CASE REVIEW

GVHD(Graft-versus-host disease)

Graft versus Host Disease

Result of allogenic T cells reacting with antigenic targets on host cells

Acute GVHD within first 3 months Chronic GVHD beyond 3 months

Acute GVHD Higher incidence

Mismatch, unrelated donors, old age patients unable to receive full doses of drugs

Skin epidermis, hair follicles are damaged. Liver small bile ducts show segmental disruption. Intestine crypt (destruction), mucosal ulceration.

Main Sx : skin rash, liver enzyme abnormality, diarrhea

Acute GVHD

• GradeⅠ no require treatment.

• Grade Ⅱ-Ⅳ aggressive therapy.

Acute GVHD- prevention & Tx

Immunosuppressive drugs early after transplantation Combinations of methotrexate, cyclosporine,

tacrolimus, prednisolone, anti-T cell Ab Removal of T-cells from stem cell

Increased incidence of graft failure, and recurrance Despite prophylaxis

Matched sibling 30% Unrelated donors 60%

Tx: glucocorticoids, antithymocyte globulin, monoclonal antibodies targeted against T cells

Chronic GVHD 20-50% of patients surviving >6mo (after allogenic transplantation)

Common in.. Old age, mismatched or unrelated stem

cell, preceding episode of acute GVHD

Autoimmune disorder like Sx. Malar rash, sicca syndrome, arthritis,

obliterative bronchilitis, bile duct degeneration, cholestasis

Chronic GVHD Treatment

Single-agent prednisone or cyclosporine Standard Tx.

Resolve 1-3 years

Susceptible to significant infection TMX, all suspected infection