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- bone marrow transplant
- bone marrow
graft-versus-host disease
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What is graft-versus-host disease (GVHD)?
Graft-versus-host disease (GVHD) is a condition that can occur after a bone marrow transplant, where donor cells (the graft) attack the recipient's (host) tissues. This happens when T cells, a type of white blood cell in the donor marrow, recognize the host cells as foreign and attack them.
GVHD can be acute, occurring within three months of the transplant, or chronic, occurring after three months and sometimes lasting for years. Symptoms range from mild to severe, including skin rash, liver disease, and gastrointestinal issues. Close tissue matching between donor and recipient is crucial to minimize GVHD risk in allogeneic transplants. Treatment involves suppressing the activation of transplanted T cells while maintaining the donor marrow's viability, often using immunosuppressive agents.
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What happens in the body during GVHD?
In graft-versus-host disease (GVHD), donor T cells recognize the recipient's cells as foreign and attack them. Because the recipient's immune system is compromised, it cannot defend against the donor cells.
Acute GVHD typically occurs within 3 months of the transplant, potentially causing a skin rash, liver disease (jaundice), or gastrointestinal issues (diarrhea, nausea, vomiting). Chronic GVHD occurs later, with symptoms such as hair loss, skin rash, Sjögren syndrome, hepatitis, and weight loss. Treatment involves immunosuppressants to suppress T-cell activation while maintaining the donor marrow's viability.
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Why does GVHD occur after a transplant?
Graft-versus-host disease (GVHD) arises after a bone marrow transplant when donor marrow cells (the graft) recognize the recipient's tissues (the host) as foreign and mount an immune attack. Donor T cells, a type of white blood cell, mediate this attack by targeting host cells. The recipient's compromised immune system is unable to defend against the donor cells, leading to GVHD. Close tissue matching between donor and recipient is essential to minimize GVHD risk. GVHD may be acute (occurring within 3 months of transplant) or chronic (occurring later), with symptoms ranging from a skin rash and gastrointestinal illness to liver disease.
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Which organs are most commonly affected by GVHD?
Graft-versus-host disease (GVHD) occurs after a bone marrow transplant when donor marrow cells (the graft) attack the recipient's tissues (the host). Donor T cells, recognizing host cells as foreign, mediate this attack. GVHD can be acute (within three months post-transplant) or chronic (beyond three months).
The most commonly affected organs in acute GVHD are the skin, liver, and gastrointestinal tract. Skin involvement manifests as a rash, liver disease as jaundice, and gastrointestinal disease as diarrhea, nausea, and vomiting. Chronic GVHD can affect various organs, leading to symptoms like hair loss, skin rash, Sjögren syndrome, hepatitis, and weight loss.
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What are some symptoms of GVHD?
Graft-versus-host disease (GVHD) occurs after a bone marrow transplant, where donor cells attack the recipient's tissues. GVHD can be acute (within 3 months post-transplant) or chronic (more than 3 months post-transplant).
Symptoms of acute GVHD include skin rash, liver disease (jaundice), and gastrointestinal issues like diarrhea, nausea, and vomiting. Chronic GVHD symptoms include hair loss, skin rash, Sjögren syndrome, hepatitis, and weight loss. Close tissue matching minimizes GVHD risk in allogeneic transplants, but it can still occur.
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How do doctors diagnose and treat GVHD?
Graft-versus-host disease (GVHD) happens after a bone marrow transplant, where donor marrow cells (the graft) target the recipient's tissues (the host). Donor T cells, a type of white blood cell, mediate this attack, recognizing host cells as foreign. GVHD can be acute (within three months post-transplant) or chronic (beyond three months), with varying symptoms like skin rash, liver disease, or gastrointestinal issues.
Diagnosis involves recognizing these symptoms in transplant recipients. Treatment aims to suppress donor T cell activation while preserving donor marrow viability. Immunosuppressants like cyclosporine and glucocorticoids, and antimetabolites such as methotrexate, are commonly used. Monoclonal antibodies may be used for GVHD that doesn't respond to these agents.
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graft-versus-host disease (GVHD), condition that occurs following a bone marrow transplant, in which cells in the donor marrow (the graft) attack tissues of the recipient (the host). This attack is mediated by T cells, a type of white blood cell normally occurring in the human body and therefore found in donor grafts. T cells attack and kill antigens—“nonself,” or foreign, substances that have the potential to harm the body. In GVHD, donor T cells recognize host cells as “nonself,” and, because the immune systems of bone marrow transplant recipients are compromised by disease, host tissues are incapable of mounting an immune response against the donor cells.
GVHD may be acute or chronic, and symptoms range from mild to severe. Acute disease typically occurs within three months of the transplant and may manifest as a skin rash, as liver disease, with symptoms of jaundice, or as gastrointestinal disease, with diarrhea, nausea, and vomiting. Chronic disease occurs more than three months after a bone marrow transplant and sometimes lasts several years. Symptoms of chronic disease include hair loss, skin rash, Sjögren syndrome (or sicca syndrome), hepatitis, and weight loss.
In the case of allogeneic (genetically different) bone marrow transplants, which are the most common type of marrow transplant, close matching of tissue between donor and recipient is essential to minimize GVHD. Tissue matching is based on a set of cell-surface proteins called human leukocyte antigen (HLA). These proteins play a central role in enabling T cells to respond to foreign substances. However, even with exact HLA matching, about 40 percent of allogeneic transplant recipients are still affected by acute GVHD. The risk of GVHD can be avoided through autologous (genetically identical) transplantation. In this type of transplant, which is used in patients with certain forms of cancer, the hematopoietic stem cells from a patient’s own marrow are harvested and stored prior to exposure to high-dose chemotherapy or radiation therapy. The stem cells are then reinfused into the patient following therapy. The risk for GVHD also can be eliminated by the removal of T cells in donor marrow prior to transplantation. However, because this procedure leaves the graft—and therefore the recipient’s body—largely devoid of immune protection, it significantly increases the risk for other complications associated with bone marrow transplantation, including infection and graft failure.
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Treatment for GVHD attempts to suppress the activation of transplanted T cells while simultaneously maintaining the viability of donor marrow. This is accomplished through a carefully managed treatment regimen, which generally includes the administration of immunosuppressive agents such as cyclosporine and glucocorticoids (e.g., cortisone) and antimetabolites such as methotrexate that interfere with cellular metabolism and proliferation. Patients who have GVHD that is refractive to these agents may be treated with a monoclonal antibody, which is designed to bind to and block specific targets involved in generating immune responses. An example of a monoclonal antibody that may be used in the treatment of GVHD is muromonab-CD3, which works by blocking the ability of donor T cells to recognize antigens. Other monoclonal antibodies that may be used for GVHD act by blocking receptors involved in mediating T-cell activation.