Graft-versus-host disease classification: Difference between revisions
Shyam Patel (talk | contribs) No edit summary |
Shyam Patel (talk | contribs) No edit summary |
||
| Line 10: | Line 10: | ||
* The ''acute'' or ''fulminant'' form of the disease (aGVHD) is normally observed within the first 100 days post-transplant<ref>[http://www.marrow.org/PHYSICIAN/improved_management_gvhd.html Graft versus Host Disease], from the [[National Marrow Donor Program]]</ref>, and is a major challenge to transplants owing to associated morbidity and mortality<ref>{{cite journal |author=Goker H, Haznedaroglu IC, Chao NJ |title=Acute graft-vs-host disease: pathobiology and management |journal=Exp. Hematol. |volume=29 |issue=3 |pages=259–77 |year=2001 |pmid=11274753 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0301-472X(00)00677-9}}</ref>. | * The ''acute'' or ''fulminant'' form of the disease (aGVHD) is normally observed within the first 100 days post-transplant<ref>[http://www.marrow.org/PHYSICIAN/improved_management_gvhd.html Graft versus Host Disease], from the [[National Marrow Donor Program]]</ref>, and is a major challenge to transplants owing to associated morbidity and mortality<ref>{{cite journal |author=Goker H, Haznedaroglu IC, Chao NJ |title=Acute graft-vs-host disease: pathobiology and management |journal=Exp. Hematol. |volume=29 |issue=3 |pages=259–77 |year=2001 |pmid=11274753 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0301-472X(00)00677-9}}</ref>. | ||
* The ''chronic'' form of graft-versus-host-disease (cGVHD) normally occurs after 100 days. The appearance of moderate to severe cases of cGVHD adversely influences long-term survival <ref>{{cite journal |author=Lee SJ, Vogelsang G, Flowers ME |title=Chronic graft-versus-host disease |journal=Biol. Blood Marrow Transplant. |volume=9 |issue=4 |pages=215–33 |year=2003 |pmid=12720215 |doi=10.1053/bbmt.2003.50026 |url=}}</ref>. | * The ''chronic'' form of graft-versus-host-disease (cGVHD) normally occurs after 100 days. The appearance of moderate to severe cases of cGVHD adversely influences long-term survival <ref>{{cite journal |author=Lee SJ, Vogelsang G, Flowers ME |title=Chronic graft-versus-host disease |journal=Biol. Blood Marrow Transplant. |volume=9 |issue=4 |pages=215–33 |year=2003 |pmid=12720215 |doi=10.1053/bbmt.2003.50026 |url=}}</ref>. | ||
Skin, liver, and GI GvHD are divided by staging. | |||
Skin: | |||
* Stage 0: no rash | |||
* Stage 1: maculopapular rash < 25% of body surface area | |||
* Stage 2: maculopapular rash 25-50% of body surface area | |||
* Stage 3: maculopapular rash >50% of body surface area | |||
* Stage 4: generalized erythema plus bullous formation | |||
Liver: | |||
This distinction is not arbitrary: acute and chronic graft-versus-host-disease appear to involve different [[immune cell]] subsets, different [[cytokine]] profiles, somewhat different host targets, and respond differently to treatment. | This distinction is not arbitrary: acute and chronic graft-versus-host-disease appear to involve different [[immune cell]] subsets, different [[cytokine]] profiles, somewhat different host targets, and respond differently to treatment. | ||
Revision as of 05:17, 13 June 2017
|
Graft-versus-host disease |
|
Differentiating Graft-versus-host disease from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Graft-versus-host disease classification On the Web |
|
American Roentgen Ray Society Images of Graft-versus-host disease classification |
|
Risk calculators and risk factors for Graft-versus-host disease classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Classification can be related to time-of-onset or to disease severity. Time-of-onset classification divides GvHD into acute or chronic. Severity classification divides GvHD into stages and grades.
Classification
Clinically, graft-versus-host-disease is divided into acute and chronic forms.
- The acute or fulminant form of the disease (aGVHD) is normally observed within the first 100 days post-transplant[1], and is a major challenge to transplants owing to associated morbidity and mortality[2].
- The chronic form of graft-versus-host-disease (cGVHD) normally occurs after 100 days. The appearance of moderate to severe cases of cGVHD adversely influences long-term survival [3].
Skin, liver, and GI GvHD are divided by staging. Skin:
- Stage 0: no rash
- Stage 1: maculopapular rash < 25% of body surface area
- Stage 2: maculopapular rash 25-50% of body surface area
- Stage 3: maculopapular rash >50% of body surface area
- Stage 4: generalized erythema plus bullous formation
Liver:
This distinction is not arbitrary: acute and chronic graft-versus-host-disease appear to involve different immune cell subsets, different cytokine profiles, somewhat different host targets, and respond differently to treatment.
Transfusion-associated GVHD
This type of GVHD is associated with transfusion of un-irradiated blood to immunocompromised recipients. It can also occur in situations where the blood donor is homozygous and the recipient is heterozygous for an HLA haplotype. It is associated with higher mortality (80-90%) due to involvement of bone marrow lymphoid tissue, however the clinical manifestations are similar to GVHD resulting from bone marrow transplantation. Transfusion-associated GVHD is rare in modern medicine. It is almost entirely preventable by controlled irradiation of blood products to inactivate the white blood cells (including lymphocytes) within.
References
- ↑ Graft versus Host Disease, from the National Marrow Donor Program
- ↑ Goker H, Haznedaroglu IC, Chao NJ (2001). "Acute graft-vs-host disease: pathobiology and management". Exp. Hematol. 29 (3): 259–77. PMID 11274753.
- ↑ Lee SJ, Vogelsang G, Flowers ME (2003). "Chronic graft-versus-host disease". Biol. Blood Marrow Transplant. 9 (4): 215–33. doi:10.1053/bbmt.2003.50026. PMID 12720215.