21 - 129 - GRAFT-VS-HOST DISEASE

Question 1

most important risk factor for chronic GVHD

Answer 1

history of acute GVHD

• ther important factors include human leukocyte antigen incompatibility, older age, female donor/male recipient, and peripheral blood stem cell source (vs bone marrow)

Question 2

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Question 5

The most common presentation of acute GVHD begins with

Answer 5

erythematous-dusky macules and papules of the volar and plantar surfaces and ears that may rapidly become a diffuse morbilliform exanthem

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Question 20

These are diagnostic clinical features of chronic GVHD except?

a. poikiloderma
b. lichen planus-like eruption
c. lichen striatus-like eruption
d. morphea-like features
e. none of the above

Answer 20

c. lichen striatus-like eruption

Question 21

hese are major risk factors for the development of GVHD except?

a. Female recipient/male donor
b. Unrelated donor
c. Donor leukocyte infusion
d. Stem cell source

Answer 21

A (female donor/male recipient)

Question 22

These are distinctive clinical features of chronic GVHD except?

a. Depigmentation
b. Papulosquamous lesions
c. Pterygium
d. Scaling
e. None of the above

Answer 22

E

Question 23

Which statement correctly describes the histopathology of acute GVHD?

a. sparse lymphocytic infiltrates
b. sclerosis of upper dermis
c. atrophy of epidermis
d. follicular plugging

Answer 23

A

Question 24

Which stage of GVHD is characterized clinically by lesions in >50% BSA, subepidermal clefting histologically, with bilirubin levels of 6 to 14.9 mg/dL?

A. Stage 1

B. Stage 2

C. Stage 3

D. Stage 4

Answer 24

C

Question 25

Risk factors for chronic GVHD

Answer 25

- history of acute GVHD - most important RF - human leukocyte antigen incompatibility, - older age, - female DONOR/male RECIPIENT, - peripheral blood stem cell source (vs bone marrow)

Question 26

first line in the treatment of moderate to severe chronic GVHD

Answer 26

Systemic steroids

Question 27

in this type of transplantation, the patient’s own Hematopoietic stem cell are returned to the patient following preparative chemotherapy with or without radiation

Answer 27

autologous transplantation

Question 28

transfer of hematopoietic stem cell (HCs) from a related (nonidentical) or unrelated donor to a recipient

Answer 28

Allogeneic HCT (allo-HCT)

Question 29

transfer of HCs between identical twins

Answer 29

Syngeneic transplantation

Question 30

primary cause of non–relapse-related morbidity and mortality in alloHCT, and also rarely occurs following transplantation of solid organs, transfusion of blood products, and autologous transplantation

Answer 30

Graftversus-host disease (GVHD)

Question 31

the single most important predictor of GVHD

Answer 31

degree of human leukocyte antigen (HLA) mismatch between donor and recipient

Question 32

organs most commonly associated with acute GVHD

Answer 32

1. Skin - 81% 2. GI - 54% 3. Liver - 50% Skin involvement is often the first indicator of acute GVHD (81%), followed by GI (54%) and liver disease (50%)

Question 33

What are the 3 proposed basic requirements for GVHD according to Billingham?

Answer 33

(a) immunocompetent transplanted cells, (b) host antigens recognizable by the transplanted cells and lacking in the donor, and (c) a host incapable of mounting an immune response to the transplanted cells

Question 34

The use of particular chemotherapeutic agents such as ____________ may render the differential diagnosis of toxic erythema of chemotherapy more likely.

Answer 34

Cytarabine

Question 35

predisposition to these areas may help distinguish new onset acute GVHD from other morbilliform eruptions,

Answer 35

predisposition for acral and perifollicular sites although these features are not always present.

Question 36

What are the diagnostic clinical features of Chronic GVHD

Answer 36

■ Poikiloderma ■ Lichen sclerosus–like lesions ■ Lichen planus–like eruption ■ Morphea-like lesions ■ Sclerotic features

Question 37

What clinical features are seen in both acute and chronic GVHD

Answer 37

■ Erythema ■ Maculopapular rash ■ Pruritus

Question 38

commonly affected organs in acute GVHD

Answer 38

skin, GI tract, liver typically presenting with skin rash, new-onset elevation of total bilirubin, and/or voluminous diarrhea

Question 39

most frequently affected sites in chronic GVHD

Answer 39

skin and nails, oral mucosa, eyes, liver, lungs, and marrow (usually thrombocytopenia)

Question 40

econd only to skin involvement in frequency in chronic GVHD

Answer 40

Mucosal disease Erythema, lichen planus–like changes with Wickham striae, erosions and ulcerations, and mucoceles are the most common manifestations

Question 41

most commonly affected mucosa in chronic GVHD

Answer 41

buccal mucosa followed by the lips, tongue, and soft palate

Question 42

histopathologic hallmark feature of acute GVHD

Answer 42

presence of necrotic keratinocytes accompanied by a dermal lymphocytic infiltrate (usually sparse) and basal vacuolar interface alteration

Question 43

the primary cause of non–relapse-related morbidity and mortality in **alloHCT**, and also rarely occurs following transplantation of solid organs, transfusion of blood products, and autologous transplantation

Answer 43

Graftversus-host disease (GVHD)

Question 44

major salvage therapy in steroid-refractory chronic GVHD

Answer 44

ECP