Graft VS.

Host Disease
By: Kaylee Blankenship

What is it?
Occurs after a bone marrow or
stem cell transplant in which a
person receives bone marrow
tissue or cells from a donor
(allogeneic)
Common and serious
complication
Approximately 20%- 50% of
those who receive a bone marrow
transplant from a matched related
donor develop GVHD.
The risk is higher than in older
adults and those with unrelated
or mismatched donors.

PATHOPHYSIOLOGY
Development of GVHD
happens in 3 phases:
Phase 1: activation of
antigen-presenting cells
(APCs)
Phase 2: donor T-cell
activation, proliferation,
differentiation and migration
Phase 3: target tissue
destruction

Acute vs. chronic

Acute:

Occurs during the first 3 months

after the transplant
Affects 3 systems in the body: the
skin, liver and GI tract
Mild, serious, or even fatal
Onset is swift and requires quick
detection and aggressive treatment

Chronic:

Occurs beyond the first 100 days

after treatment
Onset is usually more gradual
Affects the skin, eyes, mouth, and
liver. May also affect the lungs,
heart, GI tract, vaginal lining,
muscles, connective tissue, and
immune system
Mild and rarely fatal

Clinical
manifestations
Atrophic and
Pigmentary Changes

Acute:

Abdominal pain/cramps
Nausea, vomiting, diarrhea
Jaundice
Skin rash/redness, itching

Chronic:

Dry eyes/vision changes

Dry mouth, white patches
Fatigue, muscle weakness, chronic
pain
Joint pain and stiffness
Skin rash and raised, discolored
areas of skin
SOB
Vaginal dryness
Weightloss

Keratoconjunctiva sicca

Diagnosis
Clinical assessment
CBC
Liver function tests
(AST, ALT, alkaline
phosphatase, total
protein, and albumin)
Electrolytes
Hepatic and Doppler
Sonography
Biopsy of affected area

Treatment
The main treatment is to give
MEDICATION that weaken the
new donors immune system that
the patient received during
transplant and allow the T cells to
function normally.
Medications include:
immunosuppressants,
immunomodulating agent,
photoactive agents, and
antineoplastics, topical steroids.
The most common
immunosuppressants are:

Cyclosporine
Tacrolimus
Prednisone
Mycophenolate Mofetil

Role of Nurses
Infection: leading cause of
death in patients with GVHD.
Care of central venous access
device
Skin & wound care (topical
ointments)
Diet: gut rest and
hyperalimentation. Anorexia
is common
Activity as tolerated. Mild-tomoderate for those with
chronic GVHD
Emotional Support for patient
& family

Questions
What are some of the first clinical signs and symptoms
of GVHD? (select all that apply)
A. Skin rash
B. Painful urination
C. Jaundice
D. Diarrhea
E. Tachycardia

Questions
What are some of the first clinical signs and symptoms
of GVHD? (select all that apply)
A. Skin rash
B. Painful urination
C. Jaundice
D. Diarrhea
E. Tachycardia

Questions
What differentiates acute GVHD from chronic
GVHD? (select all that apply)
A. Pathophysiology
B. Mortality outcomes
C. Onset of symptoms
D. Treatment options
E. Systems that are affected

Questions
What differentiates acute GVHD from chronic
GVHD? (select all that apply)
A. Pathophysiology
B. Mortality outcomes
C. Onset of symptoms
D. Treatment options
E. Systems that are affected

Questions
What is the most common treatment for GVHD?
A. Beta-blockers
B. Immunoglobins
C. Immunosuppressants
D. Another transplant

Questions
What is the most common treatment for GVHD?
A. Beta-blockers
B. Immunoglobins
C. Immunosuppressants
D. Another transplant