Transfusion-associated graft-versus-host disease (TA-GVHD) in fludarabine-treated patients: is it time to irradiate blood component?

Apart from these studies, in 1955, Shimoda reported 12 cases of POE (postoperative erythroderma) as a new disease that fell into severe condition with erythema on skin after surgical operation. Among these 12 cases, 6 cases died, and 5 cases of them showed leucopenia. These cases seem to be TA-GVHD. However, we should pay attention because not all patients with POE are TA-GVHD. After the report by Shimoda, many cases of POE, especially those who received cardiovascular surgery were reported as serious condition with unknown mechanism in Japan. In 1984, Aoki et al. conducted biopsy of the skin and bone marrow of a patient of POE after surgery of aortic aneurysm and found that lymphocyte-like cells bound and attacked the damaged cells in skin and bone marrow by histological examination. They reported that this condition was caused by GVHD. This report gave a strong impact on the researchers of surgery who had investigated POE, and the researchers in transfusion medicine because they were shocked by discovery of such serious side effect of transfusion. They started to collect evidences that POE developed by the same mechanism of GVHD. Sakakibara et al. showed presence of lymphocytes having HLA type different from that of the patient, in the peripheral blood of the patient with POE. Ito et al. demonstrated that postoperative erythema in immunocompetent patients is one of symptoms of TA-GVHD, because the lymphocytes in the peripheral blood of a patient changed from HLA haplotype heterozygote (phenotype of the patient) to homozygote (phenotype of the donor), when the patient had POE. This report demonstrates that TA-GVHD can develop in immunocompetent patients by one-way matching of HLA antigens. Matsushita et al. reported 2 immunocompetent female patients with TA-GVHD, and demonstrated presence of lymphocytes having Y chromatin of male donors, adjacent to damaged cells on skin lesion of female patients.