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Graft vs. Host Disease
(GVHD) - a frequent
complication of allogeneic bone marrow transplant in which the engrafted
donor cells attacks the patient's organs and tissue. GVHD tends to be more
severe in patients receiving mismatched transplants from family member or unrelated donors.
GVHD is two diseases: acute
GVHD and chronic GVHD. "Patients may develop one,
both or neither. Acute and chronic GVHD differ in their symptoms,
clinical signs and time of onset." ~
Acute GVHD usually occurs during
the first three months following an allogeneic BMT. "T-cells
present in the donor's bone marrow at the time of transplant
identify the BMT patient as "non-self' and attack the
patient's skin, liver, stomach, and/or intestines. The earliest
sign of acute GVHD is often a skin rash that usually first appears
on the patient's hands and feet." medicalistes.org
Chronic GVHD usually
develops after the third month post-transplant. "Scientists
believe that new T-cells produced after the donor's bone marrow
has engrafted in the patient may cause chronic GVHD. Most patients
with chronic GVHD experience skin problems that may include a dry
itching rash, a change in skin color, and tautness or tightening
of the skin. Partial hair loss or premature graying may also
occur." medicalistes.org
Illustrations of processes Acute and Chronic GVHD graphics
More detail: "Chronic
graft-versus-host disease (GVHD) is the most serious and common
long-term complication of allogeneic hematopoietic stem cell
transplantation (HCT), occurring in 20% to 70% of people
surviving more than 100 days.1,2
Approximately half of affected people have 3 or more involved
organs, and treatment typically requires immunosuppressive
medications for a median of 1 to 3 years. Because of higher
treatment-related (nonrelapse) mortality, chronic GVHD remains
the major cause of late death despite its association with a
lower relapse rate.3,4"
bloodjournal.org
Many risk factors exist that can predispose patients to
chronic GVHD. These include:
• prior acute GVHD • older donor/recipient age • HLA mismatch • use of an unrelated donor
• viral infection (eg, cytomegalovirus) • splenectomy • DLI • use of blood as a source of stem cells.
Early Treatment Intervention Is Key: Initial studies reported by Sullivan et al
indicated that treatment with corticosteroids alone used late in the course of
chronic GVHD resulted in a 23% survival probability at 3 years after transplantation
[7] compared to 76% if treatment was administered earlier in the course of the
disease [8].
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