title: Acute graft-versus-host disease in a nonhematopoietic stem cell transplantation candidate treated with decitabine followed by granulocyte colony-stimulating factor-primed peripheral blood stem cells infusion: a special entity of the disease?
abstract: BACKGROUND
  With a well-developed strategy of acute graft-versus-host disease (aGVHD) prophylaxis, the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients who develop aGVHD has improved considerably. Meanwhile, transfusion-associated GVHD (TA-GVHD) can be fatal. Recent advancements in immune cellular therapy are being adopted in clinical practice, although many concerns including TA-GVHD remain. This report describes a 64-year-old male non-HSCT candidate diagnosed with acute myeloid leukemia who had received decitabine followed by an infusion of granulocyte-colony-stimulating factor-primed peripheral blood stem cells (G-PBSCs) from his daughter, who carried haploidentical human leukocyte antigen. The patient developed aGVHD on the 20th day after infusion.
  
  
  METHODS
  This study is a single case report of a non-HSCT candidate who developed skin aGVHD with mild clinical course after decitabine and G-PBSCs combination. The clinical course, chimerism, and aGVHD pathology studies are detailed.
  
  
  RESULTS
  Compared with conventional aGVHD in allo-HSCT recipients and TA-aGVHD, the presentation of this case followed a self-limited clinical course without marrow aplasia or severe progression. However, the patient eventually died of leukemia without a significant graft-versus-leukemia effect.
  
  
  CONCLUSIONS
  First, the results demonstrate the existence of aGVHD in elderly non-HSCT candidates receiving adoptive cellular immune therapy. Second, aGVHD occurring under these conditions is probably a unique entity of aGVHD compared to TA-aGVHD and the conventional pattern in allo-HSCT recipients with respect to clinical course and prognosis.
authors.affiliation: Department of Hematology, Chinese PLA General Hospital, Beijing, China; Department of Pathology, Chinese PLA General Hospital, Beijing, China; The Cyrus Tang Hematology Center, Soochow University, Suzhou, Jiangsu Province, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Yuan
authors.forename: Lu
authors.initials: L
authors.lastname: Sun
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.forename: Yu
authors.initials: Y
authors.lastname: Jing
mesh_terms: D000208:Acute Disease; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001374:Azacitidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D000077209:Decitabine; D006086:Graft vs Host Disease / Q000145:classification / Q000175:diagnosis / Q000209:etiology*; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D019172:Transplantation Conditioning / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor; D000077209:Decitabine; D001374:Azacitidine