CASE REVIEW GVHD (Graft-versus-host disease)

1. CASE REVIEW GVHD (Graft-versus-host disease)

2. 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

3. 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

4. Acute GVHD • GradeⅠ no require treatment. • Grade Ⅱ-Ⅳ  aggressive therapy.

5. 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

6. 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

7. Chronic GVHD • Treatment • Single-agent prednisone or cyclosporine  Standard Tx. • Resolve  1-3 years • Susceptible to significant infection • TMX, all suspected infection