Talk:Graft-versus-host disease

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More needs to be added to this entry:

specific target organs and symptoms, current first-line treatments and salvage regimens, and the clinical grading schemes for quantifying GVHD.

  • first line treatment is high dose corticosteroids. Methotrexate + cyclosporin A are common for prophylaxis, of course.
  • salvage is I believe anti-thymocyte globulin or anti-lymphocyte globulin. (Anyone?) Off label use of TNF blockade agents (etanercept, inflixmab) has also been reported. —Preceding unsigned comment added by 140.163.254.157 (talk) 16:13, 6 February 2008 (UTC)


On the mechanism side, specific cytokine profiles, clusters of differentiation markers, effect cell subtypes for each target organ, and so on might be useful.

  • Shlomchik published a nice review in NRI last year. Nat Rev Immunol. 2007 May;7(5):340-52.
  • Ferrara et al's model of GVHD as a three-step process is still fairly common. See Blood Rev. 2003 Dec;17(4):187-94.

The three-step model is:

1) Radiation and chemical damage to the recipient's GI tract as part of the conditioning regimen. This may increase expression of adhesion molecules, costimulatory molecules, and HLA antigens. Crucially, the damage to the intestines permits bacterial endotoxin (lipopolysaccarides) into the blood stream, which triggers a tremendous inflammatory response. This then results in the activation of host dendritic cells (DCs) and are necessary for the initiation of primary and secondary immune responses.

2) Activation of donor T cells.

3) Cellular and inflammatory effector phase: a complex cascade of multiple effectors mediated by cellular effectors such as CTLs and NK cells, and inflammatory effectors such as TNF-α, IL-1 and NO.



The one big area that the page doesn't mention at all is cord blood transplantation. Cords are starting to become an area of great interest (e.g. at the 2007 American Society of Hematology meeting). Benefits seem to be: much reduced incidence of graft-versus-host-disease, often with more tolerance of HLA mismatches.

Also, the risks for GVHD need to be mentioned. Effects of conditioning regimens, "cytokine shielding", HLA matching, etc.

Ah, you obviously know what you're talking about. I've been meaning to improve this article forever, but if you're motivated, please go for it. I'm happy to help however I can. MastCell Talk 00:34, 7 February 2008 (UTC)

[edit] GVHD or GvHD

Both are used here. Preference? GvHD would be mine.io_editor (talk) 19:13, 20 April 2008 (UTC)

Hmm... I like GVHD better :) ...but honestly, it's no big deal either way. MastCell Talk 21:06, 20 April 2008 (UTC)
Very well, either is fine - but then it occurred to me there is AGVHD and CGVHD on the page - somewhere in literature I have seen aGVHD and cGVHD which to me look better (and in themselves are perhaps reason enough to use a big V).io_editor (talk) 21:18, 20 April 2008 (UTC)
By the way, I have caused a small disaster on the HSCT page. I could not understand why the older cites would not "number" in the list. Now Arcadian has deleted them, and I see why - they were simply not referenced into the text. I am out of time for 1-2 days to check how relevant they were; perhaps you were involved with authorship way back when page started, or at least know which ones are relevant (off-hand, perhaps the original HCST or BMT paper was included and is now lost?).io_editor (talk) 21:24, 20 April 2008 (UTC)