Induction of hyperacute graft-vs-host disease after donor leukocyte infusions

Background: Infusions of leukocytes obtained from the original bone marrow donor is a new approach for treating patients who have a relapse of leukemi a after allogeneic bone marrow transplantation. Up to 90% of patients who a chieved remission developed graft-vs-host disease (GVHD). However, any desc ription of the clinical and histologic features in these cases is lacking. Observations: We describe 2 patients in whom a severe, peculiar, hyperacute , fatal GVHD developed after treatment with donor leukocyte infusions and i nterferon alfa. The patients had not received any additional chemotherapy o r GVHD prophylaxis. In both patients, the eruption started with the appeara nce of erythematous plaques at the interferon alfa injection sites, and a g eneralized maculopapular eruption subsequently developed. The clinical lesi ons evolved from acute to lichenoid within several days. The histologic exa mination also demonstrated unusual findings and showed features of both acu te and chronic lichenoid GVHD. Conclusions: Donor leukocyte infusions without GVHD prophylaxis may provoke a severe fatal hyperacute GVHD. In the cases presented herein, we discuss the significance of the rapid clinical evolution from acute to lichenoid an d the combination of histologic features of both acute and chronic GVHD in the biopsy specimens.