Graft-versus-host disease history and symptoms: Difference between revisions
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Classically, acute graft-versus-host-disease is characterized by selective damage to the [[liver]], [[skin]] and [[mucosa]], and the [[gastrointestinal tract]]. Newer research indicates that other graft-versus-host-disease target organs include the [[immune system]] (the [[Haematopoiesis|hematopoietic system]], such as the [[bone marrow]] and the [[thymus]]) itself, and the [[lung]]s in the form of idiopathic [[pneumonia|pneumonitis]]. Chronic graft-versus-host-disease also attacks the above organs, but over its long-term course can also causes damage to the [[connective tissue]] and [[exocrine glands]]. | Classically, acute graft-versus-host-disease is characterized by selective damage to the [[liver]], [[skin]] and [[mucosa]], and the [[gastrointestinal tract]]. Newer research indicates that other graft-versus-host-disease target organs include the [[immune system]] (the [[Haematopoiesis|hematopoietic system]], such as the [[bone marrow]] and the [[thymus]]) itself, and the [[lung]]s in the form of idiopathic [[pneumonia|pneumonitis]]. Chronic graft-versus-host-disease also attacks the above organs, but over its long-term course can also causes damage to the [[connective tissue]] and [[exocrine glands]]. | ||
*GI | *GI symptoms: Acute GVHD of the [[GI tract]] can result in severe intestinal inflammation, sloughing of the mucosal membrane, severe diarrhea, abdominal pain, nausea, and vomiting. Diarrhea is typically large-volume, and bloody stools can also develop.<ref name="pmid26729898">{{cite journal| author=McDonald GB| title=How I treat acute graft-versus-host disease of the gastrointestinal tract and the liver. | journal=Blood | year= 2016 | volume= 127 | issue= 12 | pages= 1544-50 | pmid=26729898 | doi=10.1182/blood-2015-10-612747 | pmc=4807421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26729898 }} </ref> The volume of diarrhea determines the stage of GI GvHD. This is typically diagnosed via intestinal biopsy, which can be done via endoscopy or colonoscopy. | ||
*Liver | *Liver symptoms: Acute liver GvHD is measured by the bilirubin level in acute patients.<ref name="pmid26729898">{{cite journal| author=McDonald GB| title=How I treat acute graft-versus-host disease of the gastrointestinal tract and the liver. | journal=Blood | year= 2016 | volume= 127 | issue= 12 | pages= 1544-50 | pmid=26729898 | doi=10.1182/blood-2015-10-612747 | pmc=4807421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26729898 }} </ref> The degree of bilirubin elevation determines the stage of liver GvHD. This can be diagnosed via liver biopsy. | ||
*Skin | *Skin symptoms: This results in a diffuse maculopapular rash, sometimes in a lacy pattern. This can be diagnosed via skin biopsy. | ||
*Pulmonary | *Pulmonary symptoms: Symptoms include shortness of breath and cough. Severe pneumonitis can result in respiratory failure requiring intubation. | ||
Acute GVHD is staged as follows: overall grade (skin-liver-gut) with each organ staged individually from a low of 1 to a high of 4. Patients with grade IV GVHD usually have a poor prognosis. If the GVHD is severe and requires intense immunosuppression involving steroids and additional agents to get under control, the patient may develop severe infections as a result of the immunosuppression and may die of infection. | Acute GVHD is staged as follows: overall grade (skin-liver-gut) with each organ staged individually from a low of 1 to a high of 4. Patients with grade IV GVHD usually have a poor prognosis. If the GVHD is severe and requires intense immunosuppression involving steroids and additional agents to get under control, the patient may develop severe infections as a result of the immunosuppression and may die of infection. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]
Overview
The clinical presentation of GvHD can be quite diverse, depending on the types of organs affected and the severity of the immunologic reaction.
History and Symptoms
Classically, acute graft-versus-host-disease is characterized by selective damage to the liver, skin and mucosa, and the gastrointestinal tract. Newer research indicates that other graft-versus-host-disease target organs include the immune system (the hematopoietic system, such as the bone marrow and the thymus) itself, and the lungs in the form of idiopathic pneumonitis. Chronic graft-versus-host-disease also attacks the above organs, but over its long-term course can also causes damage to the connective tissue and exocrine glands.
- GI symptoms: Acute GVHD of the GI tract can result in severe intestinal inflammation, sloughing of the mucosal membrane, severe diarrhea, abdominal pain, nausea, and vomiting. Diarrhea is typically large-volume, and bloody stools can also develop.[1] The volume of diarrhea determines the stage of GI GvHD. This is typically diagnosed via intestinal biopsy, which can be done via endoscopy or colonoscopy.
- Liver symptoms: Acute liver GvHD is measured by the bilirubin level in acute patients.[1] The degree of bilirubin elevation determines the stage of liver GvHD. This can be diagnosed via liver biopsy.
- Skin symptoms: This results in a diffuse maculopapular rash, sometimes in a lacy pattern. This can be diagnosed via skin biopsy.
- Pulmonary symptoms: Symptoms include shortness of breath and cough. Severe pneumonitis can result in respiratory failure requiring intubation.
Acute GVHD is staged as follows: overall grade (skin-liver-gut) with each organ staged individually from a low of 1 to a high of 4. Patients with grade IV GVHD usually have a poor prognosis. If the GVHD is severe and requires intense immunosuppression involving steroids and additional agents to get under control, the patient may develop severe infections as a result of the immunosuppression and may die of infection.
References
- ↑ 1.0 1.1 McDonald GB (2016). "How I treat acute graft-versus-host disease of the gastrointestinal tract and the liver". Blood. 127 (12): 1544–50. doi:10.1182/blood-2015-10-612747. PMC 4807421. PMID 26729898.