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Open Access 01-12-2016 | Case report

Graft-versus-host disease after radiation therapy in patients who have undergone allogeneic stem cell transplantation: two case reports

Authors: Sarah A. Milgrom, Yago Nieto, Chelsea C. Pinnix, Grace L. Smith, Christine F. Wogan, Gabriela Rondon, L. Jeffrey Medeiros, Partow Kebriaei, Bouthaina S. Dabaja

Published in: Journal of Medical Case Reports | Issue 1/2016

Abstract

Background

Patients who undergo allogeneic stem cell transplantation and subsequent radiation therapy uncommonly develop graft-versus-host disease within the irradiated area. We quantified the incidence of this complication, which is a novel contribution to the field. From 2010 to 2014, 1849 patients underwent allogeneic stem cell transplantation, and 41 (2 %) received radiation therapy afterward. Of these, two patients (5 %) developed graft-versus-host disease within the irradiated tissues during or immediately after radiation therapy.

Case presentation

The first patient is a 37-year-old white man who had Hodgkin lymphoma; he underwent allogeneic stem cell transplantation from a matched unrelated donor and received radiation therapy for an abdominal and pelvic nodal recurrence. After 28.8 Gy, he developed grade 4 gastrointestinal graft-versus-host disease, refractory to tacrolimus and steroids, but responsive to pentostatin and photopheresis. The other patient is a 24-year-old white man who had acute leukemia; he underwent allogeneic stem cell transplantation from a matched related donor and received craniospinal irradiation for a central nervous system relapse. After 24 cobalt Gy equivalent, he developed severe cutaneous graft-versus-host disease, sharply delineated within the radiation therapy field, which was responsive to tacrolimus and methylprednisolone.

Conclusions

We conclude that graft-versus-host disease within irradiated tissues is an uncommon but potentially serious complication that may follow radiation therapy in patients who have undergone allogeneic stem cell transplantation. Clinicians must be aware of this complication and prepared with strategies to mitigate risk. Patients who have undergone allogeneic stem cell transplantation represent a unique population that may offer novel insight into the pathways involved in radiation-related inflammation.

Flowers ME, Inamoto Y, Carpenter PA, Lee SJ, Kiem HP, Petersdorf EW, et al. Comparative analysis of risk factors for acute graft-versus-host disease and for chronic graft-versus-host disease according to National Institutes of Health consensus criteria. Blood. 2011;117(11):3214–9. doi:10.1182/blood-2010-08-302109.CrossRefPubMedPubMedCentral

Jagasia M, Arora M, Flowers ME, Chao NJ, McCarthy PL, Cutler CS, et al. Risk factors for acute GVHD and survival after hematopoietic cell transplantation. Blood. 2012;119(1):296–307. doi:10.1182/blood-2011-06-364265.CrossRefPubMedPubMedCentral

Okamoto S, Takahashi S, Inoue T, Tojo A, Tani K, Kikuchi A, et al. Cutaneous chronic graft-versus-host disease localized to the field of total lymphoid irradiation. Bone Marrow Transplant. 1996;17(1):111–3.PubMed

Sharp H, Grosshans D, Kadia T, Dabaja BS. Cutaneous graft-versus-host disease after proton-based craniospinal irradiation for recurrent Philadelphia-positive acute lymphoblastic leukaemia. BMJ Case Reports. 2012;2012. doi:10.1136/bcr.02.2012.5742.

Socie G, Gluckman E, Cosset JM, Devergie A, Girinski T, Esperou H, et al. Unusual localization of cutaneous chronic graft-versus-host disease in the radiation fields in four cases. Bone Marrow Transplant. 1989;4(1):133–5.PubMed

Hong JH, Chiang CS, Sun JR, Withers HR, McBride WH. Induction of c-fos and junB mRNA following in vivo brain irradiation. Brain Res Mol Brain Res. 1997;48(2):223–8.CrossRefPubMed

Akashi M, Hachiya M, Koeffler HP, Suzuki G. Irradiation increases levels of GM-CSF through RNA stabilization which requires an AU-rich region in cancer cells. Biochem Biophys Res Commun. 1992;189(2):986–93.CrossRefPubMed

Steinauer KK, Gibbs I, Ning S, French JN, Armstrong J, Knox SJ. Radiation induces upregulation of cyclooxygenase-2 (COX-2) protein in PC-3 cells. Int J Radiat Oncol Biol Phys. 2000;48(2):325–8.CrossRefPubMed

Son EW, Rhee DK, Pyo S. Gamma-irradiation-induced intercellular adhesion molecule-1 (ICAM-1) expression is associated with catalase: activation of Ap-1 and JNK. J Toxicol Environ Health A. 2006;69(24):2137–55. doi:10.1080/15287390600747759.CrossRefPubMed

10.

Pasi F, Facoetti A, Nano R. IL-8 and IL-6 bystander signalling in human glioblastoma cells exposed to gamma radiation. Anticancer Res. 2010;30(7):2769–72.PubMed

11.

Zhang JS, Nakatsugawa S, Niwa O, Ju GZ, Liu SZ. Ionizing radiation-induced IL-1 alpha, IL-6 and GM-CSF production by human lung cancer cells. Chin Med J (Engl). 1994;107(9):653–7.

12.

Shiao SL, Coussens LM. The tumor-immune microenvironment and response to radiation therapy. J Mammary Gland Biol Neoplasia. 2010;15(4):411–21. doi:10.1007/s10911-010-9194-9.CrossRefPubMedPubMedCentral

13.

Gupta A, Probst HC, Vuong V, Landshammer A, Muth S, Yagita H, et al. Radiotherapy promotes tumor-specific effector CD8+ T cells via dendritic cell activation. J Immunol. 2012;189(2):558–66. doi:10.4049/jimmunol.1200563.CrossRefPubMed

14.

Burnette BC, Liang H, Lee Y, Chlewicki L, Khodarev NN, Weichselbaum RR, et al. The efficacy of radiotherapy relies upon induction of type i interferon-dependent innate and adaptive immunity. Cancer Res. 2011;71(7):2488–96. doi:10.1158/0008-5472.CAN-10-2820.CrossRefPubMedPubMedCentral

15.

Abdel-Wahab Z, Dar MM, Hester D, Vervaert C, Gangavalli R, Barber J, et al. Effect of irradiation on cytokine production, MHC antigen expression, and vaccine potential of interleukin-2 and interferon-gamma gene-modified melanoma cells. Cell Immunol. 1996;171(2):246–54. doi:10.1006/cimm.1996.0200.CrossRefPubMed

16.

Ciernik IF, Romero P, Berzofsky JA, Carbone DP. Ionizing radiation enhances immunogenicity of cells expressing a tumor-specific T-cell epitope. Int J Radiat Oncol Biol Phys. 1999;45(3):735–41.CrossRefPubMed

Title: Graft-versus-host disease after radiation therapy in patients who have undergone allogeneic stem cell transplantation: two case reports
Authors: Sarah A. Milgrom
Yago Nieto
Chelsea C. Pinnix
Grace L. Smith
Christine F. Wogan
Gabriela Rondon
L. Jeffrey Medeiros
Partow Kebriaei
Bouthaina S. Dabaja
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Journal of Medical Case Reports / Issue 1/2016
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-016-0999-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Graft-versus-host disease after radiation therapy in patients who have undergone allogeneic stem cell transplantation: two case reports

Abstract

Background

Case presentation

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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