Graft-Versus-Host Disease (GVHD): overview

At least 60 thousand hematopoietic stem cell transplants are performed annually in the world. The outcome of the operation is largely determined by the likelihood and severity of the graft versus host reaction (disease). White blood cells of the donor’s immune system that remain within the donor tissue (graft) recognize the recipient (host) as foreign (dependent). White blood cells present in the transplanted tissue then attack the cells of the recipient’s body, resulting in disease. This should not be confused with transplant rejection, which occurs when the transplant recipient’s immune system rejects the transplanted tissue; GvHD occurs when the white blood cells of the donor’s immune system are rejected by the recipient.

The basic principle (alloimmunity) is the same, but the details and, of course, may differ. GvHD can also occur after a blood transfusion if the blood products used have not been irradiated or processed with an approved pathogen suppression system.

Types of reactions

Specialists identify the following types of pathology: 

• acute, which appears in the first 100 days after transplantation; 
• chronic, which develops at a later date. Severe forms of the acute phase of the disease are life-threatening; chronic rather rarely leads to the death of the patient, but worsens the quality of life and can lead to disability.

Treatment

Specialists of the Israeli clinic Tel Aviv Medical Clinic use innovative approaches in the treatment of blood cancer. With the help of the latest equipment, it is possible to identify pathology at the initial stage and successfully cure it. Our qualified doctors use a comprehensive approach to cancer treatment, which includes chemotherapy, surgery, and drug treatment.

The following drugs are often used to treat the disease: in the steroid-refractory phase, antithymocyte globulin, extracorporeal photopheresis, monoclonal antibodies to interleukins or their receptors, methotrexate, cyclosporin, tacrolimus, sirolimus, anti-thymocyte globulin, etc. are used. Also prescribed is mycophenolate mofetil, an ester of mycophenolic acid, which blocks the proliferation of T and B lymphocytes. It is believed that in the patient’s refractory to corticosteroids, the use of mycophenolate mofetil alone or in combination with cyclosporine, tacrolimus is justified.

The doctors of our clinic believe that the presence of this reaction means that the donor’s lymphocytes act on the recipient’s body, and therefore on the remaining tumor cells. This effect, which in some cases reduces the risk of disease recurrence, is called graft versus tumor.