Myth or reality: Graft versus host disease after autologous hematopoietic cell transplantation, a multicentre experience

Acute graft-versus-host disease (aGvHD) is a rare but clinically significant complication of autologous hematopoietic cell transplantation. The aim of this retrospective multicenter study was to evaluate the clinical features, outcomes and risk factors associated with autologous graft-versus-host disease (auto-GvHD) in 19 patients. The cohort included 12 multiple myeloma and 7 lymphoma patients with a median age of 58 years. All patients developed aGvHD, predominantly involving the gastrointestinal tract, skin or liver, with isolated organ involvement in the majority. Conditioning regimens commonly included melphalan and all patients underwent peripheral blood hematopoietic cell transplantation. First-line treatment with topical corticosteroids and systemic methylprednisolone was effective in most cases, while steroid-resistant GvHD was successfully treated with cyclosporine and ruxolitinib. Lenalidomide maintenance therapy in multiple myeloma patients did not lead to GvHD recurrence. No GvHD-related mortality was observed and complete responses were achieved in all treated cases. These findings underscore the importance of early detection and prompt treatment of auto-GvHD, particularly in high-risk populations and highlight the need for further research to elucidate its pathophysiology and optimise management strategies.