acute graft versus host disease


Also found in: Acronyms.

acute graft versus host disease

A distinctive syndrome of dermatitis, hepatitis, and enteritis developing within 100 days of allogeneic haematopoietic (stem) cell transplantation. Acute GVHD occurs in up to 2/3 of HLA-identical siblings and is increasingly common as HLA mismatching increases, and occurs in 80% of marrow recipients.
 
Clinical findings
• Hyperacute GVHD—fever, generalised erythroderma, desquamation with 2 weeks of transplantation.
• Acute GVHD—pruritic or painful rash, elevated liver enzymes with cholestatic jaundice; GI tract involvement is associated with diarrhoea, bleeding, painful bloating, and ileus.

Complications
Acute GVHD carries an increased risk of pneumonia and sterile effusions, hemorrhagic cystitis, thrombocytopenia, and anaemia.
 
Diagnosis
Lab—autoimmune cytopaenias, increased alkaline phosphatase, cholestasis, hypoalbuminaemia due to GVHD-associated leakage of protein into the gut, negative nitrogen balance, electrolyte imbalance due to diarrhoea.

Management
Primary prophylaxis with cyclosporin A (CSA), methotrexate, antithymocyte globulin (ATG). If Acute GVHD develops, corticosteroids, increase dose of CSA, add tacrolimus, ATG, and various monoclonal antibodies—none of which have proven clearly superior.
References in periodicals archive ?
Without ATIR(TM) treatment this would not be possible because of the high risk of acute Graft versus Host Disease with mismatched donor immune cells.
Professor Andrea Velardi says: "So far, we have treated 25 blood cancer patients who have received bone marrow from mismatched donors, including donor immune cells that are selectively depleted of cells causing acute Graft versus Host Disease using the ATIR(TM) process.
AMSTERDAM, September 22 /PRNewswire/ -- Kiadis Pharma announced today that its lead product ATIR(TM) has been granted orphan drug designation (ODD) by the European Medicines Agency (EMEA) for the prevention of acute Graft versus Host Disease (GvHD) following an allogeneic bone marrow transplantation.
The risk of developing grade II-IV acute graft versus host disease (GVHD) increased from 38% in the children receiving standard cyclosporine doses to 57% in those given the lower dose of the drug.
Mielke selective allodepletion with ATIR(TM) carries significant potential for improving the outcome of mismatched (haploidentical ) transplants by allowing early immune reconstitution with less severe or no acute Graft versus Host Disease (GvHD).
No patient has developed lethal acute Graft versus Host Disease, the major complication that prohibits the use of this treatment without ATIR.
PDL, the "Company") (Nasdaq: PDLI) announced today the presentation of a Phase I clinical trial using its Nuvion(TM) (SMART(TM) Anti-CD3 Antibody) in the treatment of steroid-resistant acute graft versus host disease (GvHD), a potentially fatal complication of bone marrow transplantation.
T10B9 has been evaluated in clinical trials for the treatment of graft rejection episodes in heart, liver and kidney transplant recipients and for the prevention of acute graft versus host disease following bone marrow transplantation.

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