Development of spontaneous factor VIII inhibitor in association with acutegraft-versus-host disease

A 57-year-old female with recurrent AML underwent a T cell-depleted (TCD) b one marrow (BM) plus TCD and CD34-selected peripheral blood stem cell (PBSC ) transplant. Eleven weeks post transplantation, the patient developed acut e graft-versus-host disease (GVHD) manifested by rash and elevated liver en zymes. Concurrently, the patient presented with a bleeding diathesis and a left forearm hematoma due to the development of a spontaneous factor VIII i nhibitor. She was treated with human recombinant factor VIII and intravenou s methylprednisolone. Subsequently she was managed with a prednisone taper leading to resolution of the GVHD, as well as the spontaneous factor VIII i nhibitor. Bone marrow transplant-related spontaneous factor VIII inhibitor has previously been reported in association with one patient with chronic G VHD. To our knowledge this is the first report of spontaneous factor VIII i nhibitor associated with acute GVHD.