Pediatric Graft-Versus-Host Disease (GvHD) and the Pharmacist

Abstract

Graft-versus-host disease (GvHD) is a reaction of donor immune cells against host tissues. It does not occur in autologous transplantation. The activated donor T-cells damage host cells after an inflammatory cascade that begins with the preparative regimen. The acute GvHD is a major obstacle for patients undergoing allo-HSCT. It principally involves the skin, gastrointestinal tract, liver, and thymus. The acute GvHD symptoms are dermatitis (skin rash), cutaneous blisters, crampy abdominal pain with or without diarrhea, persistent nausea and vomiting, and/or hepatitis. These symptoms commonly initiate on the first 100 days after allo-HSCT or later. Formerly, the acute GvHD was defined as occurring within the first 100 days following allo-HSCT and chronic GvHD as occurring after 100 days. Today, with the development of new strategies, such as reduced intensive conditioning, this definition is less clear. The nowadays’ classification includes both late acute GvHD, which occurs after 100 days, and the overlap syndrome, which contains features of both. The acute GvHD diagnosis is clinically done, and the histologic confirmation is important, especially if the symptoms are atypical or involve just the liver or gut [1].