The skin is given a stage based on the amount of body surface area involved. Doctors classify the severity of acute GVHD according to the number of organs involved and the degree to which they are affected.Įach organ is staged individually, with each stage ranging between 1 (mildest) to 4 (most severe). Patients with signs and symptoms of acute GVHD may need to have tests to confirm the diagnosis and rule out other conditions that may mimic acute GVHD, such as drug reactions and infections.Īcute GVHD may be mild, moderate or severe. This is the body’s response to the immune system’s attack on organs. Low blood counts are not necessarily classic signs of acute GVHD, but it is extremely common for patients with GVHD to develop low blood counts. Some patients develop liver failure, with symptoms of bleeding, confusion or ascites (excess fluid in the abdomen).Acute liver GVHD can appear as jaundice (yellowing of the skin or eyes) from liver damage and inability to excrete a substance called bilirubin (bilirubin is produced when the liver breaks down old red blood cells).It can only be identified by blood tests that show higher than normal liver enzymes, indicating damage to the liver. Acute GVHD of the liver most commonly has no symptoms.Diarrhea can be as severe as several liters of stool each day. The most classic symptom of GVHD of the GI tract is diarrhea, caused by inflammation of the colon.More severe rash may include blistering or peeling skin.Mild rash may be slightly sore or itchy and look like a minor sunburn.Rash may spread to cover the entire body.Rash often starts as a faint redness that may appear anywhere, including the palms of the hands and the soles of the feet.Rash is the most common symptom of GVHD of the skin. Early detection and treatment may help limit the severity of GVHD. Call your transplant team immediately if you have any of these symptoms. Patients must be aware of the symptoms of acute GVHD. Some may be mild, and some can be severe and even life-threatening. Signs and symptoms of acute GVHD most often affect the skin, gastrointestinal (GI) tract or liver. Receiving total body irradiation as part of the conditioning regimen.Female donor for male recipient y Intensity of the transplant conditioning regimen.Unrelated donor-receiving stem cells from an unrelated donor even if the donor is a perfect HLA match.HLA mismatch-receiving stem cells from a related donor who is not a perfect HLA match.The following risk factors are usually associated with an increased change of moderate to severe acute GVHD: Somewhere between 30 to 70 percent of transplant recipients develop acute GVHD. It can affect the skin, the liver and the gastrointestinal (GI) tract (stomach, intestines and colon). Acute GVHDĪcute GVHD usually develops within the first 100 days after transplantation, but it can occur later. That is why it is important for the donor’s stem cells to have HLA markers that are as similar to the patient’s as possible-to prevent the donor’s cells from attacking the patient’s cells, leading to GVHD. If they find cells with a different pattern of markers, they will attack and kill those cells. These white blood cells know which pattern of HLA markers is normal for a person’s body. They tell white blood cells in the immune system which cells belong in the body and which ones do not. HLA markers play an important role in the body’s immune response to foreign substances such as bacteria and viruses. Except for identical twins, everyone has different HLA markers. There are many HLA markers, and different people have different patterns of markers. Human leukocyte antigen (HLA) typing, also called “tissue typing,” is a test done to identify proteins called HLAs found on the surface of most cells in the body. Importance of Human Leukocyte Antigen (HLA) Typingīefore an allogenic stem cell transplant, the patient and the potential donor are tested to see if the donor’s stem cells are a good match for the patient. Patients may develop one type, both types, or neither type. GVHD occurs when the donor stem cells (“the graft”) attack healthy cells in the patient (“the host”), causing the condition “graft-versus-host disease” or GVHD.There are two main categories of GVHD:Įach type affects different organs and tissues and has different signs and symptoms. Then they are replaced with healthy stem cells from a donor. In this treatment, a patient’s own damaged or diseased blood-forming stem cells are destroyed. Graft-versus-host disease (GVHD) is a potentially serious complication of allogeneic stem cell transplantation and reduced-intensity allogeneic stem cell transplantation.
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