Acute and Chronic Graft Vs Host Dx

Question 1

Chronic graft vs host dx happens when

Answer 1

transplanted non identical donor immune cells (T lymphocytes) recognize transplant recipient cells (host) as foreign and initiate an immune reaction

Question 2

acute graft vs host dx happens when

Answer 2

happens within 100 days of hematopoietic cell transplantation median time is 19 days after stem cell transplant Chronic GVHD happens anytime after 100 days

Question 3

acute graft vs host dx process involves

Answer 3

strong inflammatory components

Chronic GVHD has more autoimmune and fibrotic features

Question 4

acute graft vs host dx presentation

Answer 4

painful maculopapular rash that progresses to toxic epidermal necrolysis.

abdominal pain,

diarrhea,

elevated LFTs (bilirubin, alkaline phosphatase)

Question 5

Risk factors for acute graft vs host dx

Answer 5

human leukocyte antigen mismatch unrelated donor

gender disparity (female to male donor)

lack of prophylactic GVHD regimen (MTX and cyclosporine)

Question 6

Chronic graft vs host dx happens when:

Answer 6

occurs anytime after 100 days and most often happens at 201 days after stem cell transplant

Question 7

risk factors for chronic graft vs host dx

Answer 7

older age of donor recipient

prior acute GVHD

seropositive CMV in either donor or recipient

Question 8

chronic graft vs host dx presentation

Answer 8

get a skin rash that resembles lichen planus (purple, pruritic, polygonal papules) on extremities can see scleroderma in areas of hypo and hyperpigmentation (“salt and pepper”) pattern can see elevated LFTs, bilirubin, alkaline phosphatase and see dry oral mucosa with ulcerations, dry eyes with possible cataracts, bronchiolitis obliterans, eosphageal webs and esophageal strictures and fasciitis and joint strictures

Question 9

Diagnosis of graft vs host disease

Answer 9

skin or GI biopsy

Question 10

treatment of graft vs hose dx is

Answer 10

steroids for acute GVHD localized therapy with topical steroids for skin involvement and cyclosporine eye drops is preferred for limited chronic GVHD. See extensive chronic GVHD requires systemic steroids with cyclosporine or tacrolimus.

Question 11

Treatment of CHRONIC graft versus host disease

Answer 11

one or two organ system involvement with mild systems can use focused therapy -

oral ulceration - viscous lidocaine

cutaneous disease can use topical corticosteroids, psoralen ultraviolet radiatio nor topical calcineurin inhibitors

Involvement of 3 or more organs systems generally requires systemic therapy for which prednisone is 1st line treatment based on expert opinion.

Second line treatment is additional calcineurin inhibitor