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.