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Graft VS. Host DiseaseBy: Kaylee Blankenship

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What is it?

Occurs after a bone marrow orstem cell transplant in which aperson receives bone marrowtissue or cells from a donor(allogeneic)

Common and seriouscomplication

Approximately 20%- 50% ofthose who receive a bone marrowtransplant from a matched related

donor develop GVHD.

The risk is higher than in olderadults and those with unrelatedor mismatched donors.

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PATHOPHYSIOLOGY

Development of GVHD

happens in 3 phases:

Phase 1: activation ofantigen-presenting cells

(APCs)

Phase 2: donor T-cell

activation, proliferation,

differentiation and migration

Phase 3: target tissue

destruction

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Acute vs. chronic

Acute:

Occurs during the first 3 monthsafter the transplant

Affects 3 systems in the body: theskin, liver and GI tract

Mild, serious, or even fatal Onset is swift and requires quick

detection and aggressive treatment

Chronic:

Occurs beyond the first 100 daysafter treatment

Onset is usually more gradual Affects the skin, eyes, mouth, and

liver. May also affect the lungs,heart, GI tract, vaginal lining,muscles, connective tissue, andimmune system

Mild and rarely fatal

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Clinical

manifestations

Acute:

Abdominal pain/cramps

Nausea, vomiting, diarrhea

Jaundice

Skin rash/redness, itching

Chronic:

Dry eyes/vision changes

Dry mouth, white patches

Fatigue, muscle weakness, chronicpain

Joint pain and stiffness

Skin rash and raised, discoloredareas of skin

SOB

Vaginal dryness

Weightloss

Atrophic and

Pigmentary Changes

Keratoconjunctiva sicca

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Diagnosis

Clinical assessment

CBC

Liver function tests(AST, ALT, alkalinephosphatase, totalprotein, and albumin)

Electrolytes

Hepatic and DopplerSonography

Biopsy of affected area

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Treatment

The main treatment is to giveMEDICATIONthat weaken thenew donors immune system thatthe patient received duringtransplant and allow the T cells tofunction normally.

Medications include:immunosuppressants,immunomodulating agent,photoactive agents, andantineoplastics, topical steroids.

The most common

immunosuppressants are: Cyclosporine

Tacrolimus

Prednisone

Mycophenolate Mofetil

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Role of Nurses

Infection: leading cause ofdeath in patients with GVHD.

Care of central venous accessdevice

Skin & wound care (topicalointments)

Diet: gut rest andhyperalimentation. Anorexiais common

Activity as tolerated. Mild-to-moderate for those withchronic GVHD

Emotional Support for patient& family

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Questions

What are some of the first clinical signs and symptoms

of GVHD? (select all that apply)

A. Skin rash

B. Painful urination

C. Jaundice

D. Diarrhea

E. Tachycardia

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Questions

What are some of the first clinical signs and symptoms

of GVHD? (select all that apply)

A. Skin rash

B. Painful urination

C. Jaundice

D. Diarrhea

E. Tachycardia

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Questions

What differentiates acute GVHD from chronic

GVHD? (select all that apply)

A. Pathophysiology

B. Mortality outcomes

C. Onset of symptoms

D. Treatment options

E. Systems that are affected

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Questions

What differentiates acute GVHD from chronic

GVHD? (select all that apply)

A. Pathophysiology

B. Mortality outcomes

C. Onset of symptoms

D. Treatment options

E. Systems that are affected

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Questions

What is the most common treatment for GVHD?

A. Beta-blockers

B. Immunoglobins

C. Immunosuppressants

D. Another transplant

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Questions

What is the most common treatment for GVHD?

A. Beta-blockers

B. Immunoglobins

C. Immunosuppressants

D. Another transplant