TRANSFUSION-INDUCED GRAFT-VS-HOST DISEASE NLM AIDSLINE Important note: Information in this article was accurate in 1991. The state of the art may have changed since the publication date.

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TRANSFUSION-INDUCED GRAFT-VS-HOST DISEASE

Hematology; 12:539-55 1990. Unique Identifier : AIDSLINE ICDB/91675408
Spitzer TR; Vincent T. Lombardi Cancer Res. Center, Georgetown Univ. Hosp.,; Washington, DC

Abstract: Graft-vs-host disease (GVHD) following transfusion of whole blood or blood components is an uncommon, but increasingly recognized, complication in immunocompromised individuals. Incidence, pathogenesis, and clinical features of GVHD are reviewed; and strategies for prevention in patients (pts) at highest risk are discussed. Topics include incidence, pathogenesis, clinical features, associations (neonates, postcardiac surgery, aplastic anemia, and pregnancy, impaired cell-mediated immunity [nonmalignant disorders], lymphoproliferative malignancies, acute leukemia, chronic lymphocytic leukemia, thoracic duct lymphocyte infusion, neuroblastoma, glioblastoma multiforme, and rhabdomyosarcoma), treatment, prognosis, prevention of transfusion-induced GVHD (physicochemical methods and blood product irradiation), and recommendations for blood product irradiation for GVHD prophylaxis. Factors influencing the development of transfusion-induced GVHD include nature (and degree) of impairment of cellular immunity, number of infused immunocompetent T lymphocytes, and possibly degree of genetic disparity between donor and host. Clinical features are similar to those of GVHD following bone marrow transplantation but include severe bone marrow involvement in most cases and more fulminant clinical course (and higher mortality). No effective therapy is known for transfusion-induced GVHD. The outcome was fatal in 64 of 78 reported cases of transfusion-induced GVHD. No therapy, including high-dose corticosteroids, has impacted clearly on the natural history of the disease. Surviving cases have been characterized by relatively mild disease manifestations, spontaneously reversible tissue injury, and sometimes at least partial resolution of the underlying immune deficit (eg, successful remission induction in acute leukemia). Supportive care (antibiotics, transfusional support, etc.) is essential during periods of peripheral cytopenia. Bone marrow transplantation from a mismatched sibling donor was attempted in one pt with marrow aplasia, but early post-transplant death occurred due to overwhelming candidal sepsis. Since transfusion-induced GVHD can be prevented by irradiating blood products with 2500-3500 rad, pts at high risk (by virtue of impaired cellular immunity and/or clinical experience) should receive only irradiated blood products. (93 Refs)
Keywords: Acquired Immunodeficiency Syndrome/IMMUNOLOGY *Blood Transfusion Graft vs Host Disease/DIAGNOSIS/*IMMUNOLOGY/PREVENTION & CONTROL Human Immune Tolerance/IMMUNOLOGY Lymphocyte Depletion Prognosis Risk Factors T-Lymphocyte Subsets/IMMUNOLOGY MONOGRAPH REVIEWKWDacquiredimmunodeficiencysyndrome/immunologyKWDbloodtransfusiongraftvshostdisease/diagnosis/KWDimmunology/prevention&controlhumanimmunetolerance/immunologylymphocytedepletionprognosisriskfactorst-lymphocytesubsets/immunologymonographreview
911030
M91A1128

Copyright © 1991 - National Library of Medicine. Reproduced under license with the National Library of Medicine, Bethesda, MD.

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