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Graft-versus-host
disease (GVHD) is a common complication after allogeneic transplant.
Your medical team will be monitoring you for this problem.
Graft
refers to the donated bone marrow/stem cells and host is the transplant
recipient. GVHD may be acute or chronic and ranges from mild
manifestations to life-threatening disease.
The
risk for GVHD increases as the disparity between the donors HLA markers
and the recipient's HLA markers increases (how well donor and recipient
are matched.)
HLA stands for Human Leukocyte Antigen. HLA markers are certain
molecules found on the surface of cells
Although
patients and donors are matched immunologically prior to transplant
there are still mismatches at minor markers that are only avoided if the
patient and donor are identical twins.
Acute
GVHD typically occurs in the first three months
following transplant.
T-lymphocytes
or T-cells are a type of white cell that play an important role in the
immune response by recognizing foreign organisms in the body.
The donor's T-cells are harvested along with the other stem cells
at collection and are transplanted into the recipient.
Acute
GVHD occurs when the donor's T-cells recognize the recipient's blood
cells as foreign and forge an attack on the recipient's tissue and
organs.
Acute
GVHD can affect the skin, liver and gastrointestinal tract and may
include one or all three.
Four
Stages of GVHD
There
are four stages of acute GVHD, mild, moderate, severe, and
life-threatening, and are graded by the number of organs involved and
the severity of each affected.
A
skin rash is usually the first manifestation of acute GVHD and typically
appears on the palms of hands, soles of feet, and/or face. The rash may
progress to other areas of the body and appear similar to sunburn or may
progress to blistering of the skin.
Watery
or bloody diarrhea with cramping is the typical manifestation of GVHD of
the gastrointestinal tract.
Symptoms
of liver GVHD may include jaundice, bleeding problems, and enlargement
of the liver. Liver enzymes in the blood will be monitored closely
beginning with the first suspicion of liver GVHD.
A
biopsy of the affected area may be done to assist with diagnosis.
Immunosuppressive medications will likely be prescribed prior to
transplant to avoid GVHD.
This page was last
edited on 06/19/2003
Written
by Rachael Myers Lowe, cancerpage.com
Reviewed by Katie Mullaly, RN, MSN and Jane Quigley, RN, BSN
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