¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

GVHD

acute & chronicÀÇ ±âÁØ : 3°³¿ù

1) Acute GVHD : ´ë°³ 2-4ÁÖ »çÀÌ ¹ß»ý

¨ç Áõ»ó

skin - erythematous maculopapular rash

intestine - anorexia or diarrhea

liver - Bil, AST/ALT, ALP¡è

¨è Áø´Ü

Biopsy·Î ÇÑ´Ù.

skin - hair follicle, epidermidis ¼Õ»ó

liver - small bile duct¼Õ»ó

intestine - cryptÆÄ±«, mucosal ulceration

¨é ¹ß»ý·ü Áõ°¡ÀÇ À§ÇèÀÎÀÚ

i) mismatched or unrelated donors

ii) older pt

iii) ¿¹¹æ¾àÁ¦¸¦ ÃÖ´ë¿ë·® »ç¿ëÇÒ¼ö ¾øÀ»¶§

¨ê ¿¹¹æ

1st prevention : MTX + (cyclosporine or tacrolimus)

most effective & widely used regimens

2nd prevention : stem cell·ÎºÎÅÍ T cell remove

±×·¯³ª T cell depletionÀº graft failure¸¦ Áõ°¡½ÃŲ´Ù.

¿¹¹æ¿¡µµ ºÒ±¸Çϰí significant acute GVHD°¡ ¹ß»ýÇϴµ¥

matched sibling : -30%

unrelated donor : 60%

¨ë Ä¡·á

glucocorticoids, ATG or monoclonal Ab(T cell target)

2) chronic GVHD

6°³¿ù ÀÌ»ó »ýÁ¸Çϴ ȯÀÚÀÇ 20-50%¿¡¼­ ¹ß»ýÇÑ´Ù.

¨ç ¹ß»ýºóµµ°¡ Áõ°¡ÇÏ´Â °æ¿ì

i) older pt

ii) mismatch or unrelated stem cells

iii) acute GVHD°æÇèÇÑ °æ¿ì

¨è Áõ»ó - autoimmune disorder¿Í À¯»ç

malar rash, sicca syndrome, arthritis, obliterative bronchiolitis,

bile duct degeneration, cholestasis

¨é Ä¡·á

single agent Pd or cyclosporine - standard tx at present

´ëºÎºÐ ȸº¹µÇÁö¸¸ ¸é¿ª¾ïÁ¦Á¦ Ä¡·á°¡ 1-3³â ÇÊ¿äÇÏ´Ù.

±×·¯¹Ç·Î significant infectionÀÇ À§ÇèÀÌ Áõ°¡Çϴµ¥ ¿¹¹æÀûÀ¸·Î TMP/SMX¸¦ º¹¿ëÇØ¾ß

ÇÑ´Ù.

°¨¿°ÀÌ ÀǽɵǸé Àû±ØÀûÀÎ Ä¡·á°¡ ÇÊ¿äÇÏ´Ù.