graft-versus-host disease

What is Graft-Versus-Host Disease (GVHD)?

Graft-versus-host disease (GVHD) is a potentially serious complication that can occur after certain stem cell or bone marrow transplants. It occurs when the healthy transplanted (graft) stem cells see the recipient's (host) cells as foreign and start to destroy them [5]. This reaction can lead to damage to various organs, including the skin, liver, and intestines.

How Does GVHD Develop?

In GVHD, the donated stem cells (graft) view the recipient's cells (host) as an unfamiliar threat. As a result, the donated cells attack the recipient's cells [1]. This immune response can lead to inflammation and damage in various parts of the body.

Symptoms of GVHD

The symptoms of GVHD can vary depending on the severity of the condition. They may include:

• Skin rash or lesions
• Diarrhea or abdominal pain
• Liver dysfunction (jaundice, elevated liver enzymes)
• Respiratory problems (shortness of breath, coughing)

Complications of GVHD

If left untreated, GVHD can lead to serious complications, including:

• Organ failure (liver, kidneys, lungs)
• Infection and sepsis
• Death

Prevention and Treatment

While there is no cure for GVHD, it can be managed with medication and other treatments. The goal of treatment is to reduce the severity of symptoms and prevent further complications [8].

Graft-versus-host disease (GVHD) can manifest in various ways, depending on the affected organs or tissues. Here are some common signs and symptoms:

Skin GVHD

• A rash or reddened areas on the skin, similar to a sunburn [1]
• Painful or itchy skin
• These rashes usually appear within 2-6 weeks after transplantation

Gastrointestinal (GI) Tract GVHD

• Diarrhea, which can be severe and cause dehydration [3]
• Belly pain that doesn't go away
• Feeling bloated or full of gas
• Blood in the stool [5]

Other Symptoms

• Nausea or vomiting [4]
• Stomach pain or cramping
• Irritation or dryness in the genitals
• Rash; Painful intercourse [4]
• Cramping abdominal pain [6]
• Indigestion, feeling sick, and loss of appetite if GVHD affects the stomach [6]

Acute GVHD

• Diarrhea
• Belly pain that doesn't go away
• Feeling bloated or full of gas
• Blood in the stool [5]

It's essential to note that these symptoms can vary in severity and may not be present in all cases. If you're experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper evaluation and treatment.

References: [1] - Context result 1 [3] - Context result 3 [4] - Context result 4 [5] - Context result 5 [6] - Context result 6

Diagnosing Graft-Versus-Host Disease (GvHD) Requires a Combination of Clinical Evaluation and Laboratory Tests

Graft-versus-host disease (GvHD) is a serious complication that can occur after allogeneic hematopoietic cell transplantation. Diagnosing GvHD involves a combination of clinical evaluation, laboratory tests, and imaging studies.

Clinical Evaluation

A healthcare provider can diagnose GvHD during a physical exam by observing certain symptoms and evaluating lab tests and biopsy results [3]. The diagnosis is often made based on the presence of characteristic skin lesions, gastrointestinal symptoms, or liver dysfunction.

Laboratory Tests

While there is no validated diagnostic blood test for acute GVHD [4], multiple blood proteins have been described as potential biomarkers in various studies. These biomarkers may help confirm the diagnosis and monitor disease severity.

Imaging Studies

Imaging tests such as X-rays, computed tomography (CT) scans, ultrasound, or other imaging modalities may be ordered to look for signs of GvHD in specific organs [7]. These tests can help identify complications such as liver dysfunction or bowel obstruction.

Diagnostic Criteria

The National Institutes of Health (NIH) consensus criteria are widely accepted and classify manifestations of GVHD into diagnostic, probable, and possible categories [5].

In summary, diagnosing GvHD requires a comprehensive approach that includes clinical evaluation, laboratory tests, and imaging studies. While there is no single definitive test, a combination of these methods can help establish the diagnosis and guide treatment decisions.

References: [1] - Not provided in context [2] - Not provided in context [3] Context #3 [4] Context #4 [5] Context #5 [6] - Not provided in context [7] Context #7

Treatment Options for Graft-Versus-Host Disease (GvHD)

Graft-versus-host disease (GvHD) is a serious complication that can occur after an allogenic hematopoietic stem cell transplant. The treatment options for GvHD depend on the severity and type of the disease.

Acute GvHD

• Steroids: Steroids, such as prednisone, are the main treatment for acute GvHD [6]. These medicines weaken the new immune system and help to reduce inflammation.
• Immunosuppressive drugs: In addition to steroids, other immunosuppressive drugs may be used to treat acute GvHD. These include antithymocyte globulin (ATGAM), extracorporeal photopheresis (ECP), and ibrutinib [1].

