Acute graft-versus-host disease of the heart.
Graft-versus-host disease (GVHD) is a frequent cause of morbidity and mortality after bone marrow transplantation. Acute GVHD most commonly involves the skin, gastrointestinal tract, and liver. Involvement of other organ systems is rare and remains controversial. We report a patient with GVHD who suffered a fatal ventricular arrhythmia shortly after bone marrow transplantation. Autopsy of the heart showed lymphocyte infiltration. Investigations for cardiotrophic viruses were negative, and chimerism analysis of the heart showed both donor and recipient DNA. We conclude that the cause of death was possibly graft-versus-host disease of the heart. A review of the literature revealed a total of 14 cases of possible cardiac GVHD. All but one of the reported cases have occurred in pediatric patients and six of those patients died, suggesting that this may be a rare but frequently fatal complication of pediatric allogeneic stem cell transplant.
Roberts
Stephen S
SS
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA. sroberts@usuhs.mil
Leeborg
Nicky
N
Loriaux
Marc
M
Johnson
F Leonard
FL
Huang
Meei-Li
ML
Stenzel
Peter
P
Thiede
Christian
C
Godder
Kamar T
KT
D000208:Acute Disease; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D009206:Myocardium / Q000473:pathology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D014184:Transplantation, Homologous / Q000009:adverse effects