Clinical impact of hyperacute graft-versus-host disease on results of allogeneic stem cell transplantation

Abstract

Summary:The current study defines the incidence and clinical manifestations of hyperacute graft-versus-host disease (haGVHD; fever, skin rash, diarrhea, and hepatic dysfunction) and analyzes the risk factor and the impact of haGVHD on the results of allogeneic stem cell transplantation (SCT). In all, 90 patients underwent allogeneic SCT from 71 matched siblings or 19 alternative donors. Immediate high-dose steroids were administered to 22 patients who met the criteria. The overall incidence of haGVHD was 36.7% (n ¼ 34) and haGVHD was also strongly correlated with acute (aGVHD) (Po0.001) and extensive chronic GVHD (cGVHD) (P ¼ 0.007), and found to be associated with decreased probability of relapse (P ¼ 0.0017). Early intervention with steroids within 7 days after the diagnosis of haGVHD might be associated with better survival. A survival analysis of the overall survival and disease-free survival did not reveal any difference between haGVHD þ and haGVHDÀ groups. In multivariate analysis, the use of an alternative donor (P ¼ 0.020) was identified as the only risk factor. Immediate high-dose steroids were effective in treating haGVHD. We conclude that in an allogeneic setting, haGVHD is not an uncommon manifestation, associated with the development of aGVHD or cGVHD. The only risk factor for haGVHD was the use of an alternative donor.

Hyperacute GVHD: risk factors, outcomes, and clinical implications

“…On the other hand, HLA disparity was a significant risk factor irrespective of the timing of GVHD onset. The impact of HLA disparity on the incidence of early-onset acute GVHD has been reported by Kim et al 13 and by Powles and colleagues. 14,15 Powles et al described the most severe form of hyperacute GVHD, which occurred following haploidentical transplantation and consisted of an abrupt and often fatal clinical syndrome of fever, rash, massive noncardiogenic pulmonary edema, often with renal failure, and seizures.…”

“…A comparison between the incidence of hyperacute GVHD in the current study and in the few published reports is not possible because the definitions vary substantially in terms of both time of onset and clinical manifestations. 7,[13][14][15][16] In our study we used the same diagnostic criteria for hyperacute GVHD and acute GVHD occurring after HSCT. Although GVHD is classically related to reactivity of donor T cells against host tissues, the severity of acute GVHD is affected by the toxicity of the preparative regimen, 4,5 the breakdown of mucosal barriers, and inflammatory cytokines, in addition to the immune graft-versus-host reaction.…”

Engraftment syndrome: double-edged sword of hematopoietic cell transplants

“…Because ES can resemble acute (or hyperacute 28,29 ) GVHD, the question arises whether ES is an early manifestation of GVHD. Gorak et al 10 described ES following reduced-intensity conditioning (RIC) allotransplants.…”

Hyperacute GVHD and emergence of peripheral CD3+CD56+ T cells and activated natural killer cells are useful markers for early diagnosis of post-transplant hemophagocytic syndrome

“…5 The previously reported patients with HPS following allo-SCT, and our patient had high-grade fever, skin eruption, and diarrhea in common; these are typical manifestations of hyperacute GVHD, 2,3 although the possibility of toxicity from the preparative regimen cannot be excluded. The negative postmortem findings for GVHD in our patient cannot exclude the diagnosis of hyperacute GVHD because it had resolved before death and because the pathological findings of hyperacute GVHD are not always identical with those of conventional GVHD.…”

“…The negative postmortem findings for GVHD in our patient cannot exclude the diagnosis of hyperacute GVHD because it had resolved before death and because the pathological findings of hyperacute GVHD are not always identical with those of conventional GVHD. 5,6 High-dose corticosteroid is usually effective for hyperacute GVHD. However, this persisted despite corticosteroids in this patient and finally resulted in fatal HPS, although the time from the onset of hyperacute GVHD to steroid initiation might have influenced the outcome.…”