Severe Liver Dysfunction after Donor Lymphocyte Infusion for Relapsed Multiple Myeloma.

Tae-Hoon No, Nae-Yun Heo, Seung Ha Park, Joon Hyuk Choi, Junghwan Lee, Sung Nam Lim, Seon Yang Park
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Abstract

Donor lymphocyte infusion (DLI) is performed to augment an anti-tumor immune response or ensure donor stem cells remain engrafted following allogeneic stem cell transplantation but may induce graft-versus-host disease (GVHD) involving skin, intestine, and liver. Although hepatic involvement of GVHD can manifest as mild to severe hepatitis, few reports have mentioned acute severe liver dysfunction with encephalopathy. We experienced a case of acute severe liver dysfunction with semicoma after DLI in a patient with relapsed multiple myeloma following allogeneic stem cell transplantation, in whom chronic viral hepatitis B had been suppressed by antiviral treatment. The patient recovered after high-dose glucocorticoid administration based on an assessment of hepatic GVHD. Clinicians should be aware of the possibility of this catastrophic hepatic complication after DLI in hematologic disorders.

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移植淋巴细胞治疗复发性多发性骨髓瘤后出现严重肝功能障碍。
进行捐献者淋巴细胞输注(DLI)是为了增强抗肿瘤免疫反应,或确保异体干细胞移植后捐献者干细胞继续参与移植,但可能诱发移植物抗宿主疾病(GVHD),累及皮肤、肠道和肝脏。虽然移植物抗宿主疾病的肝脏受累可表现为轻度至重度肝炎,但很少有报道提到急性重度肝功能障碍伴有脑病。我们曾接诊过一例异体干细胞移植后复发的多发性骨髓瘤患者,其慢性乙型病毒性肝炎已通过抗病毒治疗得到抑制,但在DLI后出现急性严重肝功能障碍并伴有半结肠瘤。根据肝脏GVHD评估结果,患者在使用大剂量糖皮质激素后康复。临床医生应该意识到,血液病患者在进行DLI后可能会出现这种灾难性的肝脏并发症。
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