring under these conditions is probably a unique entity of aGVHD compared to TA-aGVHD and the conventional pattern in allo-HSCT recipients with respect to clinical course and prognosis.

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