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12 - Graft-Versus-Host Disease – Prophylaxis and Acute

Published online by Cambridge University Press:  23 November 2009

Joseph H. Antin
Affiliation:
Dana-Farber Cancer Institute, Boston
Deborah Yolin Raley
Affiliation:
Dana-Farber Cancer Institute, Boston
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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:

  1. Classic acute GVHD

  2. Persistent, recurrent, or late-onset acute GVHD

  3. Chronic GVHD

  4. 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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Publisher: Cambridge University Press
Print publication year: 2009

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