Summary:Acute graft-versus-host disease (aGVHD) after autologous progenitor cell transplantation has been associated with blood transfusion or cyclosporine. Mild aGVHD grades I-II, identified as autoaggression or engraftment syndrome, has recently been described in autologous progenitor transplantation. Here, we report the first case of pathologically documented grade IV aGVHD after autologous peripheral blood progenitor cell transplantation in a patient with breast cancer. The allogeneic origin was excluded by molecular techniques, and no cyclosporine or cytokines were administered. Keywords: GVHD; autologous transplantation; breast cancer Acute graft-versus-host disease (aGVHD) is a well-known complication of allogeneic bone marrow (BM) transplantation that typically presents with dermatitis, hepatitis and enteritis developing within 100 days after bone marrow infusion. 1 Less frequently, aGVHD has been reported to be associated with blood transfusion, mainly in immunocompromised patients. 2 Furthermore, particular clinical features of aGVHD have recently been described in some patients receiving syngeneic or autologous transplants. This spontaneous aGVHD after autologous BM or peripheral blood progenitor cell (PBPC) transplantation is usually less severe and has a better response to immunosuppressive treatment than allogeneic or transfusion-associated aGVHD. 3 Similarly, autologous GVHD induced by cyclosporine is usually mild, 4 although serious cases related to the concomitant administration of cytokines such as gamma-interferon have been described. 5 Although an exponential increase of autologous BM and PBPC transplantation has been observed during the last decade, cases of severe spontaneous aGVHD are extremely unusual. Here, we report the first case of fatal grade IV Correspondence: Professor V Vicente, Centro Regional de Hemodonación, C/ Ronda de Garay s/n, 30003 Murcia, Spain Received 15 June 1998; accepted 22 October 1998 aGVHD associated with autologous PBPC transplantation in a patient with breast carcinoma. Case reportA previously healthy 40-year-old female was diagnosed in November 1994 with stage III breast carcinoma. Bilateral breast silicone prostheses were implanted for cosmetic reasons in 1984. Breast cancer treatment consisted of radical mastectomy, adjuvant chemotherapy with FEC (5 fluorouracil, epirubicin, cyclophosphamide), and chest wall and axillary irradiation (50 Gy). On revaluation no evidence of disease was found, but an elevated Ca 15.3. In this setting, autologous PBPC transplantation was scheduled as consolidation therapy. Apheresis was started after the patient had received G-CSF for 3 days (8 g/kg/day) subcutaneously. Leukapheresis yield was 5.79 × 10 8 /kg white blood cells and 2.04 × 10 6 /kg CD34 + cells. In August 1995, after conditioning with STAMP-V (cyclophosphamide 6 g/m 2 , carboplatin 800 mg/m 2 , thiotepa 500 mg/m 2 ), all the material collected was infused. Cytokines were not used and the patient engrafted granulocytes (Ͼ0.5 × 10 9 /l) and platelet (Ͼ20 × 10 9 /l) by...

A month later he was readmitted complaining of fever, malaise, and lethargy. Intravenous pyelography disclosed a non-functioning left kidney, and retrograde studies on the left side showed a stricture of the ureter at the level of L4. Laparotomy confirmed continued blockage of the ureter by dense fibrous tissue and also a small abscess at the site of the T-tube ureterostomy. Left nephrectomy was performed. Histological examination of the kidney showed severe acute pyelonephritis secondary to ureteric obstruction. This was considered to be a complication of the T-tube ureterostomy.

Although the life‐threatening cytomegalovirus (CMV) disease is a well known complication following allogeneic hematopoietic stem cell transplantation (HSCT), it has been considered infrequent after autologous peripheral blood stem cell transplantation (PBSCT). On the other hand, the massive involvement of the gastrointestinal (GI) tract as the primary site of fatal CMV disease is particularly rare after autologous PBSCT. We present the case of a woman who suffered from CMV disease after high‐dose busulphan/melphalan/thiotepa (BuMelTT) and autologous PBSCT. The primary site of infection was the GI tract, which was extensively affected. During the fifth week post‐transplant the patient started with epigastralgia, diarrhea, fever, GI bleeding, and thrombocytopenia, and she died on day +52. Another case of fatal CMV disease among the few patients treated with BuMelTT has been recently reported, which suggests that the immunodeficiency associated with that regimen can be as intense as that occurring after allogeneic BMT.

Although the life-threatening cytomegalovirus (CMV) disease is a well known complication following allogeneic hematopoietic stem cell transplantation (HSCT), it has been considered infrequent after autologous peripheral blood stem cell transplantation (PBSCT). On the other hand, the massive involvement of the gastrointestinal (GI) tract as the primary site of fatal CMV disease is particularly rare after autologous PBSCT. We present the case of a woman who suffered from CMV disease after high-dose busulphan/melphalan/thiotepa (BuMelTT) and autologous PBSCT. The primary site of infection was the GI tract, which was extensively affected. During the fifth week post-transplant the patient started with epigastralgia, diarrhea, fever, GI bleeding, and thrombocytopenia, and she died on day +52. Another case of fatal CMV disease among the few patients treated with BuMelTT has been recently reported, which suggests that the immunodeficiency associated with that regimen can be as intense as that occurring after allogeneic BMT.

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