Onkológia 3/2021

GvHD – pathophysiology, clinical manifestations, diagnosis and classification

Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially life-saving procedure and often the only curative option for various diseases of the hematopoietic system, but its efficacy is limited by the secondary disease called graft-versus-host disease (GvHD). Acute and chronic GvHD remain a leading cause of morbidity and mortality after allogeneic transplantation. GvHD is caused by the response of transplanted donor immune cells to histocompatibility antigens expressed on tissues of the transplant recipient. Acute GvHD is primarily induced by T cells commonly by type I T-cell response, whereas chronic GvHD is induced by both T and B cells, similar to that of autoimmune disorders. Recent studies highlight complex interactions between different effector cell type and target cells in peripheral tissues, particularly in gastrointestinal tract. GvHD is a multisystemic disorder that may involve several organs, including skin, lungs, gastrointestinal tract, hepatobiliary and musculoskeletal system. Early and correct diagnosis and control of GvHD are key factors of a successful outcome of HSCT. This article provides an overview of pathophysiology, clinical manifestations, risk factors, diagnostic criteria and classification systems for acute and chronic GvHD.

Keywords: reakcia štepu proti hostiteľovi, patofyziológia, rizikové faktory, klinické prejavy, diagnostické kritériá, klasifikácia