title: Development of spontaneous factor VIII inhibitor in association with acute graft-versus-host disease.
abstract: A 57-year-old female with recurrent AML underwent a T cell-depleted (TCD) bone marrow (BM) plus TCD and CD34-selected peripheral blood stem cell (PBSC) transplant. Eleven weeks post transplantation, the patient developed acute graft-versus-host disease (GVHD) manifested by rash and elevated liver enzymes. Concurrently, the patient presented with a bleeding diathesis and a left forearm hematoma due to the development of a spontaneous factor VIII inhibitor. She was treated with human recombinant factor VIII and intravenous methylprednisolone. Subsequently she was managed with a prednisone taper leading to resolution of the GVHD, as well as the spontaneous factor VIII inhibitor. Bone marrow transplant-related spontaneous factor VIII inhibitor has previously been reported in association with one patient with chronic GVHD. To our knowledge this is the first report of spontaneous factor VIII inhibitor associated with acute GVHD.
authors.affiliation: Hematology/Oncology Division, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Brentjens
authors.forename: L
authors.initials: L
authors.lastname: Smith
authors.forename: L
authors.initials: L
authors.lastname: Reich
authors.forename: A A
authors.initials: AA
authors.lastname: Jakubowski
mesh_terms: D000208:Acute Disease; D005169:Factor VIII / Q000008:administration & dosage / Q000276:immunology*; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D006406:Hematoma / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D007951:Leukemia, Myeloid / Q000150:complications / Q000628:therapy; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D007518:Isoantibodies; D011994:Recombinant Proteins; C078147:F8 protein, human; D005169:Factor VIII