GVHD

Question 1

NIH Classification criteria

Answer 1

Early- until 100 days
chronic- more than 100 days
late onset acute- features of acute but more than 100 days.
overlap- any time. features of both acute and chronic

Question 2

risk factors

Answer 2

HLA disparity
sex disparity
peripheral blood graft
conditioning intensity

Question 3

Clinical menifstation of acute GVHD

Answer 3

Skin- maculupapular rash (near the time of the white blood cell engraftment)
GI- diarrhea
LIver- hyperbiltubinemia

Question 4

Skin involvment degree

Answer 4

Stage 1 – Maculopapular rash <25 percent of body area
Stage 2 – Maculopapular rash 25 to 50 percent of body area
Stage 3 – Generalized erythroderma
Stage 4 – Generalized erythroderma with bullous formation, often with desquamation

Question 5

GI involvment degree

Answer 5

Requires pathologic evaluation of the tissue:

Stage 1 – Diarrhea 500 to 1000 mL/day
Stage 2 – Diarrhea 1000 to 1500 mL/day
Stage 3 – Diarrhea 1500 to 2000 mL/day
Stage 4 – Diarrhea >2000 mL/day or pain or ileus

Question 6

upper GI involvnemt clinical menifestations

Answer 6

Anorexia, dyspepsia, food intolerance, nausea, and vomiting
Mucosistis- usually due to chemotherapy

Responds well to immunosupression.

Question 7

Liver involvment

Answer 7

Requires biopsy
Usually cocomintant G| and skin involvment

Stage 1 – Bilirubin 2 to 3 mg/dL
Stage 2 – Bilirubin 3 to 6 mg/dL
Stage 3 – Bilirubin 6 to 15 mg/dL
Stage 4 – Bilirubin >15 mg/dL

Question 8

Rare menifestations of acute GVHD

Answer 8

Hematologic- cytopenia, hypogammaglobulinemia
Ocular-photophobia, hemorrhagic conjunctivitis, and lagophthalmos
Kidney- nephritis or nephrotic syndrome
Lung- pneumonitis

Question 9

IBMTR grading system

Answer 9

Grade A – Stage 1 skin involvement alone (maculopapular rash over <25 percent of the body) with no liver or gastrointestinal involvement

Grade B – Stage 2 skin involvement; Stage 1 to 2 gut or liver involvement

Grade C – Stage 3 involvement of any organ system (generalized erythroderma; bilirubin 6.1 to 15.0 mg/dL; diarrhea 1500 to 2000 mL/day)

Grade D – Stage 4 involvement of any organ system (generalized erythroderma with bullous formation; bilirubin >15 mg/dL; diarrhea >2000 mL/day or pain or ileus)