Induction of autologous graft-versus-host disease with cyclosporin A afterperipheral blood stem cell transplantation: Analysis of factors affecting induction

Background: Induction of autologous graft-versus-host disease after periphe ral blood stem cell transplantation has not been studied well. Objective: The purpose of this study was to analyze the factors that affect the development of autologous graft-versus-host disease. Methods: Nineteen patients with non-Hodgkin's lymphoma underwent peripheral blood stem cell transplantation followed by the administration of cyclospo rin A for 28 days (group A) or 21 days (group B) and IFN-gamma. Results: Autologous graft-versus-host disease failed to develop in the any of the group A patients, who did not receive total body irradiation for con ditioning and underwent the transplantation,vith unmanipulated peripheral b lood stem cells, although cytotoxic activity against autologous lymphocytes was detectable in peripheral blood mononuclear cells obtained from all of them after the transplantation. Autologous graft-versus-host disease develo ped in 2 of 4 patients in group A who received enriched CD34(+) cells and i n 7 of 11 patients who underwent conditioning with total body irradiation. Maculopapular erythema that was compatible with graft-versus-host disease d eveloped on days 19 to 27 after the transplantation in these patients and r esolved after 3 to 9 days without treatment. Conclusions: Either the depletion of regulatory cells from the graft by enr ichment of CD34(+) cells or the abolition of the autoregulation by includin g total body irradiation in the conditioning regimen may be effective in in ducing autologous graft-versus-host disease after peripheral blood stem cel l transplantation. Three weeks of cyclosporin A therapy appears to be suffi cient to induce autologous graft-versus-host disease in recipients of perip heral blood stem cells.