Graft versus host disease (GVHD) is a frequent complication in transplanted patients with haematological malignancy: rarely fatal, can be prevented and treated
It is called ‘Graft versus host disease’ (GVHD) and is a disorder that can occur after an allogeneic bone marrow or hematopoietic stem cell transplant performed to treat a blood cancer. Complications related to the aggression by donor cells on the recipient’s tissues can be mild or serious, even fatal, and it is important that patients also know how to recognize the first symptoms in order to promptly report them to doctors who can intervene with therapies most suitable for the individual case. Because of this the American National Comprehensive Cancer Network has just published a new guideline dedicated to the sick, so that they are informed about the potential signals and treatment options available, most effective if the disease is diagnosed early.
The “new” immune system can attack the host
Allogenic bone marrow and stem cell transplants are very important treatments for patients with blood cancer: they are especially indicated for healing in different types of leukemia, myelodysplasia, lymphoma and myeloma. “One of the objectives of the transplant is to give the patient the donor’s immune system, which is capable of fighting against cancer – explains Francesca Bonifazi, head of bone marrow transplants to the Director of the Transplant Program and Advanced Cell Therapies, IRRCS Azienda Ospedaliero-Universitaria Sant’Orsola Polyclinic in Bologna -. Graft versus host disease, or graft versus host disease, is a frequent complication: in practice it is an attack on the patient’s body by the new immune system that is transplanted. Today we have several strategies available both to prevent it and to treat it effectively, but recognizing it and intervening early is crucial for the lives of patients “. According to recent estimates GVHD affects about 30-50% of transplant recipients who, in a variable percentage between 10 and 70%, develop a chronic form of it. . And the numbers continue to be important also because, in order to offer greater chances of recovery to oncohematological patients, thanks to scientific advances, even donors that are not fully compatible are used more frequently, given that just over half of those in need are found. (in the family or in the international registry) a truly identical donor.
Beware of these symptoms
“In practice, after transplantation, it may happen that the transplanted immune system recognizes the recipient’s tissues as foreign and attacks them – explains Bonifazi, past president of the Italian Bone Marrow Transplant Group (Gitmo) -. The main target is the epithelial cells of the skin, liver, skin and intestine, for this reason the main symptoms are yellowing of the skin and the “whites” of the eyes (jaundice); nausea, vomiting, diarrhea (often hemorrhagic), abdominal cramps; rash, itching, dark spots or hardening of the skin. They can appear suddenly, even years after the transplant and it is important for the patient to speak to their doctor immediately “. But symptoms such as difficulty in breathing, shortness of breath, cramps, dry mucous membranes, blurred vision and burning eyes must also be reported. To try to prevent GVHD, transplant patients are prescribed immunosuppressive drug therapy which can then be suspended over time. If, despite this treatment, a patient develops acute GVHD, there are other therapeutic options and new drugs are being developed for the most difficult situations. «Less and less frequently, fortunately, GVHD is lethal – concludes Bonifazi -, but it can have a big negative impact on the life of those who suffer from it. Today we also have several ongoing trials which we hope will lead to new progress both in the prevention and in the treatment of this complication. It is certain that not neglecting the first rye is decisive for intervening in the initial phase, with greater effectiveness “.
January 14, 2022 (change January 14, 2022 | 13:16)
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