Lymphoma & related disorders
Posttransplant lymphoproliferative disorders (PTLD)
Graft versus host disease
Author: Nat Pernick, M.D.
Last author update: 1 September 2011
Last staff update: 23 August 2022
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: Posttransplantation lymphoproliferative disorders graft versus host disease
Table of Contents
Definition / general | Pathophysiology | Treatment | Microscopic (histologic) description | Differential diagnosisCite this page: Pernick N. Graft versus host disease. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphomanonBposttransgvhd.html. Accessed April 20th, 2024.
Definition / general
- Common complication of allogeneic bone marrow transplantation seen in 20 - 50% of HLA identical and 70% of nonidentical / unrelated recipients
- Causes 1/3 of bone marrow transplant deaths
- Acute GVHD: within 100 days of transplant; affects skin, GI tract, liver
- Skin - maculopapular rash of palms, soles, trunk, later entire body; may progress to bullous patches and desquamation
- GI - diarrhea (profuse, bloody), nausea, abdominal pain
- Liver - elevated liver function tests, nausea, vomiting
- Also oral GVHD with xerostomia
- Chronic GVHD: after 200 days of transplant; autoimmune-like symptoms, wasting, recurrent infections, prolonged immunodeficiency
Pathophysiology
- Due to donor T cytotoxic (CD8+) T cells introduced with bone marrow cells as bystanders that attack recipient tissue
- Donor T cells recognize host HLA antigens, proliferate and secrete Interleukin-2 and then other cytokines including tumor necrosis factor, IL-1 and interferon, causing tissue damage
Treatment
- Increased immunosuppression, irradiation (treatment opposite that of posttransplant lymphoproliferative disease)
Microscopic (histologic) description
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Skin: Transplant Proc 1974;6:367
- Grade 1: vacuolar degeneration of basal epithelial cells or acanthocytes
- Grade 2: also dyskeratosis, apoptosis of keratinocytes (eosinophilic bodies) surrounded by lymphocytes, spongiosis, edema of overlying epithelium
- Grade 3: also splitting and degeneration of acanthocytes and basal cells, causing cleft formation and separation of dermoepidermal junction
- Grade 4: sloughing of overlying epithelium
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Rectum:
- Early: flatting / atrophy of mucosa, degeneration and loss of crypts; occasional apoptotic bodies surrounded by lymphocytes
- Late: mucosal sloughing
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Salivary glands:
- Grade 1: abnormal mononuclear infiltrates with or without ductal epithelial necrosis
- Grade 2: also obliteration of ducts
Differential diagnosis
- Chemotherapy effect, drug reaction, infection
