Why Does cGVHD Occur?
cGVHD occurs due to a mismatch between the donor and recipient's immune systems. Even with a well-matched donor, differences in minor
histocompatibility antigens can trigger an immune response. The donor T-cells recognize the recipient's tissues as foreign and initiate an immune attack, leading to inflammation and fibrosis in various organs.
What Are the Symptoms of cGVHD?
The symptoms of cGVHD can be diverse and affect multiple organs. Commonly impacted areas include the skin, liver, eyes, mouth, gastrointestinal tract, and lungs. Patients may experience:
Skin rashes and thickening
Jaundice and liver dysfunction
Dry eyes and oral ulcers
Digestive issues such as diarrhea and abdominal pain
Respiratory symptoms including cough and shortness of breath
How is cGVHD Diagnosed?
Diagnosis of cGVHD involves a combination of clinical evaluation, laboratory tests, and biopsies. Physicians look for typical signs and symptoms and may use scoring systems to assess the severity and extent of the disease.
Biopsies of affected tissues can provide definitive evidence of cGVHD by revealing characteristic pathological changes.
Corticosteroids to reduce inflammation
Immunosuppressive agents such as cyclosporine and tacrolimus
Biologic therapies like rituximab and ibrutinib
Supportive care measures including physical therapy and nutritional support
In refractory cases, extracorporeal photopheresis (ECP) and other advanced therapies may be considered.
What Are the Risks and Prognosis of cGVHD?
The prognosis of cGVHD varies widely depending on the severity and response to treatment. Complications can include chronic infections, organ dysfunction, and reduced quality of life. However, some patients may achieve remission and return to normal activities. The balance between controlling cGVHD and maintaining immune function is crucial, as over-suppression can lead to increased risk of infections and
relapse of the original cancer.
How Can cGVHD Be Prevented?
Preventing cGVHD involves careful donor selection and prophylactic immunosuppression. Techniques such as T-cell depletion in the graft and the use of post-transplant cyclophosphamide have shown promise in reducing the incidence of cGVHD. Early intervention and close monitoring post-transplant are essential to manage emerging symptoms effectively.
Conclusion
Chronic Graft Versus Host Disease (cGVHD) is a challenging complication of hematopoietic stem cell transplantation in cancer patients. Understanding its pathogenesis, symptoms, and treatment options is crucial for optimizing patient outcomes. Ongoing research is focused on improving preventive strategies and developing more targeted therapies to manage this condition.
