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BMTCN Review Chapter 5 - Graft-Versus-Host Disease GVHD - correct answer Competent donor t-cells recognize antigens, mount immune response, and and attack recipient organs Classifications of GHVD - correct answer Acute Chronic Hyperacute Overlap Syndrome Acute GVHD - correct answer ...

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  • November 23, 2023
  • 28
  • 2023/2024
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  • bmtcn review chapter 5 graft versus host disease

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BMTCN Review Chapter 5 - Graft-Versus-
Host Disease
GVHD - correct answer Competent donor t-cells recognize antigens, mount immune response, and and attack recipient organs
Classifications of GHVD - correct answer Acute
Chronic
Hyperacute
Overlap Syndrome
Acute GVHD - correct answer Generally occurs within first 100 days or nor meeting chronic criteria
Presents as erythematous, maculopapular rash, nausea, vomiting, anorexia, profuse diarrhea, ileus, or cholestatic liver
Chronic GVHD - correct answer Has manifestations of autoimmune disease and no charaacteristics of acute GVHD
Involves multiple organs (skin, eyes, oral mucosa, ling, GI tract, liver)
Usually diagnosed within the first year
Median onset 4-6 months MOST FREQUENT OCCURRENCE IN FIRST YEAR
Hyperacute GHVD - correct answer Can be fatal
Fever greater than 38.3 C on two occasions or for more than 3 days prior to engraftment with lack of resolution after minimum of 3 days with abx and antifungal agents
rapid development of rash
Hepatic dysfuntion
More than 5 stools per day of mucoid green diarrhea
High dose steroid treatment
Difficult to differentiate with engraftment syndrome
Overlap Syndrome - correct answer Features of acute and chronic appear at the same time
Incidence of GVHD - correct answer Grades 2-4, 20-85%
Risk factors (Acute and Chronic) - correct answer Most important: degree of HLA mismatch
Graft source
Gender mismatch (greatest: parous female donor to male recipient)
Donors over age 40 High dose TBI
Conditioning intensity
Higher CD34+ cell count
Prophylaxis
Unmanipulated graft (t-cell depletion)
Donor transfusion status
Related vs unrelated (best: HLA mathced sibling)
Pathophysiology Phase 1 - correct answer Occurs prior to transplant when preparative regimen may damage host (GI, skin, liver)
Permeable mucosa leads to secretion of inflammatory cytokines
Cytokines upregulate major histocompatibility complexes and minor histocompatibility antigens (host)
Mature T cells (donor) recognize upregulated recipient tissue as foreign and mount an immunologic response
Pathophysiology Phase 2 - correct answer Donor T cell activation
Donor T cells come into contact with minor antigens on recipients cells blood stream
Some donor T cells recognize antigens as foreign and bind them

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