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References

Graft-versus-Host disease (GVHD)

Common manifestations of GVHD are rashes, diarr-hea and pneumonitis.

Graft-versus-host disease is a widespread inflammatory disease that results of an immune reaction. GVHD is caused by donor T cells (transplanted with the graft) that recognize the patient as foreign and attack the histoincompatible tissues. Donor T cells recognize host's tissues expressing cell surface molecules that differs between members of the same species and act as transplantation barriers.

Common manifestations of GVHD are rashes, diarrhea and pneumonitis. The immune system, skin, gut, liver and intestinal tract are the main targets of GVHD. By contrast, "immunologically privileged" sites such as the eye, testes, and brain that are also excluded from normal immune reactions are spared. GVHD can be very severe and even fatal if not treated with immunosuppression and is a major cause of transplant-related mortality. The incidence and severity of GVDH varies with the most severe forms when the patient and the donor are HLA-mismatched.

GVHD may occur in acute or chronic form.

Requirements for the onset of GVHD

GVHD was observed for the first time in 1966 after infusion of spleen cells into irradiated mice. At that time, Billingham defined 3 requirements for GVHD to occur. These 3 requirements are present in HSCT. Immunocompetent cells are co-transfused with the graft and the patient who is not genetically identical to the donor has been conditioned so that he cannot reject (destroy) the donor cells.

GVL is the beneficial effect of GVHD

The clinical manifestations of GVHD are the results of the attack of donor T cells on tissues as skin, liver and intestine. The donor cells also attack the hematopoietic cells of the patient. The destruction of the last hematopoietic cells of the patient however is extremely beneficial because it also destroys the residual leukemic cells. In fact, this graft-versus-leukemia effect or GVL is one of the main reasons why HSCT is able to cure leukemia so effectively. Read more...