Please enable JavaScript.
Coggle requires JavaScript to display documents.
Chronic Graft-versus-Host Disease, Depend on the organs and tissues…
Chronic Graft-versus-Host Disease
Altered Physiology
complication of allogeneic stem cell transplantation and reduced-intensity allogeneic stem cell transplantation
donor's T cells view the patient's healthy cells as foreign, and attack and damage them via cytokine release
T cells recognize self from nonself by the human leukocyte antigens (HLA) marking cells
stem cells from peripheral blood have higher risk of causing cGVHD than those from bone marrow
Clinical Manifestations
SKIN: rash, raised or discolored areas, intolerance to temperature changes, thickening or tightening (restricts joint movement)
LIVER: abdominal swelling, jaundice, abnormal liver function test results
EYES: dry eyes or vision changes
MOUTH: very dry, white patches inside mouth, pain or sensitivity to hot, cold, spicy, mint and acidic foods, difficulty eating, gum disease and tooth decay
PULMONARY: shortness of breath, persistent chronic cough, wheezing
GI TRACT: loss of appetite, difficulty swallowing, pain with swallowing, nausea, vomiting, diarrhea, unexplained weight loss
NEUROMUSCULAR: fatigue, muscle weakness and cramps, pain, joint stiffness
GENITALIA: Females- dryness, itching, ulcerations and scaring, narrowing, pain with intercourse; Males- narrowing or scarring of urethra, itching or scarring of penis and scrotum, irritation
CONNECTIVE TISSUE: decreased range of motion in joints, tightness in joints
NAILS: changes in texture, hard and brittle nails, nail loss
HAIR: loss of hair on head, premature gray hair, loss of body hair
Multi-system Alterations
SKIN: mediated by transforming growth factor-β1, a cytokine that keratinocytes (epidermal skin cells) undergoing apoptosis express on stimulation by interferon-γ (IFNγ); fasciitis, sclerosis, lichen planus
LIVER: elevation of serum aminotransferases
NEUROMUSCULAR: immune-mediated neuropathies, myasthenia gravis and myositis in the PNS and various cerebrovascular complications, demyelination and immune-mediated encephalitis in the CNS
GI TRACT: narrowing, irritation, change of tissues
MOUTH: oral lichen planus
PULMONARY: bronchiolitis obliterans syndrome
Treatment Modalities
Immunosuppressive medicines for many affected organs or severe symptoms
prednisone (alone, with cyclosporine, or with tacrolimus)
ibrutinib, methotrexate, mycophenolate mofetil, sirolimus, extracorporeal photopheresis, low-dose interleukin-2, ruxolitinib
Localized therapy for one or two affected organs
topical steroid ointment, immunosuppressive eye drops
Risk Factors
HLA mismatch or unrelated donor
older patient age or older donor age
female donor for male recipient and number of children female donor has had
stem cell source
prior acute GVHD
Depend on the organs and tissues affected, severity of symptoms and impact diagnosis has on daily life; can take many months to years
most frequently involved: mouth, skin, liver