02789nas a2200241   4500008004100000020001400041024001700055245010600072210006900178260029900247300001600546490000700562520178300569100001902352700001802371700001902389700001902408700001802427700001702445700002302462700001702485856004502502       2003                        eng d  a0041-1132  awdn, 041736000aTransfusion-associated GVHD after fludarabine therapy in a patient with systemic lupus erythematosus.0 aTransfusionassociated GVHD after fludarabine therapy in a patien  a(C) 2003 Blackwell Science Ltd.bFrom the Department of Transfusion Medicine, Warren G. Magnuson Clinical Center; the National Institute of Arthritis, Musculoskeletal and Skin Diseases; and the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institutes of Hc2003  a1667 - 16710 v433 aBACKGROUND: Fludarabine, a purine antimetabolite with potent immunosuppressive properties, has previously been associated with the development of transfusion-associated GVHD (TA-GVHD) in patients with hematologic malignancies. Its role as a risk factor for TA-GVHD in patients without underlying leukemia or lymphoma is uncertain., STUDY DESIGN AND METHODS: A 42-year-old female with refractory lupus nephritis received three monthly cycles of fludarabine (30 mg/m2/day on Days 1-3) and cyclophosphamide (500 mg/m2 on Day 1). Three months after the last dose of fludarabine, she received 2 units of packed RBCs and 6 units of pooled random platelets, none of which were irradiated. Two weeks later, fever, rash, aminotransferase elevations, hyperbilirubinemia, and pancytopenia developed., RESULTS: Marrow biopsy showed severe aplasia and skin biopsy was consistent with GVHD. Allele-level HLA typing on circulating lymphocytes revealed extra HLA alleles not present in her pretreatment sample, but identical to the HLA haplotypes of an unrelated platelet donor. Treatment with antithymocyte globulin, cyclosporine, and prednisone was followed by preparatory conditioning for a PBPC transplant from an HLA-identical sibling, but the patient died of disseminated candidiasis before transplant., CONCLUSIONS: Fludarabine and other purine analogs are increasingly used in the treatment of disorders other than hematologic malignancy, such as autoimmune disease. The occurence of TA-GVHD after fludarabine therapy in a patient with lupus strongly suggests that this drug is sufficiently immunoablative to be an independent risk factor for TA-GVHD. Irradiation of blood components should be considered in all patients who receive fludarabine therapy., (C) 2003 Blackwell Science Ltd.1 aLeitman, Susan1 aTisdale, John1 aBolan, Charles1 aPopovsky, Mark1 aKlippel, John1 aBalow, James1 aBoumpas, Dimitrios1 aIllei, Gabor  uhttps://notifylibrary.org/reference/4216