Graft versus host disease
Description
- Donor T cells recognise host tissue as foreign after allogeneic HSCT (or, rarely, transfusion)
- Billingham requirements - all three needed:
- Graft contains immunocompetent cells
- Host expresses antigens absent from the donor
- Host cannot reject the graft
Acute vs chronic - classified by features, not by day 100
| Acute | Chronic | |
|---|---|---|
| Target organs | Skin, gut, liver | Multi-system, autoimmune-like |
| Pathology | Apoptosis, epithelial destruction | Fibrosis, sclerosis |
| Typical onset | Around engraftment to day 100 | 3-24 months |
| Categories | Classic; late-onset acute (>day 100) | Classic; overlap syndrome (features of both) |
- *The day-100 rule is obsolete* (NIH consensus) - a patient with new sclerosis at day 60 has chronic GVHD
- Graft-versus-leukaemia is the same biology - abolishing GVHD entirely raises relapse
6 more sections, plus exam facts
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