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- Title
Transfusion-associated GVHD after fludarabine therapy in a patient with systemic lupus erythematosus.
- Authors
Leitman, Susan F.; Tisdale, John F.; Bolan, Charles D.; Popovsky, Mark A.; Klippel, John H.; Balow, James E.; Boumpas, Dimitrios T.; Illei, Gabor G.
- Abstract
<bold>Background: </bold>Fludarabine, a purine antimetabolite with potent immunosuppressive properties, has previously been associated with the development of transfusion-associated GVHD (TA-GVHD) in patients with hematologic malignancies. Its role as a risk factor for TA-GVHD in patients without underlying leukemia or lymphoma is uncertain.<bold>Study Design and Methods: </bold>A 42-year-old female with refractory lupus nephritis received three monthly cycles of fludarabine (30 mg/m2/day on Days 1-3) and cyclophosphamide (500 mg/m2 on Day 1). Three months after the last dose of fludarabine, she received 2 units of packed RBCs and 6 units of pooled random platelets, none of which were irradiated. Two weeks later, fever, rash, aminotransferase elevations, hyperbilirubinemia, and pancytopenia developed.<bold>Results: </bold>Marrow biopsy showed severe aplasia and skin biopsy was consistent with GVHD. Allele-level HLA typing on circulating lymphocytes revealed extra HLA alleles not present in her pretreatment sample, but identical to the HLA haplotypes of an unrelated platelet donor. Treatment with antithymocyte globulin, cyclosporine, and prednisone was followed by preparatory conditioning for a PBPC transplant from an HLA-identical sibling, but the patient died of disseminated candidiasis before transplant.<bold>Conclusions: </bold>Fludarabine and other purine analogs are increasingly used in the treatment of disorders other than hematologic malignancy, such as autoimmune disease. The occurence of TA-GVHD after fludarabine therapy in a patient with lupus strongly suggests that this drug is sufficiently immunoablative to be an independent risk factor for TA-GVHD. Irradiation of blood components should be considered in all patients who receive fludarabine therapy.
- Subjects
BLOOD diseases; GRAFT versus host disease; IMMUNOSUPPRESSION; HLA histocompatibility antigens; CANDIDIASIS; ANTIMETABOLITES; ANTIVIRAL agents; BLOOD platelet transfusion; COMBINATION drug therapy; DISEASE complications; RED blood cell transfusion; HISTOCOMPATIBILITY testing; IMMUNOSUPPRESSIVE agents; SYSTEMIC lupus erythematosus; TREATMENT effectiveness; CYCLOPHOSPHAMIDE
- Publication
Transfusion, 2003, Vol 43, Issue 12, p1667
- ISSN
0041-1132
- Publication type
journal article
- DOI
10.1046/j.0041-1132.2003.00579.x