Info
Ac GVHD
- usually within 6 mo of transplant; NEJM 2017;377:2167)
- Clinical grades I–IV based on scores for
- skin (maculopapular rash)
- liver (bilirubin level)
- GI (diarrhea) bx supports diagnosis
Prev.
- immunosuppression (MTX + cyclosporine, or tacrolimus),
- T-cell depletion of graft, post-Tx cyclophos. for haploidentical, some high-risk allo (BBMT 2008;14:641)
Rx
- grade I → topical Rx;
- grades II–IV → associated with ↓ survival and
∴ treated with immunosuppressants * corticosteroids * cyclosporine A * tacrolimus * rapamycin * mycophenolate mofetil