Tu31 - Development of Proliferating Cell Nuclear Antigen Autoantibodies with Manifestation of Graft Versus Host Disease after Peripheral Blood Stem Cell Transplantation

Abstract Text: Chronic graft-versus-host disease (cGVHD) is one of the most significant autoimmune manifestation after allogenic peripheral stem cell transplantation (PBSCT). Anti-nuclear antibody (ANA) expression was frequently observed in patients after allogenic PBSCT. However, there has been no written report of proliferating cell nuclear antigen (PCNA)-like pattern of ANA expression in patients with cGVHD. We present a case of 30-year-old woman who developed antinuclear antibody formation against PCNA with development of systemic graft-versus-host disease after allogenic PBSCT. The patient was diagnosed with T-lymphoblastic lymphoma for her mediastinal mass. She had received chemotherapy for 8 months and underwent allogenic PBSCT from the human leukocyte antigen-matched sibling donor. ANA was negative at the time of PBSCT. Two months after PBSCT, the patient developed acute GVHD at colon. Chronic skin and pulmonary GVHD occurred at 6 months and 9 months, respectively, after PBSCT. Together with her pulmonary GVHD manifestation, ANA test displayed strong immunoreactivity (PCNA-like pattern, 1:640) in her serum and pleural fluid. Other autoantibodies were not detected. Pulmonary complications contribute to late mortality post PBSCT. Currently, pulmonary cGVHD is diagnosed with bronchiolitis obliterans with a disease severities ranging from subclinical PFT impairment to respiratory failure, and the pathophysiology is not fully understood. Because of the non-specific clinical symptoms, a standardized approach is necessary to detect pulmonary cGVHD early before irreversible structural changes occur. Therefore, our case indicates that laboratory work-up including autoantibody test can be helpful for differential diagnosis.