Hepatitic variant of graft-versus-host disease after donor lymphocyte infusion

Abstract

Graft-versus-host disease (GVHD) of the liver is characterized by bile duct damage and portal lymphocytic infiltrate. We report acute hepatitislike presentation of GVHD after donor lymphocyte infusion (DLI). Between April 1998 and September 2001, 73 patients received 94 DLI treatments. Liver GVHD developed after DLI in 22 (30%) patients whose median age was 43 years (range, 21 to 61 years). Onset of liver dysfunction was at 35 days (range, 11 to 406 days) after DLI. Fifteen patients underwent liver biopsy, and the diagnosis of liver GVHD was confirmed in 13 (87%) patients. After viral hepatitis and recent drug exposure were excluded, 11 (50%) patients were given a diagnosis of a hepatitic variant of GVHD based on histologic evidence of lobular hepatitis (n ‫؍‬ 5), elevation of maximum serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level more than 10 times the upper normal limit (n ‫؍‬ 9), or both. There was a significant difference in maximum ALT (P ‫؍‬ .002) and AST (P ‫؍‬ .01) level between the hepatitic-variant and classical GVHD groups. GVHD progressed in 14 (64%) patients, and 10 patients died after a median follow-up of 221 days (range, 31-1284 days). These observations suggest that GVHD that occurs after DLI may have distinct clinical features. Hepatiticvariant GVHD should be considered in the differential diagnosis in DLI recipients with unexplained hepatitis. (Blood. 2002; 100:3903-3907)

Pulse cyclophosphamide for corticosteroid-refractory graft-versus-host disease

“…Pulse cyclophosphamide and GVHD J Mayer et al for different drugs in the treatment of hepatic GVHD. 23,26,29,30,32,34,35 We would like to emphasize, however, that different subgroups belonged to our group of hepatic GVHD (true acute GVHD, post-DLI GVHD, and chronic GVHD after acute GVHD). Despite this, we think that the efficiency of pulse Cy in liver GVHD deserves further attention.…”

“…22 The recently described hepatitic variant of GVHD 23 is not included in this GVHD staging system, and was diagnosed on the basis of marked serum aminotransferase (ALT or AST) elevation (more than 10 times the upper normal limit) and exclusion of other potential causes. 23 Extensive tests were performed to achieve a precise diagnosis of GVHD. The first treatment in all patients was prednisone or methylprednisolone at a dose of 2 mg/kg/day or higher, together with cyclosporine.…”

Optimal management of chronic graft‐versus‐host disease in children

“…Isolated hepatic chronic GVHD is being seen with increased frequency with the use of donor-lymphocyte infusions . Furthermore, while cholestasis is the normal finding, the concept of hepatitic chronic GVHD is now being identified more often, with some patients presenting mostly with elevations of serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) (Strasser et al, 2000;Akpek et al, 2002). Hepatitic GVHD can also be seen in children (MelinAldana et al, 2007).…”

Acute hepatic failure as onset of progressive sclerodermatous chronic graft-versus-host disease after donor lymphocyte infusion

“…GVHD after DLI often has an unusual clinical course, intermediate between chronic and acute GVHD, and a poor prognosis. [1][2][3] Unusual presentations of liver GVHD, such as the hepatitic variant or autoimmune hepatitis, have been reported in literature. [3][4][5] They can occur during the tapering of immunosuppressive therapy or off therapy.…”

“…[1][2][3] Unusual presentations of liver GVHD, such as the hepatitic variant or autoimmune hepatitis, have been reported in literature. [3][4][5] They can occur during the tapering of immunosuppressive therapy or off therapy. 3,5 The hepatitic variant seems to be more frequent after DLI than the classical cholestatic variant.…”