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Graft-Versus-Host Disease, Pediatric

Valerie I. Brown, MD, PhD Reviewed 10/2018
 


BASICS

DESCRIPTION

Graft-versus-host disease (GVHD) is a multiorgan inflammatory process that develops when immunologically competent T lymphocytes from a histoincompatible donor are infused into an im...

DIAGNOSIS

HISTORY

  • Acute GVHD

    • Rash: usually first manifestation; pruritus or burning sensation can precede rash.

    • Diarrhea, abdominal pain, and intestinal bleeding: unusual to precede skin disease

    • Anorexia,...

TREATMENT

GENERAL MEASURES

  • Prophylaxis for P. jiroveci pneumonia and pneumococcal infection

  • Antifungal coverage if on multiple immunosuppressive agents

  • Hypogammaglobulinemia: IVIG

  • Monitor closely for vira...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Corticosteroids: osteoporosis, diabetes

  • Calcineurin inhibitors: hypertension, renal dysfunction, hypomagnesemia

  • Sirolimus: hyperlipidemia, leukope...

ADDITIONAL READING

  • Carpenter PA, Macmillan ML. Management of acute graft-versus-host disease in children. Pediatr Clin North Am.  2010;57(1):273–295. [View Abstract on OvidInsights]

  • Dhir S, Slatte...

CODES

ICD9

  • 279.50 Graft-versus-host disease, unspecified

  • 279.51 Acute graft-versus-host disease

  • 279.52 Chronic graft-versus-host disease

  • 279.53 Acute on chronic graft-versus-host disease

  • 996.85 Complicatio...

FAQ

  • Q: Do all patients with acute GVHD get chronic GVHD?

  • A: No. ~30% of patients <10 years of age who receive HLA-identical sibling HSCT will get acute GVHD, whereas only 13% will develop chronic GV...

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