Book contents
- Frontmatter
- Contents
- Acknowledgments
- Manual of Stem Cell and Bone Marrow Transplantation
- 1 Rationale for Transplantation
- 2 Types of Transplantation
- 3 HLA Matching in Allogeneic Transplantation
- 4 Stem Cell Source
- 5 Pretransplant Evaluation and Counseling of Patient and Donor
- 6 Conditioning Regimens
- 7 Stem Cell Infusion
- 8 ABO Compatibility
- 9 Engraftment
- 10 Preventative Care
- 11 Transplant-Related Complications
- 12 Graft-Versus-Host Disease – Prophylaxis and Acute
- 13 Graft-Versus-Host Disease – Chronic
- 14 Engraftment Syndrome
- 15 Infectious Disease
- 16 Graft Rejection And Failure
- 17 Gastrointestinal Complications
- 18 Pulmonary Complications
- 19 Veno-Occlusive Disease
- 20 Special Transfusion-Related Situations
- 21 Cardiovascular Complications
- 22 Neurologic Complications
- 23 Cystitis
- 24 Donor Lymphocyte Infusion
- 25 Transplantation: Regulation And Accreditation
- Appendix
- Index
12 - Graft-Versus-Host Disease – Prophylaxis and Acute
Published online by Cambridge University Press: 23 November 2009
- Frontmatter
- Contents
- Acknowledgments
- Manual of Stem Cell and Bone Marrow Transplantation
- 1 Rationale for Transplantation
- 2 Types of Transplantation
- 3 HLA Matching in Allogeneic Transplantation
- 4 Stem Cell Source
- 5 Pretransplant Evaluation and Counseling of Patient and Donor
- 6 Conditioning Regimens
- 7 Stem Cell Infusion
- 8 ABO Compatibility
- 9 Engraftment
- 10 Preventative Care
- 11 Transplant-Related Complications
- 12 Graft-Versus-Host Disease – Prophylaxis and Acute
- 13 Graft-Versus-Host Disease – Chronic
- 14 Engraftment Syndrome
- 15 Infectious Disease
- 16 Graft Rejection And Failure
- 17 Gastrointestinal Complications
- 18 Pulmonary Complications
- 19 Veno-Occlusive Disease
- 20 Special Transfusion-Related Situations
- 21 Cardiovascular Complications
- 22 Neurologic Complications
- 23 Cystitis
- 24 Donor Lymphocyte Infusion
- 25 Transplantation: Regulation And Accreditation
- Appendix
- Index
Summary
OVERVIEW
Graft-versus-host disease (GVHD) is one of the classical complications of allogeneic stem cell transplantation. It is dependent on the presence of histocompatibility differences between the host and the donor. These can be minor antigens in the case of matched transplantation or major histocompatibility complex (MHC) antigens if there is some human leukocyte antigen (HLA) incompatibility. Minor antigens are presented to the T cells presumably in the same way that bacterial or viral antigens are presented to T cells. Thus, in essence, the graft is functioning as if there were a severe infection, and the graft tries to eradicate antigens that are intrinsic to the host. This results in the tissue damage that we clinically recognize as GVHD.
There are two main categories of GVHD, acute and chronic, each with two subcategories:
Classic acute GVHD
Persistent, recurrent, or late-onset acute GVHD
Chronic GVHD
Classic chronic GVHD
Previously, acute GVHD (aGVHD) was arbitrarily assigned to all allogeneic manifestations that occurred before day 100. Similarly cGVHD was the manifestations occurring after day 100. This distinction is no longer considered useful. It is now recognized that there can be late-onset aGVHD (frequently but not exclusively after reduced intensity transplantation) that looks clinically like aGVHD.
Moreover, there can be cGVHD that occurs early after transplantation, which is considered classic without features of aGVHD, and an overlap syndrome in which features of chronic and acute GVHD appear together.
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- Chapter
- Information
- Manual of Stem Cell and Bone Marrow Transplantation , pp. 53 - 75Publisher: Cambridge University PressPrint publication year: 2009