Question

Ms. Miller is a 62-year-old female with past medical history of leukemia and undergoes a hematopoietic stem cell transplantation. Graft-versus-host disease is one of the complications that can occur.

1. Using your own words, describe to the patient and family what graft-versus-host disease is.

2. Differentiate between acute and chronic GVHD.

3. Describe the treatment regimen for GVHD.

4. There can be different clinical manifestations based on organ system. Describe clinical manifestations for three different systems and nursing priorities for each.

Answer 1

1).

Although immunity is a body’s important protective response, immunosuppressant drugs are used in the treatment of certain autoimmune diseases, and during the organ transplantation. Examples of immunosuppressant drugs include, cyclosporine, and tacrolimus.

GVHD occurs when the tissues of the recipient are attacked by the cytotoxic T cells and natural killer cells of the transplant. This can be suppressed using immunosuppressant drugs such as cyclosporine A and tacrolimus. So, a kidney transplant recipient may not develop GVHD if there is a near perfect HLA match, and immune-suppressants are used.

In the given case, the patient had stem cell transplantation. So, he is taking immunosuppressant tacrolimus to prevent the destructive immunological response “graft rejection or graft-versus-host disease (GVHD).”

2).

The symptoms of acute GVHD are manifested within less than 100 days after cell transplantation, and is induced by T cell donor cells due to mismatch in the histocompatibility antigens. In chronic GVHD, the symptoms manifest after 100 days of cell transplantation. The symptoms of GVHD include, rashes, thickening or tightening of the skin, yellow discoloration of the skin and eyes, and swelling in the abdomen.

3).

The treatment of GVHD include, immunosupressant drug like prednisone, and tecrolimus.