What Is GVHD?
When the transplant graft’s immune cells identify the host as alien and attack the recipient’s body cells, this results in Graft-versus-host disorder. It is a typical adverse event after the allogeneic hematopoietic stem cell transplant. Based on the timing of onset, a cutoff of 100 days post-transplant GVHD can be classified into below types:
- Acute GVHD: Within the first 100 days post-transplant with typical clinical signs of acute GVHD such as skin rashes, liver dysfunction, and gastrointestinal issues such as diarrhea and abdominal pain
- Chronic GVHD: This can manifest with the typical clinical characteristics of chronic GVHD, such as dry eyes and mouth, joint stiffness, and skin thickening after the first 100 days, and may persist for months or years.
- Persistent or Recurrent or Late-Onset Acute GVHD: Appears with clinical signs of traditional acute GVHD but after 100 days of transplantation.
Factors for GVHD Occurrence and Severity
- Donor-Recipient Factors: Increase in GVHD incidence with unmatched donor transplants, HLA disparity, and sex mismatching
- Origin of Stem Cells: Among the sources that can produce stem cells, the use of umbilical cord blood or bone marrow lowers the GVHD incidence
- Aging: Individuals with pre-existing morbidities and older recipients have a higher risk of developing severe GVHD.
- Immune Modulation Factors: GVHD incidence is lower with triple therapy (cyclosporine, methotrexate (MTX), and prednisone as compared with double therapy (cyclosporine and MTX). Statins can inhibit APC function and reduce MHC class II expression in the pre-clinical setting
- Chemotherapy and Radiation Therapy: An excessive dose of chemotherapy damages nearby tissue and increases the circulating cytokines levels, leading to a cytokine storm. This increases the graft’s immune cells’ capacity to recognize host antigens.
What’s New in the GVHD Domain – Upcoming Technologies
Novel development, technological advancement, and ongoing research are rapidly improving the diagnosis, prevention, and treatment of GVHD. Following are some of the latest technologies and upcoming approaches in the GVHD domain:
Figure 6: Latest Technologies and Upcoming Approaches
Future Prospective and Conclusion
GVHD still has various risks. To improve treatment and results, individuals around the world are continuously working on novel technologies. With the help of ongoing research and new therapeutic approaches, the success rate of stem cell and bone marrow transplants can be increased. The future of GVHD treatments will depend on personalized medicine, immunosuppressive strategies, and cellular therapies. Collaboration and investment in healthcare infrastructure are necessary to ensure that treatments are accessible to patients worldwide.
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