Induction of autologous graft-versus-host disease with cyclosporin A after peripheral blood stem cell transplantation: Analysis of factors affecting induction

Background: Induction of autologous graft-versus-host disease after peripheral blood stem cell transplantation has not been studied well. Objective: The purpose of this study was to analyze the factors that affect the development of autologous graft-versus-host disease. Methods: Nineteen patients with non-Hodgkin's lymphoma underwent peripheral blood stem cell transplantation followed by the administration of cyclosporin A for 28 days (group A) or 21 days (group B) and IFN-γ. Results: Autologous graft-versus- host disease failed to develop in the any of the group A patients, who did not receive total body irradiation for conditioning and underwent the transplantation with unmanipulated peripheral blood stem cells, although cytotoxic activity against autologous lymphocytes was detectable in peripheral blood mononuclear cells obtained from all of them after the transplantation. Autologous graft-versus-host disease developed in 2 of 4 patients in group A who received enriched CD34⁺ cells and in 7 of 11 patients who underwent conditioning with total body irradiation. Maculopapular erythema that was compatible with graft-versus-host disease developed on days 19 to 27 after the transplantation in these patients and resolved after 3 to 9 days without treatment. Conclusions: Either the depletion of regulatory cells from the graft by enrichment of CD34⁺ cells or the abolition of the autoregulation by including total body irradiation in the conditioning regimen may be effective in inducing autologous graft- versus-host disease after peripheral blood stem cell transplantation. Three weeks of cyclosporin A therapy appears to be sufficient to induce autologous graft-versus-host disease in recipients of peripheral blood stem cells.