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Difference between revisions of "Graft-versus-host disease"
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Graft-versus-host disease (view source)
Revision as of 04:52, 18 January 2011
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===General=== | ===General=== | ||
*Complication of hematopoietic stem cell transplantation, i.e. bone marrow transplantation (BMT). | *Complication of hematopoietic stem cell transplantation, i.e. bone marrow transplantation (BMT). | ||
**Affects skin, liver (bile ducts), gastrointestinal tract.<ref name=pmid15792120>{{cite journal |author=Niino D, Nakashima M, Kondo H, ''et al.'' |title=Correlation of donor-derived keratinocytes and severity of graft-versus-host disease (GVHD) in epidermis |journal=Pathol. Res. Pract. |volume=200 |issue=11-12 |pages=775–81 |year=2005 |pmid=15792120 |doi= |url=}</ref><ref>{{cite journal |author=van Dijk AM, Kessler FL, Verdonck LF, ''et al.'' |title=Primary human keratinocytes as targets in predicting acute graft-versus-host disease following HLA-identical bone marrow transplantation |journal=Br. J. Haematol. |volume=111 |issue=3 |pages=791–6 |year=2000 |month=December |pmid=11122139 |doi= |url=}}</ref> | |||
*The histology of GVHD in the intestine is the same as rejection in bowel transplantation.<ref>GT. 14 January 2011.</ref> | *The histology of GVHD in the intestine is the same as rejection in bowel transplantation.<ref>GT. 14 January 2011.</ref> | ||
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*May present as diarrhea. | *May present as diarrhea. | ||
*Main DDx (clinical): infection. | *Main DDx (clinical): infection. | ||
===Microscopic (skin)=== | |||
Features:<ref name=stanford>{{cite web |url=http://surgpathcriteria.stanford.edu/transplant/skinacutegvhd/printable.html |title=Acute Graft versus Host Disease of the Skin |last1= |first1= |last2= |first2= |date= |work= |publisher= |accessdate=January 17, 2011}}</ref> | |||
#Keratinocyte apoptosis. | |||
#Epidermotropic lymphocytic infiltrate = lymphocytes in the epidermis. | |||
#Vacuolar degeneration of basal and suprabasal cells in the epidermis. | |||
====Grading<ref name=stanford/>==== | |||
*Grade I: Only vacuolar changes, no apoptosis; not treated. | |||
*Grade II: Only scattered apoptotic cells. | |||
*Grade III: Focal separation/cleft formation at the dermal-epidermal junction. | |||
*Grade IV: Extensive necrosis with degeneration of epidermis. | |||
Notes: | |||
*Same scheme applies to esophagus... it has the same structure. | |||
*Originally described in NEJM.<ref name=pmid235092>{{cite journal |author=Thomas ED, Storb R, Clift RA, ''et al.'' |title=Bone-marrow transplantation (second of two parts) |journal=N. Engl. J. Med. |volume=292 |issue=17 |pages=895–902 |year=1975 |month=April |pmid=235092 |doi=10.1056/NEJM197504242921706 |url=}}</ref> | |||
===Microscopic (intestine)=== | ===Microscopic (intestine)=== | ||