Abstract
Graft-versus-host disease (GvHD) results from the recognition of the hematopoietic stem cell transplantation (HSCT) recipient’s tissues as being foreign by immunocompetent donor T cells. GvHD remains a major cause of HSCT-related morbidity and mortality. Historically, acute GvHD is defined as GvHD that is evident prior to day 100 post-HSCT. However, acute GvHD can occur after this arbitrary HSCT milestone, and the diagnosis of acute GvHD is made based on the clinical presentation and other factors and not necessarily on the timing. The incidence of acute GvHD has been reported from 20% to 70%. Acute GvHD most commonly affects the skin ranging from mild erythema confined to the palms and soles to full-body erythroderma with bullae. The GI tract and liver are common target organs of acute GvHD but are rarely affected without skin involvement. Because acute GvHD is associated with high morbidity and mortality rates, patients receive GvHD prophylaxis during the peri-HSCT period in an effort to prevent, or at least ameliorate, acute GvHD. The choice of medications for GvHD prophylaxis is based on the type of HSCT, the degree of histoincompatibility between the donor and the recipient, the hematopoietic stem cell (HSC) source, and the age of the donor and recipient at the time of HSCT. The diagnosis is most often made on a clinical basis and treated with immunosuppression. Mortality risk corresponds to the stage and grade of acute GvHD. The identification of biomarkers of acute GvHD is an active area of investigation. This chapter addresses the risk factors, clinical features, diagnostic studies, and management of acute GvHD as well as strategies for GvHD prophylaxis. Chapter 19 focuses on chronic GvHD.
References
Przepiorka D, et al. 1994 Consensus conference on acute GVHD grading. Bone Marrow Transplant. 1995;15(6):825–8.
Glucksberg H, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation. 1974;18(4):295–304.
Nassereddine S, et al. Acute graft versus host disease: a comprehensive review. Anticancer Res. 2017;37(4):1547–55.
Jacobsohn DA. Acute graft-versus-host disease in children. Bone Marrow Transplant. 2008;41(2):215–21.
Morris ES, Hill GR. Advances in the understanding of acute graft-versus-host disease. Br J Haematol. 2007;137(1):3–19.
Lee SE, et al. Risk and prognostic factors for acute GVHD based on NIH consensus criteria. Bone Marrow Transplant. 2013;48(4):587–92.
Simonin M, et al. More chronic GvHD and non-relapse mortality after peripheral blood stem cell compared with bone marrow in hematopoietic transplantation for paediatric acute lymphoblastic leukemia: a retrospective study on behalf of the EBMT Paediatric Diseases Working Party. Bone Marrow Transplant. 2017;52(7):1071–3.
Chao NJ, Chen BJ. Prophylaxis and treatment of acute graft-versus-host disease. Semin Hematol. 2006;43(1):32–41.
Chao NJ, et al. Cyclosporine, methotrexate, and prednisone compared with cyclosporine and prednisone for prophylaxis of acute graft-versus-host disease. N Engl J Med. 1993;329(17):1225–30.
Teshima T, Reddy P, Zeiser R. Reprint of: Acute Graft-versus-Host Disease: Novel Biological Insights. Biol Blood Marrow Transplant. 2016;22(3 Suppl):S3–8.
Ciurea SO, Bayraktar UD. "No donor"? Consider a haploidentical transplant. Blood Rev. 2015;29(2):63–70.
Sung AD, Chao NJ. Concise review: acute graft-versus-host disease: immunobiology, prevention, and treatment. Stem Cells Transl Med. 2013;2(1):25–32.
Jacobsohn DA, Vogelsang GB. Acute graft versus host disease. Orphanet J Rare Dis. 2007;2:35.
Cloutier J, et al. Upper versus lower endoscopy in the diagnosis of graft-versus-host disease. J Clin Gastroenterol. 2016;PMID:27428729.
DeSimone RA, Schwartz J, Schneiderman J. Extracorporeal photopheresis in pediatric patients: practical and technical considerations. J Clin Apher, vol. PMID; 2017. p. 28304115.
Khandelwal P, et al. Ruxolitinib as salvage therapy in steroid-refractory acute graft-versus-host disease in pediatric hematopoietic stem cell transplant patients. Biol Blood Marrow Transplant. 2017;23(7):1122–7.
Lexi-Comp. Lexi-Comp online database. Lexi-Drugs. http://online.lexi.com/lco/action/home/switch. Accessed 24 Jan cited 2016.
Ram R, et al. Prophylaxis regimens for GVHD: systematic review and meta-analysis. Bone marrow transplantation. 2009;43(8):643–53.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Bride, K.L., Patel, N.S., Freedman, J.L. (2018). Acute Graft-Versus-Host Disease: Diagnosis, Prophylaxis, and Treatment. In: Brown, V. (eds) Hematopoietic Stem Cell Transplantation for the Pediatric Hematologist/Oncologist. Springer, Cham. https://doi.org/10.1007/978-3-319-63146-2_18
Download citation
DOI: https://doi.org/10.1007/978-3-319-63146-2_18
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-63144-8
Online ISBN: 978-3-319-63146-2
eBook Packages: MedicineMedicine (R0)