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Graft versus host disease

ბოლო მიმოხილვა: 17 Sep 2025
ბოლო განახლება: 09 Apr 2025

შეჯამება

განსაზღვრება

ანამნეზი და გასინჯვა

ძირითადი დიაგნოსტიკური ფაქტორები

  • allogeneic hematopoietic cell transplantation (HCT) recipient
  • human leukocyte antigen (HLA) mismatch and unrelated donor
  • parous female donor
  • female donor with male recipient
  • new-onset painful mouth sores
  • hyperpigmented skin lesions
  • diffuse maculopapular rash
  • genital signs and symptoms
  • nausea, vomiting, abdominal pain, profuse diarrhea, and anorexia
სრული ტექსტი

სხვა დიაგნოსტიკური ფაქტორები

  • joint stiffness or tightness
  • day +21 to day +25 after HCT
  • cyclophosphamide + total body irradiation (Cy/TBI) conditioning regimen
  • peripheral blood stem cell transplant
  • dry, gritty, and painful eyes
  • jaundice
  • hepatomegaly
  • scleroderma
სრული ტექსტი

რისკფაქტორები

  • HLA mismatch and unrelated donor
  • prior acute GVHD
  • recipient or donor in older age group
  • female donor with male recipient
  • parous female donor
  • type and stage of underlying malignant condition
  • high-intensity conditioning radiation regimen
  • peripheral blood stem cell transplant
  • donor lymphocyte infusion (DLI)
  • absent or suboptimal GVHD prophylaxis
  • white or black race
  • cytomegalovirus (CMV) seropositive
  • splenectomy
  • low performance status score
  • low socioeconomic status
სრული ტექსტი

დიაგნოსტიკური კვლევები

1-ად შესაკვეთი გამოკვლევები

  • CBC
  • serum electrolytes
  • liver functions tests
  • urinalysis
  • urine culture
  • blood culture
  • stool culture
  • viral polymerase chain reaction (PCR) studies
სრული ტექსტი

გასათვალისწინებელი კვლევები

  • CT abdomen
  • Doppler ultrasound of the liver
  • tissue biopsy (skin, gastrointestinal [GI] tract, liver, or lung)
  • pulmonary function tests
  • high-resolution CT chest
  • bronchoalveolar lavage (BAL) and culture
  • echocardiogram
  • barium swallow or upper gastrointestinal endoscopy
  • 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan
სრული ტექსტი

ახალი ტესტები

  • serum biomarkers

მკურნალობის ალგორითმი

საწყისი

hematopoietic cell transplantation (HCT) recipient

მწვავე

acute: grade I

acute: grade II-IV

მიმდინარე

chronic

კონტრიბუტორები

ავტორები

Sung Won Choi, MD, MS
Sung Won Choi

Professor

Department of Pediatrics

Division of Pediatric Hematology Oncology/Blood and Marrow Transplantation

University of Michigan

Ann Arbor

MI

გაფრთხილება:

SWC is an author of a number of references cited in this topic.

Lyndsey Runaas, MD
Lyndsey Runaas

Assistant Professor, Hematology and Oncology

Division of Hematology/Oncology

Medical College of Wisconsin

Milwaukee

WI

გაფრთხილება:

LR declares that she has no competing interests.

მადლიერება

Dr Sung Choi and Dr Lyndsey Runaas would like to gratefully acknowledge Dr Pavan Reddy, a previous contributor to this topic.

利益声明

PR is an author of a number of references cited in this topic.

同行评议者

Corey Cutler, MD, MPH, FRCPC

Associate Professor of Medicine

Harvard Medical School

Dana-Farber Cancer Institute

Boston

MA

利益声明

CC declares that he has no competing interests.

Waseem Qasim, BMedSci (Hons), MBBS, MRCP (UK), MRCPCH, PhD

Senior Lecturer

Institute of Child Health

Consultant in Paediatric Immunology & Bone Marrow Transplantation

Great Ormond Street Hospital

London

UK

利益声明

WQ declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant. 2015 Mar;21(3):389-401.e1.全文  摘要

Penack O, Marchetti M, Aljurf M, et al. Prophylaxis and management of graft-versus-host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation. Lancet Haematol. 2024 Feb;11(2):e147-59. 摘要

Dignan FL, Amrolia P, Clark A, et al. Diagnosis and management of chronic graft-versus-host disease. Br J Haematol. 2012 Jul;158(1):46-61.全文  摘要

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation [internet publication].全文

Dignan FL, Clark A, Amrolia P, et al. Diagnosis and management of acute graft-versus-host disease. Br J Haematol. 2012 Jul;158(1):30-45.全文  摘要

Carpenter PA, Kitko CL, Elad S, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group report. Biol Blood Marrow Transplant. 2015 Jul;21(7):1167-87.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Graft versus host disease images
  • 鉴别诊断

    • Drug rash
    • Radiation or chemotherapy-induced rash
    • Bacterial gastroenteritis
    更多 鉴别诊断
  • 指南

    • NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation
    • Prophylaxis and management of graft-versus-host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations
    更多 指南
  • 医学计算器

    The Minnesota Refined Acute GvHD Risk Score

    更多 医学计算器
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