Graft-versus-host disease

Definition

Graft-versus-host-disease is a condition that can occur following bone marrow transplant. The condition may be acute or chronic, mild or severe. Severe cases can often be life-threatening. See also transplant rejection.

Causes, incidence, and risk factors

Bone marrow transplants are performed in specialized hospitals to treat and potentially cure certain types of leukemia or other cancers that have invaded the bone marrow. Doctors also perform experimental bone marrow transplants to treat non-malignant conditions, such as sickle cell anemia.

In the transplant, the host's bone marrow is destroyed with chemotherapy or radiation, and then the host receives replacement bone marrow from a donor. Most recipients undergo allogeneic transplants, which means they receive genetically matched bone marrow from a donor, usually a close family member or occasionally someone outside the family who has been found to be a match.

Sometimes, autologous transplants are performed. Here, the person is given back his or her own marrow once it has been purged of malignant cells.

While the goal of bone marrow transplantation is to eradicate tumor cells and thus the cancer, drugs are also given to suppress the host's immune system to permit the new donor marrow to implant without being destroyed by the host's immune system.

Varying degrees of graft-versus-host disease are viewed as an expected complication of bone marrow transplantation since tissue typing can find close, but not perfect, tissue matches between donor and recipient (see histocompatibility antigens ). Only identical twins have identical tissue types.

Some research suggests that a low level of GVHD may be helpful in fighting the disease that caused the need for the transplant in the first place.

Symptoms

Acute:

• Skin rash
• Diarrhea
• Abnormal liver function test
• Increased susceptibility to infection

Symptoms usually begin within 2 months after transplantation.

Chronic:

• Skin rash
• Dermatitis
• Hair loss
• Liver damage
• Dry eyes and dry mouth
• Increased susceptibility to infections
• Possibly lung and gastrointestinal disorders

Chronic symptoms start more than 3 months after transplant.

Treatment

Treatment consists of suppressing the immune response, but doing so without damaging the new marrow. Immune suppressants often used to treat cancer are also carefully used in decreased dosages to suppress or prevent graft-versus-host disease.

Treatment of acute GVHD includes:

• High-dose corticosteroids
• Antibodies to T cells are a second-line option

Expectations (prognosis)

The outcome varies. Sometimes treatment of the condition can lead to severe complications.

Complications

• Moderate-to-severe damage to the liver, lung, or gastrointestinal tract
• Severe infection

Calling your health care provider

As a rule, people with bone marrow grafts are very closely monitored. However, if any of the above symptoms appear, call your health care provider immediately.

Prevention

ABO (blood group) and HLA (tissue antigen) typing before transplantation can ensure a close antigenic match. Whenever possible, compatible family donors can further decrease the risk.

Illustrations

Antibodies

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