Graft-versus-host disease

Abstract

Key Features: Graft versus host disease (GVHD) is induced by donor immunocompetent T lymphocytes transferred into allogeneic hosts incapable of rejecting them. It is a consequence of the interactions between antigen-presenting cells (of both recipient and donor origin) and mature T-lymphocytes of the donor. GVHD is one of the major obstacles that have to be overcome in an otherwise curative transplant procedure and constitutes a major cause of transplant-related morbidity and mortality. The underlying trigger for this condition is the transfer of cells in an artificial setting e.g., peripheral blood stem cell transplantation, bone marrow transplantation, cord blood transplantation, and infrequently, transfusion of unirradiated blood products (rarely, maternofetal lymphocyte engraftment) and solid organ transplantation. There are two major forms of GVHD-acute and chronic. The distinction between these forms is historically related to the time of first occurrence (see Table 7.4.1) Both acute and chronic GVHD are systemic diseases: the skin and also liver and gastrointestinal tract are the most frequently involved organs. The mainstay for the therapy of GVHD is systemic immunosuppressive therapy. © 2010 Springer-Verlag Berlin Heidelberg.