Graft-Versus-Host Disease in Consecutive Patients with Acute Myeloid Leukaemia Treated with Blood Cells from Normal Donors

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Abstract
Two consecutive patients with acute myeloid leukemia (AML) developed severe probable graft-vs.-host disease (GVHD) following transfusion of blood products from normal donors. In 1 patient the AML had arisen de novo; in the other it occurred 4 yr after the patient developed non-Hodgkin''s lymphoma (NHL) and was treated with radiotherapy and combination cytotoxic chemotherapy [cyclophosphamide, vincristine, procarbazine, prednisolone]. Both patients received anti-leukemic treatment with doxorubicin and cytosine arabinoside and intensive hematological supportive care with transfusions of red blood cell, white blood cell and platelet concentrates obtained from normal donors. Clinically the GVHD in each patient was manifest by a severe erythematous rash, intractable diarrhea and abnormalities in the liver function tests. On pathological examination the skin in each case showed the typical changes of GVHD. Both patients died. There have been few previous reports of GVHD occurring after accidental engraftment of immunosuppressed patients undergoing therapy for acute leukemia. It may occur more often than has been previously recognized. At present there is controversy concerning the possible anti-leukemic effects of granulocyte transfusions. Until the relative importance of the benefits and deleterious effects of cells with the potential for engraftment is determined by further studies, the routine irradiation of all cellular blood products intended for administration to acute leukemia patients undergoing intensive cytoreductive chemotherapy is recommended.