Graft-versus-host disease

Causes and Risks:
Bone marrow transplants are done when a person has certain types of leukemia or the bone marrow has been invaded by other types of malignancy . In the transplant, bone marrow is destroyed by drugs, radiation or both and is replaced with "compatible" marrow from a donor. While marrow destruction kills the cancer , it also suppresses the persons immune system, thus allowing the new donor marrow to implant without being destroyed by the recipient's immune system.

Graft-versus-host disease occurs when the new donor marrow makes antibodies against the host (person who received the marrow) and tries to destroy the host as if it were a disease or foreign material.

Varying degrees of graft-versus-host disease are viewed as an expected complication of bone marrow transplantation since tissue typing can find close but not perfect tissue matches between donor and recipient (see Histocompatibility antigens ). Only identical twins have identical tissue types.

Prevention:
ABO (blood group) and HLA (tissue antigen ) typing before transplantation ensures a close antigenic match. Whenever possible, compatible family donors can further decrease the risk.

Symptoms:
Acute :

Note: symptoms begin within 2 weeks after transplantation.

Chronic :

Note: Symptoms occur after 3 months and resemble autoimmune diseases (in which the donor graft makes antibodies against the body tissues) such as lupus .

Signs and Tests:
Acute :

Chronic :



Treatment:
Treatment consists of suppressing the immune response , but doing so without damaging the new marrow. Corticosteroids, antithymocyte globulins and cyclosporine (A) drugs are used. Immune suppressants often used to treat cancer are also carefully used in decreased dosages to suppress or prevent graft-versus-host disease.

These include:

  • antithymocyte globulin
  • cyclosporine
  • corticosteroids (prednisone)
  • cyclophosphamide
  • methotrexate



Prognosis:
The outcome varies. Sometimes treatment of the condition can lead to severe complications.

Complications:



Call Your Healthcare Provider:
As a rule, people with bone marrow grafts are very closely monitored. However, if any of the above symptoms appear, call your health care provider immediately.


Graft vs. Host disease has many manifestations including skin rashes and hardening of the skin surface, shown here on the back. Graft vs. Host disease can occur after a bone marrow transplant, if the donated bone marrow cells begin to reject the body into which they were implanted.



The horizontal lines in the nails are called Beau's lines. Beau's lines may develop after any major metabolic condition. They may appear following chemotherapy or, as in this case, as a result of Graft vs. Host disease.