Acute Graft-versus-Host Disease
With a successful marrow transplant, the recipient’s lymphohemopoietic cells are replaced by donor derived cells. Thus, in contrast to solid organ transplantation where the recipient’s immune system remains in place and attempts at immu-nosuppression are aimed at preventing the reaction of recipient cells against the transplanted organ, the directions in marrow transplantation are basically reversed. Although a marrow transplant can also be rejected (see below), once engraftment has been achieved, the recipient’s body is “invaded” by the donor derived immune system. Consequently, the potential complications are those of a reaction of donor derived cells against recipient tissue and organs. We have to assume that in all instances of marrow transplantation an interaction between donor and host cells (graft-vs-host reaction) takes place. However, it was noted in early experiments that syngeneic, i.e. genetically identical marrow, could be transferred to a pretreated recipient without any clinically recognizable adverse reaction. In contrast, when marrow from an allogeneic donor was used in clinical syndrome developed which was originally termed secondary disease. This syndrome, subsequently called graft-vs-host disease (GVHD), is manifested mostly in skin, liver, and intestinal tract, although other targets such as the conjunctivae can be involved as well (see Table 13).
KeywordsLeukemia Diarrhea Barium Methotrexate Luminal
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