Peripheral Blood allo-HSCT : A Part from the Book Chapter : A Case Report on Relapsed Chronic Lymphocytic Leukaemia with Concomitant Extensive Chronic Graft Versus Host Disease after Allogeneic Haematopoietic Stem Cell Transplantation Successfully Treated with Oral Venetoclax

allo-HSCT

The patient received ibrutinib covered by medical insurance for 4 months and achieved normal full blood count and LDH. There were no smudge cells or abnormal lymphocytes in the blood smear. Repeat CECT of the neck, thorax, abdomen, and pelvis showed complete regression of lymphadenopathies and splenomegaly. However, IP on the repeat bone marrow revealed a residual 14% abnormal lymphocytes. The disease was in partial remission according to the International Workshop on CLL (iwCLL) 2018 guidelines. Owing to high-risk CLL with 17p deletion, a peripheral blood allo-HSCT from an HLA-identical sibling was recommended. The RIC regimen consisted of fludarabine 30 mg/m2 for 5 days, intravenous busulfan 3.2 mg/kg/day for 2 days, and cyclophosphamide 60 mg/kg/day for 1 day. The donor’s peripheral blood stem cell (PBSC) was mobilised by granulocyte colony-stimulating factor (G-CSF) at the dose of 10 mcg/kg/day for 3 days. A total of 5.03 × 106 CD34 per recipient body weight was infused. GVHD prophylaxis consisted of cyclosporine (CSA) and mycophenolate mofetil (MMF). The patient achieved neutrophil and platelet engraftment on day 15 after allo-HSCT.

Author(s) Details:

Ching Soon Teoh
Haematology Unit, Department of Internal Medicine, Hospital Pulau Pinang, Jalan Residensi, 10990
Georgetown, Penang, Malaysia.

Ai Sim Goh
Haematology Unit, Department of Internal Medicine, Hospital Pulau Pinang, Jalan Residensi, 10990
Georgetown, Penang, Malaysia.


Also See : The Body’s Center of Gravity : A Part from The Book Chapter : Influence of Body Mass Index on Balance in Healthy Young Adults


Recent Global Research Developments in Graft Versus Host Disease Overview

Chronic GVHD: Chronic GVHD is a significant cause of late morbidity and mortality after allogeneic hematopoietic cell transplantation (AHCT). It occurs when immune cells from the donor (the graft) recognize the recipient (the host) as foreign, leading to tissue injury. Chronic GVHD can affect various organs, including the eyes, mouth, skin, joints, gastrointestinal tract, liver, lungs, and genitalia [1].

Risk Factors: Factors influencing GVHD risk include human leukocyte antigen (HLA) matching, donor type, graft source, gender disparity, conditioning intensity, and GVHD prophylaxis.

Acute vs. Chronic GVHD:

  • Acute GVHD typically occurs within the first 100 days post-transplant and may involve the skin, gastrointestinal tract, and liver.
  • Chronic GVHD manifests later and affects multiple organs. Skin, eyes, mouth, and gastrointestinal tract are commonly involved.

Treatment and Prevention:

  • Corticosteroids remain the mainstay of treatment for chronic GVHD.
  • Novel immunomodulatory and targeted therapies are being explored.
  • Clinicians caring for AHCT recipients should be familiar with GVHD management.

An Overview of Graft-Versus-Host Disease [2]

  • Graft-versus-host disease (GVHD) is a potentially fatal complication and is one of the most common causes of non-relapse mortality after allogeneic hematopoietic stem cell transplantation. Factors that determine the risk of GVHD include the degree of human leukocyte antigen matching, donor type, graft source, gender disparity, conditioning intensity, and the type of GVHD prophylaxis. GVHD comprises two distinct entities categorized as acute or chronic depending upon specific manifestations.

References

  • Hamilton, B. K. (2021). Updates in chronic graft-versus-host disease. Hematology, 2021(1), 648-654.

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