title: Spontaneous graft versus host disease occurring in a patient with multiple myeloma after autologous stem cell transplant.
abstract: Graft versus host disease (GVHD) is a common complication of allogeneic transplant. Acute GVHD primarily affects the skin, liver, and GI tract generally within the first 100 days after transplant. GVHD following an allogeneic transplant occurs as a result of donor T-cell recognition of host alloantigens. In contrast, patients undergoing ASCT are not subjected to the genetic disparity that occurs with allogeneic transplant, and in principal, should not develop this proinflammatory response. A clinical syndrome, however, has been described in patients following autologous transplant that shares the same features as GVHD occurring in recipients post-allogeneic transplant [1-3]. Previously reported cases have described skin, liver, and GI tract manifestations consistent with what is seen in allogeneic GVHD. Biopsies of the skin and GI tract mucosa have demonstrated similar histological features as well. Interestingly, the majority of reported cases seem to occur in patients with multiple myeloma undergoing consolidative ASCT. Historically, however, these patients have been described as having a relatively benign course with mild skin rash, nausea, vomiting, and/or diarrhea that is responsive to immunosuppression. In this article, we present a case of fatal, spontaneous GVHD in a patient with multiple myeloma following ASCT.
authors.affiliation: Temple Bone Marrow Transplant Program, Philadelphia, PA, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Fidler
authors.forename: Thomas
authors.initials: T
authors.lastname: Klumpp
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mangan
authors.forename: MaryEllen
authors.initials: M
authors.lastname: Martin
authors.forename: Manish
authors.initials: M
authors.lastname: Sharma
authors.forename: Robert
authors.initials: R
authors.lastname: Emmons
authors.forename: Meina
authors.initials: M
authors.lastname: Lu
authors.forename: Patricia
authors.initials: P
authors.lastname: Kropf
mesh_terms: D017809:Fatal Outcome; D005260:Female; D041981:Gastrointestinal Tract / Q000473:pathology; D006086:Graft vs Host Disease / Q000209:etiology* / Q000276:immunology / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology / Q000473:pathology*; D012867:Skin / Q000473:pathology; D014182:Transplantation, Autologous