TRANSFUSION-ASSOCIATED GRAFT-VERSUS-HOST DISEASE IN A PATIENT TREATEDWITH CLADRIBINE (2-CHLORODEOXYADENOSINE) - DEMONSTRATION OF EXOGENOUSDNA IN VARIOUS TISSUE-EXTRACTS BY PCR ANALYSIS

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.