Acute and Chronic Disease Reports
Open Access

Understanding Graft-Versus-Host Disease: A Complex Complication of Transplantation

Eolia Dulery^{* *}Correspondence: Eolia Dulery, Department of Clinical Hematology and Cellular Therapy, University of Saint Antoine, Paris, France, Email:

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Description

A potentially fatal illness known as Graft-Versus-Host Disease (GVHD) can develop after Hematopoietic Stem Cell Transplantation (HSCT). This complex immune-mediated disorder arises when the transplanted donor cells recognize the recipient's tissues as foreign, leading to an immune response that damages multiple organs. In this article, this will explore the causes, risk factors, clinical manifestations, and management strategies of GVHD, shedding light on this challenging post-transplant complication. Following a bone marrow, or stem cell, transplant when a patient gets bone marrow tissue or cells from a donor, GVHD may develop. Allogeneic transplants fall under this category. The newly transplanted cells view the body of the receiver as being alien. When this occurs, the recipient's body is attacked by the cells.

Causes and risk factors

GVHD occurs when donor T cells, present in the transplanted stem cells, recognize the recipient's tissues as foreign and mount an immune attack. The primary risk factor for developing GVHD is the degree of Human Leukocyte Antigen (HLA) mismatch between the donor and recipient. Higher degrees of mismatch increase the likelihood and severity of GVHD. Other factors include the type of transplant (allogeneic vs. autologous), conditioning regimen intensity, age of the recipient and donor, and the presence of certain genetic variants and altered activity of endogenous brain opioids. Taken together, these phenomena appear to explain the central physiopathology of Fibromyalgia (FM).

Acute GVHD

Within the first few months after transplantation, acute GVHD frequently happens. It commonly affects the skin, liver, and gastrointestinal tract. Symptoms may include a characteristic rash, jaundice, diarrhea, abdominal pain, and nausea. Acute GVHD can range from mild to severe, and prompt diagnosis is crucial for effective management. According to the number and degree of organ involvement, acute GVHD is staged. According to the degree, or stage, of involvement in three organs, patients are categorised into one of four categories (I-IV) in this method. Stages for the liver, gastrointestinal tract and skin are determined by the percentage of body surface affected, the degree of bilirubin increase, and the amount of diarrhoea.

Chronic GVHD

Chronic GVHD presents several months after transplantation and can persist for years. It often affects multiple organs, including the skin, lungs, liver, gastrointestinal tract, and musculoskeletal system. The clinical manifestations can vary widely, encompassing skin changes, dry eyes, oral ulcers, joint stiffness, liver dysfunction, and respiratory symptoms. Chronic GVHD can significantly impact the patient's quality of life and requires long-term management.

Diagnosis and management

Diagnosing GVHD involves a combination of clinical evaluation, biopsy of affected organs, and analysis of donorrecipient chimerism. The severity of GVHD is graded based on clinical and laboratory findings. Management strategies aim to suppress the immune response while preserving Graft- Versus-Leukemia (GVL) effects.

Treatment for GVHD involves a stepwise approach that includes immunosuppressive medications, such as corticosteroids, calcineurin inhibitors, and other agents that target specific immune pathways. Supportive care measures, including skin care, nutritional support, and treatment of organ-specific complications, are also vital. For severe cases or when standard treatments fail, novel approaches such as extracorporeal photopheresis and mesenchymal stem cell therapy may be considered.

Conclusion

Graft-versus-host disease is a challenging and potentially lifethreatening complication of hematopoietic stem cell transplantation. Increased understanding of its causes, risk factors, clinical manifestations, and management strategies has improved patient outcomes. Ongoing therapies and advances in immunosuppressive therapies hold promise for further improving the management of this complex condition. Ocular GVHD causes inflammation and infiltration of the lacrimal gland, conjunctiva, and ocular surface by involving both cellmediated and humoral immunity.