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Evolutions in the Clinical Management of GVHD

  • Cecilia C. S. YeungEmail author
  • H. Joachim Deeg
Chapter

Abstract

Graft-versus-host disease (GVHD) was first described as a transplant-related secondary disease by Van Bekkum and colleagues. This transplant-related disease was then recognized to be dependent upon subsets of donor T lymphocytes. GVHD can occur in a more acute presentation or with delayed or late onset in a chronic form mediated by different T-cell subsets in addition to B cell hyperactivity against the host. The development of acute GVHD (aGVHD) is a major risk factor for subsequent development of chronic GVHD (cGVHD). Therefore, prevention of the acute form will also reduce the frequency of cGVHD. At the time of presentation, the diagnosis of GVHD may not be immediately apparent: biopsies, in particular of the skin and gut, may be helpful in establishing the diagnosis. The involvement of various organs such as the liver or lung can be documented by invasive procedures. Currently, involvement of the bowel, especially when persistant or steroid resistant, and pulmonary involvement are prognostically more severe manifestations of GVHD. This chapter provides guidance for strategies to establish the diagnosis, the extent of the disease, and guidance to the appropriate management.

Keywords

Chronic GVHD Skin Liver Gastrointestinal tract Lungs Tissue biopsies Biomarkers 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of PathologyUniversity of Washington School of MedicineSeattleUSA
  3. 3.Pathology SectionSeattle Cancer Care AllianceSeattleUSA
  4. 4.Department of MedicineUniversity of Washington School of MedicineSeattleUSA
  5. 5.Department of MedicineCarl Carus UniversityDresdenGermany
  6. 6.Miklos Kohary and Natalia Zimonyi Kohary Endowed ChairFred Hutchinson Cancer Research CenterSeattleUSA

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