Severe Liver Dysfunction after Donor Lymphocyte Infusion for Relapsed Multiple Myeloma

Area of Science:

• Immunology
• Hepatology
• Hematology

Background:

• Donor lymphocyte infusion (DLI) is a critical treatment post-allogeneic stem cell transplantation to enhance anti-tumor immunity and engraftment.
• Graft-versus-host disease (GVHD) is a known complication of DLI, potentially affecting the skin, intestine, and liver.

Observation:

• A patient with relapsed multiple myeloma developed acute severe liver dysfunction with encephalopathy following DLI.
• The patient had a history of chronic viral hepatitis B, which was suppressed by antiviral therapy at the time of DLI.

Findings:

• This case represents a rare instance of acute severe liver dysfunction with encephalopathy, a severe manifestation of hepatic GVHD post-DLI.
• High-dose glucocorticoid therapy led to the patient's recovery, supporting the diagnosis of hepatic GVHD.

Implications:

• Clinicians must consider acute severe liver dysfunction with encephalopathy as a potential catastrophic complication of DLI in patients with hematologic disorders.
• Early recognition and prompt treatment with immunosuppressants like glucocorticoids are crucial for managing this severe hepatic complication.