Severe autologous GVHD after hematopoietic progenitor cell transplantation for multiple myeloma

• Published in: Bone marrow transplantation (Basingstoke) Vol. 43; no. 2; pp. 169 - 177
• Main Authors: Drobyski, W R, Hari, P, Keever-Taylor, C, Komorowski, R, Grossman, W
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2009; Nature Publishing Group
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Autografts; Autoimmunity; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Cell Biology; Cells (biology); Combined Modality Therapy; Complications; Complications and side effects; Corticoids; Corticosteroids; Dosage and administration; Drug therapy; Fatal Outcome; Graft versus host reaction; Graft vs Host Disease - etiology; Graft vs Host Disease - immunology; Hematologic and hematopoietic diseases; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulinopathies; Immunopathology; Immunosuppressive agents; Internal Medicine; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Multiple myeloma; Multiple Myeloma - drug therapy; Multiple Myeloma - surgery; Multiple Myeloma - therapy; original-article; Patient outcomes; Patients; Progenitor cells; Public Health; Regulatory mechanisms (biology); Risk factors; Stem cell transplantation; Stem Cells; Steroids; Therapy; Toxicity; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; United States; multiple myeloma; tandem transplants; GVHD; Immunopathology; Graft versus host disease; Hematology; Stem cell; Hematopoietic cell; Malignant hemopathy; Myeloma; Immunoglobulinopathy; Lymphoproliferative syndrome; Graft; Cancer
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2008.295

GVHD is a recognized complication of autologous hematopoietic progenitor cell transplantation (HPCT), but has typically been reported to respond well to primary therapy with corticosteroids. In this study, we report the development of severe autologous GVHD in five patients who underwent HPCT for multiple myeloma. In all cases, response to corticosteroids was unsatisfactory and three of these patients ultimately died from complications that ensued from prolonged immunosuppressive therapy. Severe autologous GVHD occurred only in patients transplanted for multiple myeloma and was observed at a much higher frequency in patients undergoing their second HPCT. The severity of this syndrome primarily in patients undergoing second HPCTs suggests that repetitive exposure to high-dose therapy may compromise endogenous peripheral regulatory mechanisms and predispose these patients to autoimmunity. Given the evolving role of second autologous transplantations in the therapeutic armamentarium for multiple myeloma, consideration of this potential toxicity may be appropriate when considering treatment options for these patients.