title: Severe acute graft-versus-host disease after T-cell depleted allogeneic stem cell graft from a second donor caused by persisting T-cells from the first donor.
abstract: HLA disparity is a major risk factor for graft rejection and GVHD. We report a patient with CML (accelerated phase) who underwent allogeneic SCT from a mismatched unrelated donor and developed acute GVHD. With immunosuppression, GVHD symptoms improved but graft rejection occurred. After a second conditioning regimen, the patient received a second graft from a haploidentical related donor. Engraftment occurred, but the patient died from GVHD and pulmonary aspergillosis. Chimeric analysis revealed that all leukocytes were of donor 2 origin apart from CD3+ T cells, which were 100% donor 1 type. Thus, in spite of intensified immunosuppression and successful transplantation of a second graft, T cells from the first donor persisted and induced severe acute GVHD.
authors.affiliation: Department of Haematology, Oncology, Immunology and Rheumatology, University of Tübingen, Tübingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Wiesmann
authors.forename: P
authors.initials: P
authors.lastname: Bader
authors.forename: M
authors.initials: M
authors.lastname: Bamberg
authors.forename: C
authors.initials: C
authors.lastname: Faul
authors.forename: L
authors.initials: L
authors.lastname: Kanz
authors.forename: H
authors.initials: H
authors.lastname: Einsele
mesh_terms: D000208:Acute Disease; D000328:Adult; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D008212:Lymphocyte Depletion; D013601:T-Lymphocytes / Q000276:immunology*; D014019:Tissue Donors; D018183:Transplantation Chimera; D014184:Transplantation, Homologous