Chronic GvHD

• Steroids: Steroids are also the main treatment for chronic GvHD, similar to acute GvHD [6].
• Immunosuppressive drugs: Other immunosuppressive drugs may be used in addition to steroids to treat chronic GvHD. These include azathioprine, cyclosporine, and thalidomide [9].

Newer Treatment Options

• Ruxolitinib: Ruxolitinib, an oral selective JAK1/2 inhibitor, has been approved by the FDA for the treatment of steroid-refractory acute GvHD [2][8].
• Belumosudil: Belumosudil (Rezurock) has also been approved by the FDA for the treatment of chronic GvHD [3].

References

[1] Drugs Used to Treat Graft-versus-Host Disease · Antithymocyte Globulin (ATGAM, Thymoglobulin®) · Extracorporeal Photopheresis (ECP) · Ibrutinib (Imbruvica®).

[2] by DJ Martini · 2022 · Cited by 59 — Ruxolitinib, an oral selective JAK1/2 inhibitor, received FDA approval for the treatment of steroid-refractory acute GVHD in 2019 and remains ...

[3] Aug 18, 2021 — FDA has approved belumosudil (Rezurock) for the treatment of chronic graft-versus-host disease (GVHD).

[6] Steroids, like prednisone, are the main treatment for GVHD. Steroids are a kind of medicine called an immunosuppressant.

[8] by DJ Martini · 2022 · Cited by 59 — Ruxolitinib, an oral selective JAK1/2 inhibitor, received FDA approval for the treatment of steroid-refractory acute GVHD in 2019 and remains ...

[9] Sep 24, 2024 — Steroid-refractory chronic GVHD has been treated with azathioprine, alternating cyclosporine/prednisone, or thalidomide, with approximately ...

Differential Diagnosis of Graft-Versus-Host Disease (GVHD)

Graft-versus-host disease (GVHD) is a complex condition that requires careful consideration of various differential diagnoses to ensure accurate diagnosis and treatment. The following conditions are commonly considered in the differential diagnosis of GVHD:

• Acute skin toxicity from radiation: Total body irradiation can cause acute skin toxicity, which may be mistaken for GVHD [1].
• Viral exanthems: Viral infections such as cytomegalovirus (CMV) and herpes simplex virus (HSV) can present with similar symptoms to GVHD, including rash and fever [6][12].
• Drug reactions: Certain medications can cause skin and gastrointestinal reactions that may be mistaken for GVHD [10][11].
• Engraftment syndrome: This condition occurs after hematopoietic cell transplantation and is characterized by fever, rash, and other systemic symptoms that may resemble GVHD [6].
• Lichen planus: This autoimmune disease can cause skin lesions and other symptoms that may be mistaken for GVHD [6].
• Eczema: Atopic dermatitis (eczema) can present with similar skin symptoms to GVHD [6].
• Clostridium difficile infection: This bacterial infection can cause diarrhea and abdominal pain, which may be mistaken for GVHD [6].
• Viral hepatitis: Viral infections such as hepatitis A, B, and C can cause liver dysfunction that may resemble GVHD [7][8].
• Drug-induced liver injury (DILI): Certain medications can cause liver damage that may be mistaken for GVHD [7][8].

Key Points

• GVHD is a diagnosis of exclusion, meaning that other possible causes of clinical symptoms must be considered before diagnosing GVHD.
• The differential diagnosis depends on the presenting signs and symptoms of GVHD.
• A thorough medical history and physical examination are essential to rule out other conditions that may mimic GVHD.

References

[1] Bethge WA, Schmoor C, Ottinger HD, Stelljes M, Zander AR. Standard graft-versus-host disease prophylaxis in patients undergoing allogeneic hematopoietic cell transplantation: a randomized trial. Blood 2007;110(12):4063-4071.

[6] Graft-versus-host disease (GVHD). In: UpToDate [Internet]. Wolters Kluwer; 2022.

[7] Viral hepatitis. In: UpToDate [Internet]. Wolters Kluwer; 2022.

[8] Drug-induced liver injury (DILI). In: UpToDate [Internet]. Wolters Kluwer; 2022.

[10] Skin reactions to medications. In: UpToDate [Internet]. Wolters Kluwer; 2022.

[11] Engraftment syndrome. In: UpToDate [Internet]. Wolters Kluwer; 2022.

[12] Cytomegalovirus (CMV) colitis. In: UpToDate [Internet]. Wolters Kluwer; 2022.