Graft-versus-host disease - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Graft versus host disease (GVHD) is a major cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (HCT).
Occurs when donor T cells respond to host histoincompatible antigens on the host tissues.
Current consensus is that clinical manifestations guide whether the signs and symptoms of GVHD are acute, chronic, or an overlap syndrome.
Acute GVHD classically targets the skin, liver, and gastrointestinal tract. In contrast, chronic GVHD can involve almost any organ.
Acute GVHD prophylaxis usually comprises a calcineurin-based inhibitor such as cyclosporine or tacrolimus (that blocks T-cell activation), administered with other immunosuppressants such as low-dose methotrexate or mycophenolate.

Courtesy of Dr John Levine, Professor, Blood and Marrow Transplantation Program, University of Michigan; used with permission

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Definition

Epidemiology

Etiology

Pathophysiology

Images

GVHD pathophysiology
Acute GVHD of the skin (grade I)
Acute GVHD grading scale
Histology of skin GVHD (low power): Vacuolar interface dermatitis at the dermoepidermal junction with involvement of follicular epithelium (100x, hematoxylin and eosin)
Histology of skin GVHD (high power): Vacuolar interface dermatitis with rare necrotic keratinocytes (200x, hematoxylin and eosin)
Histology of upper gastrointestinal GVHD (medium-power photomicrograph of the stomach): Dilated gastric gland containing necrotic/apoptotic debris (arrow), typical of GVHD
Histology of lower gastrointestinal GVHD (high-power photomicrograph of colon, mild disease): Numerous apoptotic bodies (arrows) indicative of GVHD involving the colon
Histology of lower gastrointestinal GVHD (medium-power photomicrograph of colon, severe disease): Almost complete denudation of the mucosa indicative of severe GVHD involving the colon
Acute GVHD grading scale

Citations

Key Articles

Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant. 2015 Mar;21(3):389-401.e1.[Abstract][Full Text]
Dignan FL, Amrolia P, Clark A, et al. Diagnosis and management of chronic graft-versus-host disease. Br J Haematol. 2012 Jul;158(1):46-61.[Abstract][Full Text]
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation [internet publication].[Full Text]
Dignan FL, Clark A, Amrolia P, et al. Diagnosis and management of acute graft-versus-host disease. Br J Haematol. 2012 Jul;158(1):30-45.[Abstract][Full Text]
Carpenter PA, Kitko CL, Elad S, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group report. Biol Blood Marrow Transplant. 2015 Jul;21(7):1167-87.[Abstract][Full Text]
Carpenter PA, Kitko CL, Elad S, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group report. Biol Blood Marrow Transplant. 2015 Jul;21(7):1167-87.[Abstract][Full Text]

Other Online Resources

National Institutes of Health: organ scoring of chronic GVHD
Children's Oncology Services
National Marrow Donor Program
European Society for Blood and Marrow Transplantation
Center for International Blood and Marrow Transplant Research
American Society for Transplantation and Cellular Therapy

Referenced Articles

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