Talk:Graft-versus-host disease

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(GVHD) is a common complication following an allogeneic tissue transplant. It is commonly associated with stem cell or bone marrow transplant but the term also applies to other forms of tissue graft. Immune cells (white blood cells) in the tissue (the graft) recognize the recipient (the host) as "foreign". The transplanted immune cells then attack the host's body cells. GVHD can also occur after a blood transfusion if the blood products used have not been irradiated[citation needed].

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The above (from the page) is incorrect. This wikipedia page is describing Graft rejection reactions, which can occur in any tissue transplant (other than autografts). Graft-versus host disease is specific fot immunocompetent tissue, i.e. bone marrow. — Preceding unsigned comment added by 74.75.201.170 (talk) 00:37, 24 March 2013 (UTC)

More needs to be added to this entry:

specific target organs and symptoms, current first-line treatments and salvage regimens, and the clinical grading schemes for quantifying GVHD.

• first line treatment is high dose corticosteroids. Methotrexate + cyclosporin A are common for prophylaxis, of course.
• salvage is I believe anti-thymocyte globulin or anti-lymphocyte globulin. (Anyone?) Off label use of TNF blockade agents (etanercept, inflixmab) has also been reported. —Preceding unsigned comment added by 140.163.254.157 (talk) 16:13, 6 February 2008 (UTC)

On the mechanism side, specific cytokine profiles, clusters of differentiation markers, effect cell subtypes for each target organ, and so on might be useful.

• Shlomchik published a nice review in NRI last year. Nat Rev Immunol. 2007 May;7(5):340-52.
• Ferrara et al's model of GVHD as a three-step process is still fairly common. See Blood Rev. 2003 Dec;17(4):187-94.

The three-step model is:

1) Radiation and chemical damage to the recipient's GI tract as part of the conditioning regimen. This may increase expression of adhesion molecules, costimulatory molecules, and HLA antigens. Crucially, the damage to the intestines permits bacterial endotoxin (lipopolysaccarides) into the blood stream, which triggers a tremendous inflammatory response. This then results in the activation of host dendritic cells (DCs) and are necessary for the initiation of primary and secondary immune responses.

2) Activation of donor T cells.

3) Cellular and inflammatory effector phase: a complex cascade of multiple effectors mediated by cellular effectors such as CTLs and NK cells, and inflammatory effectors such as TNF-α, IL-1 and NO.

The one big area that the page doesn't mention at all is cord blood transplantation. Cords are starting to become an area of great interest (e.g. at the 2007 American Society of Hematology meeting). Benefits seem to be: much reduced incidence of graft-versus-host-disease, often with more tolerance of HLA mismatches.

Also, the risks for GVHD need to be mentioned. Effects of conditioning regimens, "cytokine shielding", HLA matching, etc.

Ah, you obviously know what you're talking about. I've been meaning to improve this article forever, but if you're motivated, please go for it. I'm happy to help however I can. MastCell ^Talk 00:34, 7 February 2008 (UTC)

GVHD or GvHD

Both are used here. Preference? GvHD would be mine.io_editor (talk) 19:13, 20 April 2008 (UTC)

Hmm... I like GVHD better :) ...but honestly, it's no big deal either way. MastCell ^Talk 21:06, 20 April 2008 (UTC)

Very well, either is fine - but then it occurred to me there is AGVHD and CGVHD on the page - somewhere in literature I have seen aGVHD and cGVHD which to me look better (and in themselves are perhaps reason enough to use a big V).io_editor (talk) 21:18, 20 April 2008 (UTC)

By the way, I have caused a small disaster on the HSCT page. I could not understand why the older cites would not "number" in the list. Now Arcadian has deleted them, and I see why - they were simply not referenced into the text. I am out of time for 1-2 days to check how relevant they were; perhaps you were involved with authorship way back when page started, or at least know which ones are relevant (off-hand, perhaps the original HCST or BMT paper was included and is now lost?).io_editor (talk) 21:24, 20 April 2008 (UTC)

Incorrect/missing reference

In the "Types" section the following statement is made:

Later in 1987, the disease was further described with genetic explanation by Kevin Smith in 'IJ ed. 867-5309'

but no reference given in the "References" section. This should be moved the the "References" section and the appropriate journal name and format inserted Akylejones (talk) 20:32, 20 October 2010 (UTC)

Too technical for most readers to understand?

This page has been tagged as being too technical for most readers to understand since August of 2008. WP:TECHNICAL says "Technical templates added without explanation are likely to be either ignored or removed." Unless someone objects, I am going to wait seven days and then remove the tag. You might consider adding a confusing tag instead. (posted 12:56, 1 March 2011) Guy Macon (talk) 01:59, 5 March 2011 (UTC)

Removed tag. Guy Macon (talk) 20:00, 7 March 2011 (UTC)

Confusing Tag justification

I have to agree with Guy Macon that the confusing tag should be used here instead of the "too technical" tag. The wording is understandable enough however there are a few weird things. For instance, (1) GVHD is not a complication of bone marrow transplant only, as the abstract seems to suggest. It is a common medical term to describe complications arising from any kind of graft. The article contradicts itself by going on to describe exactly this. (2) There is a sentence describing maculopapular rash related to skin GVHD and then a sentence about mucosal damage to the vagina right afterward. This is presumably related to skin GHVD but this is not clear from the wording. (3) The section regarding Transfusion-associated GVHD should either link directly to that article (which is barely more than a stub) or, preferably, the Transfusion-associated GVHD article should be merged with this one since it is a form of GVHD. TAGVHD should then redirect to this article. These are just a few of the problem that stood out to me; there are many more. I will re-write it myself if I feel like it some day but probably someone more qualified can? - Bart simpson rules (talk) 19:31, 9 July 2011 (UTC)

"(1) GVHD is not a complication of bone marrow transplant only, as the abstract seems to suggest. It is a common medical term to describe complications arising from any kind of graft". <--- This, (and the article) is incorrect. Graft rejection reactions can occur in any kind of tissue transplant, but graft-versus host disease is specific fot immunocompetent tissue, of which bone marrow is really the only one used in transplants. — Preceding unsigned comment added by 74.75.201.170 (talk) 00:29, 24 March 2013 (UTC)

Possible hoax section deleted

I have removed the unsourced statements:

“ Brandon Schmidt has been credited with first discovering Graft Versus Host Disease in 1927. Later, in 1987, the disease was further described with genetic explanation by Kevin Smith in 'IJ ed. 867-5309' " ”

from the 'Types' section.

• This was added in 2 edits here on 24 January 2009.
• A Google search, here for " "Brandon Schmidt" + Graft versus host disease" returns only about 230 hits. All of them them appear to be mirrors of the WP article. 867-5309 is a number known from a popular song from 1982. I say HOAX! - 220.101.30 talk^\edits (aka 220.101) 18:48, 10 November 2011 (UTC)

New treatments

doi:10.1182/blood-2011-08-339465 - Blood review on new treatment strategies. Looks like a good secondary source. JFW | T@lk 19:41, 5 January 2012 (UTC)

Should be a section for pseudo-GVHD

There should be a section, or at least a mention, of pseudo-GVHD (which may occur after autologous marrow or stemcell transplants). — Preceding unsigned comment added by 140.107.39.177 (talk) 21:22, 4 March 2015 (UTC)

Review

BJH doi:10.1111/bjh.13959 JFW | T@lk 11:35, 29 March 2016 (UTC)

NEJM doi:10.1056/NEJMra1703472 JFW | T@lk 14:14, 28 December 2017 (UTC)

What is GVHD

What is GVHD T.Sakshini Rao (talk) 12:37, 23 December 2019 (UTC)