TRANSFUSION-ASSOCIATED GRAFT-VERSUS-HOST DISEASE IN A PATIENT TREATEDWITH CLADRIBINE (2-CHLORODEOXYADENOSINE) - DEMONSTRATION OF EXOGENOUSDNA IN VARIOUS TISSUE-EXTRACTS BY PCR ANALYSIS
Gb. Zulian et al., TRANSFUSION-ASSOCIATED GRAFT-VERSUS-HOST DISEASE IN A PATIENT TREATEDWITH CLADRIBINE (2-CHLORODEOXYADENOSINE) - DEMONSTRATION OF EXOGENOUSDNA IN VARIOUS TISSUE-EXTRACTS BY PCR ANALYSIS, British Journal of Haematology, 89(1), 1995, pp. 83-89
Transfusion-associated graft-versus-host disease can occur in both imm
unocompetent and immunocompromised hosts. Cladribine is a synthetic an
alogue of adenine used in the treatment of lymphoid malignancies, comm
only associated with a decrease in T lymphocytes. Cladribine was given
for a low-grade non-Hodgkin's lymphoma with thrombocytopenia as the m
ain side-effect. Six units of pooled non-irradiated platelets were tra
nsfused from six unrelated donors; 10 d later a clinical picture typic
al of graft-versus-host disease resulted. Polymerase chain reaction of
the highly polymorphic DNA minisatellites and HLA-DR oligotyping were
used to demonstrate the exogenous DNA. In the patient's blood and tis
sues, only the pattern of donor 5 was found. The patient (DRB10301/11
01; DRB30101/02) and this donor (DRB1*0301/1104; DRB3*02) by chance s
hared a partial common haplotype. This complication highlights the sen
sitivity of DNA minisatellite analysis. It further raises the question
of transfusion and of prophylactic irradiation of all blood products
in immunosuppressed patients and those treated with cladribine. This c
ase represents a previously unreported situation where an immunosuppre
ssed patient was able to eliminate cells from five totally HLA-DR diss
imilar donors but not from one heterozygous donor with strong HLA-DR s
imilarity.