TRANSFUSION-ASSOCIATED CHRONIC CUTANEOUS GRAFT-VERSUS-HOST DISEASE

Transfusion-associated graft-versus-host disease (TAGVHD) occurs in im munocompromised persons who receive nonirradiated blood products conta ining immunologically competent donor lymphocytes. TAGVHD occurs almos t exclusively as an acute illness and has a very high mortality rate, We describe a patient with a long history of non-Hodgkin's lymphoma in whom acute TAGVHD developed after transfusion of packed red blood cel ls from two unrelated donors. TAGVHD developed despite pretreatment of the transfused units with white blood cell filters. The patient survi ved and subsequently had clinical manifestations typical of chronic cu taneous graft-versus-host disease. HLA phenotyping studies suggested t hat elements from both transfusion donors engrafted. TAGVHD is a rare but probably underdiagnosed disorder that, although usually fatal, may evolve into chronic graft-versus-host disease. Treatment of blood pro ducts with white blood cell biters does not appear adequate to prevent TAGVHD.