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Chronic graft-versus-host disease in Child
See also in: Nail and Distal Digit,Oral Mucosal Lesion
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Chronic graft-versus-host disease in Child

See also in: Nail and Distal Digit,Oral Mucosal Lesion
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Contributors: Philip I. Song MD, Ivy Lee MD, Jonathan Cotliar MD, Susan Burgin MD
Other Resources UpToDate PubMed

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Synopsis

Chronic graft-versus-host disease : Alkaline phosphatase elevated, ALT elevated, AST elevated, Lower extremity edema, Oral white plaque, Arthralgia, Dry eyes, Dry mouth, Hardened skin, Scaly plaques
Graft-versus-host disease (GVHD) refers to organ dysfunction resulting from the introduction of foreign immunocompetent lymphocytes or bone marrow tissue (the graft) into an immunologically defective host. Most GVHD occurs in patients who have undergone allogeneic bone marrow transplants, but it may occur in solid organ transplant and blood transfusion recipients.

Cutaneous GVHD has both an acute and a chronic form. Acute GVHD normally occurs within 2-4 weeks of stem cell infusion and typically presents as a morbilliform eruption that may progress to erythroderma or, rarely, a toxic epidermal necrolysis-like picture.

Chronic cutaneous GVHD usually presents a mean of 4 months after transplantation with mucocutaneous manifestations. The incidence of chronic GVHD is estimated to be 60%-70% in recipients of allogeneic stem cell transplants with mismatched and unrelated donors, and about 30% in recipients of fully histocompatible sibling donor transplants. Chronic GVHD can occasionally be triggered by exposure to UV light, physical trauma, herpes zoster, or Borrelia infections. Almost all chronic GVHD patients will have skin involvement. Oral mucosal, hepatic, and ocular involvement is also quite common. Chronic GVHD increases the overall risk of systemic and recurrent bacterial infections.

GVHD is a major source of morbidity and mortality among transplant recipients. The risk of developing chronic GVHD increases with advancing age, prior acute GVHD, history of splenectomy, and donor or recipient cytomegalovirus seropositivity. On the other hand, chronic GVHD is associated with beneficial graft-versus-tumor effects and reduced risk of leukemia relapse, especially with more severe chronic GVHD.

Codes

ICD10CM:
D89.811 – Chronic graft-versus-host disease

SNOMEDCT:
402356004 – Chronic graft-versus-host disease

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Differential diagnoses for chronic GVHD include the following:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:02/01/2017
Last Updated:02/01/2017
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Chronic graft-versus-host disease in Child
See also in: Nail and Distal Digit,Oral Mucosal Lesion
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A medical illustration showing key findings of Chronic graft-versus-host disease : Alkaline phosphatase elevated, ALT elevated, AST elevated, Lower extremity edema, Oral white plaque, Arthralgia, Dry eyes, Dry mouth, Hardened skin, Scaly plaques
Clinical image of Chronic graft-versus-host disease - imageId=6320846. Click to open in gallery. caption: 'Sclerodactyly with some pink, scaly, and eroded plaques on the fingertips. Note the thinned thumbnail and scattered hyperkeratotic papules on the palm.'
Sclerodactyly with some pink, scaly, and eroded plaques on the fingertips. Note the thinned thumbnail and scattered hyperkeratotic papules on the palm.

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