Korean J Gastroenterol.  2024 Mar;83(3):123-126. 10.4166/kjg.2024.007.

Severe Liver Dysfunction after Donor Lymphocyte Infusion for Relapsed Multiple Myeloma

• No TH
• Heo NY
• Park SH
• Choi JH
• Lee J
• Lim SN
• Park SY

• KMID: 2554266
• DOI: http://doi.org/10.4166/kjg.2024.007

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.

Keyword

Graft vs Host Disease; Liver Failure, Acute

Figure

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  Fig. 1 Initial abdominal CT showed no cirrhotic feature or splenomegaly, suggesting portal hypertension.

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  Fig. 2 Serum aminotransferase and total bilirubin level changes during acute liver failure. DLI, donor lymphocyte infusion; ER, emergency room; mPD, methyl prednisolone.

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