GRAFT VERSUS HOST DISEASE

A complication of bone marrow transplant in which

T cells in the donor bone marrow graft go on the
offensive and attack the host’s tissues.

Graft versus host disease is seen most often in

cases where the blood marrow donor is unrelated to
the patient or when the donor is related to the
patient, but not a perfect match.
 The immune system isoverview
the body’s tool
to fight infection and disease. It works
by seeing harmful cells as “FOREIGN”
and attacking them. When you receive
a donors stem cells “The Graft” and
their job is to recreate the donor’s
immune system in your body “The
Host”
Examples of Graft
versus host disease
 CLINICAL MANIFESTATION

There are types of GVHD : The ACUTE GVHD and CHRONIC

GVHD
Symptoms in both acute and chronic GVHD range from MILD
to SEVERE.
Acute GvHD usually happens within the first 6 months after a
transplant common acute symptoms include:
 Abdominal pain, or cramps, nausea, vomiting and diarrhea
Jaundice (yellow coloring of the skin or eyes) or other liver
problem.
Skin Rash, itching, redness on areas of the skin.
 ACUTE GVHD

• ACUTE GVHD
Typically occurs around the time of engraftment.
Previously mis-defined as GVHD which occurs prior to day.

Three main organ involved

Skin: mascularpapular rash
GI system: Nausea/vomiting and diarrhea
Liver abnormalities: typically cholestatic (jaundice)
Chronic GVHD

Chronic GvHD usually starts more than 3 months after a

transplant, and can last a lifetime. Chronic symptoms may include:
Dry eyes or vision changes
Dry mouth, white patches inside the mouth, and sensitivity to
spicy food, odynophagia
Fatigue, muscle weakness, and chronic pain
Joint pain or stiffness
Skin rash with raised, discolored areas, as well as skin tightening
or thickening
Shortness of breath due to lung damage
Vaginal dryness
Weight loss
 DIAGNOSIS
Laboratory study results in DvHD are as follows:
CBC – Autoimmune cytopenias
(Thrombocytopenia, anemia, leukopenia) may be observed with chronic
GvHD.
LIVER FUNCTION TEST – elevation of the alkaline phosphatase
concentration an early signs of liver involvement by GvHD;
hypoalbuminemia is typically due to GvHD associated intestinal
protein leak and a negative nitrogen balance.
Serum electrolytes and chemistries (e..g.. Potassium, magnesium,
bicarbonate levels) may be altered; massive diarrhea and diminished
oral intake can lead to serious electrolyte abnormalities.
• Patients recovering from bone marrow
transplantation are usually hospitalized for several
weeks following transplant and are monitored
closely for signs of developing GVHD or infection.
The best treatment for GVHD is prevention. This
consist of cocktail of immunosuppressive drugs
such as:
This consist of cocktail of immunosuppressive drugs such as:

Ciclosporin
Methotrexate
Cyclophosphamide
 Mycophenolate
Tacrolimus
Sirolimus
Prednisone
 The combination of ciclosporin and
methotrexate has been found to significantly
decrease the severity of GVHD. These drugs
weaken the ability of the donors immune cells to
launch an attack on the patient’s organs.