Graft-versus-host disease occurs after the administration of foreign immunologically competent cells to an individual who is immunologically compromised. It is a clinical syndrome characterized by cutaneous changes, gastrointestinal dysfunction and liver dysfunction. Cutaneous graft-versus-host reaction is usually the earliest and certainly the most common form of the disease. The diagnosis of graft-versus-host disease is a complex clinicopathologic skill requiring considerable experience. There as yet appears to be no pathognomonic single clinical or histologic feature in the acute phase. In this review article, the definition, immunological aspects and. clinical features of graft-versus-host disease, diagnostic criteria of acute cutaneous graft-versus-host reaction and graft-versus-tumor effect are discussed.
Diagnosis ; Graft vs Host Disease ; Liver Diseases

Chronic graft-versus-host disease (cGVHD) continues to be a major complication in long-term survivors after allogeneic hematopoietic stem cell transplantation and is the principal cause of morbidity and non-relapse mortality. With the new approaches in the immune mechanisms of cGVHD, the diagnosis, prophylaxis and treatment of cGVHD are involved. This review summarises the current progress of research on cGVHD.
Chronic Disease ; Female ; Graft vs Host Disease ; diagnosis ; etiology ; therapy ; Humans ; Male ; Prognosis ; Risk Factors

Adult ; Female ; Graft vs Host Disease ; diagnosis ; Hepatitis, Autoimmune ; diagnosis ; Humans

BACKGROUND: Chronic graft-versus-host disease(GVHD) is a major cause of morbidity and mortality in long-term survivors of bone marrow transplantation, an increasingly used therapeutic option for hematological disorders. Cutaneous manifestations are frequently the presenting feature; therefore, the dermatologist needs to be aware of the wide spectrum of chronic cutaneous GVHD, enabling early diagnosis and management. OBJECTIVE: We investigated the clinical and histological features of chronic cutaneous GVHD in recipients receiving allogenic BMT. METHODS: On the basis of the patients' charts, photographs and biopsy specimens, we investigated the occurring interval, clinical manifestations and histological characteristics of chronic cutaneous GVHD in 37 patients from January 1, 1996 through December 31, 2000. RESULTS AND CONCLUSION: 1. The chronic cutaneous GVHD was preceded by the acute form of GVHD in 56.7% of patients, and occurred as an extension(18.9%) of acute GVHD, after a disease-free interval(37.8%), or with no precedent(43.2%). The disease usually developed at a mean 251days after transplant. 2. The chronic cutaneous GVHD mainly presented as maculopapular(37.8%), lichenoid(37.8%), or sclerodermoid(13.5%) patterns. 3. Histologically, 35.1% of biopsy specimens showed characteristic acute GVHR-like change, 40.5% showed lichen planus-like, and 13.5% was scleroderma-like histology. Lichen planus-like feature mixed with scleroderma-like was 2.7%, and 8.1 % was non-specific. 4. Appearing after day 100, the acute GVHD other than chronic GVHD was detected in some cases, and the lichenoid rash of chronic GVHD in one case was observed as early as day 60. 6. Our opinions are that the time of occurrence is not a reliable parameter for the clinical picture of GVHD and histologic parameters do not absolutely separate between acute and chronic GVHD as defined by days after BMT. 7. Mortality rate was 21 % in our cases.
Biopsy ; Bone Marrow Transplantation ; Early Diagnosis ; Exanthema ; Graft vs Host Disease* ; Humans ; Lichens ; Mortality ; Survivors ; Transplants*

Graft-versus-host disease can develop in immunosuppressed individuals who receive blood product transfusions that contain imrnunocompetent lymphocytes. We report a case of transfusion-associated graft-versus-host disease(TA-GVHD) that developed in a patient with acute lymphocytic leukemia who were undergoing therapy. The groups at risk for development of TA-GVHD, the clinical presentation and course, and methods of diagnosis are summarized. Prevention of TA-CVHD is possible by irradiation of blood products given to patients at risk, but problems remain in determining the groups that warrant such measures. We should be aware of the risk of developing TA-GVHD after routine blood transfusion, especially in areas where the population's HLA types are rather homogeneous.
Blood Transfusion ; Diagnosis ; Graft vs Host Disease ; Humans ; Leukemia* ; Lymphocytes ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Transplants*

Graft vs Host Disease ; diagnosis ; therapy ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Postoperative Complications ; diagnosis ; therapy ; Transplantation Conditioning

