Chronic myelogenous leukemia
An adult patient with chronic myelogenous leukemia sits down with you to discuss his questions and concerns about his upcoming bone marrow transplant. He received some educational materials and participated in a family conference during which health team members described the procedure and potential complications. He has been told that he has a risk of graft rejection or graft versus host disease (GVHD), but he does not understand the distinction (Chapter 12, Learning Objectives 1, 2, 10, 11).
What are the similarities between graft versus host disease and graft rejection?
What are the pathophysiologic differences between graft versus host disease and graft rejection?
How would these differences be manifested clinically?
Studies have shown a protective effect of mild to moderate GVHD in cancer patients who have had a bone marrow transplant. Based on your understanding, can you explain these findings?
Instructions:
Your primary post should be at least 200 words long and should include references to the textbook or another course resource using APA 7th edition format.
Sample Solution
Graft Versus Host Disease (GVHD) and Graft Rejection: A Comparison
Similarities
Graft versus host disease (GVHD) and graft rejection are both immune system reactions that can occur after a bone marrow transplant. In both cases, the immune system recognizes the transplanted cells as foreign and attacks them.
Pathophysiologic Differences
- Graft rejection: This occurs when the recipient's immune system attacks the donor cells. The recipient's T cells recognize the donor's major histocompatibility complex (MHC) antigens as foreign and mount an immune response.
- GVHD: This occurs when the donor's immune cells attack the recipient's tissues. The donor's T cells recognize the recipient's MHC antigens as foreign and mount an immune response.
Clinical Manifestations
- Graft rejection: Symptoms can vary depending on the type of transplant. In a bone marrow transplant, symptoms may include fever, chills, fatigue, and skin rash.
- GVHD: Symptoms can affect multiple organs. Acute GVHD can cause skin rash, fever, diarrhea, and liver inflammation. Chronic GVHD can cause skin thickening, dry eyes, and joint pain.
Full Answer Section
Protective Effect of Mild to Moderate GVHD
Studies have shown that mild to moderate GVHD can be protective in cancer patients who have had a bone marrow transplant. This is likely due to the following reasons:
- Elimination of residual cancer cells: The donor's immune cells can recognize and attack residual cancer cells that may have been left behind after the transplant.
- Prevention of relapse: GVHD can help to prevent the recurrence of the original cancer.
However, it is important to note that severe GVHD can be life-threatening. Therefore, the goal of treatment is to balance the risk of GVHD with the benefits of the transplant.
References
- [Textbook Reference: Chapter 12, Learning Objectives 1, 2, 10, 11]