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Graft Versus Host Disease (GHVD) in Critically Ill Oncologic Patients

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Oncologic Critical Care

Abstract

Graft-versus-host-disease (GVHD) is the most common life-threatening complication of allogeneic hematopoietic stem cell transplantation (ASCT). More than 40% of ASCT patients admitted to the intensive care unit (ICU) has GVHD, which has been reported to be associated with worsened ICU outcomes. GVHD commonly involves mucocutaneous tissues, gastrointestinal tract, and liver, manifesting itself in rash, diarrhea, anorexia, and cholestasis. Chronic GVHD may also involve lungs directly causing bronchiolitis obliterans which may complicate mechanical ventilation. GVHD prophylaxis improves survival in ASCT patients. Calcineurin inhibitors are the backbone of GVHD prophylaxis and are frequently combined with methotrexate, mycophenolate mofetil, or sirolimus. While corticosteroids are used for the first-line treatment of GVHD, many options exist for steroid-refractory GVHD. Almost all GVHD agents suppress the immune system rendering patients susceptible to bacterial, viral, and fungal infections. The novel T cell selection methods used for GVHD prevention may cause less immunosuppression resulting in improved ICU outcomes. In this chapter, we will focus on the impact of GVHD and its treatment on the management of the critical care patient.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Aras Medical Center, Ankara, Turkey

    Ulas Darda Bayraktar

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  1. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Joseph L. Nates

  2. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Kristen J. Price

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Bayraktar, U.D. (2019). Graft Versus Host Disease (GHVD) in Critically Ill Oncologic Patients. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74698-2_31-1

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