Autologous graft-versus-host disease after CD34(+)-purified autologous peripheral blood progenitor cell transplantation

Autologous graft-versus-host disease (GVHD) has been frequently reported af ter cyclosporine A (CsA) administration in the autologous setting. This com plication is related to the disruption of self-tolerance mechanisms induced by CsA and may exert an antitumor effect. We report the spontaneous occurr ence of autologous GVHD after CD34(+)-purified peripheral blood progenitor cell transplantation (PBPCT) in 5 out of 24 consecutive patients (20.8%). T he syndrome was characterized by skin rash (5/5), pruritus (5/5), eosinophi lia (5/5), and fever (2/5) occurring at a median of 37 days (range 22-60) a fter transplantation. Diagnosis was confirmed by skin biopsy in all patient s. The syndrome was self-limiting, lasted a median of 25 days, and did not require treatment. The rate of autologous GVHD was high after CD34(+)-purif ied autologous PBPCT. In fact, no autologous GVHD was documented in an hist orical control of 100 consecutive patients submitted to unmanipulated PBPCT at the same institution. The manipulation of the graft by the purging proc edure causes a profound T lymphocyte depletion, thus possibly perturbing th e equilibrium between autoregulatory cells and autocytotoxic T cells. These observations add new interest to the antitumor efficacy of autologous GVHD and suggest new questions regarding the role of transplantation for autoim mune diseases.