Graft-versus-host disease as an unusual complication following autologous stem cell transplantation

Abstract

IntroductionGraft-versus-host disease (GVHD) is a common and serious complication after allogeneic stem cell transplantation (allo-SCT). However, a similar syndrome has been reported after autologous stem cell transplantation (ASCT) as well.Case reportA 61-year-old female diagnosed with immunoglobulin (Ig) G lambda multiple myeloma completed 10 cycles of bortezomib, thalidomide, and dexamethasone (VTD) and 2 cycles of cyclophosphamide, thalidomide, and dexamethasone (CTD). High-dose of melphalan (200 mg/kg) was given as conditioning, followed by an infusion of 2.5 × 106 CD34+ cells/kg. Three months later, she received her second ASCT. On Day +25 after tandem ASCT, the patient developed a maculopapular, itchy skin rash, which covered her face, trunk, and limbs. A skin biopsy was in line with the diagnosis of GVHD. The other organs were not involved. Treatment with systemic and local corticosteroids (CSs) resulted in the improvement of skin lesions, but the CSs were slowly tapered due to toxicity. In the following weeks, she developed symptoms of liver and gut involvement, which were resistant to steroids. The introduction of other immunosuppressive agents failed to achieve a response. As a consequence, she had cytomegalovirus (CMV) reactivation, as well as pancytopenia, and eventually, she died of infectious complications.ConclusionsGVHD after ASCT remains a rare but life-threatening complication with poor prognosis.

An Update on Hematopoietic Stem Cell Transplantation in Patients with Multiple Myeloma

“…In autologous GVHD, there is dysregulation of the immune responses due to: the primary disease such as MM, HD melphalan used the conditioning therapy before HSCT; and the use of immunomodulatory agents in the treatment of MM [163]. The clinical and histological manifestations of autologous GVHD are similar to those encountered in acute GVHD following allogeneic HSCT although the clinical features tend to be milder and self-limited in most cases [68,160,161,[164][165][166]. Autologous GVHD can involve the: skin, liver, and gastrointestinal tract [68,160,162,[164][165][166].…”

“…The clinical and histological manifestations of autologous GVHD are similar to those encountered in acute GVHD following allogeneic HSCT although the clinical features tend to be milder and self-limited in most cases [68,160,161,[164][165][166]. Autologous GVHD can involve the: skin, liver, and gastrointestinal tract [68,160,162,[164][165][166]. Treatment is usually symptomatic although immunosuppression with corticosteroids is usually needed in severe cases [68,160,164,162,165].…”

“…Autologous GVHD can involve the: skin, liver, and gastrointestinal tract [68,160,162,[164][165][166]. Treatment is usually symptomatic although immunosuppression with corticosteroids is usually needed in severe cases [68,160,164,162,165]. Death as a consequence of infectious complications has been reported in severe forms of autologous GVHD [165].…”

Recent Updates on Multiple Myeloma

“…Recently a competitive inhibitor peptide (AHXCLSADSSGSYLYVCKK) capable of interrupting the binding between FLC and uromodulin, preventing obstruction, was described as effective in animal models. Earlier another agent, a polypeptide pituitary adenylate cyclase-activating poly-peptide with 38 residues (PACAP38), has demonstrated high activity at blocking cellular damage from FLCs in an in vitro setting [165]. Despite additional data regarding the clinical efficacy and the potential role in this setting are warranted, therapeutic approaches that can target the monoclonal protein rather than the plasma cell are extremely attractive, avoiding the use of toxic chemotherapy, in patients with AL amyloidosis who may be too frail to be treated with medical therapy.…”