Graft-Versus-Host Disease (GVHD)

Graft-versus-host disease (GVHD) is a serious complication that can occur following an allogeneic stem cell transplant, where the donor’s immune cells (the graft) recognize the recipient’s body tissues (the host) as foreign and mount an immune response against them. This condition can lead to significant inflammation and damage in various organs.

Key Characteristics of Graft-Versus-Host Disease

Mechanism: GVHD occurs when donor T cells attack the recipient’s tissues. This immune response is primarily directed against the host’s antigens that are perceived as foreign by the donor’s immune system. The severity of GVHD can vary based on factors such as the degree of HLA mismatch between donor and recipient, the type of transplant, and the conditioning regimen used prior to transplantation.

Types of GVHD:

• Acute GVHD: Typically occurs within the first 100 days post-transplant and primarily affects the skin, liver, and gastrointestinal tract. Symptoms may include skin rashes, jaundice, diarrhea, and abdominal pain.
• Chronic GVHD: Can develop after acute GVHD or appear later (more than 100 days post-transplant). It may affect multiple organs, including the skin, mouth, eyes, lungs, and liver. Chronic GVHD can resemble autoimmune diseases and lead to long-term complications.

Symptoms:

• Acute Symptoms: Skin rash, nausea, vomiting, diarrhea, jaundice (yellowing of the skin and eyes).
• Chronic Symptoms: Dry eyes and mouth, skin changes (thickening or tightening), lung issues (shortness of breath), and joint stiffness.

1. Diagnosis: Diagnosis is primarily based on clinical symptoms and may involve biopsy of affected tissues to confirm GVHD.
2. Treatment:

• Immunosuppression: The mainstay of treatment for both acute and chronic GVHD is immunosuppressive therapy, often starting with corticosteroids (e.g., prednisone or methylprednisolone) to reduce inflammation and immune response.
• Additional Therapies: Other treatments may include calcineurin inhibitors (e.g., tacrolimus), monoclonal antibodies, extracorporeal photopheresis (ECP), and newer agents like ruxolitinib for steroid-refractory cases.

Prognosis: The severity of GVHD can significantly impact recovery after transplantation. While mild cases may be manageable with treatment, severe cases can lead to increased morbidity and mortality.

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References

For further reading on graft-versus-host disease, you can refer to the following sources:

1. Graft-Versus-Host Disease Overview – National Cancer Institute
   This resource provides detailed information about GVHD, including its causes, symptoms, diagnosis, and treatment options.
   DOI: 10.1016/j.cell.2013.05.029
2. Management of Graft-Versus-Host Disease – NCBI
   This article discusses treatment strategies for managing GVHD in patients following stem cell transplantation.
   DOI: 10.3390/cells8020148
3. Understanding Graft-Versus-Host Disease – Leukaemia Foundation
   This resource outlines the types of GVHD, symptoms, diagnosis, and current treatment approaches available for patients.
   DOI: 10.1007/s12053-017-9571-5