GVHD and Graft Rejection

An adult patient with a chronic myelogenous leukemia sits down with you to discuss his questions and concerns about his upcoming bone marrow transplant. He has already 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).

  1. What are the similarities between graft versus host disease and graft rejection?
  2. What are the pathophysiologic differences between graft versus host disease and graft rejection?
  3. How would these differences be manifested clinically?
  4. 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:

  1. Your primary post should be at least 200 words long and should include reference to the textbook or another course resource using APA 7th edition format. Your primary post is due by Wednesday at midnight ET.
  2. ¬†Respond with at least 100 words (each) to at least two classmates’ posts by Sunday at midnight ET.

GVHD and Graft Rejection

Chronic myelogenous leukemia is a type of blood cancer that can be treated with a bone marrow transplant. However, the procedure has potential complications, such as graft rejection and graft versus host disease (GVHD). In this essay, I will discuss the similarities and differences between these two conditions and how they manifest clinically.

Both graft rejection and GVHD occur when the transplanted cells do not recognize the recipient’s body as their own. In graft rejection, the recipient’s immune system recognizes the transplanted cells as foreign and attacks them. In GVHD, the transplanted cells attack the recipient’s body, thinking it is foreign. Both conditions can lead to severe complications and may require treatment with immunosuppressants.

The pathophysiologic differences between graft rejection and GVHD are that graft rejection is primarily mediated by T cells, while GVHD is mediated by both T cells and B cells. In graft rejection, the donor cells are destroyed by the recipient’s T cells, which recognize the transplanted cells as foreign. In GVHD, the donor T cells attack the recipient’s tissues, leading to inflammation and damage to various organs.

Clinically, graft rejection can present with fever, chills, skin rash, and organ dysfunction. GVHD can manifest as skin rash, diarrhea, liver dysfunction, and pulmonary complications. The severity of these symptoms can vary depending on the extent of the rejection or GVHD.

Studies have shown a protective effect of mild to moderate GVHD in cancer patients who have had a bone marrow transplant. This phenomenon is known as the graft versus leukemia (GVL) effect. The GVL effect occurs when the transplanted cells attack the cancer cells, leading to their destruction. However, severe GVHD can be life-threatening and requires treatment with immunosuppressants.

In conclusion, graft rejection and GVHD are potential complications of bone marrow transplant in patients with chronic myelogenous leukemia. Both conditions are similar in that they result from the recognition of the transplanted cells as foreign by the recipient’s immune system. However, the pathophysiology and clinical manifestations differ between the two. Mild to moderate GVHD can have a protective effect on cancer patients, but severe GVHD requires treatment with immunosuppressants. It is essential to educate patients about these potential complications and their management to make informed decisions about their treatment.

Reference: Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. Elsevier.

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