Graft-versus-host disease

Graft-versus-host disease occurs when immunologically competent cells in the graft target antigens on cells in the recipient. It is generally a disease of T cell activity, and is a potential complication of any transplantation.

• is a complication that often occurs after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in up to 50% of cases, where donor T- and B cells derived from the graft recognize and attack host antigens (1)

The skin, liver, and gastrointestinal system are primarily affected. For unknown reasons, organs such as the kidney are often spared. Acute and chronic forms are recognised. The condition may be fatal especially if the recipient is immunologically impaired. Chronic disease is more likely in older patients.

A graft-versus-tumour effect is recognised and is associated with a more favourable outcome. Note however that it will be lost in grafts from identical twins.

The standard first-line chronic graft-versus-host disease (cGVHD) therapy is glucocorticoids (GCs) (2)

Reference:

• Saidu NEB, Bonini C, Dickinson A, Grce M, Inngjerdingen M, Koehl U, Toubert A, Zeiser R, Galimberti S. New Approaches for the Treatment of Chronic Graft-Versus-Host Disease: Current Status and Future Directions. Front Immunol. 2020 Oct 9;11:578314.
• Zeiser R. Novel Approaches to the Treatment of Chronic Graft-Versus-Host Disease. J Clin Oncol. 2023 Feb 17:JCO2202256.