Chemotherapy-induced acral erythema (CIAE) is a toxic reaction to a number of different chemotherapeutic agents, and causes symmetrical, well-demarcated, painful erythema on the palms and soles which is self-limiting. CIAE with bullous reaction in relation to methotrexate has been reported, but it is more commonly associated with cytosine arabinoside. The differential diagnosis of this condition from more serious conditions such as graft-vs-host disease or toxic epidermal necrolysis is essential. In this paper, we report the case of a 65-year-old man who developed bullous acral erythema after the administration of high-dose methotrexate for the treatment of Non-Hodgkin's lymphoma.
Aged ; Cytarabine ; Diagnosis, Differential ; Erythema* ; Graft vs Host Disease ; Hand-Foot Syndrome ; Humans ; Lymphoma, Non-Hodgkin ; Methotrexate ; Stevens-Johnson Syndrome

OBJECTIVETo assess the value of short tandem repeat (STR) analysis with fluorescence labeling polymerase chain reaction (PCR) in evaluating the status of engraftment and predicting the occurrence of graft-versus-host disease (GVHD) following orthotopic liver transplantation.

METHODSThe method of STR analysis with fluorescence labeling PCR was established. DNA was extracted by monoclonal magnetic beads from the peripheral blood nucleated cells of 23 recipients and labeled with 4 fluorescence dyes before and at 7 days after orthotopic liver transplantation.

RESULTSIn the 23 patients studied, 5 patients showed mixed chimeras after orthotopic liver transplantation. Two of the 5 patients with mixed chimeras developed GVHD and died. The other 18 patients did not show mixed chimeras, and only one of them developed GVHD. The incidence of GVHD was significantly different between the patients with and without mixed chimeras (40% vs 5.6%, P<0.05).

CONCLUSIONPCR-STR analysis after orthotopic liver transplantation can be indicative of engraftment and help to predict the occurrence of GVHD following orthotopic liver transplantation.

Adult ; Female ; Graft vs Host Disease ; diagnosis ; Humans ; Liver Transplantation ; Male ; Microsatellite Repeats ; Middle Aged ; Polymerase Chain Reaction ; methods

OBJECTIVETo observe the relationship between variation of IL-2, IL-4, IL-18 and IP10 mRNA expressions in peripheral blood and the occurrence of acute graft-versus-host disease (aGVHD), and investigate whether some cytokines combined expression profiles could improve the diagnostic accuracy of aGVHD.

METHODSA total of 58 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) were enrolled for the study. Peripheral blood samples were collected at different time points after transplantation. The mRNA expression levels of 4 kinds of cytokines (IL-2, IL-4, IL-18, IP10) were measured by real-time quantitative PCR (RQ-PCR). The relationship between mRNA expression level and the occurrence of aGVHD was analyzed with clinical features.

RESULTSThe expression levels of IL-2 and IL-18 at the onset of aGVHD were much higher than those after engraftment, being 2.69-fold and 3.12-fold increase, respectively (P = 0.000 & P = 0.000). The expressions of IL-2 and IL-18 mRNAs were slightly increased in patients with infection, but not statistically significant (P = 0.208 & P = 0.123). There was a slight but not statistically significant decrease of IL-4 and IP10 mRNA expressions at the onset of aGVHD (P = 0.230 & P = 0.325). Either IL-2 or IL-18 expression level could diagnose aGVHD as an independent factor (P = 0.000 & P = 0.000). The multivariate logistic regression analysis showed that the main factors related to aGVHD were IL-2, IL-18 and IL-4 (β = 1.13, P = 0.068 & β = 1.339, P = 0.047 & β = -0.600, P = 0.008 respectively). A composite panel of these three cytokines produced a better model for the diagnosis of aGVHD (AUC: 0.862, 95%CI: 0.768 - 0.957, P = 0.000), and the sensitivity and specificity were 75.0% & 83.3% respectively.

CONCLUSIONThe diagnosis of aGVHD can be optimized with a composite cytokines panel.

Cytokines ; blood ; Graft vs Host Disease ; diagnosis ; Hematopoietic Stem Cell Transplantation ; Humans ; Interleukin-18 ; blood ; RNA, Messenger

Recent studies indicate that patients with chronic graft-versus-host disease (GVHD) are not expected to show positivity for anti-mitochondrial antibody (AMA), which is a specific disease marker for primary biliary cirrhosis (PBC). A differential diagnosis between PBC and hepatic involvement of GVHD based on clinical manifestations and pathologic study is difficult because both diseases show similar results. Therefore, the presence of AMA may be important for distinguishing each disease. Here, we report a case of hepatic involvement of chronic GVHD with positive AMA, in which the pathologic findings and initial presentation of clinical findings were compatible with both PBC and chronic GVHD.
Antibodies ; Diagnosis, Differential ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Liver Cirrhosis, Biliary