Severe acute graft-versus-host disease occurring after syngeneic BMT for AML in a patient not given prior cyclosporin A therapy

A syndrome akin to graft-versus-host disease in the recipient of syngeneic stem cells is hitherto described as being milder, self-limiting and confine d to the skin. It is enhanced by prior cyclosporin A therapy. We describe h ere a recipient of a syngeneic marrow transplant who did not receive primin g with cyclosporin A and yet developed severe and progressive graft-versus- host disease which necessitated and responded to high-dose immunosuppressiv e therapy. We believe that this is because the conditioning regimen in stem cell transplant acts to reset the immune system enabling it to recognise ' self' antigens.