Abstract
With a successful marrow transplant, the recipient’s lymphohemopoietic cells are replaced by donor-derived cells. Thus, in contrast to solid organ transplantation where the recipient’s immune system remains in place and attempts at immunosuppression are aimed at preventing the reaction of recipient cells against the transplanted organ, a double-barrier exists in marrow transplantation: transplanted marrow may fail to reconstitute successfully hemopoiesis in the recipient (graft failure due to immunological mechanisms or other factors) or donor lymphocytes may attack recipient tissue. While graft failure has generally been a problem only with HLA incompatible transplants, after marrow T-cell depletion and in some patients sensitized by prior transfusions, GVHD has been a major problem with all allogeneic transplants. We have to assume that in all instances of marrow transplantation an interaction between donor and host cells (graft-vs-host reaction) takes place. However, it was noted in early experiments that syngeneic, i.e., genetically identical marrow, could be transferred to a pretreated recipient without any clinically recognizable adverse reaction. In contrast, when marrow from an allogeneic donor was used a clinical syndrome developed which was originally termed secondary disease. This syndrome, subsequently called GVHD, is manifested mostly in skin, liver, and intestinal tract, although other targets such as the conjunctivae can be involved as well (see Table 15).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Atkinson K, Horowitz MM, Gale RP, Van Bekkum DW, Gluckman E, Good RA, Jacobsen N, Kolb H-J, Rimm AA, Ringdén O, Rozman C, Sobocinski KA, Zwaan FE, Bortin MM (1990) Risk factors for chronic graft-versus-host disease after HLA-identical sibling bone marrow transplantation. Blood 75:2459–2464
Burakoff SJ, Deeg HJ, Ferrara J, Atkinson K (1990) Graft-vs-Host Disease: Immunology, Pathophysiology, and Treatment. Marcel Dekker Inc. New York 1–725
Champlin R, Ho W, Gajewski J, Feig S, Burnison M, Holley G, Greenberg P, Lee K, Schmid I, Giorgi J, Yam P, Petz L, Winston D, Warner N, Reichert T (1990) Selective depletion of CD8+ T lymphocytes for prevention of graft-versus-host disease after allogeneic bone marrow transplantation. Blood 76:418–423
Deeg HJ, Henslee-Downey PJ (1990) Management of acute graft-versus-host disease. Bone Marrow Transplantation 6:1–8
Deeg HJ, Cottier-Fox M (1990) Clinical spectrum and pathophysiology of acute graft-vs.-host disease. In: Burakoff SJ, Deeg HJ, Ferrara J, Atkinson K (eds): Graft-vs-Host Disease: Immunology, Pathophysiology, and Treatment. Marcel Dekker, New York 311–335
Ferrara JLM, Deeg HJ (1991) Graft-versus-host disease. N Engl J Med 324:667–674
Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA, Lerner KG, Thomas ED (1974) Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 18:295–304
Korngold R, Sprent J (1978) Lethal graft-versus-host disease after bone marrow transplantation across minor histocompatibility barriers in mice. Prevention by removing mature T cells from marrow. J Exp Med 148:1687
Lazarus HM, Coccia PF, Herzig RH, Graham-Pole J, Gross S, Strandjord S, Gordon E, Cheung NKV, Warkentin PI, Spitzer TR, Warm SE (1984) Incidence of acute graft-versus-host disease with and without methotrexate prophylaxis in allogeneic bone marrow transplant patients. Blood 64:215
Maraninchi D, Mawas C, Guyotat D, Reiffers J, Vernant JP, Gratecos N, Hirn J, Novakovitch G (1988) Selective depletion of marrow-T cytotoxic lymphocytes (CD8) in the prevention of graft-versus-host disease after allogeneic bone-marrow transplantation. Transplant Int 1:91–94
Martin PJ, Kernan NA (1990) T-cell depletion for the prevention of graft-vs.-host disease. In: Burakoff SJ, Deeg HJ, Ferrara J, Atkinson K (eds), Graft Versus Host Disease: Immunology, Pathophysiology, and Treatment. Marcel Dekker, New York 371–387
Mitsuyasu RT, Champlin RE, Gale RP, Ho WG, Lenarsky C, Winston D, Selch M, Elashoff R, Giorgi JV, Wells J, Terasaki P, Billing R, Feig S (1986) Treatment of donor bone marrow with monoclonal anti-T-cell antibody and complement for the prevention of graft-versus-host disease. Ann Intern Med 105:20–26
Rappeport J, Mihm M, Reinherz E, Lopansri S, Parkman R (1979) Acute graft-versus-host disease in recipients of bone marrow transplants from identical twin donors. The Lancet II, 717
Ringden O, Bäckman L, Tollemar J, Heimdahl A, Aschan J, Gahrton G, Ljungman P, Lönnqvist B, Sundberg B (1989) Long-term follow-up of a randomized trial comparing graft-versus-host disease prophylaxis using cyclosporin or methotrexate in patients with haematological malignancies. Bone Marrow Transplantation 4(Suppl. 2):119
Sale GE, Shulman HM (1984) The pathology of bone marrow transplantation. Masson Publishing, New York
Schattenberg A, De Witte T, Preijers F, Raemaekers J, Muus P, Van Der Lely N, Boezeman J, Wessels J, Van Dijk B, Hoogenhout J, Haanen C (1990) Allogeneic bone marrow transplantation for leukemia with marrow grafts depleted of lymphocytes by counterflow centrifugation. Blood 75:1356–1363
Storb R, Deeg HJ, Pepe M, Doney K, Appelbaum F, Beatty P, Bensinger W, Buckner CD, Clift R, Hansen J, Hill R, Longton G, Anasetti C, Martin P, Loughran TP, Sanders J, Singer J, Stewart P, Sullivan KM, Witherspoon R, Thomas ED (1989) Graft-versus-host disease prevention by methotrexate combined with cyclosporin compared to methotrexate alone in patients given marrow grafts for severe aplastic anaemia: Long-term follow-up of a controlled trial. Br J Haematol 72:567–572
Storb R, Pepe M, Anasetti C, Appelbaum FR, Beatty P, Doney K, Martin P, Stewart P, Sullivan KM, Witherspoon R, Bensinger W, Buckner CD, Clift R, Hansen J, Longton G, Loughran T, Petersen FB, Singer J, Sanders J, Thomas ED (1990) What role for prednisone in prevention of acute graft-versus-host disease in patients undergoing marrow transplants? Blood 76:1037–1045
Vossen JM, Heidt PJ, Guiot HFL, Dooren LJ (1981) Prevention of acute graft versus host disease in clinical bone marrow transplantation: complete versus selective intestingal decontamination. S. Sasaki et al. (eds), Recent Advances in Germfree Research, Tokai University Press 573
Wagner JE, Santos GW, Noga SJ, Rowley SD, Davis J, Vogelsang GB, Farmer ER, Zehnbauer BA, Saral R, Donnenberg AD (1990) Bone marrow graft engineering by counterflow centrifugal elutriation: Results of a phase I–II clinical trial. Blood 75:1370
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 1992 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Deeg, H.J., Klingemann, HG., Phillips, G.L. (1992). Acute Graft-Versus-Host Disease (GVHD). In: A Guide to Bone Marrow Transplantation. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-97374-1_9
Download citation
DOI: https://doi.org/10.1007/978-3-642-97374-1_9
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-97376-5
Online ISBN: 978-3-642-97374-1
eBook Packages: Springer Book Archive