Graft versus host disease (GVHD) is the most serious complication of haematopoietic system cell transplantation - most often of the bone marrow - which, if left untreated, can even lead to the patient's death. What are the causes and symptoms of graft versus host disease? How is the treatment going?

Transplant against the host(GVHD - Graft-Versus-Host Disease) is a disease, or rather an organism reaction, that occurs in a person who has undergone an allograft (from another donor) cells of the hematopoietic system, e.g. bone marrow or stem cells.

During transplant, the recipient receives blood from an unknown donor along with T lymphocytes (white blood cells). Graft versus host disease occurs when T cells recognize the recipient's organism as foreign and begin to attack it, destroying it. Unfortunately, the presence of T lymphocytes in a transplant is essential as it reduces the risk of transplant rejection, so they cannot be removed to avoid disease development.

The graft-versus-recipient reaction is most common in patients with leukemia who have undergone a bone marrow transplant, and the organs that typically attack T cells are skin, oral mucosa, gastrointestinal tract, eyes and lungs.

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There are three forms of the disease - mild, moderate and severe, which leads to disability. There is also a distinction between acute graft versus host disease that occurs up to about 100 days post-transplant (aGVHD) and chronic graft versus host disease that occurs later post-transplant (cGVHD).

Graft versus Host Disease (GVHD) - Causes

The causes of the disease are not exactly known, but a lot of risk factors are known about it. The largest of these is the incompatibility of the human leukocyte antigen between the recipient and the donor. The recipient's lowered immunity, which was previously weakened by the underlying disease, infections and radiation or chemotherapy, is also not without significance.

The age and gender differences between the recipient and the donor are also risk factors (especially when the donor is a woman and the recipient is a man).

Graft versus Host Disease Symptoms

  • changes to the skin - rash, dark patches or darkening of the skin
  • changes in the oral cavity - difficult to heal erosions, ulcers, hypertrophy of the mucosa in mechanically irritated areas, impaired salivation, oral infections and a tendency to caries

Symptoms of the disease usually appear in the first three years after transplantation - usually between 3 and 14 months after transplantation

  • erosions, ulcers in the genital area. In women, the vagina may even become scarred and narrow
  • adhesive bronchiolitis - shortness of breath with exertion, coughing, wheezing
  • fasciitis, joint stiffness
  • dry eye syndrome

These are symptoms sufficient for the diagnosis of GVHD (according to the US National Institute of He alth working group).

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Graft versus Host Disease (GVHD) Treatment

The symptoms of mild GVH disease can be treated topically. Then, steroid ointments are used on the skin, and in the case of oral membrane involvement - rinses and steroid gels.

Patients with moderate disease are given intravenous glucocorticosteroids (most often prednisone) to weaken the activity of donor T cells.

In severe form, immunosuppressive therapy is required. The usual combination of treatment with cyclosporine and prednisone is used.

However, high doses of drugs can lead to a significant decrease in immunity, which can lead to infections and infections, therefore antibacterial and antifungal prophylaxis is also necessary.

Graft versus host disease (GVHD) - prognosis

10-year survival reaches 80% patients with the mild form and only 5 percent. with a severe form GVHD.

Category:

Immune system