Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- receptor de transplante alogênico de células hematopoéticas (HCT)
- novo episódio de lesões bucais dolorosas
- lesões cutâneas hiperpigmentadas
- exantema maculopapular difuso
- sinais e sintomas genitais
- náuseas, vômitos, dor abdominal, diarreia profusa e anorexia
Outros fatores diagnósticos
- rigidez ou constrição articular
- dia +21 ao dia +25 após o HCT
- olhos secos, arenosos e dolorosos
- icterícia
- hepatomegalia
- esclerodermia
Fatores de risco
- Incompatibilidade do HLA e doador não aparentado
- DECH aguda prévia
- receptor ou doador em idade avançada
- doadora mulher com receptor homem
- doadora mulher que já teve filhos
- tipo e estágio da neoplasia subjacente
- esquema de radiação de condicionamento de alta intensidade
- transplante de células-tronco do sangue periférico
- infusão de linfócitos do doador (ILD)
- profilaxia de DECH ausente ou aquém do ideal
- raça branca ou negra
- soropositivo para o citomegalovírus (CMV)
- esplenectomia
- baixo escore de capacidade funcional
- condição socioeconômica baixa
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Hemograma completo
- eletrólitos séricos
- testes da função hepática
- urinálise
- urocultura
- hemocultura
- coprocultura
- estudos de reação em cadeia da polimerase viral
Investigações a serem consideradas
- tomografia computadorizada (TC) abdominal
- ultrassonografia com Doppler do fígado
- biópsia de tecido (pele, trato gastrointestinal, fígado ou pulmão)
- testes de função pulmonar
- tomografia computadorizada (TC) de alta resolução do tórax
- lavagem broncoalveolar (LBA) e cultura
- ecocardiograma
- esofagografia baritada ou endoscopia digestiva alta
- Tomografia por emissão de pósitrons com fluordesoxiglucose (18F) (FDG-PET)
Novos exames
- biomarcadores séricos
Algoritmo de tratamento
receptor de transplante de células hematopoéticas (HCT)
agudo: grau I
agudo: grau II-IV
crônico
Colaboradores
Autores
Sung Won Choi, MD, MS
Professor
Department of Pediatrics
Division of Pediatric Hematology Oncology/Blood and Marrow Transplantation
University of Michigan
Ann Arbor
MI
Disclosures
SWC is an author of a number of references cited in this topic.
Lyndsey Runaas, MD
Assistant Professor, Hematology and Oncology
Division of Hematology/Oncology
Medical College of Wisconsin
Milwaukee
WI
Disclosures
LR declares that she has no competing interests.
Acknowledgements
Dr Sung Choi and Dr Lyndsey Runaas would like to gratefully acknowledge Dr Pavan Reddy, a previous contributor to this topic.
Disclosures
PR is an author of a number of references cited in this topic.
Peer reviewers
Corey Cutler, MD, MPH, FRCPC
Associate Professor of Medicine
Harvard Medical School
Dana-Farber Cancer Institute
Boston
MA
Disclosures
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
Disclosures
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.
References
Key articles
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.Full text Abstract
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. Abstract
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.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: hematopoietic cell transplantation [internet publication].Full text
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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- Erupção cutânea induzida por radiação ou quimioterapia
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- Prophylaxis and management of graft-versus-host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations
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