Graft-versus-host disease: pathophysiological and clinical aspects

Area of Science:

• Hematology
• Immunology
• Transplantation Medicine

Background:

• Graft-versus-host disease (GVHD) is a major complication following allogeneic stem cell transplantation.
• It is mediated by donor T lymphocytes attacking recipient tissues, primarily affecting the skin, liver, and gastrointestinal tract.
• Acute GVHD occurs within 100 days in 35-50% of HLA-identical marrow graft recipients, with significant mortality.

Purpose of the Study:

• To summarize the clinical manifestations, incidence, and treatment of acute and chronic graft-versus-host disease.
• To highlight the challenges in preventing and managing GVHD post-transplantation.
• To underscore the high susceptibility to infections in GVHD patients.

Main Methods:

• Review of clinical observations and outcomes in patients undergoing allogeneic marrow transplantation.
• Analysis of incidence rates for acute and chronic GVHD based on time post-transplantation.
• Summary of established and experimental therapeutic approaches for GVHD.

Main Results:

• Acute GVHD affects 35-50% of recipients, with severe cases leading to death in about half of patients, often due to infections.
• Chronic GVHD develops in approximately 45% of long-term survivors, affecting similar organs plus glands and mucous membranes.
• Prevention strategies like isolation and immunosuppression have not been uniformly successful.

Conclusions:

• GVHD remains a significant challenge in allogeneic transplantation, necessitating improved prevention and treatment.
• Established treatments include immunosuppressants like glucocorticosteroids and cyclosporine.
• Patients with GVHD are highly vulnerable to life-threatening bacterial and fungal infections.